M.D. The practice of medicine is changing, as nearly half of all physicians work as employees of medical groups, hospitals or health maintenance organizations. Many physicians, angered about losing control to managed care organizations, are responding by turning to unions to address their concerns. Residents may find themselves with little control over their environment, often unable to advocate effectively for their patients or themselves. Despite a long tradition of physician organization and self-representation, house staff does not have a protected right to pursue group representation and bargaining.
Collective bargaining can benefit residents and patients in several ways.
It allows negotiation of contract disputes between residents and the hospital administration, and thereby provides a mechanism for discussion of important issues without fear of retribution. Such issues include patient care, resident working conditions and the implementation of training requirements. Opponents of collective bargaining often express the concern that establishment of house staff organizations would lead to strikes, which reflects a misrepresentation of the goals of organized negotiation. Residents would be empowered to engage in good-faith negotiations with hospital administrators. Consistent with the AMA Code of Ethics, the brief is categorically against strikes, particularly where patient care is withheld for the purpose of gaining leverage in collective bargaining.