Doctors on Strike

Pickets are a common sight in New York City, but there was something different about the workers marching in front of 21 metropolitan hospitals last week: they were doctors. In the first major strike ever undertaken by American M.D.s, about 2,000 interns and residents took to the picket lines for four days to protest what they regarded as intolerable working conditions.

The strike against voluntary and municipal hospitals with a total capacity of 12,000 beds had been brewing for a long time. Since last fall, the Committee of Interns and Residents, with 3,000 members at the various hospitals, has been attempting to negotiate a new contract for its members. The problem of money was solved rather easily when the young doctors, who currently earn between $13,500 and $19,200 a year, agreed to drop their demands for an 11 % increase in salary. They settled with the League of Voluntary Hospitals for an 8% hike instead.

Horror Stories. But neither side would budge on the issue of working schedules. The doctors objected to a hallowed hospital tradition: occasional work weeks of 100 hours or more, including tours of continuous duty that last for 36 hours or longer with only brief breaks for catnaps. As a result, they said, exhausted interns and residents sometimes make mistakes that could otherwise be avoided. Some of the striking interns and residents told horror stories of falling asleep on their feet during operations; one admitted that he had pulled out several stitches after dozing off while holding an incision open with retractors. To reduce the chances of hospital accidents, the C.I.R. asked for a shorter week with a limit of 15 hours to a shift whenever possible.

The demand was turned down by the league, which argued that interns and residents were in reality receiving a postgraduate education. Thus their hours were not a matter for negotiation. Hospital officials and many older doctors who had gone through equally grueling initiations into medicine for much less money insisted that such schedules are necessary to train interns and residents and to guarantee continuity of care for the patient. Said Dr. S. David Pomrinse, director of Mount Sinai Hospital: "We try to train our doctors to watch the patient, not the clock."

Patients Unaffected. C.I.R. officials claim that it was the league's intransigence that forced them to act. "We got into the strike with tremendous remorse, reluctance and every intention to improve patient care," says Dr. Jay Dobkin, 28, chairman of the doctors' negotiating committee.

In fact, the dispute, which was settled before week's end, had little effect on patient care. Only 46 out of a total of 350 doctors walked out at Metropolitan Hospital; most New York University Hospital interns and residents refused to join the strike. Many of the struck hospitals were able to maintain their normal capacity by pressing senior physicians into service. Even the strikers helped; they frequently slipped off picket lines to care for their patients.

Under the settlement that ended the walkout, the hospitals agreed to form committees of interns, residents and physician members of their medical executive boards to work out separate agreements on work hours and patient care tailored to meet each institution's financial and medical needs. The hospitals also agreed to a C.I.R. demand that no intern or resident be required to work more than one out of every three nights, a practice most of these institutions now follow anyway.

The effects of the strike are likely to be felt far beyond New York. The American Medical Association, which has had trouble attracting younger physicians, endorsed the strikers' demands for shorter shifts. The organization's action can only encourage other interns and residents to make similar demands on hospitals across the nation.

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