The Doctors' Union

As recently as a decade ago, the idea of unionizing was repugnant to most U.S. physicians. Now the notion appears to be more attractive. In the past several years, local physicians' unions have sprung up in San Francisco, Chicago, Ann Arbor, Mich., and in New York City, where members successfully struck for shorter hours last spring (TIME, March 31). Last week American medicine took another significant step toward unionization. Meeting in Washington, D.C., the Physicians National Housestaff Association, which claims to represent some 18,000 interns, residents and postgraduate fellows in teaching hospitals round the country, decided overwhelmingly to become a national labor union.

House officers, as P.N.H.A. members are called, have been growing increasingly impatient with what they see as the slow pace of reform in U.S. medicine, and increasingly militant about what they consider their own exploitation. They have also become extremely skeptical of organized medicine's promises, usually extracted under the threat of a strike or job action, to improve patient care or shorten the 100-hour weeks that house physicians sometimes work. "Goodwill arrangements and personal promises are swell," says P.N.H.A. Executive Director Steve Diamond, "but they have about the same value as a no-return beer bottle. Written contracts have proved to be the only way we can guarantee compliance by all those nice deans and administrators out there."

The P.N.H.A. has petitioned the National Labor Relations Board to include house staff under the National Labor Relations Act, thus giving them the right to form into bargaining units and seek representation by a labor union. The P.N.H.A. petition has the strong support of Senator Edward Kennedy, who agrees with the organization's criticism of American medicine and its announced intention of improving patient care. It is not expected to draw active opposition from the American Med ical Association, which disapproves of unionization but approved the New York strikers' demand for shorter shifts to improve patient care. The A.M.A., says a spokesman, "believes that physicians are better represented by a professional association with broad purposes than by a union with a frequent focus on narrow, economic objectives."

But the P.N.H.A.'s request for recognition has been categorically condemned by the Association of American Medical Colleges, a national organization that provides most of the internship, residency and postgraduate programs in the U.S. The A.A.M.C. maintains that interns and residents are students, not employees, and should thus be denied the right to bargain collectively. Says A.A.M.C. President John A. D. Cooper: "Equality of bargaining power in the adversary environment is incompatible with the nature of the student-teacher relationship."

The A.A.M.C. is at least partially correct, but it fails to recognize another reality: that interns and residents are in fact, if not in name, employees of the hospitals in which they train, and they provide a substantial proportion of the care offered by these institutions.

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