Before she became a doctor, Dr. Susan Londerville worked as a secretary--in union and non-union shops. "The difference was like night and day," she said recently. When she searched for a residency program after graduating from medical school, she chose Highland Memorial Hospital in Oakland "partly because it had a residents' union."
When you are a doctor in training, "people really abuse you," she said. Her motivation in going to a union hospital was not just about making her life easier but to seek protection against bad working conditions that could result in poor patient care, she said.
Dr. Stanley Borg, a senior resident at Martin Luther King/Drew Medical Center, is in a union, too, the Joint Council of Interns and Residents. But Los Angeles County sapped the union's strength--intentionally, according to union members--by transferring some doctors to the University of Southern California payroll, where they are not eligible for membership.
Convinced that neither the people who control hospitals nor the medical establishment would address their concerns, a group of California interns and residents have taken unionization among physicians to a new level. The California Assn. of Interns and Residents, about a quarter of the state's 8,000 resident physicians, last month signed an affiliation agreement with the Service Employees International Union. CAIR includes a group of house staff organizations that bargain for interns and residents at specific institutions around the state. But its affiliation agreement with SEIU is the first time nationally that physicians-in-training have joined forces with an AFL-CIO member union.
Among CAIR's major goals is a bargaining agreement with the University of California, which employs more than half of the state's resident physicians. The agreement includes a provision exempting the doctors from SEIU strike activity.
SEIU, the nation's largest health-care union, counts a very small number of other physicians who work for public hospitals among its nearly 400,000 health-care workers. But that might change soon, said Dan Stewart, organizing director for SEIU's health-care division, because an increasing number of doctors are salaried workers instead of professionals with their own business. "They are employees of HMOs (health maintenance organizations), or a group practice, or some doc-in-a-box chain (independent emergency clinics)," he said. SEIU is getting a trickle of interest from HMO doctors who want to know about the union but "aren't yet sure how their colleagues will feel," Stewart said.
On the surface, the California doctors' alliance with SEIU is about a common labor concern: the quest for reasonable working conditions. But the unionization move also highlights a generational difference between young doctors and some in the medical establishment over what it takes to produce a competent, dedicated physician.
"We had approached the administrations. We just found them to be unresponsive," said Dr. Carole Maccauley, the CAIR president who in June completed a residency in pediatrics at the UC Irvine Medical Center.
The major issue, CAIR said, is working conditions, including workweeks that stretch to 100 hours or more and shifts as long as 40 hours. CAIR also complains of physicians being made to perform tasks that they say are not essential to learning how to be a doctor. Broken promises from hospital administrations are another issue, Maccauley said. Others say they hope SEIU will give them the strength to prevent such tactics as Los Angeles County's move against the Joint Council of Interns and Residents.
CAIR signed with SEIU less than a month after the American Board of Medical Specialties vetoed a recommendation by the Accreditation Council for Graduate Medical Education to put some limits on work hours for interns and residents. It would have allowed residents to be on overnight call no more than once every third night and would have guaranteed at least one day off a week. The proposal was supported by some teaching physicians, but it faced opposition from surgeons and other academics. The board said the measure was too specific to be applied to all residency programs.
Interns and residents must put in long hours, said Dr. Ralph C. Jung, director of graduate medical education at the University of Southern California Health Sciences Center. "Interns and residents are apprentices. They are learning to intensely apply what they learned in school. This finite period--three to seven years, depending on the specialty--is the last opportunity to give them an intensified training to prepare them for the level of intensity in the profession. The question is, does the level of intensity have to be as harsh, as bad or as severe as some think it is?" he said.