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Amicus Brief Filed in Support of Collective Negotiations for Residents
JAMA. 1998;279:650.
The February 18 Resident Forum reported on the issue of collective negotiations between resident physicians and their institutions. As mentioned in that column, the Committee of Interns and Residents (CIR), a labor union, has petitioned the National Labor Relations Board to permit CIR to represent the residents at Boston Medical Center. In late January the American Medical Association (AMA) and the Massachusetts Medical Society (MMS) filed an amicus, or "friend of the court," brief in the case.
The position of the AMA and MMS was based on their existing policies. In the amicus brief, they stated that "residents have a unique status as participants in graduate medical education programs and should have the right to negotiate as a group about legitimate issues relating to patient care and resident well-being, but they should not have the right to strike." However, both associations agreed that the educational concerns of the training institution are paramount and should not be subject to negotiation. Andrew Thomas, MD, the resident member of the AMA Board of Trustees explained, "We are not asking that residents have the right to negotiate the educational requirements of their residency which are established by the ACGME [Accreditation Council for Graduate Medical Education] and the Residency Review Committees. There may be, however, opportunities for residents to negotiate how those requirements would be met. Other legitimate issues for negotiation include adequacy of medical equipment, availability of adequate laboratory and ancillary staff support, availability of adequate call rooms, and security for physicians and patients."
The AMA and MMS amicus brief also stated that "the proper forum for developing a model for residents seeking to negotiate with institutions is the ACGME, which accredits and oversees virtually all graduate medical education programs in the United States." Both medical associations believe that the ACGME's current Institutional Requirements need to be amended to protect residents' ability to negotiate without fear of retribution. Because of the AMA and MMS position, the ACGME's Institutional Review Committee has already been reviewing the Institutional Requirements and will be proposing several changes.
The AMA and ACGME are taking other steps on this issue. The AMA, through its Division of Representation, is reviewing collective negotiation models that already exist at some training institutions and will be developing ways to help residents form negotiating groups. The ACGME is looking into ways to implement stronger and quicker enforcement of its Institutional Requirements.
The AMA-Resident Physicians Section (AMA-RPS) is following this issue closely and will continue to act on behalf of residents. To receive more timely updates on collective negotiations and on other issues that effect resident and fellow physicians, we encourage you to subscribe to the AMA-RPS blast e-mail service. This service is only available to residents or fellows who are members of the AMA. You can receive subscription instructions by sending the message INFO AMA-RPS-L to the e-mail address: listserv{at}peach.ease.lsoft.com. If you have any questions about collective negotiations or about the AMA-RPS listserv, please contact Ashish Bajaj, AMA Department of Resident Physician Services, at (312) 464-4743 or by e-mail: ashish_bajaj{at}ama-assn.org.
Prepared by Ashish Bajaj, Department of Resident Physician Services, American Medical Association.
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