Working without Rights: Recognizing Housestaff Unionization-An Argument for the Reversal of Cedars-Sinai Medical Center and St. Clare's Hospital

By Shorb, Jennifer A. | Vanderbilt Law Review, May 1999 | Go to article overview

Working without Rights: Recognizing Housestaff Unionization-An Argument for the Reversal of Cedars-Sinai Medical Center and St. Clare's Hospital


Shorb, Jennifer A., Vanderbilt Law Review


I. INTRODUCTION

Increased competition in today's health care industry has contributed to the industry's growing emphasis on cost-containment.1 Concerns about this focus on the bottom line have motivated some caregivers to attempt to improve working conditions and the quality of patient care through unionization.2 One such group, "housestaff' or "house officers," is comprised of hospital interns, residents, and fellows.3 These individuals are medical school graduates seeking additional training for licensure and specialization.4 Housestaff are often overworked, underpaid, and forced to deal with working conditions that adversely affect patient care.5 Such conditions force many house officers to join union organizations and seek the right to bargain collectively.6 The housestaff unionization movement began in the 1930s when house officers sought to remedy poor working conditions and inadequate patient care.7 This movement is still alive today despite the National Labor Relation Board's ("NLRB") refusal to recognize housestaff collective bargaining rights.8

In 1976, the NLRB in Cedars-Sinai Medical Center considered whether house officers working in private nonprofit hospitals have the right to collectively bargain under the National Labor Relations Act ("NLRA" or "the Act").9 The NLRB held that housestaff were "primarily students" rather than employees, and therefore not entitled to collective bargaining rights.10 The following year, in St. Clare's Hospital and Health Center, the NLRB clarified its holding in Cedars-Sinai and reaffirmed its denial of housestaff collective bargaining rights.11 More than twenty years later dramatic changes have occurred in the health care industry, and the NLRB has decided to re-examine its determination that housestaff are not employees.l2 On February 13, 1997, the Committee of Interns and Residents ("CIR")13 filed a case petition seeking exclusive collective bargaining representation of the housestaff employed by Boston Medical Center.l4 The Regional Director subsequently held a hearing on the issue15 and dismissed the case petition, citing Cedars-Sinai and St. Clare's Hospital.ls The NLRB has granted review of the Regional Director's decision in the Boston Medical Center case.l7 In light of the dramatic changes that have occurred in the health care industry since the Cedars-Sinai and St. Clare's Hospital decisions, the Board should classify housestaff as employees and allow them to bargain collectively.

The Board's decision in Cedars-Sinai was based on the notion that housestaff work primarily for educational purposes rather than as service providers.ls In addition to factors present at the time of the decision, recent legal and economic developments and changes in the health care industry support reversal of the Cedars-Sinai decision.19 In Cedars-Sinai, the NLRB ignored many strong indicia of employment, such as salary, benefits, hours worked, insurance coverage, and the value-adding services of the housestaff.20 The Board also failed to recognize that statutory interpretation and legislative history supported classifying housestaff as employees.21 Recent Supreme Court interpretations of the term "employee" also suggest that housestaff fall within Section 2(3) of the NLRA.22 Since 1976, the majority of public sector jurisdictions considering this issue have determined that housestaff are employees for purposes of collective bargaining.2 Numerous federal agencies and government bodies treat housestaff as employees for various purposes such as paying taxes, receiving worker's compensation, and stating a claim under Title VII.24 In addition, the concerns underlying the physician unionization movement and the views of the American Medical Association ("AMA") demonstrate the importance of granting housestaff coverage under the NLRA.

This Note advocates the reversal of the NLRB's decisions in Cedars-Sinai and St. Clare's Hospital. Further, it recommends that the NLRB classify housestaff as employees under Section 2(3) of the NLRA, thus entitling them to complete protection under federal labor laws. …

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