Collective bargaining in the health care field: the housestaff controversy

The drive to contain health care costs will have a significant effect on future labor relations in health care delivery. Labor expense is, and will continue to be, the most important component of the typical health care organization's operational budget. Consequently, it is only logical that labor should receive the highest degree of operational control. A problem with this approach, however, is that the labor components of the typical health care provider are no longer atypical. The labor components of today's provider include--among others--in-house employees, independent contractors, group practices, and contractual agreements with various freestanding facilities. In order for a provider to successfully handle this diversity, mid-level management should have an understanding of the public regulation of labor relations. For example, government statistics show that between 1965 and 1971, over one-half of the man-days lost due to strikes in private hospitals were the result of recognition strikes. The fact that housestaff are at the same time both students and employees presents a situation where a clear decision concerning their status under the National Labor Relations Act, cannot be reached easily. A compromise, in which housestaff would be allowed to bargain on matters unrelated to the educational sphere, might be the best solution to ensuring a continuous flow of effective health care. Therefore, hospital management must be aware of their relationship with the housestaff.