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March 01, 2005

Doctor, No?

Cross posted at The Next Hurrah.

I was listening to All Things Considered last night with my flu-wracked wife, when we heard a piece about a lawsuit against a medical resident who'd just finished a 36-hour hospital shift. The resident in question, zonked out after an absurdly long shift,  rear-ended a college student and caused the student massive, unrepairable brain damage.  There was a weird tenor to the story, which focused on the safety aspects of residents driving home after pulling two-day shifts -- it was almost an afterthought when one of the commenters mentioned how incredibly unsafe it is to force medical doctors to diagnose patients, prescribe and administer meds, and generally be responsible for the well-being of sick people when the doctors have been rendered incompetent by fatigue.  As the NPR sidebar notes, "[i]nterns working 30-hour shifts in an intensive care unit made 36 percent more serious medical errors, including 5.6 times more serious diagnostic errors, as compared to those same interns when they were scheduled to work no more than 16 consecutive hours."  I don't mean to downplay the tragedy of auto accidents caused by sleep-driving residents and interns, but it seems to me that the bigger problem here is that our teaching hospitals expect doctors to care for patients on no sleep.  As the American Medical Student Association points out, we don't let truckers drive for more than 10 hours straight -- why the hell would we let doctors work longer than that in our hospitals?

Anyway, the NPR piece featured a representative from the Committee of Interns and Residents, the labor union that's had a good deal of success in organizing residents across the US.  The CIR rep spoke about the dangers to both motorists and patients caused by our archaic and willfully stupid overwork of residents and interns.  As my wife and I nodded approvingly, I said something like, "Yeah, the CIR is doing a good job -- but I bet that the NLRB is going to build on their decision that university TAs can't organize, and screw interns and residents too."

Call me Carnac.  I open the BNA Daily Labor Report this morning (subscription only, alas), and what do I see?   (Answer below the fold!)

NLRB 'Likely' to Follow Ruling in Brown,
Reverse Boston Medical, Attorney Predicts

DORADO, PUERTO RICO--Following the National Labor Relations Board's recent decision in Brown University that graduate student teaching assistants and research assistants are not employees covered by federal labor law, it is "very likely" that the board will reverse its 1999 decision in Boston Medical Center that medical interns, residents, and fellows are covered employees, a Philadelphia management attorney said Feb. 28 at an American Bar Association conference. The board ruled in Boston Medical, 330 N.L.R.B. 152, 162 LRRM 1329 (1999), that medical interns, residents, and fellows are employees protected by the National Labor Relations Act. Doreen S. Davis of Morgan, Lewis & Bockius said the same test the three-member board majority used in deciding Brown, 342 N.L.R.B. No. 42, 175 LRRM 1089 (2004 -- whether the relationship between the teaching assistants and the university is primarily academic or economic--leads to the conclusion that medical interns, residents, and fellows have a primarily academic relationship with the teaching hospitals where they work and should not be permitted to collectively bargain.

So the doctors that triage you, diagnose your illness, and order treatment for you when you check into an emergency room aren't actually doctors, according to the management oligopoly -- they're students.  Because it's not enough to work them to the bone in exchange for relatively little pay -- now the hospitals can strip them of employee protections and their dignity as medical professionals. 

This is an abortion from a labor law perspective, but it's even worse from a health policy viewpoint. 

Posted by Trapper John at March 1, 2005 06:15 PM