Physicians and collective bargaining.

This article discusses both the history of physician collective bargaining and the applicability of the 1974 health amendments of the National Labor Relations Act to this subject. Gordon outlines the issues for housestaff programs as well as for hospital-based professionals. The scope of physician bargaining includes: wages, hours, working conditions and issues related to the quality of patient care. Housestaff collective bargaining often addresses the issues of on-duty meals, free laundry and uniforms, subsidized housing, parking facilities, and on-call rooms. The concerns of staff physicians include tenure, pensions, and insurance benefits. Gordon suggests that the difficulty and novelty of physician/ hospital collective bargaining will frequently result in an impasse. He states that the propriety or impropriety of a doctors' strike depends upon: (l) the patient-care implications of the grievance causing the strike; (2) the gravity of the grievance leading to work stoppage; (3) the consequences of the strike for patient care; and (4) the other alternatives available. In the view of the author, a doctors' strike may be justified when it arises from a grievance relating to patient care as well as to self-aggrandizement. He states,"...if the strike is the only effective method of making known conditions prejudicial to patient care, including conditions which regularly and systematically cause loss of health and life, the physician may be obliged to engage in such a strike, rather than desist from such action." He concludes that as professionals shift from being private entrepreneurs to salaried employees, they will be compelled to use a collective bargaining approach for professional as well as economic concerns.