Vanderbilt Law Review

Article Title

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


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

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 specialty. A clinical fellow is a physician who has completed an internship and a residency and is taking an educational postgraduate program to qualify for certification in an identifiable subspecialty of medicine.