Published May 29, 2002
Sixel: Physicians note two sides to residents' class action
By L.M. SIXEL
Copyright 2002 Houston Chronicle
SIX months ago, more than a dozen offshore oil-drilling companies in Houston agreed to pay $75 million in back wages to 60,000 laborers.
It turned out that the companies had gotten together and set wages over three decades, which kept pay artificially low.
Now a class-action lawsuit is taking a similar tack against the nation's teaching hospitals and medical schools, including the Baylor College of Medicine, accusing it of fixing the wages and working conditions of their medical residents.
The lawsuit, filed in Washington, D.C., earlier this month, contends that the hospitals, medical schools and the National Resident Matching Program, which has matched medical residents to hospitals for the past 50 years, violates federal antitrust laws by restricting competition in recruitment, hiring, employment and compensation.
Newly minted physicians are prohibited from finding their own training job and negotiating a wage. Instead, residents must take the residency that they're assigned and take the wage that is offered.
"It's a great suit," Houston employment lawyer Andrew Golub said. "I don't know why I didn't think of it myself."
The system makes residents indentured servants for the duration of their employment, Golub said. And no matter how bad the job gets, the resident can't pick up and move to another hospital.
According to the lawsuit, which seeks to represent 200,000 resident physicians, the lack of competition allows employers to pay artifically low wages, which average less than $10 an hour.
And lack of competition lets employers require the residents to work 100 hours a week, including 36-hour and 48-hour shifts.
Resident physicians must accept the conditions because completing a residency is necessary for certification. In Texas, physicians must spend a year as residents to receive licenses to practice. To get board certified in a specialty takes three to seven years.
Many exhausted residents moonlight at other jobs to pay their living expenses and medical school debt, which averages about $100,000, according to the lawsuit.
The National Resident Matching Program issued a statement in which it categorically denies it illegally restrains trade or is engaged in any wrongdoing in the matching of prospective residents to residency programs.
And a spokeswoman for Baylor refused to comment because of the pending litigation. Baylor residents rotate to several area hospitals, including Methodist Hospital, Texas Children's Hospital, St. Luke's Episcopal, Ben Taub General Hospital, Veterans Affairs Medical Center and the Institute for Rehabilitation and Research.
Baylor identifies the residents it wants and Baylor sets the terms of the educational program, Methodist spokeswoman Emma Chambers said.
"We look to Baylor to provide us with qualified residents, and then we pay Baylor for those related expenses," Chambers said.
A child psychiatrist in Houston said that when she went through residency, she was lucky because her specialty was in demand. There were more spots available than residents, so it wasn't hard to find a good residency in Philadelphia, her first choice.
But her friends in orthopedics and dermatology didn't have that luxury because of the paucity of openings. They had to move to Alaska, if that's where the matching program put them.
And negotiate on pay? She recalled, asking not to be identified, "You have no say. They tell you the pay when you interview."
She said she never thought about the recruitment and selection system until now because "this was the way it worked." When you went to medical school, you agreed to the terms of education and training, she said.
But in retrospect, she believes it is wage fixing.
"It's cheap staffing for hospitals," she said.
The medical director of one hospital in Houston, who asked not to be identified because he doesn't know if his hospital will get dragged into the lawsuit, agreed residents represent inexpensive staffing.
If he had to pay the residents what licensed physicians earn, he said, he would hire the licensed doctors.
If the residents are successful in the lawsuit, "it would be the end of residency," he said. And patients would suffer because the shortage of doctors would just get worse.
The medical director took issue with the suit's contention that salaries are fixed. Each medical school has a different salary structure, he said.
And, he said, most residents would do the residency without a salary because they need the training to get a license.
"I never considered it a job," he said. "It's training."
But, he said, it's a sympathetic argument. They've finished medical school. How can you pay them $40,000 a year?
However, he added, he wouldn't want to see a doctor with just a year of experience. He'd want the best, and that's someone with years of training.
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