STATUS OF REDUCED-SCHEDULE RESIDENCY a physician demands total denial of outside pleasures HEA INGS HELi TO AMENI LABOR ACT and interests. REMAINS IN DOUBT The right of housestaff to form collective bargaining units under the There are two major types of reduced-schedule resi- The reduced-schedule residency is a relatively new protection and rules of the National Labor Relations Act (NLRA) has dencies. In one type (known as shared-scheduled posi- concept in medicine. These programs have emerged been hotly contested for the past few years. Last year,the issue came to tions) conventional part-time positions are offered, sal- during the last decade as an alternative to traditional resi- the public eye after a series of strikes. At that time, housestaff at five aries are half the usual stipend, and the time required to dency programs for probably two reasons. First, the in- hospitals asked the National Labor Relations Board (NLRB) to assert reach board eligibility is proportionately increased. This creased enrollment of women in medical school has al- jurisdiction over them. This action would have given housestaff the type of program may be offered to an individual or to a most certainly resulted in an increase in physician-phy- right to vote on whether or not they wanted to be represented by a pair of students. In the latter case, the couple shares time sician and student-student marriages. Secondly, recent union in contract negotiations with their hospitals. and patient responsibility and assures continuity of care. social changes have created an atmosphere where peo- The AAMC entered the case as amicus curiae (friend of the court) in The other type is based on alternating blocks of time ple consciously reassess the relative importance of per- opposition to the housestaff petition. AAMC, which represents the away from the program. A two-year residency would sonal and professional goals. Presently, physicians enter- become twice as long with the house officer performing (Continued on page 3) ing residencies are trying to achieve a new balance his or her duties in perhaps three-month rotations with between the personal,family, and professional aspects of equivalent time off between blocks. Two people sharing their lives. It is no longer universally accepted that being such a residency would simply alternate responsibility. U.S. STUDENTS ON FOREOGN SCHOOLS: Housestaff today seek these programs for a variety of Vokme 1, NuinbeT 1 MANPOWER PROVOSOONS STIR WIDESPREAD DEBATE OSR OPINION SURVEY—Continued reasons. Physician couples who have decided to share SReng 1977 The new health manpower law (PL 94-484) contains a provision that equally in the responsibilities of housekeeping and child in order to receive 1978-80 capitation grants, medical schools must permission 6) Reduced-schedule residencies are rearing make up a small but important population. accept into their M.D. programs a number of American students who compatible with high quality train- Another group is comprised of women physicians, com- have completed basic science studies at foreign medical schools. PubIished Iby ing. l mitted to the profession but unwilling to defer child This provision was hastily added to the law in Conference,and it was without o 5 10 bearing and family responsibilities to the post-residency AssOcIatIon of Anneoican initially popular with proponents of the theory that U.S. health care 7) Reduced-schedule residencies years. Still others seek these programs in order to pur- r MedOca0Colileges problems are due primarily to a physician shortage. It soon became will promote the proliferation of sue research interests, usually at the same institution. foo. apparent, however, that the issue is much more complicated. The law poorly motivated and under-trained Since their inception, reduced-schedule residencies The Oirganizafion specifies that schools cannot reject these students for academic rea- reproduced doctors. have existed in a grey zone of semi-official 1 acceptance. of sons if the students have passed Part. I of the National Boards. Schools be o 5 10 Institutions do not advertise such positions, and the can only use non-academic criteria in justifying their failure to accept to 8) Reduced-schedule programs NIRMP listing of approved residencies makes no special Studear2 RepresentaftOwes the required number of transfer students from foreign medical should be developed openly, accred- note of their existence at certain hospitals. The Liaison Not schools. In this way, passage of NBME Part I is substituted for the ited by standard means, and listed as Committee on Graduate Medical Education (LCGME) schools' usual applicant evaluation procedures. The deans of many such by NIRMP. does not have special guidelines to assure their quality. medical schools feel that being forced to admit a specified number of 5 10 At a recent AAMC Executive Council meeting this o Housestaff Status: AAMC students "around" the standard admission process is an unjustified 9) This newsletter has served a useful issue was discussed and some members of the council ar- . Students or threat to the autonomy of their institutions. Others feel that the law is the function by providing new informa- gued that AAMC should not actively encourage institu- discriminatory—that it allows rejected applicants who were wealthy of • Employees? tion. 1 tions to offer reduced-schedule programs. They main- enough to attend high-priced foreign schools access that their poorer o 5 10 tained that medicine was a full-time job requiring a full- O U.S. Students in counterparts did not have. It is also thought to be possible that stu- 10) Additional issues published three time commitment. They argued that official endorse- dents from foreign medical schools might take available third-year or four times per year would be ment of the concept would inevitably result in a popula- Foreign Schools collections slots from students in U.S. two-year medical schools. useful. tion of under-motivated, part-time physicians. It was Since there is currently no reliable estimate of the actual numbers of the 0 5 10 their feeling that the present status of these programs O Can Student Input students involved, it is not possible to predict the full effect of the new Comments on areas discussed in this issue or on other was adequate to deal, on a personal level, with the very Influence Decisions at law. Because of this and because of great difficulties which will from matters of concern relating to medical education (use few cases who demonstrate a genuine need for a re- the National Level? undoubtedly accompany the verification and translation of docu- separate sheet if necessary): duced-schedule training program. ments, it is unlikely that the law can be implemented until academic There will be more discussion of this issue before a year 1978-79. AAMC has testified in a Pennsylvania lawsuit brought to decision is reached. OSR has consistently endor§ed the O Reduced-Schedule Document force earlier implementation of the law and has explained the prob- concept, and we would like you to let us know your Residencies: Problem lems which schools would face if forced to implement the transfer thoughts on this question by responding to the survey on Or Solution? provisions on such short notice. page 3. OSR has reviewed the provisions of PL 94-484 relating to U.S. OSR National Chairperson: students studying abroad; in general, we share the views of AAMC regarding these aspects of the law. We feel that this provision will be psR REPORT Thomas A. Rado, Ph.D. hard to implement, that it is somewhat discriminatory, and that it does Published by the Association of Amer- represent an unwarranted intrusion into the admissions process. ican Medical Colleges fOr the Orga- OSR National Chairperson- Some medical school deans have indicated that they may recom- nization of Student Representatives. Elect: Paul Distributed free of charge to all U.S.. Scoles mend that their schools refuse capitation rather than comply with this medical students. provision. OSR has consistently argued against this course of action. According to the law, students cease to qualify for the new Federal Editor: Diane Newman, Optional: AAMC Divi- Program of Insured Loans for Health Professions Students when their sion of Student Programs,One Dupont Copyright © 1977 by the Association schools become ineligible for capitation. Under these conditions, we Circle, N.W., Washington, D.C. 20036, of American Medical Colleges (202) 466-5057 feel that refusal of capitation would result in undue hardship for large Name Date numbers of medical students. 4 PERSPECTIVES: CREATIVITY ON THE facts, questions, and proposed solutions. You are an . LABOR ACT (Continued from page 1) SILENT CONSTITUENCY important and largely untapped source of such data. In entirely possible that AAMC is correct in prophesying the list which follows this letter, the members of the major teaching hospitals in the U.S., presented an argu- grave difficulties for post-graduate medical education if This issue of OSR Report marks the beginning of a ma- Administrative Board are identified along with the areas ment based on the premise that interns, residents, and the Thompson Amendment passes. It is also true, how- jor new direction for the Organization of Student Rep- in which they are working. If you are interested in one or fellows are students on stipend, rather than employees ever, that housestaff have just grievances which might be resentatives (OSR) of the Association of American Med- more of these areas, if you have questions or ideas, con- on salary. (Students in general are not eligible for NLRB best settled in the egalitarian atmosphere of collective ical Colleges (AAMC). AAMC has played a decisive role tact these people. We will respond to you. recognition.) A point raised by AAMC was that the bargaining.