Hospital Mergers Reinforce the Need for a Strong Resident Voice

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The 2013-2014 residency year has brought about a number of changes for CIR members as hospitals have merged and formed larger medical systems. In this issue of Vitals, we zero in on one hospital merger, between Mount Sinai Health System and Continuum Health Partners that embodies some of CIR’s greatest victories and greatest challenges—strong chapters of empowered residents with a real voice in their hospitals and residents trying to form new chapters and being met with resistance from their employers every step of the way.

The absorption of smaller hospitals into larger healthcare systems is nothing new but the rate at which it’s occurring has increased rapidly in recent years. According to the healthcare research firm Irving Levin Associates, 2009 saw 50 hospital mergers and acquisitions but in 2012, that number jumped to 105, and experts say this could be just the beginning of more consolidation and upheaval. 2013 was a big year for CIR members in this regard, as Continuum Health Partners, a New York City-based hospital network including Beth Israel and St. Luke’s-Roosevelt, merged with Mount Sinai Medical Center to form the Mount Sinai Health System – a mega
teaching institution with four hospitals and approximately 2200 residents on its payroll.

Residents at St Luke’s-Roosevelt have had a CIR chapter since 2001, residents at the Institute for Family Health just won their first CIR contract and Elmhurst residents are ready to start negotiating.

Merging hospital systems always argue that the move improves hospital efficiency and capacity to care for more patients. However, studies in recent years have shown that hospital mergers frequently lead to increased health care costs as larger hospitals are able to strengthen their negotiating power with insurance companies and raise their prices. There is also concern from the Federal Trade Commission about the legality of large scale hospital system mergers when it comes to the potential for monopolies within a community.

What is known for sure is that merger means change. The new Mount Sinai Health System has already closed down
the child and adolescent psychiatry inpatient unit at Mount Sinai Hospital and an inpatient medicine floor at Beth Israel Hospital. The new system has also begun to change graduate medical education, bringing all hospitals into the the Icahn School of Medicine affiliation, altering program oversight and rotation schedules.

Residents have a stake both in how patient care is provided and in the structure and oversight of their own training, but have not been given an opportunity to participate in any of the decision making. This disregard for the needs and expertise of residents has highlighted the ongoing lack of resident voice in the Mount Sinai Health System and inspired housestaff across all hospitals to organize to join CIR. One major challenge is the hospital’s claim that residents are students, not employees, and therefore do not have a right to unionize.

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