Long Beach Veterans Administration Medical Center, Long Beach, California (Activity) and Physicians National Housestaff Association (Labor Organization/Petitioner)

 



[ v07 p434 ]
07:0434(66)RO
The decision of the Authority follows:


 7 FLRA No. 66
 
 LONG BEACH VETERANS ADMINISTRATION
 MEDICAL CENTER, LONG BEACH, CALIFORNIA
 Activity
 
 and
 
 PHYSICIANS NATIONAL HOUSESTAFF ASSOCIATION
 Labor Organization/Petitioner
 
                                            Case No. 8-RO-2
 
                    DECISION AND DIRECTION OF ELECTION
 
    UPON A PETITION DULY FILED WITH THE FEDERAL LABOR RELATIONS AUTHORITY
 UNDER SECTION 7111(B)(1)(A) OF THE FEDERAL SERVICE LABOR-MANAGEMENT
 RELATIONS STATUTE (THE STATUTE), A HEARING WAS HELD BEFORE A HEARING
 OFFICER OF THE AUTHORITY.  THE HEARING OFFICER'S RULINGS MADE AT THE
 HEARING ARE FREE FROM PREJUDICIAL ERROR AND ARE HEREBY AFFIRMED.
 
    UPON THE ENTIRE RECORD IN THIS CASE, INCLUDING THE POST-HEARING
 BRIEFS FILED BY THE PARTIES AND THE AMICI CURIAE, /1/ THE AUTHORITY
 FINDS:
 
    THE PETITIONER, PHYSICIANS NATIONAL HOUSESTAFF ASSOCIATION, SEEKS AN
 ELECTION IN A UNIT OF ALL MEDICAL INTERNS, RESIDENTS, AND FELLOWS WHO
 ARE PHYSICALLY ASSIGNED TO THE LONG BEACH VETERANS ADMINISTRATION
 MEDICAL CENTER (ACTIVITY), EXCLUDING ALL OTHER PROFESSIONAL EMPLOYEES IN
 ADDITION TO THE STATUTORY EXCLUSIONS.  THE ACTIVITY, JOINED BY THE AMICI
 CURIAE, CONTENDS THAT THE PETITION SHOULD BE DISMISSED, IN ESSENCE,
 BECAUSE:  (1) THE MEDICAL INTERNS, RESIDENTS, AND FELLOWS ARE GRADUATE
 MEDICAL STUDENTS USING THE ACTIVITY AS A CLINICAL CLASSROOM, RATHER THAN
 "EMPLOYEES" OF THE ACTIVITY WITHIN THE MEANING OF SECTION 7103(A)(2) OF
 THE STATUTE;  AND (2) THE PETITIONED-FOR UNIT IS NOT APPROPRIATE FOR
 EXCLUSIVE RECOGNITION WITHIN THE MEANING OF SECTION 7112(A)(1) AND (B)
 OF THE STATUTE. /2/
 
    THE ACTIVITY IS A LARGE MEDICAL CENTER WITHIN THE DEPARTMENT OF
 MEDICINE AND SURGERY, WHICH IS A MAJOR SUBDIVISION WITHIN THE VETERANS
 ADMINISTRATION (AGENCY).  /3/ THE ACTIVITY IS UNDER THE OVERALL
 SUPERVISION OF A MEDICAL CENTER DIRECTOR, AND IS ORGANIZED INTO FOUR
 MAJOR SERVICES:  PROFESSIONAL, ADMINISTRATIVE, EDUCATIONAL, AND
 RESEARCH.  THE CHIEF OF STAFF OF THE ACTIVITY ACTS FOR THE MEDICAL
 CENTER DIRECTOR IN THE DIRECTION AND COORDINATION OF THE PROFESSIONAL
 SERVICES, WHEREIN THE MEDICAL INTERNS, RESIDENTS, AND FELLOWS ARE
 ASSIGNED.  THE PROFESSIONAL SERVICES ARE EACH HEADED BY A CHIEF OF
 SERVICE AND INCLUDE, FOR EXAMPLE, ANESTHESIOLOGY, MEDICAL, PSYCHIATRY,
 RADIOLOGY, SURGERY.
 
    THE PETITIONED-FOR UNIT CONSISTS OF APPROXIMATELY 200 MEDICAL
 INTERNS, RESIDENTS, AND FELLOWS.  /4/ THESE INDIVIDUALS ARE PHYSICIANS
 WHO HAVE COMPLETED THE FOUR-YEAR COURSE OF STUDY AT A MEDICAL SCHOOL
 ("UNDERGRADUATE MEDICAL EDUCATION"), HAVE BEEN AWARDED THE DOCTOR OF
 MEDICINE DEGREE, AND HAVE CHOSEN TO PURSUE GRADUATE MEDICAL TRAINING IN
 VARIOUS SPECIALTY FIELDS.  ALMOST ALL PHYSICIANS RECEIVING THE DOCTOR OF
 MEDICINE DEGREE ENGAGE THEMSELVES IN GRADUATE MEDICAL TRAINING PROGRAMS
 IN TEACHING HOSPITALS (SUCH AS THE ACTIVITY) THAT ARE ASSOCIATED WITH A
 MEDICAL SCHOOL, AND DO SO BECAUSE OF TWO MAJOR CONSIDERATIONS:  FIRST,
 CERTAIN STATES REQUIRE ONE YEAR OF GRADUATE TRAINING IN ORDER TO FULFILL
 LICENSE REQUIREMENTS FOR THE PRACTICE OF MEDICINE.  SECOND, BY PURSUING
 A THREE TO SEVEN YEAR PROGRAM OF GRADUATE TRAINING, A PHYSICIAN CAN BE
 ELIGIBLE FOR CERTIFICATION FROM AMONG 23 DIFFERENT SPECIALTY BOARDS OF
 MEDICINE, FOR EXAMPLE, SURGERY, INTERNAL MEDICINE, PATHOLOGY.  ALTHOUGH
 BECOMING "BOARD ELIGIBLE" OR "BOARD CERTIFIED" IS NOT A LEGAL
 REQUIREMENT OR QUALIFICATION FOR A PHYSICIAN, SUCH STATUS CONFERS
 BENEFITS SUCH AS HOSPITAL PRIVILEGES AND PROFESSIONAL STANDING.
 
    THE AGENCY'S TRAINING RESPONSIBILITY IN THE HEALTH CARE FIELD IS
 MANDATED BY 38 U.S.C. 4101(A) AND (B)(1976), WHICH STATES THAT WHILE THE
 PRIMARY FUNCTION OF THE AGENCY'S DEPARTMENT OF MEDICINE AND SURGERY IS
 TO PROVIDE MEDICAL CARE AND TREATMENT TO VETERANS, A PROGRAM OF
 EDUCATION AND TRAINING OF HEALTH MANPOWER IS TO BE CARRIED OUT TO THE
 EXTENT FEASIBLE WITHOUT INTERFERING WITH THE PRIMARY FUNCTION.  AS OF
 THE END OF THE FISCAL YEAR ENDING SEPTEMBER 30, 1979 (FY 1979), SOME
 23,393 HOUSE STAFF ROTATED THROUGH APPROXIMATELY 7,400 FULL-TIME HOUSE
 STAFF POSITIONS SUPPORTED BY THE AGENCY.  THE ACTIVITY IS ONE OF 140 OF
 THE AGENCY'S 172 MEDICAL CENTERS WHICH OFFER GRADUATE MEDICAL TRAINING
 PROGRAMS IN AFFILIATION OR INTEGRATION WITH 104 ACCREDITED MEDICAL
 SCHOOLS.
 
    GRADUATE MEDICAL TRAINING PROGRAMS, OR "RESIDENCY PROGRAMS," MAY BE
 CATEGORIZED AS:  (1) INDEPENDENT (INTRAMURAL)-- A PROGRAM CONDUCTED
 WITHIN A SINGLE INSTITUTION (THE ASSIGNMENT OF RESIDENTS IS LIMITED TO
 THAT INSTITUTION);  (2) AFFILIATED-- WHEN TWO OR MORE INSTITUTIONS
 DEVELOP FORMAL AGREEMENTS AND CONJOINT RESPONSIBILITIES TO PROVIDE
 COMPLEMENTARY FACILITIES, TEACHING STAFF, AND TEACHING SESSIONS (THE
 ASSIGNMENT OF RESIDENTS IS ROTATED THROUGH TWO OR MORE PARTICIPATING
 INSTITUTIONS);  AND (3) INTEGRATED-- WHEN A SINGLE PROGRAM DIRECTOR
 ASSUMES THE RESPONSIBILITY FOR A RESIDENCY PROGRAM INVOLVING MORE THAN
 ONE INSTITUTION, AND IS RESPONSIBLE FOR ALL APPOINTMENTS OF THE
 RESIDENTS AND OF THE TEACHING STAFF.
 
    THE ACTIVITY OFFERS RESIDENCY PROGRAMS WHICH, WITH ONE EXCEPTION, ARE
 EITHER INTEGRATED OR AFFILIATED WITH THE UNIVERSITY OF CALIFORNIA,
 COLLEGE OF MEDICINE AT IRVINE, CALIFORNIA (UCI), A CHARTERED CORPORATION
 WITHIN THE STATE OF CALIFORNIA.  THE RECORD DISCLOSES THAT UCI SPONSORS
 39 ACCREDITED RESIDENCY PROGRAMS, OF WHICH APPROXIMATELY 29 ARE
 OPERATIVE AT THE ACTIVITY.  A MAJORITY OF THESE PROGRAMS ARE INTEGRATED
 PROGRAMS.
 
    THE ACTIVITY AND UCI ARE PARTIES TO AN "AFFILIATION AGREEMENT," THE
 TERMS OF WHICH PROVIDE THAT UCI, THROUGH THE ACTIVITY'S DIRECTOR AND THE
 STAFF OF "CONSULTING AND ATTENDING SPECIALISTS" (PHYSICIANS HIRED BY THE
 AGENCY ON A FEE BASIS WHO HOLD FACULTY APPOINTMENTS AT UCI), WILL
 SUPERVISE THE TRAINING AND RESEARCH PROGRAMS OF THE ACTIVITY, AND SUCH
 PROGRAMS AS ARE OPERATED JOINTLY.  ALSO UNDER THE TERMS OF THE
 AGREEMENT, THE ACTIVITY RETAINS FULL RESPONSIBILITY FOR ITS OWN
 OPERATION AND ADMINISTRATION, WHICH MEANS FULL RESPONSIBILITY FOR THE
 CARE OF PATIENTS, INCLUDING ALL ADMINISTRATIVE AND PROFESSIONAL
 FUNCTIONS.  THE RECORD DISCLOSES THAT THE CHIEFS OF EACH OF THE
 ACTIVITY'S PROFESSIONAL SERVICES THAT ARE INVOLVED IN HOUSE STAFF
 PROGRAMS CONDUCT THE DAY-TO-DAY OPERATIONS OF SUCH PROGRAMS.
 
    THE AFFILIATION AGREEMENT ALSO PROVIDES FOR THE ESTABLISHMENT OF A
 "DEANS COMMITTEE" UNDER THE STATUTORY AUTHORITY SET FORTH IN 38 U.S.C.
 4112(B)(1976).  THIS COMMITTEE INCLUDES THE DEAN OF UCI AS CHAIRMAN,
 CERTAIN OF UCI'S DEPARTMENT CHAIRMEN, AND THE DIRECTOR AND THE CHIEF OF
 STAFF OF THE ACTIVITY.  AT THE CHAIRMAN'S DISCRETION, OTHER EMPLOYEES OF
 THE AGENCY, INCLUDING REPRESENTATIVES OF "VA HOUSE STAFF," MAY FROM TIME
 TO TIME PARTICIPATE IN DEANS COMMITTEE MEETINGS.  THE COMMITTEE, IN
 COOPERATION WITH AGENCY PERSONNEL, ESTABLISHES GRADUATE MEDICAL TRAINING
 PROGRAMS, AND DETERMINES THEIR SCOPE, ORGANIZATION, STANDARDS OF
 PERFORMANCE AND ADEQUACY OF FACILITIES.  UNDER THE AFFILIATION
 AGREEMENT, HOUSE STAFF CANDIDATES ARE NOMINATED BY THE DEANS COMMITTEE
 AND APPROVED BY THE ACTIVITY.  THE ACTIVITY APPOINTS HOUSE STAFF UNDER
 THE AUTHORITY OF 38 U.S.C. 4114(B)(1)(1976), WHICH PROVIDES:
 
    THE ADMINISTRATOR (OF VETERANS AFFAIRS) SHALL HAVE AUTHORITY TO
 ESTABLISH RESIDENCIES AND
 
    INTERNSHIPS;  TO APPOINT QUALIFIED PERSONS TO SUCH POSITIONS WITHOUT
 REGARD TO CIVIL-SERVICE OR
 
    CLASSIFICATION LAWS, RULES, OR REGULATIONS;  AND TO PRESCRIBE THE
 CONDITIONS OF SUCH
 
    EMPLOYMENT, INCLUDING NECESSARY TRAINING, AND THE CUSTOMARY AMOUNT
 AND TERMS OF PAY (WHICH MAY
 
    BE ESTABLISHED RETROACTIVELY BASED ON CHANGES IN SUCH CUSTOMARY
 AMOUNT AND TERMS) DURING THE
 
    PERIOD OF SUCH EMPLOYMENT AND TRAINING.
 
    A RESIDENCY REVIEW BOARD (REFERRED TO AS A HOUSE STAFF REVIEW
 COMMITTEE IN PUBLISHED AGENCY GUIDELINES) AT THE ACTIVITY PROVIDES A
 MECHANISM THROUGH WHICH THE ACTIVITY, IN CONJUNCTION WITH THE DEANS
 COMMITTEE, EVALUATES, REVIEWS, AND MAKES RECOMMENDATIONS TO THE ACTIVITY
 DIRECTOR FOR ACTION WITH RESPECT TO THE APPOINTMENT AND ESTABLISHMENT OF
 GRADE, PROFESSIONAL PERFORMANCE, EDUCATIONAL ACHIEVEMENT, DISCIPLINE,
 CONTINUATION, ADVANCEMENT, AND TERMINATION OF HOUSE STAFF.
 RECOMMENDATIONS BY THE BOARD CONCERNING WHETHER A RESIDENT'S
 PERFORMANCE
 WAS SATISFACTORY AND WHETHER HE OR SHE SHOULD CONTINUE IN THE RESIDENCY
 PROGRAM ARE BASED, IN PART, ON WRITTEN PERFORMANCE EVALUATIONS OF EACH
 RESIDENT BY ALL SUPERVISORS OF THE RESIDENT DURING EACH SIX-MONTH
 PERIOD, OR AT THE END OF EACH ROTATION, WHICHEVER COMES FIRST.  THE
 AGENCY'S PUBLISHED GUIDELINES PROVIDE THAT THE ACTIVITY'S RESIDENCY
 REVIEW BOARD BE COMPOSED OF FIVE VOTING MEMBERS, INCLUDING TWO SENIOR
 MEMBERS OF THE ACTIVITY'S HOUSE STAFF, AND THREE OF THE FOLLOWING
 PHYSICIANS:  THE ACTIVITY'S ASSOCIATE CHIEF OF STAFF FOR EDUCATION, ONE
 MEMBER OF THE DEANS COMMITTEE, AND ONE OR MORE OF THE ACTIVITY'S CHIEFS
 OF SERVICE.
 
    IN CONTRAST TO MEDICAL STUDENTS WHO PAY A TUITION TO UCI AND MAY BE
 ASSIGNED AS CLINICAL CLERKS TO THE ACTIVITY ONLY ON A WOC (WITHOUT
 COMPENSATION) BASIS IN ORDER TO FURTHER THEIR UNDERGRADUATE MEDICAL
 STUDIES, HOUSE STAFF RECEIVE A "STIPEND." HOUSE STAFF ASSIGNED TO THE
 ACTIVITY RECEIVE STIPENDS FROM EITHER THE AGENCY OR NON-AGENCY SOURCES.
 AGENCY STIPEND RATES FOR HOUSE STAFF VARY THROUGHOUT THE COUNTRY
 DEPENDING ON THE HOUSE STAFF "RECRUITMENT AREA." THE AGENCY'S STIPEND
 RATES FOR THE ACTIVITY RELATE TO THE STIPEND RATES PREVAILING AT LOCAL
 HOSPITALS WHICH HAVE AN IMPACT ON THE ACTIVITY'S RECRUITMENT CAPABILITY.
  THE AGENCY ALLOCATES THE BUDGETING SUPPORT FOR HOUSE STAFF STIPENDS ON
 A YEARLY BASIS ACCORDING TO ITS OWN AGENDA OF PRIORITIES.  THE AGENCY
 WEIGHS A NUMBER OF CONSIDERATIONS IN DECIDING WHICH OF ITS MEDICAL
 CENTERS AND WHICH SPECIALTIES OF MEDICINE ARE GOING TO RECEIVE HOW MANY
 STIPEND HOUSE STAFF SLOTS.  /5/
 
    AFTER THE AGENCY PROVIDES THE ACTIVITY WITH AN ALLOCATION OF STIPEND
 SLOTS FOR EACH RESIDENCY PROGRAM, EACH PROFESSIONAL SERVICE OF THE
 ACTIVITY, IN CONJUNCTION WITH ITS COUNTERPART AT UCI, FILLS THE SLOTS
 AND DEVELOPS A ROTATION SCHEDULE FOR THE YEAR.  /6/ ROTATIONS THROUGH
 THE ACTIVITY VARY IN LENGTH DEPENDING ON THE PARTICULAR INTEGRATED OR
 AFFILIATED RESIDENCY PROGRAM.  AS AN EXAMPLE, FOR INTEGRATED PROGRAMS
 DURING A RECENT 12-MONTH PERIOD, THE AVERAGE LENGTH OF STAY AT THE
 ACTIVITY RANGED FROM 4 MONTHS FOR HOUSE STAFF ROTATING THROUGH THE
 ACTIVITY'S ANESTHESIOLOGY SERVICE AND REHABILITATION MEDICINE SERVICE,
 TO 11 MONTHS FOR THE DERMATOLOGY RESIDENCY.  BY COMPARISON, A FIRST-YEAR
 HOUSE STAFF OFFICER IN THE ACTIVITY-BASED AFFILIATED INTERNAL MEDICINE
 RESIDENCY PROGRAM WILL SPEND A MINIMUM OF 10 MONTHS IN THE MEDICAL
 SERVICE OF THE ACTIVITY.  A MAJORITY OF THE MORE THAN 200 HOUSE STAFF AT
 THE ACTIVITY ARE IN THE INTERNAL MEDICINE RESIDENCY PROGRAM AND RELATED
 SUBSPECIALTIES.
 
    WHILE AT THE ACTIVITY, HOUSE STAFF RECEIVE A COMBINATION OF FORMAL
 AND CLINICAL TRAINING.  FORMAL TRAINING INCLUDES LECTURES, LABORATORY
 WORK, TEACHING ROUNDS, AND CONFERENCES.  MOST OF THE HOUSE STAFF'S TIME
 IS SPENT IN CLINICAL TRAINING, WHICH INCLUDES DIRECT PATIENT
 COMMUNICATION, OBSERVATION, AND EVALUATION, AS WELL AS ADMINISTRATION OF
 PATIENT CARE UNDER THE OVERALL SUPERVISION OF "ATTENDING PHYSICIANS."
 /7/ A PATIENT CARE TEAM MAY INCLUDE MEDICAL STUDENTS FROM UCI FROM TIME
 TO TIME, BUT IT WILL NORMALLY INCLUDE FIRST-YEAR RESIDENTS, MORE SENIOR
 RESIDENTS, FELLOWS, AND THE ATTENDING PHYSICIAN.  THE MORE EXPERIENCED
 MEMBERS OF THE TEAM PROVIDE GUIDANCE AND INSTRUCTION TO THE MORE JUNIOR
 MEMBERS UNDER THE OVERALL GUIDANCE OF THE ATTENDING PHYSICIAN.
 
    THE RECORD REVEALS THAT IN ALL THE ACTIVITY'S PROFESSIONAL SERVICES,
 MOST OF THE HOUSE STAFF'S TIME IS SPENT IN DIRECT PATIENT CARE
 ACTIVITIES.  FOR EXAMPLE, THE FIRST-YEAR RESIDENT IN THE ACTIVITY'S
 MEDICAL SERVICE FUNCTIONS AS THE PATIENT'S PRIMARY PHYSICIAN,
 RESPONSIBLE FOR THE PATIENT'S WORK-UP AND DAILY CARE.  FIRST-YEAR
 RESIDENTS IN THE MEDICAL SERVICE ARE RESPONSIBLE FOR TAKING PATIENT
 HISTORIES;  PERFORMING PHYSICAL EXAMINATIONS;  ORDERING TESTS,
 MEDICATIONS, AND DIETS;  MAKING INITIAL DIAGNOSES;  ORGANIZING A PLAN OF
 TREATMENT;  AND TAKING DAILY CARE OF ASSIGNED PATIENTS.  SENIOR
 RESIDENTS AND FELLOWS ARE ORIENTED TO PROVIDING ADVICE, SUPPORT, AND
 DIRECTION TO MORE JUNIOR HOUSE STAFF RATHER THAN PROVIDING DIRECT
 PATIENT CARE.
 
    HOUSE STAFF WORK AT THE ACTIVITY SEVEN DAYS PER WEEK, AND WORK LONG,
 SOMETIMES IRREGULAR HOURS, FREQUENTLY AT NIGHT AND ON WEEKENDS.  /8/
 ATTENDING PHYSICIANS ARE ON DUTY ONLY BETWEEN 8:00 A.M. AND 4:30 P.M.,
 MONDAY THROUGH FRIDAY.  ALTHOUGH ATTENDING PHYSICIANS ARE SUBJECT TO
 CALLS FOR ASSISTANCE OR ADVICE FROM HOUSE STAFF ON DUTY, GENERALLY
 SENIOR RESIDENTS OR FELLOWS ARE CALLED FIRST.  WHEN THE ATTENDING
 PHYSICIANS ARE NOT ON DUTY, HOUSE STAFF EXERCISE INDEPENDENT JUDGMENT IN
 DIAGNOSING PATIENTS, DETERMINING TREATMENT, AS WELL AS INITIATING AND
 MONITORING TREATMENT.  HOUSE STAFF MAY PRESCRIBE MEDICATION FOR PATIENTS
 AND WRITE ORDERS ON PATIENTS WHICH NURSES AND OTHER STAFF ARE REQUIRED
 TO FOLLOW.  HOUSE STAFF ALSO PERFORM THESE FUNCTIONS WHEN ATTENDING
 PHYSICIANS ARE ON DUTY;  THE DIFFERENCE IS THE IMMEDIACY OF SUPERVISION.
  EXAMPLES OF INDEPENDENT JUDGMENT INCLUDE DETERMINATIONS BY PSYCHIATRY
 RESIDENTS WHETHER TO DISCHARGE OR ADMIT PATIENTS-- INCLUDING INVOLUNTARY
 ADMISSIONS-- WHEN PERFORMING THE "ON DUTY" (OD) PSYCHIATRIST FUNCTION
 (WHEN THE HOUSE STAFF OFFICER IS THE ONLY PSYCHIATRIST AT THE ACTIVITY).
  FURTHER, WHILE ALL SURGICAL OPERATIONS ARE UNDER THE GENERAL
 SUPERVISION OF ATTENDING PHYSICIANS, THE RECORD INDICATES THAT AT ANY
 TIME, A NUMBER OF THE SURGICAL OPERATIONS AT THE ACTIVITY ARE PERFORMED
 BY HOUSE STAFF WITH THE PHYSICAL PRESENCE OF ATTENDING PHYSICIANS.
 
    BY CONTRAST, THE INVOLVEMENT OF UNDERGRADUATE MEDICAL STUDENTS IN THE
 CLINICAL CARE OF PATIENTS IS STRICTLY AN ACADEMIC EXERCISE PURSUANT TO
 EARNING THE DOCTOR OF MEDICINE DEGREE.  WHILE PUBLISHED AGENCY POLICY
 DESCRIBES HOUSE STAFF AS PHYSICIANS SERVING ON THE PROFESSIONAL STAFF OF
 AGENCY FACILITIES IN THE CAPACITY OF RESIDENTS, MEDICAL STUDENTS AS
 CLINICAL CLERKS ARE SPECIFICALLY PRECLUDED FROM ASSUMING ANY
 RESPONSIBILITY OR AUTHORITY FOR PROVIDING INDEPENDENT PATIENT CARE.
 MOREOVER, REFERRING SPECIFICALLY TO ITS HOUSE STAFF PROGRAM, PUBLISHED
 AGENCY POLICY STATES THAT THE MEANS FOR ATTAINING TRAINING OBJECTIVES
 ARE ESSENTIALLY THE SAME AS THOSE FOR ACCOMPLISHING THE PRIMARY MISSION,
 PATIENT CARE AND TREATMENT.  TO THIS END, THE AGENCY HAS REQUIRED THAT
 THE BASIC CONDUCT OF ITS HOUSE STAFF PROGRAMS CONFORM TO THE "ESSENTIALS
 OF ACCREDITED RESIDENCIES" (ESSENTIALS) APPROVED BY THE LIAISON
 COMMITTEE ON GRADUATE MEDICAL EDUCATION (LCGME).  THE ESSENTIALS REQUIRE
 THAT HOUSE STAFF BE INTEGRATED INTO THE MEDICAL STAFF AS TRUE COLLEAGUES
 IN ORDER TO PARTICIPATE IN COMMUNICATIONS WHICH CONTRIBUTE ULTIMATELY TO
 POLICY-MAKING DECISIONS.  /9/
 
    THE RECORD DISCLOSES THAT HOUSE STAFF PAID BY THE ACTIVITY RECEIVE
 THEIR STIPEND PAYMENTS EACH REGULAR BIWEEKLY PAY PERIOD, AND THAT THEIR
 PAY IS SUBJECT TO FEDERAL AND STATE INCOME TAX, AND SOCIAL SECURITY
 DEDUCTIONS.  THE PERIOD OF SERVICE OF HOUSE STAFF AT THE ACTIVITY IS
 CREDITABLE SERVICE FOR CIVIL SERVICE RETIREMENT.  THEY ACCRUE ANNUAL AND
 SICK LEAVE.  UNUSED SICK LEAVE AT THE TIME OF TERMINATION MAY BE
 RECREDITED UPON RETURN TO FEDERAL EMPLOYMENT WITHIN THREE YEARS.  IN
 CONTRAST TO HOUSE STAFF WHO MAY BE ROTATED TO THE ACTIVITY AND YET
 CONTINUE TO BE PAID BY, AND EARN FRINGE BENEFITS AT, THEIR "HOME"
 HOSPITAL, HOUSE STAFF ASSIGNED TO THE ACTIVITY AND PAID BY THE AGENCY
 HAVE WORKER'S COMPENSATION TYPE BENEFITS FOR INJURY OR ILLNESS ON THE
 JOB, INCLUDING MEDICAL CARE AND HOSPITALIZATION, COMPENSATION FOR LOSS
 OF PAY, AND DEATH BENEFITS TO SURVIVORS.  IN ADDITION, AGENCY STIPEND
 HOUSE STAFF AT THE ACTIVITY ARE ELIGIBLE TO CHOOSE AMONG SEVERAL FEDERAL
 EMPLOYEES' HEALTH BENEFITS PLANS, AS WELL AS TO TAKE FEDERAL EMPLOYEE
 GROUP LIFE INSURANCE.
 
    THE RECORD ALSO DISCLOSES THAT THE FEDERAL TORT CLAIMS ACT APPLIES TO
 AGENCY HOUSE STAFF;  THAT IS, THE FEDERAL GOVERNMENT IS RESPONSIBLE FOR
 THE NEGLIGENCE AND MALPRACTICE OF HOUSE STAFF ACTING WITHIN THE SCOPE OF
 THEIR EMPLOYMENT.  IN ADDITION, ALL AGENCY MEDICAL CENTERS ARE CAUTIONED
 TO ADVISE HOUSE STAFF AND NON-FEDERAL INSTITUTIONS TO WHICH THEY MAY BE
 ASSIGNED THAT THE FEDERAL GOVERNMENT WILL NOT BE RESPONSIBLE FOR ANY
 CLAIMS AGAINST THEM ARISING OUT OF THEIR ACTIVITIES AT THE NON-FEDERAL
 INSTITUTION.
 
                        DISCUSSION AND CONCLUSIONS
 
    JURISDICTION
 
    THE FIRST ISSUE BEFORE THE AUTHORITY IS WHETHER HOUSE STAFF ARE
 EMPLOYEES WITHIN THE MEANING OF SECTION 7103(A)(2) OF THE STATUTE.
 SECTION 7103(A)(2)(A) OF THE STATUE PROVIDES, IN PERTINENT PART, THAT AN
 "'EMPLOYEE' MEANS AN INDIVIDUAL . . . EMPLOYED IN AN AGENCY." THE
 AUTHORITY FINDS THAT THE HOUSE STAFF WHO ARE ASSIGNED TO THE ACTIVITY
 AND WHO ARE PAID STIPENDS BY THE AGENCY ARE EMPLOYEES OF THE ACTIVITY
 WITHIN THE MEANING OF THE STATUTE.  THE EVIDENCE ESTABLISHES THAT AN
 EMPLOYER-EMPLOYEE RELATIONSHIP EXISTS BETWEEN THE ACTIVITY AND THE HOUSE
 STAFF WHO ARE ASSIGNED TO THE ACTIVITY AND WHO ARE PAID STIPENDS BY THE
 AGENCY.  IN THIS REGARD, THE ACTIVITY RETAINS FINAL AUTHORITY TO APPOINT
 THE HOUSE STAFF FOUND TO BE EMPLOYEES.  THE AGENCY COMPENSATES THESE
 EMPLOYEES WITH SALARY AND FRINGE BENEFITS OF THE SORT PAID TO OTHER
 FEDERAL EMPLOYEES FOR THE DIRECT PATIENT CARE SERVICES WHICH EMPLOY MOST
 OF THEIR TIME AND CONSTITUTE THE NORMAL AND PRIMARY FUNCTION OF THE
 ACTIVITY.  THE PATIENT CARE SERVICE PROVIDED BY THESE EMPLOYEES IS
 CONTROLLED BY THE ACTIVITY'S PROFESSIONAL SERVICES ON A DAY-TO-DAY
 BASIS.  /10/ FINALLY, THE ACTIVITY RETAINS FINAL AUTHORITY TO EVALUATE
 PROFESSIONAL PERFORMANCE AND EDUCATIONAL ACHIEVEMENT, AND TO DISCIPLINE,
 ADVANCE, AND RETAIN THESE EMPLOYEES.
 
    HOWEVER, THE AUTHORITY FINDS THAT THE HOUSE STAFF WHO ARE ASSIGNED TO
 THE ACTIVITY AND WHO ARE PAID STIPENDS FROM NON-AGENCY SOURCES ARE NOT
 EMPLOYEES OF THE ACTIVITY WITHIN THE MEANING OF THE STATUTE.  ALONG WITH
 THE FACT THAT THIS GROUP OF HOUSE STAFF IS NOT PAID BY THE AGENCY, /11/
 THE AUTHORITY FINDS SIGNIFICANT THE FACT THAT THIS GROUP OF HOUSE STAFF
 IS NOT ELIGIBLE TO SHARE IN THE VARIOUS EMPLOYEE BENEFITS AND
 PROTECTIONS PROVIDED BY THE AGENCY TO THE HOUSE STAFF THAT IT PAYS.
 
    IN LIGHT OF THESE FINDINGS, THE AUTHORITY IS MINDFUL OF THE
 LEGISLATIVE HISTORY OF THE STATUTE PERTAINING TO SECTION 7103(A)(4).
 /12/ IN DISCUSSING THE DEFINITION OF "LABOR ORGANIZATION" CONTAINED IN
 H.R. 11280, WHICH APPEARS UNCHANGED IN SECTION 7103(A)(4) OF THE
 STATUTE, THE HOUSE COMMITTEE ON POST OFFICE AND CIVIL SERVICE NOTED
 THAT:  /13/
 
    SUBSECTION (A)(4) OF SECTION 7103 DEFINES "LABOR ORGANIZATION" AS AN
 ORGANIZATION COMPOSED
 
    IN WHOLE OR IN PART OF EMPLOYEES, IN WHICH EMPLOYEES PARTICIPATE AND
 PAY DUES, AND WHICH HAS
 
    AS A PURPOSE THE DEALING WITH AN AGENCY CONCERNING GRIEVANCES AND
 CONDITIONS OF
 
    EMPLOYMENT.  THE COMMITTEE INTENDS THAT THE LATTER CRITERION BE
 DEEMED AS MET BY AN
 
    ORGANIZATION WHICH HAS ONE . . . OF ITS BASIC PURPOSES, THOUGH NOT
 ITS ONLY PURPOSE OR ITS
 
    PRIMARY PURPOSE, THE REPRESENTATION OF EMPLOYEES IN A COLLECTIVE
 BARGAINING RELATIONSHIP.  THE
 
    TERM "LABOR ORGANIZATION" IS THUS INTENDED TO ENCOMPASS PROFESSIONAL
 ASSOCIATIONS (SUCH AS THE
 
    AMERICAN NURSES ASSOCIATION, THE NATIONAL EDUCATION ASSOCIATION, THE
 NATIONAL ASSOCIATION OF
 
    SOCIAL WORKERS, THE PHYSICIANS NATIONAL HOUSESTAFF ASSOCIATION, AND
 THE NATIONAL ECONOMIC
 
    COUNCIL OF SCIENTISTS) WHICH SEEK TO AVAIL THEMSELVES OF
 REPRESENTATIONAL RIGHTS UNDER CHAPTER
 
    71.
 
    THERE IS NO FURTHER RELEVANT LEGISLATIVE HISTORY ON THIS MATTER.
 CLEARLY THEN, IF CONGRESS INTENDED THAT THE PETITIONER HEREIN, WHO
 REPRESENTS ONLY HOUSE STAFF, BE A LABOR ORGANIZATION WITHIN THE MEANING
 OF SECTION 7103(A)(4) OF THE STATUTE, IT WOULD BE INCONSISTENT TO
 CONCLUDE THAT CONGRESS INTENDED THOSE INDIVIDUALS REPRESENTED BY THE
 PETITIONER NOT TO BE EMPLOYEES WITHIN THE MEANING OF THE STATUTE.
 
    THE AUTHORITY NOTES THAT THE STATUS OF HOUSE STAFF AS GRADUATE
 MEDICAL STUDENTS OR TRAINEES IS UNCONTROVERTED;  THEIR PURPOSE IN
 ENTERING INTO THE AGENCY'S HOUSE STAFF PROGRAM AT THE ACTIVITY IS EITHER
 TO FULFILL STATE LICENSE REQUIREMENTS OR TO BECOME ELIGIBLE FOR
 CERTIFICATION IN A SPECIALTY OF MEDICINE, OR BOTH.  HOWEVER, AN
 EMPLOYER-EMPLOYEE RELATIONSHIP EXISTS IN THESE CIRCUMSTANCES,
 NOTWITHSTANDING THE FACT THAT THE PURPOSE OF THE EMPLOYMENT MAY BE
 EDUCATIONAL.  IN THIS REGARD, AN APPRENTICE IS NO LESS AN EMPLOYEE IN
 RELATION TO AN EMPLOYER SIMPLY BECAUSE THE PRIMARY PURPOSE OF HIS
 EMPLOYMENT IS TO LEARN A CRAFT, TRADE, OR PROFESSION FROM THE EMPLOYER
 WITHIN A SPECIFIED TIME.  IF AN EMPLOYEE IS AN APPRENTICE, SUCH STATUS
 MAY AFFECT HOW, AND HOW MUCH, HE OR SHE IS COMPENSATED, BUT IT DOES NOT
 ALTER THE FACT THAT HE OR SHE IS BEING COMPENSATED FOR SERVICES RENDERED
 TO THE EMPLOYER.
 
    IN THE INSTANT CASE, THE AUTHORITY NOTES PARTICULARLY THAT THE AGENCY
 HAS DECLARED WITH RESPECT TO ITS HOUSE STAFF PROGRAM THAT THE METHODS
 FOR ACCOMPLISHING EDUCATIONAL OBJECTIVES ARE ESSENTIALLY THE SAME AS
 THOSE FOR ACCOMPLISHING PATIENT CARE OBJECTIVES, AND THAT THE ESSENTIALS
 REQUIRE THAT HOUSE STAFF BE INTEGRATED INTO THE MEDICAL STAFF AS TRUE
 COLLEAGUES.  THUS, IN THE AUTHORITY'S VIEW, THERE IS NOTHING INHERENT IN
 THE STATUS OF HOUSE STAFF AS GRADUATE MEDICAL STUDENTS OR TRAINEES WHICH
 PRECLUDES A FINDING THAT THEY ARE ALSO EMPLOYEES OF THE ACTIVITY.  /14/
 
    APPROPRIATE UNIT
 
    AS NOTED ABOVE, THE ACTIVITY FURTHER CONTENDS THAT THE PETITIONED-FOR
 UNIT OR ANY VARIATION THEREOF WOULD NOT BE APPROPRIATE.  THE AUTHORITY
 FINDS THAT A UNIT COMPOSED OF HOUSE STAFF ASSIGNED TO THE ACTIVITY AND
 PAID BY THE AGENCY WOULD CONSTITUTE AN APPROPRIATE UNIT IN THAT SUCH
 EMPLOYEES ENJOY A COMMUNITY OF INTEREST SEPARATE AND DISTINCT FROM OTHER
 PROFESSIONAL EMPLOYEES OF THE ACTIVITY, AND SUCH UNIT WOULD PROMOTE
 EFFECTIVE DEALINGS, AND EFFICIENCY OF THE ACTIVITY'S OPERATIONS.
 
    CONCERNING COMMUNITY OF INTEREST, THE RECORD ESTABLISHES THAT THE
 SUBJECT EMPLOYEES ARE APPOINTED UNDER STATUTORY AUTHORITY APPLICABLE
 ONLY TO THEM;  ARE ENGAGED IN THE SAME MISSION, UNDER COMMON OVERALL
 SUPERVISION;  ARE SUBJECT TO WORK SCHEDULES AND ROTATIONS APPLICABLE
 ONLY TO THEM;  ENJOY COMMON JOB CLASSIFICATIONS, JOB DUTIES AND
 RESPONSIBILITIES;  RECEIVE COMPENSATION UNDER A SCHEDULE APPLICABLE ONLY
 TO THEM;  AND ARE SUBJECT TO THE SAME PERSONNEL POLICIES AND PRACTICES,
 PORTIONS OF WHICH ARE APPLICABLE ONLY TO THEM.
 
    CONTRARY TO THE ACTIVITY'S CONTENTION, THE AUTHORITY FINDS THAT AN
 APPROPRIATE UNIT COMPOSED OF HOUSE STAFF ASSIGNED TO THE ACTIVITY AND
 PAID BY THE AGENCY WOULD BE SUFFICIENTLY STABLE TO PROMOTE EFFECTIVE
 DEALINGS WITH THE ACTIVITY.  ALTHOUGH HOUSE STAFF ARE SUBJECT TO
 ROTATIONS IN AND OUT OF THE ACTIVITY, THE FACTS SHOW THAT MOST HOUSE
 STAFF CAN EXPECT TO BE IN A RESIDENCY PROGRAM FOR A MINIMUM OF THREE
 YEARS AND THAT FOR ANY GIVEN 12-MONTH PERIOD, MOST HOUSE STAFF ASSIGNED
 TO THE ACTIVITY AND PAID BY THE AGENCY REMAIN AT THE ACTIVITY FOR MOST
 OF THE 12-MONTH PERIOD.  /15/ ACCORDINGLY, THE AUTHORITY FINDS THAT THE
 SUBJECT EMPLOYEES HAVE A REASONABLE EXPECTANCY OF REGULAR AND
 CONTINUOUS
 EMPLOYMENT FOR A SUBSTANTIAL PERIOD OF TIME WITH THE CONCOMITANT
 SUBSTANTIAL AND CONTINUING COMMUNITY OF INTEREST IN THE TERMS AND
 CONDITIONS OF THEIR EMPLOYMENT.  FURTHER, THE ACTIVITY'S PRIOR
 EXPERIENCE WITH OTHER ACTIVITY-WIDE UNITS IS INDICATIVE OF ITS CAPACITY
 TO EFFECTIVELY CONDUCT LABOR RELATIONS DEALINGS WITH AN APPROPRIATE UNIT
 OF HOUSE STAFF.  MOREOVER, AS TO PERSONNEL MATTERS, THE ACTIVITY'S
 "HOUSE OFFICER'S MANUAL" IS PERSUASIVE EVIDENCE OF ITS ACCOMMODATION TO
 THE PERSONNEL NEEDS AND REQUIREMENTS OF HOUSE STAFF.
 
    CONCERNING EFFICIENCY OF THE OPERATIONS OF THE ACTIVITY, THE
 AUTHORITY FINDS THAT THE ACTIVITY'S ORGANIZATIONAL AND OPERATIONAL
 STRUCTURE SHOWS THAT THE AGENCY RECOGNIZES, AND HAS MADE ACCOMMODATION
 FOR, THE UNIQUE STATUS OF HOUSE STAFF IN TERMS OF THEIR DUAL ROLE
 RELATIVE TO THE PROVISION OF PATIENT CARE AND THE AVAILABILITY OF
 TRAINING OPPORTUNITY.  THUS, THE ACTIVITY'S PROFESSIONAL SERVICES
 SUPERVISE THE CONDUCT OF THE DAY-TO-DAY OPERATIONS OF THE RESIDENCY
 PROGRAMS AND THE ACTIVITY RETAINS THE FINAL AUTHORITY TO SUPERVISE,
 EVALUATE, DISCIPLINE, PROMOTE AND RETAIN HOUSE STAFF APPOINTED BY THE
 ACTIVITY.  FURTHER, THE ACTIVITY'S AFFILIATION/INTEGRATION ARRANGEMENTS
 WITH OTHER INSTITUTIONS DO NOT INCLUDE OTHER FACILITIES OF THE AGENCY.
 THIS SHOWS THAT THE ACTIVITY'S RESPONSIBILITY FOR ITS HOUSE STAFF IS
 FOCUSED, AND NOT DILUTED AMONG OTHER COMPONENTS OF THE AGENCY.
 
    CONSIDERING THE ABOVE, THE ACTIVITY'S CONTENTION THAT THE
 PETITIONED-FOR UNIT CANNOT BE APPROPRIATE BECAUSE IT IS BASED SOLELY ON
 THE EXTENT OF ORGANIZATION IS CLEARLY WITHOUT MERIT.  THUS, UNDER ALL
 THE FOREGOING CIRCUMSTANCES, THE AUTHORITY FINDS THAT THE MEDICAL
 INTERNS, RESIDENTS, AND FELLOWS IN THE PETITIONED-FOR UNIT WHO ARE
 ASSIGNED TO THE ACTIVITY AND WHO ARE PAID BY THE AGENCY CONSTITUTE A
 UNIT WHICH IS APPROPRIATE FOR EXCLUSIVE RECOGNITION WITHIN THE MEANING
 OF SECTION 7112(A)(1) OF THE STATUTE IN THAT THE EMPLOYEES IN SUCH A
 UNIT WILL HAVE A CLEAR AND IDENTIFIABLE COMMUNITY OF INTEREST AND SUCH
 UNIT WILL PROMOTE EFFECTIVE DEALINGS WITH, AND EFFICIENCY OF THE
 OPERATIONS OF, THE ACTIVITY.
 
    ACCORDINGLY, THE AUTHORITY FINDS THAT THE FOLLOWING UNIT OF EMPLOYEES
 IS APPROPRIATE FOR THE PURPOSE OF EXCLUSIVE RECOGNITION UNDER THE
 STATUTE:  /16/
 
    ALL MEDICAL INTERNS, RESIDENTS, AND FELLOWS ASSIGNED TO THE LONG
 BEACH VETERANS
 
    ADMINISTRATION MEDICAL CENTER, LONG BEACH, CALIFORNIA, AND PAID BY
 THE VETERANS
 
    ADMINISTRATION;  EXCLUDING ALL OTHER PROFESSIONAL EMPLOYEES,
 NONPROFESSIONAL EMPLOYEES, AND
 
    EMPLOYEES DESCRIBED IN 5 U.S.C. 7112(B)(2), (3), (4), (6), AND (7).
 
                           DIRECTION OF ELECTION
 
    AN ELECTION BY SECRET BALLOT SHALL BE CONDUCTED AMONG THE EMPLOYEES
 IN THE UNIT FOUND APPROPRIATE AS SOON AS FEASIBLE.  THE APPROPRIATE
 REGIONAL DIRECTOR SHALL SUPERVISE OR CONDUCT, AS APPROPRIATE, THE
 ELECTION, SUBJECT TO THE AUTHORITY'S RULES AND REGULATIONS.  ELIGIBLE TO
 VOTE ARE THOSE IN THE UNIT WHO WERE EMPLOYED DURING THE PAYROLL PERIOD
 IMMEDIATELY PRECEDING THE DATE BELOW, INCLUDING EMPLOYEES WHO DID NOT
 WORK DURING THAT PERIOD BECAUSE THEY WERE OUT ILL, OR ON VACATION, OR ON
 FURLOUGH, INCLUDING THOSE IN THE MILITARY SERVICE WHO APPEAR IN PERSON
 AT THE POLLS.  INELIGIBLE TO VOTE ARE EMPLOYEES WHO QUIT OR WERE
 DISCHARGED FOR CAUSE SINCE THE DESIGNATED PAYROLL PERIOD AND HAVE NOT
 BEEN REHIRED OR REINSTATED BEFORE THE ELECTION DATE.  THOSE ELIGIBLE
 SHALL VOTE WHETHER OR NOT THEY DESIRE TO BE REPRESENTED FOR THE PURPOSE
 OF EXCLUSIVE RECOGNITION BY THE PHYSICIANS NATIONAL HOUSESTAFF
 ASSOCIATION.
 
    ISSUED, WASHINGTON, D.C., DECEMBER 29, 1981
 
                       RONALD W. HAUGHTON, CHAIRMAN
 
                        HENRY B.FRAZIER III, MEMBER
 
                        LEON B. APPLEWHAITE, MEMBER
 
                     FEDERAL LABOR RELATIONS AUTHORITY
 
 
 
 
 
 --------------- FOOTNOTES: ---------------
 
 
    /1/ THE AMERICAN HOSPITAL ASSOCIATION AND THE ASSOCIATION OF AMERICAN
 MEDICAL COLLEGES WERE GRANTED PERMISSION TO PARTICIPATE IN THIS
 PROCEEDING AS AMICI CURIAE.
 
    /2/ SECTION 7112 PROVIDES IN PERTINENT PART:
 
    (A)(1) THE AUTHORITY SHALL DETERMINE . . . ANY UNIT TO BE AN
 APPROPRIATE UNIT ONLY IF THE
 
    DETERMINATION WILL ENSURE A CLEAR AND INDENTIFIABLE COMMUNITY OF
 INTEREST AMONG THE EMPLOYEES
 
    IN THE UNIT AND WILL PROMOTE EFFECTIVE DEALINGS WITH, AND EFFICIENCY
 OF THE OPERATIONS OF, THE
 
    AGENCY INVOLVED.
 
    (B) A UNIT SHALL NOT BE DETERMINED TO BE APPROPRIATE UNDER THIS
 SECTION SOLELY ON THE BASIS
 
    OF THE EXTENT TO WHICH EMPLOYEES IN THE PROPOSED UNIT HAVE ORGANIZED
 . . . .
 
    /3/ PURSUANT TO SECTION 2429.5 OF THE AUTHORITY'S RULES AND
 REGULATIONS (5 CFR 2429.5(1981)), OFFICIAL NOTICE IS TAKEN BY THE
 AUTHORITY OF THE FACT THAT THERE ARE THREE UNITS OF EXCLUSIVE
 RECOGNITION AT THE ACTIVITY.  THE NATIONAL FEDERATION OF FEDERAL
 EMPLOYEES, LOCAL 541, REPRESENTS AN ACTIVITY-WIDE UNIT OF ALL GENERAL
 SCHEDULE EMPLOYEES EXCEPT PROFESSIONAL EMPLOYEES.  THE AMERICAN NURSES
 ASSOCIATION REPRESENTS A PROFESSIONAL UNIT OF NURSES.  THE AMERICAN
 FEDERATION OF GOVERNMENT EMPLOYEES, LOCAL 1965, (AFGE) REPRESENTS AN
 ACTIVITY-WIDE UNIT OF ALL WAGE GRADE EMPLOYEES.  THE UNIT REPRESENTED BY
 AFGE WAS ONE OF 236 UNITS REPRESENTED BY AFGE WHICH WERE CONSOLIDATED
 INTO AN APPROPRIATE AGENCY-WIDE UNIT IN 1979.  VETERANS ADMINISTRATION,
 WASHINGTON, D.C., 1 FLRA 457(1979).
 
    /4/ THE TERMS "RESIDENTS," "HOUSE STAFF," "HOUSE OFFICERS," AND
 "HOUSE STAFF OFFICERS" REFER TO INTERNS, RESIDENTS, AND FELLOWS
 COLLECTIVELY.  FELLOWS ARE ALSO REFERRED TO AS "SUB-SPECIALTY
 RESIDENTS." IN THE COMMON PARLANCE OF GRADUATE MEDICAL TRAINING
 PROGRAMS, THE TERM "INTERN" HAS BEEN REPLACED BY THE TERMS "FIRST-YEAR
 RESIDENT," OR "PG-1" (POSTGRADUATE ONE), OR "PGY-1" (POSTGRADUATE YEAR
 ONE) TO REFER TO A PHYSICIAN IN THE FIRST YEAR OF GRADUATE MEDICAL
 TRAINING.  FOR PURPOSES OF THIS DECISION, THE TERMS "HOUSE STAFF"
 (PLURAL) AND "HOUSE STAFF OFFICER" (SINGULAR) INCLUDE ALL SUCH
 CLASSIFICATIONS OR TITLES.
 
    /5/ SUCH CONSIDERATIONS INCLUDE REQUESTS FOR SLOTS MADE BY THE
 PARTICULAR AGENCY MEDICAL CENTER AND ITS AFFILIATED/INTEGRATED MEDICAL
 SCHOOL, AND THE CAPACITY OF THE PARTICULAR AGENCY MEDICAL CENTER TO
 CARRY OUT ITS BASIC PATIENT CARE FUNCTIONS.
 
    /6/ THE RECORD REVEALS THAT ALL THE PROFESSIONAL SERVICES AT THE
 ACTIVITY INVOLVED WITH RESIDENCY PROGRAMS USE THE "EXCHANGE METHOD";
 THAT IS, WHEN A HOUSE STAFF OFFICER STIPEND BY THE AGENCY ROTATES TO ONE
 OF THE AFFILIATED/INTEGRATED HOSPITALS, THAT HOSPITAL, IN RETURN,
 ROTATES TO THE ACTIVITY A HOUSE STAFF OFFICER THAT IT PAYS.
 
    /7/ THE TERM "ATTENDING PHYSICIAN" MEANS A PHYSICIAN AT THE ACTIVITY
 WHO HAS A FACULTY APPOINTMENT AT UCI, AND WHO IS RESPONSIBLE FOR A
 PATIENT CARE TEAM FOR A SPECIFIED TIME.
 
    /8/ HOUSE STAFF ARE NORMALLY APPOINTED ON A FULL-TIME DUTY STATUS AND
 ARE CONSIDERED AVAILABLE AND RESPONSIBLE FOR THE CARE, TREATMENT, AND
 WELFARE OF THEIR PATIENTS 24 HOURS A DAY, 7 DAYS A WEEK.
 
    /9/ SEE THE ESSENTIALS IN PERTINENT PART UNDER "I.  GENERAL
 REQUIREMENTS," "11.  EMPLOYMENT RELATIONS OF HOUSE OFFICERS," AT PAGE 16
 OF THE '78'79 DIRECTORY OF RESIDENCY TRAINING PROGRAMS.
 
    /10/ ALTHOUGH "CONTROL" IS AN IMPORTANT ELEMENT IN DETERMINING
 WHETHER AN EMPLOYER-EMPLOYEE RELATIONSHIP EXISTS, THE FACTOR OF
 "CONTROL" ALONE IS NOT CONCLUSIVE EVIDENCE AS TO AN EMPLOYER-EMPLOYEE
 RELATIONSHIP.  COMPARE DEPARTMENT OF THE ARMY, FORT BRAGG SCHOOLS, 3
 FLRA NO. 57(1980).
 
    /11/ COMPARE FORT KNOX DEPENDENT SCHOOLS, 5 FLRA NO. 5(1981).
 
    /12/ SECTION 7103(A)(4) PROVIDES IN PERTINENT PART:
 
    (4) "LABOR ORGANIZATION" MEANS AN ORGANIZATION COMPOSED IN WHOLE OR
 IN PART OF EMPLOYEES
 
    . . . .
 
    /13/ REPORT OF THE COMMITTEE ON POST OFFICE AND CIVIL SERVICE ON H.R.
 11280, H.R. REP. NO. 1403, 95TH CONG., 2D SESS. 39-40 (1978).
 
    /14/ BUT SEE CEDARS-SINAI MEDICAL CENTER, 223 NLRB 251(1976), AND ST.
 CLARE'S HOSPITAL AND HEALTH CENTER, 229 NLRB 1000(1977), WHEREIN THE
 NATIONAL LABOR RELATIONS BOARD HELD IN THE PRIVATE SECTOR THAT RESIDENTS
 AND INTERNS IN PRIVATE, NONPROFIT HOSPITALS ARE "PRIMARILY STUDENTS" NOT
 ENTITLED TO COVERAGE UNDER THE NATIONAL LABOR RELATIONS ACT (ACT).  SUCH
 RULINGS IN THE PRIVATE SECTOR UNDER THE ACT ARE NOT CONSIDERED
 DISPOSITIVE UNDER THE STATUTE.
 
    /15/ THE AUTHORITY NOTES THAT THE UNIT FOUND TO BE APPROPRIATE HEREIN
 IS COMPOSED OF HOUSE STAFF ASSIGNED TO THE ACTIVITY AND PAID BY THE
 AGENCY.  THUS, HOUSE STAFF WHO ARE ASSIGNED ON A ROTATIONAL BASIS TO
 OTHER, PRIVATE HOSPITALS ARE NOT WITHIN THE UNIT.  IN THIS REGARD, THE
 AUTHORITY HAS JURISDICTION ONLY OVER FEDERAL AGENCIES.  SEE SECTION
 7103(A)(3) OF THE STATUTE.
 
    /16/ INASMUCH AS THE UNIT FOUND APPROPRIATE HEREIN IS DIFFERENT FROM
 THAT SOUGHT BY THE PETITIONER IN THAT HOUSE STAFF PAID FROM NON-AGENCY
 SOURCES CANNOT BE INCLUDED, IF THE PETITIONER DOES NOT DESIRE TO PROCEED
 TO AN ELECTION IN THE UNIT FOUND APPROPRIATE, IT MAY WITHDRAW ITS
 PETITION.  THE WITHDRAWAL MUST BE IN WRITING AND MUST BE RECEIVED BY THE
 APPROPRIATE REGIONAL DIRECTOR NOT LATER THAN 10 DAYS AFTER THE ISSUANCE
 OF THIS DECISION.