## Facts

- Boston Medical Center Corporation operated a nonprofit acute-care teaching hospital affiliated with a medical school.
- Approximately 430 interns, residents, and fellows (“house officers”) worked at the hospital to complete postgraduate training required for specialty certification.
- House officers provided substantial direct patient care under hospital supervision, commonly comprising most of their work time.
- House officers received stipends and employment-type benefits, including various forms of paid leave and insurance coverage.
- House officers also received on-the-job instruction and attended educational programs, but did not pay tuition or receive traditional academic grades.
- A labor organization petitioned for a representation election to bargain on behalf of the house officers.
- The central dispute was whether house officers were “employees” under NLRA § 2(3), in light of prior Board precedent treating them as primarily students and outside the Act.

## Issues

1. Whether medical interns, residents, and fellows at a private nonprofit teaching hospital are “employees” within the meaning of NLRA § 2(3) despite the educational and training components of their programs.
2. Whether the dual educational and service relationship bars collective bargaining rights under the NLRA in a representation proceeding.

## Decision

- The Board held that interns, residents, and fellows in private nonprofit teaching hospitals are statutory “employees” under NLRA § 2(3).
- The Board overruled prior precedent that had excluded house officers from employee status on the ground that they were primarily students receiving a living allowance.
- The Board allowed the representation case to proceed under ordinary procedures (including unit and election determinations), recognizing the Board’s jurisdiction over the petitioned-for employees.

## Legal Principles

- NLRA § 2(3) defines “employee” broadly and does not exclude individuals who receive training or education while performing compensated work.
- Individuals may have dual status as both students/trainees and employees; an educational component does not negate employee status where the relationship is remunerative and service-based.
- The economic realities of the relationship—compensation, benefits, the employer’s control and supervision, and substantial productive work (including direct patient care)—support employee status under the Act.
- Prior Board exclusions premised on characterizing stipends as mere living allowances are rejected where compensation and benefits function as remuneration for work performed.

## Conclusion

The Board determined that house officers at a nonprofit teaching hospital are NLRA employees entitled to organize and seek collective bargaining representation, and it reversed earlier Board doctrine that treated such physicians-in-training as outside the Act based on their educational role.


Boston Med. Ctr. Corp., 330 N.L.R.B. 152 (1999)