Time to “Look for the Union Label?” First US Doctors’ Strike in Decades

Yves here. Take note of what drove the doctors to strike: not just cutting pension funding as the administration gets lavish increases, but also workplace conditions, specifically restrictions that get in the way of patient care.

By Roy Poses, MD, Clinical Associate Professor of Medicine at Brown University, and the President of FIRM – the Foundation for Integrity and Responsibility in Medicine. Cross posted from the Health Care Renewal website

A few news media outlets in California have reported on what has been up to now a very rare event – a strike by physicians. An initial summary was in an article in the San Diego Union – Tribune, whose title was

First U.S. Doctors’ Strike in Decades

A handful of doctors providing medical services to students at UC San Diego — and their colleagues at nine other University of California campuses — went on strike Tuesday.

It’s the first time in 25 years that fully licensed doctors are picketing a U.S. employer, according to the Union of American Physicians and Dentists, which represents the physicians at the UC schools.

The work stoppage began at 7:30 a.m. and is scheduled to last one day. It involves 150 health center doctors who manage the primary care and mental health needs of students.

A second article in the Union-Tribune suggested that the point of contention between the union and the University of California administration was not primarily wages,

Collective bargaining has not gone smoothly for UC student services doctors who voted to join the Union of American Physicians and Dentists in November 2013. The two sides have not been able to agree on a contract. Union members voted for the one-day strike after accusing the university system of refusing to provide key financial information that would aid their negotiations.

An article in the East Bay Express clarified that,

The central unfair labor practice complaint centers on the university’s refusal to disclose basic financial data to doctors as part of the negotiations, according to Dr. Jeff Nelson, a UC Berkeley physician and a member of the bargaining team.

‘We have asked UC for financial information as to where their funding sources are and what kind of finding they have, and they’re not giving that, even though as a public institution, they’re required to,’ Nelson told me this morning at a rally outside the Tang Center where UC Berkeley students receive health services. Citing the $3.1 billion fundraising campaign UC Berkeley completed last year, he added: ‘They have an awful lot of money.’

Without the financial statistics the union has requested, UAPD can’t fairly negotiate and settle a contract, said Sue Wilson, a UAPD spokesperson. ‘We have a right to certain information that we need in order to bargain a contract.’ For example, she said, the union has sought information about the recently approved 20 percent salary increases for chancellors, but hasn’t had any luck getting the details it requested. Wilson said the union has also filed an unfair labor practice charge regarding UC’s recent decision to require UAPD doctors to contribute more money to their pensions, despite the fact that university officials originally said they would make those changes through the contract negotiations. ‘It shows a lack of respect,’ she said.

Apparently, the striking doctors want more money not for salaries, but to improve services to patients, as discussed in the second Union-Tribune article,

Dr. Amol Doshi, one of the staff physicians who didn’t report to work Tuesday, said his decision to join the union and to strike came down to disagreements with management over how student health services is run.

He said only about 15 minutes is provided for each patient, regardless of whether that student has one or several medical issues that need to be addressed.

‘We feel like our professional autonomy is being compromised in how we can take care of our patients. We feel that the number of patients that we’re asked to see, many of whom have mental health concerns, require more time and more staffing,’ Doshi said.

The East Bay Express noted the UC administration’s response did not deal with the substance of these issues,

Reached for comment today, a UC Berkeley spokesperson referred me to the UC Office of the President. Shelly Meron, a spokesperson for that office, dismissed the union’s complaints in a phone interview this morning.'”They say this is about unfair labor practice charges. We believe this is simply a negotiation tool.’ Meron said the president’s office does not comment on the specifics of unfair labor practice charges and declined to answer questions about the union’s claims regarding financial disclosures and the pension policy.

Note that so far this story has been reported nationally only in one small item by Reuters.

Unions as One Method to Address the Plight of the Corporate Physician

So, to summarize, a small group of unionized physicians employed by the student health services of the University of California called a one day strike to protest infringements of their autonomy, particularly requirements that they see patients too quickly for what they believe to be the patients’ good, and failure to provide budgetary information relevant to the university’s financial capacity to provide better services. The physicians suspect the university has sufficient money to do so, especially given generous raises given to university managers.

The issues these physicians seem to be facing are familiar aspects of the plight of the American corporate physician. To recap the background, decades ago, most US physicians worked as solo entrepreneurs, or for small, physician owned groups. Those few who were employed worked for small non-profits, like the local teaching hospital, or local or US government. That has all changed.

Now increasing numbers of physicians are employed by increasingly large non-profits, such as hospital systems, or for-profit corporations. A 2013 Medscape article reported that the then current rate of employment was over 50%.

As such these physicians often report ultimately to managers, administrators, bureaucrats, and executives (MABEs). Many of the people they report do may not be physicians or health care professionals. Instead, they are likely to be generic managers, trained in business and management schools, with no direct experience in health care, and unclear commitment to its value. (The 2013 Medscape article cited above included results of survey suggesting the top complaint of employed physicians was being “bossed around by less-educated admins.”)

Worse, many generic managers have bought into the primacy of short-term revenue over all other considerations, including patients’ and the public’s health. Examples of mission hostile management in health care thus now abound.

In parallel, most top corporate leaders have received increasingly generous compensation, far more generous than non-management employees, including health care professionals get, and that compensation seems to rise regardless of the quality of health care their organizations provide, or even their organizations’ financial performance. (For example, see this post.)

In the media, and even the medical and health care literature, the rise of the employed, corporate physician has been celebrated, or at least accepted as inevitable. For example, see this post on a Forbes blog by a non-physician pundit with the title, “Physicians want employment, not Marcus Welby MD,” implying that choice was completely voluntary. This attitude may be a product of the long domination of market fundamentalism in the US, in which markets are seen as the solution to all social problems, so neither the outcomes of the “free market” or corporate management are to be questioned.

However, one would think that contemporary employed physicians are increasingly in a predicament, caught between their professional oaths to put individual patients first, and their generic manager bosses pushing to increase revenue no matter what. Yet for the corporate physician, protest might jeopardize their livelihood, or worse. Such physicians may feel captive of the restrictive clauses, such as confidentiality agreements and non-disparagement clauses, in the contracts they signed, possibly often under pressure and without adequate legal counsel. For example, a 2013 Medscape article was entitled, “Can you speak out without getting fired or being labeled a troublemaker?” The answer was at best, only sometimes.

Even in the limited coverage of the California student health doctors’ strike, there were references to some of these issues. These included what could be mission-hostile management (shrinking visit times regardless of patient needs), and excess compensation to top management (particularly, the Chancellors’ pay raises.) The anechoic nature of the strike, that is, the lack of media coverage so far, seems to reflect the now prevailing market fundamentalist dogma that is generally hostile to workers’ rights and organization.

Nonetheless, the doctors of the University of California student health services did organize, and now they have taken the unheard of step of calling a strike. That this did not happen sooner is a testament to the enormous power, enforced by billions in public relations and marketing, of the dogma of market fundamentalism. However, given that most physicians are now employees, and have not been having an easy time of it, this strike may be just the beginning.

In any case, organization of employed workers, collective bargaining, and even strikes, while being anathema to market fundamentalists, may be much better for society than even more radical responses to the ongoing plight of workers. Remember, it was robber baron capitalism not much different from today’s market fundamentalism, that inspired not only the rise of trade unions, but unfortunately, the rise of Marxism and ultimately Communism.

So maybe we should start looking for the “union label” more often in health care.

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  1. Bill J

    I agreed with everything in the essay except for the “unfortunately” at the end. How else were workers supposed to make heads or tails of their own relevance without aid of a scientific study of capitalism? Those workers, then and now, owe a huge debt of gratitude to good old Karl and his masterpiece. But for the example of 1917 and thunder from a viable Left in the US of the 1930’s there is no New Deal (as tepid as it was).

    1. Michael

      I like a lot of what Yves writes but I she has a class bias. We all do after all and I do not think that that matters much in what is said on this site. Communism in the USSR had nothing to do with the rise of Robber Barons in the United States unless you want to get into how the USSR viewed Western powers after they invaded the Soviets after the end of WWI.

      In the US you do not have a Civil Rights movement “led” by Martin Luther King Jr with out communist going down to the South to attempt to organize unions under the CIO’s Plan Dixie. Communists and trade unionist (mostly communists) put their lives on the line to push for racial and economic equality. The Black Church did not get involved until all other options were exhausted which is the case with most religious organizations. They are not active until the people have no where else to turn for change.

      Communism/Marxism is not Stalinism. I am not a communist but there is was no reason to throw that line into the story.

        1. Michael

          I’m not sure why you posted about his later activism. Plan Dixie takes place in the 50s. King inherited a movement he did not start the Civil Rights Movement. One of the biggest problems with the history of MLK is that many people think he started and carried the movement to victory. This leaves people vulnerable to waiting for someone to lead a social movement.

          King was killed because he advocated for economic equality. He was a threat to economic elites. Celebrating non-violence and ending legal segregation made the U.S. look good but making real economic changes was too much therefore he was assassinated by the U.S. government.

          The King family one a civil suit against the U.S. concerning this issue.

      1. Yves Smith Post author

        Did you miss that this is a cross post? Please direct your ire at the right party. I have never criticized Marxists OR Communists, and you are completely out of line in straw manning me in that manner.

        I don’t have the right to alter the words of an author. And although they were not called “Robber Barons,” Marx and Engels decried the appalling work conditions faced by factory workers in England. I can’t speak for Poses’ reasoning, but in calling it “Robber Baron capitalism” and not “Robber Barons,” he may have meant to include that.

        1. Michael

          I did think you wrote the end of the post. My apologies for that misunderstanding but I do not think you are an economic radical, maybe by today’s standards.

          We all have a bias. And I was really talking about discussions you have had concerning TARP.

          Baby is up.

    2. ambrit

      Agree with Bill J.
      Todays’ Socialisms can be seen as the Synthesis of the opposing creeds of Market Capitalism and Marxism. When you shift Communism off to the side as the “Ideal Version” of a sharing culture, the resulting versions of Capitalism/Socialism emerge as more pragmatic and viable systems. “Communism” can be viewed as the “Free Market” of the Left. Both look good on paper, etc. etc.
      What you may be lamenting is the rise of State Socialism, both the Left and Right versions. Each had a run of Terror that scared the H— out of just about everybody who survived the experience. This history goes to show the essential dysfunction of extremism of any stripe. View the contending social systems as competing religions and the analogy becomes clear and understandable.
      As a side note, since this strike concerns the California University System, could the recent CalPERS dust up have some relevance? Are the pensions of these medical professionals tied up in that boondoggle? Before this plays out, I fear many of us will need to avail ourselves of their Mental Health services.

    3. tongorad

      Agreed. But does anyone need a scientific study of capitalism to realize how much we are getting screwed nowadays? The proponents of neoliberalism are organized against workers (the understatement of the century). How can there be any doubt about that?
      Until we organize and confront, how can anything change? Bravo for those docs. We need more of that – on a massive and relentless scale. The problem is that so many see the current political cultural arrangement as the natural order of things.

  2. timbers

    “cutting pension funding as the administration gets lavish increases, but also workplace conditions, specifically restrictions that get in the way of patient care.”

    CorporateCare is working.

    With data rolling in with eye grabbing headlines like “income inequality rises to records in ever state”, with 43 million (or is it 33 million) without access to healthcare – Obama’s signature issue – even with the very expensive ACA in place, the term Obamanomics is set to down the annals of modern discourse as did Reaganonomics. Team Dem cheerleading is going to get a bit more difficult obfuscating the facts on the Obama record.

  3. ella

    Please someone tell Speaker Boehner that it is the administration of health care by managers and insurance companies that are interfering with the doctor patient relationship. An interference that has been ongoing and tightening for years. He believes that it is the fault of the ACA.

  4. Brooklin Bridge

    There is a great deal of residual anger on reduction in quality in care and autonomy of doctors in how they treat their patients and this has been going on for years. I know at least two doctors that retired early because of it. Unfortunately, I have met other doctors in the same age bracket who are the opposite, who parrot the medical equivalent of hard core market worshipers. These doctors don’t argue that traditional care and doctor autonomy is better for the patient, they know it is, but rather that only the wealthy patients deserve it.

    I would be curious to know if the following is true:

    1) Younger doctors have an easier time fitting into the for profit mold.

    and on a more detailed level (but much the same question),
    2) Younger doctors are more easily convinced that shorter patient examination, conveyer belt treatment, and patient care policy and techniques increasingly dictated by administrators rather than doctors is actually good for patients in the long run (like the notion that legal trials have “just” outcomes, no matter how egregious or tilted the behavior of the lawyers in individual cases, if you take the averages).

    I also find alarming the interest my health insurance company is taking in the minutest details of every doctor or hospital visit. And they sent me reminders to take my pills if I didn’t renew the prescription right on time (so I gave up taking the pills – for cholesterol – also my cholesterol is not all that high and the medication is controversial).

    1. bmeisen

      woah! the insurer doing follow-up? the next generation of cherry-picking? are they qualified health professionals? those who write the reminder to complete the medication round?

      this post is especially valuable for the insight it provides on labor relations at the top of the hierarchy in the us health system. i guess the ama remains the professional group with the broadest support among mds and that it remains as approving of the “market” deceit behind the current system as it was under nixon. a universal public health system would probably make big payoffs on that trying and expensive qualification harder to reel in. how much does an md cost thesedays?

      the transformation in the economics of the practioner model is notable, as is the emergence of groups successfully competing with the ama. surely the ama is brainstorming ways of appealing to 50% of the profession that is dependant on corporate employers who in the us tend to be overseen exclusively by representatives of capital/management and who can as such be expected to extract and hunt, maximizing their own personal compensation at the expense first of the poorly informed customer, who is also suffering and thereby even less willing to shop around, as well as the employee who is not represented on the oversight board.

  5. susan the other

    This is an example of obstruction of justice. It might not be being done at the courthouse, but it is being done in corporate secrecy. When good will fails, when trust is rotted out, everybody heads for the court of public opinion. i’ve never even heard of a doctor’s strike before, no doubt because during my lifetime most doctors were independent. If the administrators at UC will not provide the necessary documents, the doctors can argue that they have been defrauded. This is going to turn into a civil lawsuit.

  6. Carole

    I wish to thank Bill J, Michael and Ambrit for drawing attention to the bias demonstrated by the use of the word “unfortunately”.

  7. casino implosion

    As a union tradesman I view these latest developments in the long predicted “proletarianization of the professionals” with a mixture of solidarity, vindication and suppressed Schadenfreude.

    1. ambrit

      Being a construction trades worker who has the bad fortune to have lived most of my life in the “Right to Work (For Less)” South, I can sympathize up to a point. That point being that the formerly “High Skill” Tradespeople have been mainly relegated to the Lumpenproletariat now. This demonstrates a narrowing of the active tradesworker class. The doctors might be higher status individuals and so receive more interest from society, but when was the last time we saw twenty thousand doctors marching? Now, if everyone working at these clinics were to go out for a day, then heads would turn.
      Yes solidarity. Yes vindication. No Schadenfreud. The stakes are too high.

      1. Left in Wisconsin

        Organized labor has no future in the U.S. unless we can convince more high skill working people that unions are a viable vehicle for them. You can’t have a labor movement that is all public sector and home health care workers.

        1. ambrit

          Seeing as much of our manufacturing capacity has been moved to the former Third World, I’m thinking that the factory workers there are our best hope.

  8. P Fitzsimon

    Is it really market fundamentalism that drives physicians to become wage workers or is it the rise of the oligopolists, both for profit and non-profit?

  9. MyLessThanPrimeBeef

    (The 2013 Medscape article cited above included results of survey suggesting the top complaint of employed physicians was being “bossed around by less-educated admins.”)

    My guess is it was unfortunately the survey didn’t include a choice of ‘being bossed by uncaring (or money obsessed) admins.”

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