Friday, January 30, 2015

Time to "Look for the Union Label?" - "First US Doctors' Strike in Decades," at University of California Student Health

The First US Doctors' Strike in Decades

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.

ADDENDUM (2 February, 2015) - See also post entitled, "Why Physicians Must Unionize" on the On Health Care Technology blog.


Judy B said...

I find myself wondering why any part of the University of California has to turn a profit? Just to increase the managers compensation?
Of course, I think that "profit" should not be a part of our medical system, either....

Anonymous said...

Students beware. Betcha parents do not look into the quality of the health services before signing.

Gene Uzawa Dorio, M.D. said...

Margalit Gur-Arie MD on her blog "On Health Care Technology" has a well-written posting entitled "Why Physicians Must Unionize."

It can also be found on with over 100 comments.

Time to organize!

Gene Uzawa Dorio, MD
Santa Clarita, CA