Since the birth of our nation, labor unions have existed in one form or another in the United States. Unions are a force to protect the ‘working population’ from inequality, gaps in wages, and a political system failing to represent specific industry groups. Historically, unions organize skilled workers in a specific corporation, such as a railroad or production plant, however unions can organize numerous workers within a particular industry. Known as “industrial unionism”, the union gives a profession or trade a collective and representative voice. The existence of unions has already been woven into the political, economic, and cultural fabric of America; recent events suggest that it may be time for physicians and surgeons to unionize.
A labor union, is a body of workers who come together to achieve common objectives, such as improved safety, higher pay and benefits, and better working conditions. Union leadership bargains with employers on behalf of union members to negotiate labor contracts (collective bargaining.) This may include the negotiation of wages, work rules, complaint procedures, and regulations governing hiring, firing and promotion, or workplace policies.
In 2010, the percentage of workers belonging to a union in the U.S. was 11.4%, compared to 27.5% in Canada. There are strong, causal linkages between a diminished proportion of the workforce unionizing and loss of worker bargaining power. Obviously, the leadership of corporations prefers workers having less leverage while negotiating; unions allege this employer-incited opposition has contributed to the decline in membership over time.
However, the popularity of unions is growing, according to a January 2017 survey conducted by Pew which found 60% view unionization favorably. More than half of young, millennial Republicans are in favor of unions as well, something that would have been shocking a decade ago. Maybe the time is right for physicians to unionize?
In 1972, Dr. Sanford A. Marcus, a surgeon in private practice formed the Union of American Physicians and Dentists (UAPD). It has been the most successful physician union and is affiliated with the AFL-CIO. A quote from their website is apropos, “Hospital administrators easily manipulated physicians, treating them as if they were hired hands. Insurance companies were dealing with them as if they were employees. Government programs… controlled key aspects of doctors’ work, told them how much they would be paid, and what procedures they would be paid for.” This sentiment sounds familiar.
Dr. Marcus saw medicine being ripe for takeover by corporations who were more concerned with profit than ensuring high quality care was provided to patients. Medical associations were and still are overlooking the needs of front line practicing physicians; Dr. Marcus believed a union was the only organizational structure which could level the playing field. He met with the AMA and they were ardently against unionizing. The AFL-CIO initially balked at his suggestion, saying “Come back in ten years”, assuming most physicians would be employees at that point in time. It has taken more than a decade, but our profession has arrived at the point where the majority of physicians are employed. Large corporations are stripping physicians of professionalism and belittling our management role.
The Economic Policy Institute recently released a report with objective data supporting the assertion that unionization benefits workers in the long-term. The EPI report found unions definitively raise wages for both union and nonunion workers. A worker with a union contract earns 13.2 percent more in wages than a peer with similar education and background experience. Through establishing wage “transparency”, unions raise earnings of women, black, and Hispanic workers, groups whose pay tends to lag behind that of their white, male counterparts. Hourly wages for women are 9.2 percent higher than nonunionized women across similar occupations. Black unionized workers in New York City earn 36.1 percent more than nonunion laborers in the same demographic.
In addition, unionized workers have better health and wellness because unions ensure employers are held accountable for safe, non-abusive working conditions. Unions can strengthen families by obtaining better leave policies, retirement benefits, and health insurance, while at the same time, safeguarding that employees have due process in promotions, dismissals, or terminations. Front line workers often face tangible challenges often overlooked by management; as a result, they have a tremendous knowledge to suggest improvements to the workplace, make it safer, and increase productivity.
Physicians certainly qualify as an industry sector whose bargaining power has fallen far below the value of their effort. Labor unions exist to protect workers against imbalance in negotiations. In a recent Washington Post article, Jared Bernstein posed that collective bargaining should be structured by industry sector instead of by individual corporations. Interestingly enough, Larry Mishel, President of EPI and the report author, told Bernstein, “We need a design where people have collective bargaining rights as restaurant workers, as opposed to one where they gain those rights one restaurant at a time.” Physicians may need collective bargaining rights as an industry, not as employees of Everyday Hospital, USA.
UAPD has survived over four decades because they have offered traditional and innovative approaches to assist physicians with boots on the ground. While officially opposing unionization, the AMA did try their hand at it during the mid-1990s, when President Clinton was working on universal health care. After spending $3 million, they brought in 38 physicians, but the effort ended in colossal failure.
For physicians in private practice, UAPD developed a grievance process when insurance companies unfairly deny reimbursement. Their organization is run by physicians and for physicians. They have won battles against large hospital corporations, advanced pro-physician legislation, organized a compassionate strike of physicians, and countered doctor-bashing in the media.
Dr. Marcus once said, “There are no dinosaurs left…, they were unable to adapt to changing environmental conditions. We stand a much better chance of preserving our professionalism through the process of becoming unionized workers – admittedly a terribly unprofessional thing to do… But then, that’s just the sort of adaption those dinosaurs were incapable of making, isn’t it?” As the world becomes more divided, politically, economically, and medically, physicians stand to lose the profession we love dearly. The moment has arrived for physicians to put aside our differences, of gender, specialty, or political ideology, and support an organized body standing up for the collective voice of physicians.
Niran al-Agba is a pediatrician in Washington state.
Nice article Niran. This discussion has been brought up via similar articles before it and honestly carries the same rhetoric as those before it and provides awareness to clinicians but yet you don’t see many physicians moving towards unionizing despite such articles. I wonder why that is? I agree with Steve, physicians/providers are like herding cats particularly those that are twilighting in their careers (who are looking to get out/retire and not upset the apple cart) or the new physicians that have no reference point of what satisfying employment should be (their reference is often the residency program) and just wanted to be employed/accepted. I suggest those truly concerned of unionizing reach out to unions such as UAPD and there colleagues currently organized by UAPD or equivalent union to get a feel of how good such a union is in organizing/representing them. Some in Washington are doing this now Niran, I would encourage you to reach out to them to get a feel on how, for example, UAPD is doing for them. When you join a union it is in itself a big business/service you are signing up for and we as physicians should make sure that such candidate unions are going to take an active stance in representing physicians.
Herding cats. So true of trying to get doctors to work together, especially on non-clinical stuff. Have a hard time seeing this happen. I have often thought we should just go back to guilds. As of late, JCAHO and all of the other inspection agencies have jumped the shark. Little of what they demand anymore has basis in any literature, but we have to do it because they say so and we get shut down if we don’t submit. (I really hate these bastards now. After a lot of time in the military and running a group, I understand the need for some rules and regulations, but it is out of control.) If we had a guild, we could just declare guild war and say that we will triple the fees of employees of the inspection agencies until they relent and require that they show evidence that their requirements work before we need to comply.
In 1958, the Committee of Interns and Residents became the first Union for physicians, the House Staff of the New York City Hospitals. About 10 years later, they expanded to other hospital house-staff groups outside of NYC and now apparently bargain for nearly 14,000 physicians in post-graduate medical education. To begin my residency years, I began as a first year Internal Medicine Resident at Harlem Hospital in upper Manhattan NYC from 1969-70. Among many memorable events that year, I attended two meetings of the CIR Union leaders to discuss their bargaining strategy for 1970-71. The bargaining process was substantially regulated by Federal rules. Basically, it was restricted to working schedule, salary, benefits and certain highly restricted attributes of the working environment. The working environment did NOT include nursing staffing or training level, institutional leadership, hospital financial processes, or community involvement. It seemed that the only benefactors were the non-physicians who ran the Union. As far as I know, the bargaining issues have not substantially changed since 1970.
As a strategy to improve the professional focus of a Hospital’s leadership, a threat to request a vote (supervised by the Feds) for a union would generate all sorts of angst and eventual negative payback. Given our times, such a tactic may be helpful to improve professional survival but only as a last resort.
Angst sounds good to me right about now. Agree that we may be at a time for last resorts. Thanks for reading Dr. Nelson.