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What is preventing physicians from unionizing?

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  • Avatar wcinewbie 
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    Status: Physician
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    Joined: 09/30/2017

    I’ve been thinking much about the progressive abuse of physicians with us being turned into cogs in the wheel of the medical industrial complex.  Many of us have even been sidelined into being permanent employees with no job securities and insane non-competes.  Whenever extra work needs to be done (non stop paperwork, insurance authorizations, medical records, urgent patient visits, colleagues call out sick), we’re expected to step up and do it with no extra compensation.  Meanwhile, all the business and finance people are sitting on the sidelines skimming off all the money.

    What is preventing us from unionizing?  Clearly the abuse is reaching a breaking point with half the people on this forum trying to figure out how to become financially independent.

    #226943 Reply
    Vagabond MD Vagabond MD 
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    Status: Physician
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    Joined: 01/21/2016

    Employed doctors can unionize and probably should.

    Here’s a pretty good discussion of the how’s and why’s:

    https://medicaljustice.com/can-doctors-form-a-union/

    Avatar G 
    Participant
    Status: Physician, Small Business Owner
    Posts: 1876
    Joined: 01/08/2016

    Apathy when it is time for brass tacks.
    Unwillingness to strike.

    #226946 Reply
    Lordosis Lordosis 
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    Status: Physician
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    Joined: 02/11/2019

    Unwillingness to strike.

    Click to expand…

    Here it is^^^

    “Never let your sense of morals prevent you from doing what is right.”

    #226949 Reply
    Liked by Zaphod, Craigy
    CordMcNally CordMcNally 
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    Status: Physician
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    Joined: 01/03/2017
    Unwillingness to strike.

    Click to expand…

    Unwillingness, not knowing how, and scared.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #226952 Reply
    Lithium Lithium 
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    Status: Physician
    Posts: 1225
    Joined: 02/15/2016

    Lack of time.

    Not being organized.

    Student loans/golden handcuffs.

    Reminds me of the MOC problem.  We have to get actual work done, while the enemy can organize, fight, and lobby for it behind the scenes all day long.

    I’ve worked with a group that’s managed to mount pretty strong collective resistance (mainly using apps to talk and organize) but it still feels like David vs. Goliath.  After several years I am exhausted and punching out.

    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1237
    Joined: 11/07/2017

    But couldn’t we strike on the nonessential things while still providing essential care?  E.g. We are not going to waste our time filling out prior authorizations or answering email portal messages about toenail fungus or checking more boxes than necessary to get the care done.  All for one and one for all.

    Part of it is the whole herding cats thing. Doctors tend to be strong willed individualists. Just read through some of the threads on here–we have a tendency to fight to the last word over minor variances in opinion. That makes unionization difficult. The younger generation seems to me to perhaps be more collaborative so maybe that will change?

    #226958 Reply
    CordMcNally CordMcNally 
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    Status: Physician
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    But couldn’t we strike on the nonessential things while still providing essential care?

    Click to expand…

    Striking on the nonessential things would be meaningless.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #226973 Reply
    Avatar Anne 
    Participant
    Status: Physician
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    Joined: 11/07/2017
    But couldn’t we strike on the nonessential things while still providing essential care? 

    Click to expand…

    Striking on the nonessential things would be meaningless.

    Click to expand…

    Would it?  I’m not sure how much these things affect you in ER medicine, but they are a total drain on the average doctor who provides chronic care.  It would not be meaningless to those doctors, but I see how it would be meaningless to those who don’t do those things much.  I respect your opinion, and I guess I’m making my own point about arguing about minutiae.  I do think that if we all refused to tolerate the parts of the system that frustrate us most that would lead to improvement.

    #226974 Reply
    q-school q-school 
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    Status: Physician
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    Joined: 05/07/2017

    time and energy.

    lack of a unifying issue to rally around.

    plus everyone thinks they are the smartest person in the room.

     

    #226975 Reply
    CordMcNally CordMcNally 
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    Status: Physician
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    Joined: 01/03/2017

    But couldn’t we strike on the nonessential things while still providing essential care?

    Click to expand…

    Striking on the nonessential things would be meaningless.

    Click to expand…

    Would it?  I’m not sure how much these things affect you in ER medicine, but they are a total drain on the average doctor who provides chronic care.  It would not be meaningless to those doctors, but I see how it would be meaningless to those who don’t do those things much.  I respect your opinion, and I guess I’m making my own point about arguing about minutiae.  I do think that if we all refused to tolerate the parts of the system that frustrate us most that would lead to improvement.

    Click to expand…

    Yes, I think it would. The point of any strike is to cause upheaval in the system. You would need to affect essential processes for that to happen. That’s why when unions strike they don’t just quit performing non-essential things. They just don’t show up for work. It’s why physicians have never been able to strike. We care too much.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #226979 Reply
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1237
    Joined: 11/07/2017

    But couldn’t we strike on the nonessential things while still providing essential care?

    Click to expand…

    Striking on the nonessential things would be meaningless.

    Click to expand…

    Would it?  I’m not sure how much these things affect you in ER medicine, but they are a total drain on the average doctor who provides chronic care.  It would not be meaningless to those doctors, but I see how it would be meaningless to those who don’t do those things much.  I respect your opinion, and I guess I’m making my own point about arguing about minutiae.  I do think that if we all refused to tolerate the parts of the system that frustrate us most that would lead to improvement.

    Click to expand…

    Yes, I think it would. The point of any strike is to cause upheaval in the system. You would need to affect essential processes for that to happen. That’s why when unions strike they don’t just quit performing non-essential things. They just don’t show up for work. It’s why physician’s have never been able to strike. We care too much.

    Click to expand…

    When I was in med school a group of surgeons at several hospitals in a neighboring state went on strike.  They all took simultaneous leave.  I think one guy stayed for true emergencies, all the elective cases got cancelled, some urgent cases got diverted to us.  It was something over malpractice premiums–they were pressuring the state legislature.  I don’t remember how long it lasted or if it worked.  But it was a relatively homogenous group over a very specific issue.  There are so many issues to tackle, and everyone has their own opinions about which are most important, even within one specialty, where would we start?

    I think from an administrator’s point of view, things like answering all portal questions regardless of medical utility, making sure patients feel satisfied, and making sure the insurance companies have all the info they need directly from us so nobody else needs to be paid to do the trivial data mining, are essential.  But they are not essential from our POV if we are thinking just about necessary medical care.  That’s why I’m saying we could refuse to do those things that waste our time while continuing to provide care.  Either they can pay someone else to do it or can agree with us that it doesn’t need to happen.  Right now when a doctor refuses to do those things they get labeled disruptive.  If we all did it what would happen?   Would the effect be meaningless?

    #226992 Reply
    CordMcNally CordMcNally 
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    Status: Physician
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    Joined: 01/03/2017
    When I was in med school a group of surgeons at several hospitals in a neighboring state went on strike. They all took simultaneous leave. I think one guy stayed for true emergencies, all the elective cases got cancelled, some urgent cases got diverted to us. It was something over malpractice premiums–they were pressuring the state legislature. I don’t remember how long it lasted or if it worked. But it was a relatively homogenous group over a very specific issue. There are so many issues to tackle, and everyone has their own opinions about which are most important, even within one specialty, where would we start? I think from an administrator’s point of view, things like answering all portal questions regardless of medical utility, making sure patients feel satisfied, and making sure the insurance companies have all the info they need directly from us so nobody else needs to be paid to do the trivial data mining, are essential. But they are not essential from our POV if we are thinking just about necessary medical care. That’s why I’m saying we could refuse to do those things that waste our time while continuing to provide care. Either they can pay someone else to do it or can agree with us that it doesn’t need to happen. Right now when a doctor refuses to do those things they get labeled disruptive. If we all did it what would happen? Would the effect be meaningless?

    Click to expand…

    I think doing those things you mentioned would end up being seen as more of an inconvenience that had the potential to drag on for a long time. Now, if you didn’t show up for work…that would get everybody’s attention (administration, your patients, the public, media, etc.). Again, these are just my opinions as I’m not an expert on strikes as I’ve never participated in one or organized one.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #226998 Reply
    Avatar hightower 
    Participant
    Status: Physician
    Posts: 1501
    Joined: 12/07/2016

    I think it’s probably a combination of fear, ignorance, complacency, and maybe even ethical concerns (for some, I personally don’t have any objections to striking).  But, really most docs wouldn’t be able to afford to go on strike.  If you’re living paycheck to paycheck, you wouldn’t be able to go a month or two without income.  Even a 2 week strike would result in 1 month of no pay.  Most docs wouldn’t be able to handle that. So, it’s out of the question for the masses.

    I definitely think physicians should be unionizing though.  And I would gladly sign on the dotted line if presented with an opportunity.  Especially in fields like hospital medicine and primary care where working conditions have become downright miserable,  arguably unsafe, and legally very risky.

    What’s preventing me from unionizing?  I have no idea how.  I’ve never done anything like that in my life.  I don’t know of any unions anywhere near where I practice.  I don’t know any lawyers.  I don’t know anyone personally that I could even ask about this.  I would have no idea where to begin.  I also don’t think I have the energy for it.  It would be way harder to form a union from scratch than to just show up to work and put my time in.

    #226999 Reply
    Avatar hightower 
    Participant
    Status: Physician
    Posts: 1501
    Joined: 12/07/2016

    But couldn’t we strike on the nonessential things while still providing essential care?  E.g. We are not going to waste our time filling out prior authorizations or answering email portal messages about toenail fungus or checking more boxes than necessary to get the care done.  All for one and one for all.

    Part of it is the whole herding cats thing. Doctors tend to be strong willed individualists. Just read through some of the threads on here–we have a tendency to fight to the last word over minor variances in opinion. That makes unionization difficult. The younger generation seems to me to perhaps be more collaborative so maybe that will change?

    Click to expand…

    Yeah, I don’t think that would do any good.  Our employers don’t really care about the non-essential things anyway.  They just care about money.  Money comes from us seeing patients.  Unless we cut off their flow of cash, they wouldn’t even notice.

    The only way I could see physicians in the hospitalist world strike without violating patient abandonment laws, would be to refuse to admit new patients to the hospital.  We’d still have to provide care to people currently admitted though.

    #227000 Reply
    Liked by Zaphod

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