STOCK MARKET WATCH -- Wednesday, 4 February 2015

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

http://www.nakedcapitalism.com/2015/02/time-to-look-for-the-union-label-first-us-doctors-strike-in-decades.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+NakedCapitalism+%28naked+capitalism%29

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...

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