Should Doctors Unionize?

Some time ago, I penned a post advocating union membership for nurses.  Increasingly, I expect physicians to seek professional relief by joining unions in the years to come. This is not about the money.

There have been pockets of unionized physicians in the United States but efforts to organize physicians writ large have not yet gained widespread traction.  One group of doctors who are overripe to unionize is medical interns and residents.  These professionals work endless hours with sleep deprivation and have insufficient days off to recuperate or recreate.  Of course, they are underpaid for the hours they work but this ranks low on their list of grievances.  Yes, there are reforms put in place, but I have it on good authority that existing loopholes and training program policies have rendered today’s residencies very similar to mine over 3 decades ago.  

If you track the evolution of the medical profession over the past 20 years or so, unionization is understandable.  I do not think, however, that physicians unionizing is inevitable.  Other pathways are possible.

Time for doctors to wear the union label?

A generation ago, most physicians were small business owners who successfully ran their own practices.  They were in charge.  As owners and medical professionals, they were invested in the operation and success of their establishments.  Patients, their customers, could expect personalized attention.  Private businesses, in my experience, provide higher levels of customer service. As an analogy, contrast the experience of entering a privately owned hardware store (good luck finding one!) with entering a big box behemoth and hoping that you can corner a salesperson for assistance.

Over time, economic forces have largely eradicated private practices pushing physicians either into retirement or an employed model.  Physicians now work for hospitals, large medical institutions and even private equity companies.  Obviously, the mission of corporate owners might differ from that of practicing medical professionals.  This major conflict must be carefully and fairly addressed if all parties involved - including the patients - are to be satisfied.  Often this is not the case.  Economic success must not be pursued at the expense of medical quality, patient satisfaction and physician morale.  But it often is.

Trust me, years ago no physician would have even contemplated joining a union.  But physicians becoming employees has altered this calculus.  Consider the following realities of hired physicians.

• See more patients.
• Double book patients routinely.
• Respond to dozens of daily electronic inquiries from patients.
• Fight with insurance companies for medication approval.
• Comply enthusiastically with corporate productivity standards which tend to creep up.
• Adjust happily to frequent upgrades to the electronic medical record system.
• Shake off worsening symptoms of burnout.
• Accept that your schedule and professional activities are managed by administrators.
• Comply with endless meeting and compliance requirements which are checking someone else’s boxes.

Heard enough?

Like nurses, physicians are not primarily seeking greater compensation.  Unionizing is an effort to push back against professional encroachment, micromanagement and an unsatisfying working environment.

Of course, all employers are not equal and some have created a culture of appreciation and collaboration.  But many of my employed colleagues have not enjoyed this experience.

If you strip a doctor of his or her professionalism and autonomy, what do you expect?  If corporate medicine wants to avoid a unionized medical staff, then it will need to rebalance its priorities and return some measure of professional autonomy to the grunts in the trenches – physicians, nurses, pharmacists and other caregivers.  Wouldn’t this strategy serve the greater good?