Doctors Unionizing
The NY Times (their pic above) put out a piece called “Doctors Unionize to Resist the Medical Machine” and it talks about a case where a particular group of hospitalists unionized against a hospital who was trying to outsource them. I hope you get to read it but it really is nothing new. It is about administrators controlling the game and playing with the minds of employed physicians. The doctors are just sick of it and are fighting back. Do I think we all should unionize? No. I don’t even think doctors should be employed by hospitals. It is an unholy matrimony where docs are seduced by cash and the hospital is seduced by the thought of getting our patients. After they get the patients they just need bodies to see them. Doctors are nothing more to them than bodies. Having a union just creates new problems. Being free from the shackles of the hospital allows doctors to do what’s right for the patient, to be paid by the patient and to be able to push back against the medical machine. That is the ultimate fix, in my humble opinion. Actually, I am not that humble.
When I worked at the AMA in ancient times, infamous EVP James H, Sammons, MD was fond of saying: “The AMA is not, and never will be, a union.
That was then. A majority of physicians were solo practitioners or in small groups.
Now, a majority of physicians are employed or quasi-employed. Most young physicians are job seekers, not entrepeneurs. The market dynamics and technobureaucratic environment virtually obviate rugged individualism (with the notable exception of conciergists).
Unionization certainly seems to make more sense at the nadir of physician autonomy than it did in the Sammons epoch.
Today’s WSJ included a story about university professors unionizing, following suit with their primary and secondary educational cousins. Could physicians join their nursing teammates in unionization? We shall see in these interesting times. But the ground is ripe for an SEIU type organizing push at the big health systems.
I am generally not in favor of unions. However, there is strength in numbers and if it takes a union to get people to hang together so be it. Physicians shut down hospitals in West Virginia except for emergencies to get malpractice reform. This was agreed to even though the states corrupt “not so supreme ” court said they would nullify this. There is power in numbers which is why administrators and insurance companies seek to divide and conquer. Hang together or hang separately.
As I get older, I separate the concepts of generally disagreeing with a writer, disliking the writer, but finding the individual good points they make.
Marx made a big fuss over the “commoditization of labor,” i.e. its conversion into an interchangeable widget. McMedicine depends on making hospitalist-widgets that plug into 12-hour shifts and then go off to recharge. (see, e.g. http://www.commoditized.net/ and http://barefootbum.blogspot.com/2008/12/commoditization-of-labor.html which appear to develop the concept.)
“Real life is all about the narrative,” he said. “It’s sitting down and talking about bowel movements with a 79-year-old woman for 45 minutes. It’s not that interesting, but that’s where it happens.” That’s what Dr. Alexander wrote in the article.
We are limited on our time spent, and they sprinkle all sorts of confetti, jerk-work, checkboxing and such on our demands to make us “stay busy.” Often, “busy” means asking “why does this patient have Proteus, specifically, in his urine?”Some mental chimp somewhere is itching to turn that into a checkbox, but medicine cannot be made a checkbox game.