15 Minutes Into Our Future?

San Francisco continues to originate things I had never bothered to imagine:  Medical residents, interns walk off the job at UCSF Medical Center over failed contract talks.”

“Resident physicians, interns and clinical fellows walked off their shifts for 15 minutes Tuesday at noon to draw attention to failed contract negotiations between their union and the University of California San Francisco Medical Center.  Union organizers called the protest a ‘Unity Break.'”  The residents say they are underpaid, and underrepresented.  The residents are demanding to have union representation at any grievance proceeding (commonplace at neighboring hospitals, apparently).  ” While the hospital did offer more money with the overall package, union representatives say it was not enough to provide their members a living wage in San Francisco’s rental market.”  One of the fellows mentioned is hilariously concerned that the low wages harms the “diversity” of programs:  “My co-residents were pretty diverse people, like me they didn’t come from money and they were here on their own. Now almost everybody coming here is only here because they are married to somebody in tech….it changes who comes here.”  (Listening to a young doctor in San Francisco bleat about “diversity” is likely the very definition of irony, given what I suspect is the utter lack of diversity in thought out there.  But hey, I like to stereotype).

In fact, with an instinctive antipathy toward Information Age collective bargaining in general, it is tempting for me to make fun of these kids as a bunch of whiners and slackers too wimpy to have gutted it out before resident weeks were capped at 80 hours.  The union sponsoring this protest is the Service Employees International Union, a well-moneyed, nasty group of knee cappers that made headlines thugging political opponents in the 2012 general election.  The SEIU must look at a bunch of left wing, crybaby residents as a gift from the Goddess, tailor made to suit their ongoing push for social justice, including single-payer health care.  And yet…

What if the residents have a point here or there?  There is a long-established tradition of hospitals improving their bottom lines via cheap resident labor, reasonable in exchange for imparting a difficult and lucrative education.  But we have all known individuals who ran afoul of their residency program, sometimes unfairly, and had their entire future threatened.  Should they have an outside force speak up for them, given that the parent hospital’s interests are more aligned with their residency program?  What if a program determines that a resident needs evaluation and rehab for substance abuse, or for being disruptive by punching an EHR?  Might the hospital and residency program be suspected of having a, shall-we-say, not entirely unbiased viewpoint while evaluating the alleged miscreant?  It’s a question.

And what of finances?  Residents have the obligation of due diligence, and should evaluate their prospective living circumstances before sending in the Match wish list.  But economies fluctuate, and prices change.  A resident might very well want to live near an expensive inner city like Brooklyn or San Francisco to be near the action, and presumably, training excellence.  In the larger public discourse, I reject stupid, arbitrary phrases like “a living wage.”  But in a semi-indentured servitude e.g. residency, it is not practical, and often physically impossible, to either move or moonlight.  What then?  Do residency programs have a duty to see that their students can afford decent housing? 

And does this speak to the large body of physicians beyond residency?  I don’t think all collective bargaining is bad, and it arose from a time in this nation when it was sorely needed.  But wouldn’t self-serving union muscle intruding into patient care be ultimately bad for everyone except the union?  As crony-corporatism and growing numbers demanding health care as a “right” drive us into single-payer, what avenue will be left to physicians but to unionize?  Thoughts?

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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  11 comments for “15 Minutes Into Our Future?

  1. Wandal
    March 27, 2019 at 2:51 pm

    Hi, Doug. Love the NLetter . . . please keep up the great work! One thing: This segment (SF Medical Staff unhappy), and your take on it, makes me think of the public’s opinion of physicians complaining of unhappiness and stress. Not my take but only being the messenger: When ‘everyman’ sees docs making the big bucks then crying about stress, they about puke .

    • Doug Farrago
      March 27, 2019 at 6:38 pm

      This one is by Pat Conrad MD

  2. Brian
    March 27, 2019 at 2:39 pm

    I find it the criticism of unions comical when there is no ability to rule on whether the Match is a trust designed to artificially control wages and which has complete control over the physician training market. It is obviously a monopoly trust, it obviously artificially controls wages as NPs and PAs freshly minted from less than half the grad school receive twice the salary. The reason wages are not appropriate is because of the LACK of CAPITALISM here. From that point of a trust we enter a market where major health systems and health insurers have formed oligopolies who attempt to kneecap physicians during negotiations leaving only the two options, #1. Get into a huge corporation, or #2. Get devastated during negotiations (of course you can always become the “out-of-network” provider your patients can get to hate and despise.”) We are not in a capitalist market, we are in an oligopoly controlled market that controls most of the government through lobbying which then sets rules that protects the healthcare oligopoly. Now we have the delightful choice of choosing between the current oligopoly system or “medicare for all” which most certainly will increase useless paperwork and lower wages across the board. We are not in a system that allows the individual any freedoms of a capitalist market Pat Conrad attempts to envision. Recently the big boys of Envision Physician Services and United Healthcare had a negotiation and the first thing poor, destitute United Healthcare did was smear Envision to all the hospitals and major news media nationwide. Is this the future of capitalist market healthcare? Is this the best we as a nation can do?? Whatever side of the political aisle you are on you should cheer on your physician colleagues as they attempt to regain a shred of dignity. Call it a union, call it an attempt to form a business entity capable of principled capitalist negotiations, the two things aren’t that far apart and both are just trying to re-establish the very very very lop-sided balance of power that currently exists. Shame on you Pat Conrad for trying to shame your physician colleagues.

    • Pat
      March 27, 2019 at 8:04 pm

      You may want to re-read the piece. The fact that doctors are getting crushed (we agree) does not immunize unions from criticism. And far too much of our left-leaning industry may -MAY! – empower the worst sort of union excesses.

      That said unions may well be the only remaining path for docs, which is what I said.

      Sincere thanks for reading.

      • Sir Lance-a-lot
        March 27, 2019 at 9:43 pm

        “And far too much of our left-leaning industry may -MAY! – empower the worst sort of union excesses.”


        The thing about union excesses is that they only occur in other people’s unions.
        If a union is representing me and wins some obscene concession, that’s not an excess, it’s a victory. 😉

  3. Kurt
    March 27, 2019 at 2:09 pm

    San Fran is a very pricey place to live. Wonder what the residents and interns are paid? When I started in the Midwest in 1982 it was about $15,000/yr. I was single, no girlfriend or dependents and I and my folks made sure I was debt free when I got out of med school. My apartment was
    $160.00 a month (with a garage for my car! That was $15.00 extra) I did ok but again the cost of living was decent where I was at.

  4. Aaron M Levine
    March 27, 2019 at 9:16 am

    The Committee of Interns and Residents went on strike in New York in 1976 and 1979 if I recall. This was for call and income. The Orthopedic surgeons went on strike (or better term boycott as they were not a union) in 1976 to lower malpractice premiums.
    Just for an historical perspective

  5. Sir Lance-a-lot
    March 23, 2019 at 1:00 pm

    Unions are pretty much the only option for self-protection when a lot of employees work for a large organization, such that any one (or several) employee is completely expendable from the viewpoint of management. I work for a company that employs hundreds of doctors – if I shoot my mouth off, they can have me gone and another ass planted in my chair before it even reaches room temperature. The only way to have any impact at all is to wield the threat to their pocketbook inherent in a job action (strike, slowdown, whatever).

    As for motivations to unionize, I’m not only talking about making sure that we receive the wages and benefits we deserve, and receive fair treatment when accused of misbehavior, but also that threats to patient safety are addressed (faulty equipment that never gets replaced, such as the EKG machine with the 60hz hum that the tech boys say is perfectly fine; hazards, such as the way someone slips and falls in the lobby every time it rains; shortages of meds and supplies; procedural issues that allow sick patients to sit and wait without being evaluated, etc.), and other staff are treated fairly.

    Things were different back when it was possible for one or two doctors to own a small practice and use their judgement to run it to the best of their abilities. Those times are long gone, and with doctors now treated like any other employee (“You’re late!” “You’re talking too much during work hours!” “You use the phone too much!” “Get off your cell phone!” “Don’t wear that to work again!”), it’s only a matter of time before they act like other employees and join a union to protect their own rights and their patients’ safety.

  6. Mario
    March 23, 2019 at 9:57 am

    The question as I see it is, what makes the “residency”? The hospital administration, the allied healthcare personnel, the neighborhood, the brick and mortar facility? In my opinion, no. Not even the patients. The teaching attending? Yes. Without them there would be no “residency”. So where are they? As teachers shouldn’t they be concerned about every aspect of the novice physician coming to them for education? Isn’t their role as mentors, teachers, and sensai come with that responsibility? We don’t need a union. We need honor, tradition, respect. The teaching attendings should be the ones walking out. Not in the name of a union but a profession. Cowards

    • Pat
      March 23, 2019 at 10:27 am

      That’s a great point.

  7. Thomas David Guastavino
    March 23, 2019 at 7:07 am

    It is inevitable that once we have single payor the government will become abusive toward providers. Heck, the government is abusive toward providers now. A physicians union is the very definition of a necessary evil.

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