Make My Day
As we bid adieu to summer with the passing of Labor Day, may we ask, does working as a physician count as, well, labor? We use the same sort of terminology, as in “I’m going to work,” and we get paychecks, file W2s, and the vast majority have to put up with the latest faddish nonsense from our employers, from symbolic masks to pronoun absurdities. We have client bases that are angrier, and often less respectful than others (I’m guessing the customer gets a different reaction if they yell profanities at a hardware store manager, as opposed to an ER doc). Yet when our elected betters, lords, and masters in both parties talk about the sainted “working families,” it never really sounds like they include physicians. I have heard ridiculously wealthy cable commentators and persons in the clinic rail equally against doctors who “make too much,” yet I have never heard any objective standard by which they arrive at that determination. In fact, so much of anything to do with medicine seems to be increasingly feelings-driven, and the reason should be obvious.
Last month in not-so-Great Britain, so called “junior doctors, who do much of the routine work in hospitals and who work very long hours” went on strike for four days in protest against unacceptable pay. The National Health Service says this had caused a case backlog that will cost an additional 1 billion pounds. The juniors want their pay to increase 35% to get them back to 2008 levels (I haven’t looked up what they were paid then or now, so I’m taking this at face value). The government is offering them a 6% bump. Nyuk nyuk nyuk. “We as a government have to be responsible in the pay settlements that we give, and we listened to the Independent Pay Review body,” Treasury minister John Glen told Sky News.” So-called “senior doctors” i.e. consultants/specialists are set to strike for three days in early October. “Dr Vishal Sharma, the BMA consultants committee chair, said consultants would be taking to picket lines with ‘heavy hearts. We would much rather be inside the hospital seeing our patients. But we cannot sit by and watch passively as we are persistently devalued, undermined and forced to watch colleagues leave – much to the detriment of the NHS and patients,’ he said.” Of course, the very purpose, if never stated, of the NHS is to devalue physicians. That’s why the care is “free.” The Prime Minister thus far has refused to meet with the British Medical Association, and his health secretary “reiterated that no improved offer would be forthcoming and said he was concerned and disappointed by the ongoing strikes. Industrial action in August and autumn would ‘continue to affect patients and hamper efforts to cut NHS waiting lists.’”
Both sides are doing the usual game-of-chicken, each side trying to use poor suffering patients as their human shield while trying to justify their position. Which is a nice sort of symmetry, when you consider that it was British voters that gave both the politicians and the medical community so much power over their lives so long ago. Why shouldn’t patients/voters have to enjoy the consequences of their choices?
The lack of an objective value determination in the U.K. makes sense where health care is a right, and therefore any value is tied to perceived need. Over here we take the perception of a “right”, codified for the poor and the retirees, mix in the corrupt crony capitalism of Big Insurance, and then layer it with the customary class envy. All of that makes for a floating standard that can forever hold the target guilty, therefore easier to control, and force it to take what is offered.
Will we ever get to the point where U.S. doctors are going on strike? I hope so. Over the past six-plus decades of my life, unions have been largely identified with unfair demands too often backed with political pressure/government force, and that goes double for public sector unions. Over that period of time, doctors have inexorably become government agents more so with every passing day. The way physicians practice, what they prescribe, who they have to see, and how we are paid are largely controlled by arbitrary government decrees, as well as by Big Insurance and Big Hospital, both of which further enforce government edicts by way of the prostitution of crony corporatism. Where does that leave doctors?
Strangled, with only one real power left. Being in a grasping union forever negotiating pay increases or work conditions would have been unthinkable two generations ago, and even now feels unseemly, but here we are. Physicians are not leaders in health care, because they don’t control the money, and do not control the laws. We have been financially punished for not writing for enough opioid prescriptions, and then legally punished for writing too many. We can be credibly accused of fraud and severely punished, even when there was no knowledge or intent. Doctors are often sued as individuals, and especially as the conduits toward greater riches from insurance companies and hospital corporations for compassionate lawyers and grieving families through the magic of vicarious liability. And all we are left with is a single power.
So maybe just to hell with it. Let this tyrannical government swallow it whole, pretend to still let the corporations be in charge, and pull every doctor into an actual, nationwide union whose first act will be to condemn the AMA and write in blood a promise to never, ever acknowledge them again. Talk to CMS pay panels the way you already do, and deal with the idiotic ICDs and floating RVUs as always. When the venomous malpractice lawyers start whining about poor victims, strike. When the government tries to cut our pay yet again, strike. When Big Insurance tries the same, ditto. When the entitled public that empowered the lawyers, government, and insurance companies cries and complains that doctors are greedy meanies and that we shouldn’t be allowed to do this, and when they mischaracterize all of us as somehow being on the hook for an oath we all supposedly took that they do not understand and that is no longer largely administered, laugh at them, bitterly.
As we follow our foolish parent nation, it is plain that physicians gave up our power to unrelenting, ravenous forces that will never let it go. Our last power is our refusal to work. And if we are all fired and replaced by scab nurse practitioners, midwives, med techs and shamans, then we can all go fishing. It’s not like this was about patient care, anyway. Hell, it might be fun to be a union doc. Make me a government employee, and I will show you the definition of lazy.
Wow Pat! You came out swinging! Excellent article.
“…All of that makes for a floating standard that can forever hold the target guilty, therefore easier to control, and force it to take what is offered.” Bingo. And well said. No physician took an oath to be taken for granted, overworked, underpaid or abused just to take care of patients. That is utter bulls**t.
Currently in NZ where I work, physicians have a union. We are set to go on strike. Again. With the shortage here, lots of docs picking up the slack and being overworked–and underpaid. Union thinks we should be paid fairly for that “overwork”. Nice to be in a place where someone looks out for physicians’ interest for a change.
Thanks Natalie!
I totaled up the hours I worked in my career versus the total number hours I would have had to work. It’s a Chicago public teacher. I then divided by my total lifetime earnings. I took the teachers pay lifetime plus the cash value as an annuity of their lifetime pension and benefits. I make less than a Chicago public teacher. I would argue I worked harder, was smarter and had special skills than the average public teacher, but that could be debated. Debated. So even in a total socialist setting based on hours worked and the fabulous public employee benefits, I make less than a Chicago teacher per hour
You may have chose the wrong profession then? I dunno. I bailed from medicine as soon as I could at age 64.
(My wife died and I have a mentally handicapped adult son I have guardianship of. Those were reasons I bailed as soon as I could.) Don’t miss it one iota.