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What to Do About Physician Unions

 |  By Lena J. Weiner  
   March 31, 2014

As tensions between employed physicians and their hospital bosses ratchet up, HR professionals need to draft a strategy for either blocking or accepting the likely event that doctors will organize into labor unions.

If the phrase "labor union" brings to mind construction workers in hard hats, longshoremen on the docks and nurses in their scrubs demanding more favorable nurse/patient ratios, get ready—growing numbers of employed physicians may give rise to a new group of laborers seeking solidarity.

"I think the time is fast approaching when a combination of trends will drive physicians to organize," says David Leffell, Section Chief of Dermatologic Surgery and Cutaneous Oncology at Yale School of Medicine.

"Tensions between large hospital and health systems and doctors are increasing. Large health systems and hospitals are striving to de-professionalize doctors and create structures in which doctors have even less voice than they have now," he told me.

Frustrated by the lack of control he felt doctors have in modern healthcare settings, Leffell wrote an op-ed for the Wall Street Journal in January of 2013. He was surprised to see the response it got. "I believe it was the number one emailed article in the WSJ that day," said Leffell. "Clearly, it touched a nerve."

Why Unions, and Why Now?
At the root of the incipient labor movement is the growing number of physicians working as employees. According to a 2012 study sponsored by staffing group Accenture, while 57 percent of physicians were in private practice in 2000, the number had dropped to 39 percent in 2012, and shows no sign of rebounding.

"In my region, a hospital-owned physician 'foundation' gives doctors demerits for 'being late,'" Leffell says. "I call it the industrialization of medicine driving the infantilization of doctors."

As physicians and other healthcare professionals leave private practice and become employees, new issues that did not previously exist begin to creep up, including issues around compensation, working conditions, hours worked and other problems one would traditionally see with in a service industry.

While there are still few physicians' unions, some do exist, including two affiliated with the Service Employees' International Union (SEIU). The Union of American Physicians and Dentists, which is primarily active in California. And there are smaller unions affiliated with particular institutions. Additionally, many physicians are involved in state or city workers' unions—although those are not specifically unions for healthcare workers.

Flavio Casoy, public psychiatry fellow at Columbia University Medical Center is vice president of the Committee of Interns and Residents (CIR), a union affiliated with SEIU. Casoy says his involvement in CIR and the SEIU stems from his dedication to patient care.

"All these forces in healthcare make it so the places where patients are going to get care are bigger and bigger institutions. Care is becoming less and less humane, and increasingly less patient centered," he says.

"I think physicians need to have a voice to ensure [that] good, clinical care is the main objective, rather than the profits of some corporate entity," he continued. Casoy points out that non-unionized psychiatrists are asked to see as many as five patients per hour, and asks what quality of care could be expected with a patient load that high.

With a union looking out for him, ensuring that he has a voice in the care of the patient, he says he "can actually do what needs to be done to take care of this person."

Industry consolidation and shrinking reimbursements are two more motivating factors that are pushing physicians out of private practice and onto the payroll of hospitals and health systems in growing numbers. When they get there, some are finding they could use the protections offered by organized labor organizations.

Unions and HR
"I don't want to say that unions are a bad thing," says Tedd Trabert, chief human resource officer for the Health Choice Network in Doral, FL, and an ASSHRA board member. His own grandfather, he told me, was involved in a coal miners' union for years, "but I would have to say that right now is not the right time and place for [physician] unions.

 


Tedd Trabert
Chief Human Resource Officer for the Health Choice Network in Doral, FL

Trabert acknowledges the right of the employee to organize—on their own time, outside of working hours, of course. If he were confronted by physicians seeking to organize, he would ask, "What's the driving factor behind this? What causes the need for this?"

"Human resources should be the representation and voice of the people in an organization," Trabert says. He maintains that what's best for employees is a robust HR team that's working hard to protect their interests. "Get out of your office. Listen to your employees."

Labor unions in the United States first began growing in response to the industrial revolution, as artisans lost their means of production and had to begin working for others. This pattern repeats itself as physicians move from being self-reliant professionals to being duty-bound employees.

Physicians are highly educated, tend to be politically engaged and have invested significantly both financially and in terms of time, into training for their profession. While it makes little sense for doctors in private practice to unionize, it is not farfetched to think that as employed persons they would seek to organize.

The desire is exacerbated by the pace of industry consolidation and the size of mega-organizations that form as a result of all those mergers and acquisitions. "As organizations grow beyond themselves, as they become that big box, it's difficult to manage expectations," said Trabert. But "if an organization has a strong culture, it could squash the rumblings of a union."

Two Options
Would trying to squash the unions be the right way to handle the situation?

Human resources professionals have two options. They can fight the growth of unions by attempting to block them legally—a move that will cause even greater employee dissatisfaction and resentment, or they can accept what was once unthinkable—an organized labor force made up of physicians.

In the meantime, Trabert suggests a good labor relations strategy is attempting to keep lines of communications open with employees. The key to ensuring that human resources is part of the conversation—and has a real chance of staving off union growth—is stepping outside of offices and listening to what employees have to say.

Lena J. Weiner is an associate editor at HealthLeaders Media.


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