Last fall I was witness to a miraculous event. I rarely take off from work, but did so on a Friday to go to Baltimore to lend moral support to my family doctor friend, Cathy Maslen. She and her workmates at Chase Brexton Health Care (a community health clinic in the Baltimore area with a focus on the gay and transgender community and the inner-city poor) were doing something that I had never seen medical professionals do in the past—they were staging a protest about poor working conditions.
Cathy had worked at Chase Brexton for the better part of twenty years, as had many of her workmates. They are a remarkably committed and caring group of professionals, taking care of a patient population with profound needs and remarkable challenges. Even in the best of circumstances, their work is difficult. But of late, it was made even harder by the dictates of a new CEO.
In response to mounting financial pressures, Chase Brexton’s new management had cut staff through multiple rounds of layoffs, and cut physician salaries by 20 percent (though they could gain back some of the money by seeing higher numbers of patients and through compliance with burdensome government data collection efforts and “quality” initiatives). The result was that the clinical staff was being pushed to do much more with much less, and they felt that patients were being endangered as a result.
Pushed to the brink, the medical staff did something that is quite uncommon among medical professionals. They contacted a local labor organizing group, and were considering the option of unionizing. A vote on the union was scheduled.
The new CEO was not pleased. In retaliation, he hired union strike-busters, who began to harass and intimidate Chase Brexton staff. They even fired five staff members, including longtime clinicians.
As upset and demoralized as staff were, their patients may have been more so. They organized the protest I attended. Hundreds of people—patients, community members, and staff—gathered on the sidewalk outside Chase Brexton’s administrative offices. Speech after speech detailed the remarkable bond between patients and the clinical staff.
The next week the vote took place, and despite huge pressure and efforts to intimidate them, staff voted to join the union. The CEO soon resigned. It was a remarkable series of events for a profession that is not known for such things.
Traditionally, doctors have not unionized. In some instances, it is even illegal (privately-employed doctors are forbidden to unionize for the purpose of collective bargaining for better wages). But until recently, I don’t think most doctors would have considered it necessary, anyway. But times have changed.
Another factor that keeps doctors from forming unions is that unions often do something that doctors feel they cannot—they go on strike. From a moral and legal perspective, a physician strike is frowned upon. The obvious moral hazard of a physician strike is patient endangerment. It is a basic violation of our commitment to “do no harm.” And for good reason, there are well-developed legal precedents preventing physicians from abandoning patients with whom they have an established relationship.
And so, American physicians have never had much of an organized labor movement. And this may be part of the reason that American health care is in the state it is in. American physicians have no legitimate mechanism to effect change in the American health care system (nor do patients, for that matter). The balance of power in American health care rests almost entirely with government bureaucrats and health insurance and large health system executives, who exert nearly complete control. Doctors have professional organizations, like the American Medical Association and state medical societies, but resistance has not been their focus, and they have had little effect on health care reform. Many physicians have come to question these organizations’ value, and even their motives and conflicting interests in such matters.
So, when government bureaucrats say doctors need to comply with useless, wasteful programs, doctors have little choice but to comply. When insurance companies use cumbersome prior authorization processes and arbitrary denials to impede patient care, again, doctors are forced to comply. It is an important part of what is wrong with the American health care system. Doctors have little say over their own profession.
And so the time has come for physicians to organize themselves. But what form should that organization take? And assuming we organized into some new type of professional representative organization, or even a union, what should we do? Even amongst physicians, there is no real agreement about what should be done to fix the system. But one thing I can assure you, divided we will continue to fail.
Should we go on strike? I think most physicians would still consider this ill-advised because of the harm that could befall our patients. But we must find other effective ways to resist because the health care status quo is, quite literally, killing patients and ruining the practice of medicine. The system itself violates the call to “do no harm.” To honor our oath, we cannot let that continue.
Organized resistance could take many forms other than a strike. If a large group of physicians banded together and boycotted a new government program, maybe it could be altered or stopped.
Physicians are generally a very thoughtful group. I would love to see what we could come up with if we organized and put our heads, and our great energies, together. We owe it to ourselves, but even more to our patients, to try. To not try would violate the sacred oath we take to do no harm just as assuredly as abandoning our patients to this dreadful system does.