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Why Are Doctors Unionizing? · CareTalk: Healthcare. Unfiltered.

• 0:00
  David: Medical residents and fellows at Mass General Brigham just voted overwhelmingly to form a union.
• 0:05
  David: Apparently, these new physicians aren't willing to put up with the lowish pay and tough working conditions that their predecessors faced.
• 0:13
  David: Unionization is happening all over the place, but what does it mean for patient care?
• 0:17
  David: Hospital finances, physician training.
• 0:20
  David: And relationships between trainees and supervising physicians.
• 0:28
  David: Welcome to CareTalk America's Home for Incisive debate about healthcare, business, and policy.
• 0:33
  David: I'm David Williams, president of Health Business Group.
• 0:37
  John: And I'm John Driscoll, the president of Walgreens Health.
• 0:39
  David: John, you know what?
• 0:40
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• 0:47
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• 0:53
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• 0:54
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• 1:01
  David: And fashion
• 1:02
  John: David Unions doctors, what's happening?
• 1:06
  David: You know, physicians are actually forming unions at Mass General.
• 1:10
  David: As I alluded to.
• 1:11
  David: Uh, there's a vote for the residents and fellows to be in the union, and there's an overwhelming vote.
• 1:16
  David: John 1,215 voted yes.
• 1:20
  David: 412 voted no, and it was 75% turnout, so pretty decisive.
• 1:25
  David: You see it also at Montefiore.
• 1:28
  David: GW and some other places around the country.
• 1:30
  John: David, do you wanna just explain the hierarchy of the hospital, you know, staff versus residents and fellows?
• 1:35
  John: Just so people don't think that the fellows are fellows well met.
• 1:39
  John: I mean, like how this whole thing works.
• 1:41
  John: It is a little
• 1:42
  David: confusing, John.
• 1:42
  David: So.
• 1:43
  David: When someone graduates from medical school, they are a physician, but they have to work under somebody else's, uh, authority while they finish their training and they start as residents, which could be usually about four years or so.
• 1:54
  David: And then sometimes you've got people that are continue into, uh, further specialization, could be their seven or eight years, eventually become fellows, and then you have attending physicians.
• 2:04
  David: Uh, above that it can get a little bit even more confusing, John, because usually these early residents are sometimes called interns.
• 2:10
  David: Which is not to be confused with an internal medicine physician, uh, who is an attending physician.
• 2:16
  David: If
• 2:16
  John: anyone should be complaining about wages and work.
• 2:21
  John: It's older doctors who fought their way through Covid and all the doctors who are also working round the clock, who aren't 20 years old, 28 years old, and capable of kind of eating everything they want and staying up all night.
• 2:35
  John: Like why?
• 2:36
  John: What's happening with these residents and fellows, these younger, younger docs or docs in training?
• 2:41
  John: That is drawing them to the likes of the, the, the steel industry and the mining industry.
• 2:48
  John: Definitely
• 2:48
  David: seeing a generation gap.
• 2:50
  David: John, I, in speaking with some senior physicians who are not just wondering about this, but are kind of against unionization, their feeling is that you have a chance in your, your residency.
• 3:00
  David: To really be working pretty much all the time and learning as much as you can so that you can be a better doctor.
• 3:06
  David: And they're worried that actually these programs are be gonna become less prestigious.
• 3:11
  David: I was talking to somebody actually at, uh, mass General about this because the residents won't get an intense enough experience.
• 3:17
  David: So there's, there is a real generation gap, I think, but there's also a change in how medicine has been practiced.
• 3:24
  David: And so I think for everyone, like my friend who says, gee, they really, you know, regret that they resent it, they don't understand it.
• 3:30
  David: You've got others that are saying, you know what, this is, maybe this is what the physicians need.
• 3:34
  David: Cuz the system has changed a lot and they're not, the doctors aren't as autonomous as they once
• 3:38
  John: were.
• 3:39
  John: Yeah.
• 3:39
  John: I think, I think that's a really important point.
• 3:40
  John: I mean, when you think about the doctors that we went to school with, that people think about it, you know, they think about the, the glorification of the single provider of the Marcus, well BMD or the.
• 3:50
  John: The town doctor, the doctors of the independent practices, but, but 50% of all doctors are now, uh, in some form of employment.
• 3:58
  John: Um, and that wasn't true when we were younger.
• 4:00
  John: Doc.
• 4:01
  John: Being that going to medical school was in some ways a guarantee of a way to make money and have an independent practice.
• 4:07
  John: Uh, as more and more doctors become employees, and to your point about generational, a lot of older doctors do not want to be treated.
• 4:15
  John: Or told that they're an employee of, even if they are of a hospital or a system, the younger doctors actually don't have a problem with that.
• 4:21
  John: In fact, more and more younger doctors actually prefer to potentially work in the machine as an employee as opposed to an in a quasi-independent contractor.
• 4:32
  John: But it still surprises me that this is happening with.
• 4:36
  John: Younger docs and it says something, I think about how doctors also believe that in some ways their voices is, are not being heard.
• 4:44
  John: Forming a union in a place where it hasn't happened typically is a sign that people, that an employer is not really paying a lot of attention or enough attention to their employees.
• 4:54
  David: There's definitely the sense that this is also coming in, uh, in the heels of Covid, and that during that time the residents and fellows maybe were kind of abused.
• 5:05
  David: And that maybe they're the ones that really there on the, on the front line.
• 5:09
  David: And this is a bit of a reaction to it when we talk about the pay and, you know, people talk about residents having low pay.
• 5:14
  David: Just to be clear, what Mass General Brigham is paying, uh, for this coming year.
• 5:19
  David: The, the salaries range from 78,500 to $110,000 depending on how many years post-graduate they are.
• 5:26
  David: Health insurance is included.
• 5:27
  David: There's a four contribution and there's a $10,000 bonus.
• 5:31
  David: So you're talking people that are making six figures are, are close to it.
• 5:34
  David: So it's not.
• 5:35
  David: Anywhere near, you know, minimum wage, even if you're working a lot of hours.
• 5:39
  David: So it's more than just that.
• 5:40
  David: John, I think it has something to do with the idea that in the olden day when it was the single shingle, Marcus Weby or whatever, he or she was responsible, they had some autonomy and they could decide what to do.
• 5:50
  David: They could advocate for the patient.
• 5:51
  David: They could choose not to maximize profits for them for their own practice.
• 5:56
  David: Now, as an employee, my sense is some of the doctors are feeling, hey, to be an advocate for a patient, As an employee, I actually need to have a union that'll protect me when I'm not doing something.
• 6:07
  David: That's exactly what my employer
• 6:08
  John: wants.
• 6:08
  John: Yeah.
• 6:09
  John: I, I, I think that's, that's a nice way to shield the, their, their own desire to make more Look, doctors make more in the United States than they make.
• 6:17
  John: Anywhere else in the world.
• 6:19
  John: Doctors in the United States make roughly twice as much as any doctor in the industrialized world, and our outcomes suck.
• 6:26
  John: So I kind of am a little bit skeptical.
• 6:29
  John: Where I become sympathetic to doctors not being seen and heard is in 2022, there was a study across all specialties and across all age groups of doctors of about 10,000 doctors.
• 6:40
  John: And you know, 20, well, actually over 30% of those doctors complain of being burned out and doctors are typically pretty proud.
• 6:49
  John: And so actually to get them to complain, um, is, is, or even e even express concern about how hard work they're working and how.
• 6:57
  John: Poorly, they're being treated.
• 6:59
  John: You know, historically it was kind of hard, and now one out of every three doctors says, look, I'm burnt out.
• 7:04
  John: I mean, that's a, that's an extraordinary, you know, that, that's a warning, that's a flashing red if, if not yellow, if not a flashing red for the temperament.
• 7:14
  John: Of doctors in the system, and there's no question that their autonomy is being more constrained, but they're actually pretty darn well paid and they have a fair amount of autonomy.
• 7:24
  John: I think the working conditions that they are under are really difficult, and I think people's reaction to and respect of the healthcare system is down.
• 7:33
  John: I think that they, they, they all stretched very hard to serve the world and save many lives during covid.
• 7:40
  John: So I, I, I think that this is, again, for me, a sign that doc, that hospitals are really not necessarily treating their doctors and nurses.
• 7:49
  John: Uh, with the level of respect and, and collaboration that would allow them to feel like they're on the same team and when, when, when, when such, and there and there are critical resources, there aren't like a lot of doctors to go around.
• 8:01
  John: So I think it's a real threat for hospitals and anyone who employs a doc.
• 8:06
  David: Jonathan, pick up on your piece about burnout and think, what, what is burnout?
• 8:10
  David: Really mean, you know, so they're burned out, they're tired, not able to function that well.
• 8:14
  David: And you think about what are the coping mechanisms.
• 8:16
  David: So one here, which we're focused on is, you know, vote to form a, a union and participate in the union and, and throw your lot in more specifically on a collective basis.
• 8:26
  David: There's other things that are done behind the scenes that aren't as healthy, uh, some of having to do with, you know, poor diet and beyond that substance abuse.
• 8:35
  David: Behavioral health issues that come for, you know, for this workforce.
• 8:39
  David: And burnout may mean they can't actually continue to do the job, which of course, exacerbates the shortage and makes it harder for, for others.
• 8:45
  David: And so, if you think about it, what, what is healthier, you know, to be in a, in a union versus to go and, you know, a abuse yourself.
• 8:53
  David: Uh, Through some means That's, no, I, I think by way, I think that
• 8:57
  John: that's a little rough.
• 8:58
  John: I mean, to be fair, doctors are much, are, are more prone to, uh, drug and alcohol abuse based on some of the surveys.
• 9:06
  John: There's about an eight to 10% addiction rate in the, in the, in the.
• 9:11
  John: The population.
• 9:11
  John: And for docs it's, it's higher than 10 and it's gotten worse in the last two years.
• 9:16
  John: But I do think there are alternatives to, it's not either or unions or the, or the booze.
• 9:22
  John: I mean, it's like, like I actually think that we could, I mean, a lot of doctors are happy and, and believe that what they're doing is, is sort of a sacred, uh, honorable duty and they enjoy the work.
• 9:35
  John: Um, we could actually.
• 9:37
  John: Start by treating the, by really ha having the doctor's, employers, largely hospitals, but not all.
• 9:44
  John: Treat doctors like the critical partners that they are and make sure that the living conditions and the supports they need to stay emotionally healthy.
• 9:54
  John: Don't burn 'em out.
• 9:55
  John: Uh, cuz both of those statistics.
• 9:57
  John: Drug abuse and burnout would suggest that we've got a, in a, in a, in a, in a fragile enough healthcare system, one of the critical players is even more fragile than we expected.
• 10:06
  John: 50% of all nurses, David, coming out of Covid, said that they would be open to quitting the job of being a nurse if they could, if they could find a better alternative.
• 10:16
  John: Um, I don't think we've really figured out or calculated or, and weighed enough.
• 10:22
  John: The, the long term burden on docs and nurses, and I think this unionization thing, which I don't think is really gonna take off is, is just another sign, like the addiction statistics, you were suggesting that we're not treating our doctors well
• 10:35
  David: enough.
• 10:35
  David: Well, you're, you're lumping doctors and nurses.
• 10:37
  David: Nurses do tend to be unionized.
• 10:39
  David: Uh, there's a lot of unionization there.
• 10:41
  David: They still have their challenges.
• 10:42
  David: It's a different type of a, of a profession, but it's not as though hospitals aren't used to unions.
• 10:47
  David: No, it's a, it's, it's,
• 10:48
  John: it's a fair point.
• 10:48
  John: Nurses are, unionized, service workers are, are unionized.
• 10:52
  John: Um, pretty much most of the players, except for the senior leadership on the administrative side and the doctors are actually currently members of unions.
• 11:03
  John: But I, I, I, I do think this is more of a symptom, um, than a movement.
• 11:09
  John: And I, and I think it's a symptom of a real problem.
• 11:11
  David: Let's talk about how hospitals are thinking about it.
• 11:14
  David: I gave kind of, we, we talked about the perspective from the physician side and also the senior physician side that aren't in the unions.
• 11:20
  David: Hospitals obviously are worried about the financial implications.
• 11:24
  David: They don't like the loss of control, uh, that they have on their workforce.
• 11:27
  David: But, uh, what else?
• 11:29
  David: Well, I
• 11:30
  John: think, I think that the context here is really important.
• 11:32
  John: Hospitals, uh, in America have had the last, the worst six months, um, over the last six months as they've ever had.
• 11:38
  John: And, um, you know, the rating agencies would tell you the rating agency.
• 11:44
  John: Most hospitals leverage a lot of debt because they're always building and rebuilding the buildings and the systems that they've got.
• 11:49
  John: And the rating agencies would tell you that a great answer this year is you can cover the interest on your debt.
• 11:55
  John: Not that you're high performing, but they're really concerned about a lot of hospitals, particularly those in urban areas or, or, um, or disproportionate share where they're, they're caring for a disproportionate number of poor people, whether it's urban or rural.
• 12:09
  John: And a lot of hospitals are still closing.
• 12:11
  John: So I think they are not in a position financially to do a great deal more for doctors or they don't believe they are.
• 12:19
  John: Um, and so I, I think it's a little bit of a standoff.
• 12:23
  David: You know, in addition to the financial, uh, strain, I think also genuinely the physicians, the, the hospitals don't wanna have an adversarial relationship with their, their doctor.
• 12:32
  David: You know, it ch changes the way things are done.
• 12:35
  David: Um, they're worried also about, just from a legal and regulatory standpoint, there's a lot of compliance, uh, rules that you have to do when you're, when you're working with a union.
• 12:43
  David: And I think they're worried about some of them, that it's gonna hurt their own reputation on the ability to attract residents and staff.
• 12:49
  David: Hey, gee, this is a place where the physicians were treated badly enough that they had to unionize.
• 12:53
  David: It's gonna make it even harder.
• 12:55
  David: Uh, potentially for those places to recruit.
• 12:58
  John: I think that's right.
• 12:59
  John: I think that's right.
• 13:00
  John: Although there, you know, your, your counter-argument about nurses, nurses have done just fine with unions.
• 13:09
  John: Um, but you do have, um, and again, the con context here is doctors are actually paid pretty well and we don't have a ton of them.
• 13:17
  John: And I think that we have to find a way to treat 'em better.
• 13:20
  John: And again, this is a, an indicator and I think that.
• 13:24
  John: The, um, uh, the, the long-term, you know, Health of hospitals is really at risk if doctors, uh, unionize because there, there are two things they're gonna organize around.
• 13:38
  John: One is limiting the work they do, which is what you suggested earlier, and the other is compensation.
• 13:44
  John: In both cases, it uh, it could tip some of these really vulnerable hospitals into really precarious economic shape, maybe even put 'em out of business.
• 13:52
  David: So let's talk about.
• 13:53
  David: Uh, patient care as we often do.
• 13:55
  David: Some people forget the patient.
• 13:57
  David: We don't, I would say on the positive side, for patient care, you know, if your physicians are being treated better and they have higher wellbeing, that's helpful.
• 14:05
  David: Maybe some of this there'll be, you know, even more staff, potentially maybe more focused on patient safety.
• 14:11
  David: Physicians feeling they're empowered to speak up on behalf of their patients.
• 14:15
  David: But there are some negatives, John, there Actually.
• 14:16
  David: First of all, if the doctors actually go out on strike, which happened recently in New York City, at New York City Health and Hospitals, there's a five day strike that's, uh, threatened, now authorized from Mount Sinai.
• 14:28
  David: So that's coming up.
• 14:29
  David: You know, we talk about being treated well, well, higher costs, that's gonna go somewhere.
• 14:33
  David: Usually the patient has to deal with some of that.
• 14:35
  David: And then I think being in an environment where there's a strained relationship, strained relationship between the hospitals and physicians, I.
• 14:41
  David: That's not so great.
• 14:42
  David: So that's a mixed bag for patient care at best.
• 14:44
  John: Yeah, no, I'm, I don't think this is good for patient care at all except for the fact that the doctors might feel like they're being treated a little bit better.
• 14:52
  John: And hopefully that translates into, um, into better, into, into a better relationship or more time with patients.
• 14:59
  John: But that's not actually, while the, the unions have talked about that, that actually hasn't translated into anything material in terms of.
• 15:08
  John: Most of the asks.
• 15:09
  John: Most of the asks are about compensation and ours.
• 15:11
  John: They're not about more time at a patient's or a family's bedside.
• 15:15
  John: You know, what you've seen in nursing, uh, negotiations, particularly around, um, dialysis centers.
• 15:21
  John: Um, some of the, the nurses have worked to, uh, Tighten up work rule so that there would be more nurses covering a floor and or more nurses, uh, covering dialysis centers over.
• 15:34
  John: So really limiting the ability of dialysis companies like DaVita or hospitals in, for example, in California to, uh, shrink the number of, of, of the, the, the nurse to patient ratio.
• 15:46
  John: But that has not, uh, really.
• 15:49
  John: Been the focus e either of benefits, fights in general with unions and hospitals or where, where doctors have chosen to sort of make their, you know, where, where their doctors are unionized, where they've made their ask.
• 16:01
  John: I, I, I will say that those, those strikes are, um, Uh, sound really dangerous.
• 16:07
  John: Uh, but the academic data is actually mixed as to whether when the hospitals are closed, patient outcomes actually improve or not.
• 16:13
  John: There was, uh, there have been two examples, I believe, one in Israel and the other in Los Angeles, where a, what the, the biggest thing they noticed during the doctor strike was that, uh, uh, healthcare improved in the area.
• 16:24
  John: And I'm not sure that would be true long term, but it is an ironic example of, uh, the, the, the, the, the don't be, be careful what you wish for.
• 16:34
  David: Oh, John, I think you're bringing the striking points in the, uh, talking points for the strike busters.
• 16:39
  David: I'm not sure that's gonna apply with residents and fellows, but who knows?
• 16:43
  David: You've already said, uh, you've already answered my next question, which is about whether this is a trend for the future.
• 16:47
  David: I think you see it as more of a blip than a real, uh, movement that's going on.
• 16:51
  David: Is that, is that your final position?
• 16:53
  David: No, but
• 16:53
  John: I do worry about doctors in general.
• 16:55
  John: I think we, we don't, we don't, um, the healthcare system needs to do a better, better job at taking care of doctors, period, hospitals.
• 17:02
  John: Businesses that employ them.
• 17:03
  John: Organizations like Walgreens and others.
• 17:06
  John: Um, you know, the assumption doctors have done so well for so long, financially, independently in terms of social respect.
• 17:13
  John: I think this, this, these rapid structural moves towards employment, towards, uh, uh, you know, increased work, rules, oversight, and data.
• 17:22
  John: Um, um, And just the brutal, brutal burden of, of the pandemic And, and Fran frankly, the alienation of America from really a purely respectful view of medicine to one that's more skeptical.
• 17:33
  John: It's been really hard and I think we need to, uh, we need to do better job caring for our caregivers.
• 17:42
  David: I think there's, there's a bit of a trend here.
• 17:44
  David: You've got, uh, 68% of doctors in a recent survey said they were interested in being part of a union.
• 17:50
  David: It was correlated so that the younger age groups are much more interested in it, but I think it's mostly gonna be confined to residents and fellows.
• 17:58
  David: So it's probably not gonna spread to the attending, uh, physicians.
• 18:02
  David: Partly just because of, of age and autonomy, and partly even just structurally, they're not necessarily employees of the hospitals.
• 18:08
  David: And so you're not gonna have contractors that are, uh, that are unionizing.
• 18:12
  David: I wanna end John with asking you a question, which is a's two part question.
• 18:17
  David: You know, is physician unionization a good thing or a bad thing?
• 18:21
  David: And would you want your doctor to be unionized?
• 18:25
  David: Uh, so I
• 18:26
  John: think.
• 18:27
  John: In general, the, the lasting hospitals and, and, and most of these organizations need is another union to negotiate with.
• 18:35
  John: But I think unless they treat their doctors better, they're gonna see more of them.
• 18:38
  John: Fair
• 18:38
  David: enough.
• 18:39
  David: Well, I would prefer my doctor not be unionized.
• 18:42
  David: They prefer that they work in an environment where they don't feel that's necessary and they have their autonomy.
• 18:47
  David: So I'm gonna say, I understand why doctors wanna be unionized, but I prefer to have ones that are not.
• 18:56
  David: Well, that's it for yet another episode of CareTalk.
• 18:59
  David: We've been talking about unions of physicians in healthcare.
• 19:04
  David: I'm David Williams, president of Health Business
• 19:06
  John: Group, and I'm John Driscoll, the president of Walgreens Health.
• 19:09
  John: If you like what you heard or you did, please subscribe on your favorite service.