Nurses are not the only healthcare workers who are feeling aggrieved these days. Doctors are, too. Several recently enacted structural changes in our healthcare systems have heightened our sense of anxiety and frustration. Consider the headaches surrounding the adoption of non-interfacing (for the foreseeable future) electronic health record (EHR) systems, the challenges of scrolling through lengthier lists of equally ineffective, and often problematic, ICD-10 disease codes, the controversies surrounding the rollout of the Affordable Care Act and the thankless role we serve as unwitting gatekeepers for a system whose bloating costs continue to spiral out of control.
Would unionizing provide us with the necessary clout to exact some of the changes that would make our lives and those of our patients better? In 1935, the National Labor Relations Act guaranteed most private-sector workers, including those in healthcare, the right to unionize and bargain collectively. That changed in 1947 when the Taft-Hartley Act prohibited healthcare workers of nonprofit hospitals from forming unions and engaging in collective bargaining. In 1974, this specific exclusion was repealed and replaced with a specific 10-day advanced written notice requirement needed prior to any strike action.6
Yet doctors walking off the job remains a rare event in America. First, the U.S. population as a whole takes a dim view of strikes. People are not accustomed to and are generally annoyed by the inconveniences imposed by a strike action, and if one’s health were left hanging in the balance, there would be scant sympathy for and more likely a deep sense of resentment against striking physicians. Another reason that striking doctors in America is a rare occurrence is that many of us are either self-employed in private practice and, thus, not considered employees or work in teaching hospitals where we are considered supervisors. Based on some restrictive interpretations by the courts, this designation makes us ineligible to bargain collectively.
Nonetheless, there have been sporadic strikes. One review identified 13 walkouts in North America over the past 50 years: six occurred in Canada under a single-payer system, four involved U.S. medical house staff objecting to work conditions, primarily in public hospitals, and two were protests against soaring malpractice premiums.6 According to the authors, only three of these strikes could be judged as having achieved favorable results for the strikers. Not an impressive record.
Our thoughtful clinical judgment that has evolved through years of training carries little weight with insurers.
Just as the BWH nurses strike was not focused on money, our grievances have less to do with money and more to do with our perceived sense of disrespect. Of course, we would all love a hefty pay raise, but the reality is that our major grievances reflect our disaffection with the clout of some of the more powerful interests in the $3 trillion healthcare industry. Some of our greatest headaches, heartaches and misery can be traced to the often heavy-handed rules and policies imposed on us by these players. For example, one of the most unpleasant tasks physicians face nearly every hour of every day is the vexatious prior authorization (PA) process, an activity that masquerades as a rational review of drug therapy selection by the treating physician, but in reality reflects the battle between the titans—the health insurers and their pharmacy benefit managers on one side seeking lower costs and the drug manufacturers on the other side seeking higher prices for their products (see p. 17). Each side may have some valid reasons supporting their views: insurers are trying to rein in the rising costs of drugs, maintain insurance premiums at affordable levels and turn a profit, and drug companies need the revenue to support their research, earn a profit and satisfy their shareholders.
