As we all in the Northeast and coastal states dig ourselves out of the huge snowfall I sit here recovering from knee surgery and remember the first time I witnessed a strike in healthcare. I was a resident at a university hospital in Philadelphia and the nurses went on strike. I was furious! I couldn’t believe that any health care worker would forget their obligation to care for their patients. However, for those of you who may be unaware, hospital doctors in England staged their first strike in four decades starting this week, As a result, there has been significant disruptions in the health care sector, with countless operations postponed and appointments canceled, and it is grabbing the attention of the country as you would expect.
The doctors on strike, specifically the “junior doctors”, analogous to residents and fellows in the USA, are locked in a dispute over pay and working hours. Namely, they are falling behind other professions in pay per hours worked.
There is an article in the New York Times that goes into further detail here:
I would like to hear some of your thoughts on this issue.
“As we continue to make cuts to Medicare reimbursement to physicians (in the name of controlling cost) whilst seeing pharmaceutical companies and insurance companies post monster profits, it begs the question: “Have we lost our bargaining power in the marketplace?” Are we doomed to sitting on the sidelines while others with deeper pockets and bigger lobbies in Washington call the shots? I don’t know the answers to these questions, but I think England’s current conflict provides an interesting example of what happens when physicians and other health care workers are pushed to the sidelines by bureaucrats and politicians.
With the junior doctors offering only emergency care, about 3,500 operations had been affected by Tuesday afternoon, including routine procedures for knee and hip replacements — prompting a warning from Prime Minister David Cameron that the labor action would create “real difficulties for patients, and potentially worse.”
Yet the dispute over the health system carries risks for the government. The National Health Service, which is funded by taxes and payroll deductions but has faced years of financial strain, delivers most treatment without charge. Despite regular funding crises, there has been no similar strike since 1975.
In America everything is controlled by the legal profession. How many doctors are in Congress and Senate of USA? The Medicare fees were frozen in 1984. Since then fees have gone down and not up. Everybody gets a raise bot doctors. Myth of rich doctors persists. AMA sold out to Obama for what? I do not trust AMA. They always sell out to politicians. Look what you have to deal with. United Healthcare, Human, Cigna, Aetna, BCBS and how many more. They are always slashing doctors’ fees first. There is no hope. Days of getting rich practicing medicine are gone forever. Good luck. We can strike but what will we get? ZIP.
We have had theoretical advocates that represented us in the past to look out about our interests. I am talking about the AMA, state medical and specialty societies on a national basis. They have not delivered what needed to be done in the past 40-50 yrs. ANYTHING WE DO NOW WILL BE VIEWED AS GREEDY DOCTORS. We have let other forces define what and where medicine is going due to our own failure to act as a cohesive unit. Because medical care is considered a right by the government and disrupting it would face severe consequences for the “ring leaders” and maybe the rest of the profession. Think back about the transportation strikes, teacher strikes, and strikes that involved an industry that made the country run. All the air traffic controllers were fired and never worked again in their profession by President Reagan. Leaders of the strikes were jailed and the unions fined huge amounts to bankrupt them. We have missed the golden times for this . We are now sheep being led to the slaughter. But who knows that maybe an issue that comes along will unite us and we will take on the forces of evil.
I for one do not like where medicine is going. I am 70, in solo practice, and can walk away anytime. I still like what I do and think I can make a difference in a patient’s life.
It’s all part of a master plan to get physicians to the point that they will willingly maybe even gladly accept a single payer or national health system with open arms.
Worked in the NHS as an exchange Registrar in Surgery in 1983-84. Hours were much longer then than than the current 48 per week, but nothing like the 100 plus I was working as a Harvard surgery resident in Boston. As NHS residents, we did all the work. I saw my consultant once a week on Fridays. He was present only for cases for which he had a clinical interest. I performed 1500 operations in that year, in spite of 6 weeks of paid vacation and 2 weeks meeting time. It was some of the best surgical training one could get, and I would not trade it for the world. I was paid 11000 pounds per year, which was about $12,000 US dollars at the exchange rate at the time. I could not afford a down payment for an apartment in Boston for two months after my return, and house sat for parishioners at my wife’s church while riding my bicycle 13 miles each way at 4am to make it to work until I saved enough for the apartment.
The NHS runs on the house officers. Without them, it does not work. The strike is definitely justified.
never had any. Our only way to make an appropriate living is withholding services.”
If you are an employee or contractor in the U.S., you always have the right to quit under the terms of your employment contract. But if you are an employee in an organized group, you can strike (which means you can stop work and attempt to prevent others from taking your job) unless there is a law prohibiting your strike. (Many public employees are prohibited from striking.) Non-employee physicians are prohibited by anti-trust laws from organizing, including holding discussions on boycotting particular insurers. But you can certainly independently decide to refuse to accept payments from any government or private insurer (except, apparently, in the state of Massachusetts).
But if U.S. doctors increasingly become employees, they can organize, and they will be able to strike–and likely will–if their working conditions deteriorate to the point of intolerability. Nurses have struck repeatedly over the years, when they felt their demands were not being met. As an employee, I would have no problem with joining a physician’s union and striking if my employer demanded I suffer unfair compensation, unsafe working conditions, or put me at undo risk of a malpractice claim.
I feel that certain “critically necessary” specialties outside the regular day hours like ER, trauma surgeons, neurosurgery, anesthesia (the problem there might be CRNA’s), obstetricians etc. are in a position to force change by not taking call: no MOC, a law that emergency or urgent patients can not sue (just the beginning), setting of payments (not charges!), otherwise no call, forcing salaries or income and perks twice of the hospital director (see what makes a difference: the hospital director not showing up for work in the middle of the night or the OB or neurosurgeon!), etc etc. Unfortunately many of the “leaders” of those specialty organizations enjoy their perks too much to do so for their membership, but I think it is possible.
“Have we lost our bargaining power in the marketplace?”
Yes.
At this point a psychiatric floor RN in the Minneapolis area can enroll in a flexible 21 month online fully accredited psychiatric nurse practitioner program, at a total cost of less than $23,000 for a master’s degree, and can continue to work 25 hours weekly during school. Upon graduation, backed up by and uptodate subscription with treatment algorithms that are updated every 30 days using the entire world literature database, and a referral pipeline to a psychiatrist for complex cases, he or she is able to practice in a fashion that meets all currently utilized quality standards and he or she can handle 80% of cases presenting to a practice.
Are the current quality measurements and skill measurement metrics in place able to tease out the added benefit of an MD degree and a psychiatric residency? No.
Such a difference in quality probably does exist, however, on average. A lot of nurse practitioners simply work around this in the same way that family docs do, if patients don’t improve they must leave the clinic and see a psychiatrist. The economic problem for a psychiatrist, in that market, is that most patients improve, and the lion’s share of the business will stay in the NP clinic. Only the train wrecks get referred, many of them poorly insured and very complex.
Having grown up in a lower middle class household, I had to assume substantial debt, about $300,000 in 2016 dollars, to finish training. It paid off for me, and I’m able to retire today, if I wish, quite comfortably. I would be very, very, very wary of assuming that same amount of debt, for a psychiatric practice, in this marketplace, if I were a college senior.
So…strike? No. A strike will do nothing to change the economic condition of this market.
Perhaps we should think of other methods in our control. Why not reduce premed requirements to 2 or 3 years of college, instead of 4? Does medical school have to be 4 years? Why not 3.5 or 3 years? Does a psychiatric residency have to be 4 years? I doubt that it doubt that it does, 3 years would have been plenty for me, I spent my 4th year in a geriatric fellowship, and was none the worse for it.
Physicians in Europe and the rest of the developed world finish training 3 to 4 years earlier than we do, and with substantially less debt. From what I saw in the medical practices in Germany, their lifestyles certainly did NOT suffer. Assuming an income of $250,000 yearly for a U.S. graduate, that would represent an additional $750,000 in career income, and if a young physician invested HALF of that sum in a low fee total stock market index fund, by living frugally the first three years of practice, and let it ride for 30 years, it could fund a retirement on it’s own, as an independent investment vehicle.
Long overdue and just like the government offices take holidays, so should we.
Call it “doctors week” and we all take it off.
Strikes are illegal but vacation is not.
It will only get worse unless we stand up together!!! Instead of striking we should all maybe go to cash overnight and completely remove the insurance companies from the equation. That would cause so much pressure that they would start paying us for the work we do instead of their executives millions and their share holders.
Doctors have not funded Healthcare lawyers with a direct purpose in mind. We pay high premiums for malpractice but it is not the same . These lawyers are there only if we are sued. However as a cohesive body of physicians hiring good Healthcare lawyers who would have a dedicated purpose chosen by the body of physicians such as the injustices targeting awareness and change toward the injustices that are threatening doctors by insurance companies. There is then a momentum that can help start some changes for docs to inform the public who really have no idea.
It means forming an organization funded by physicians with this sole purpose in mind .Since many docs are afraid of backlash perhaps retired physicians who no longer have to worry about practice being scrutinized but interested in perpetuating reform could run the organization along with any physician not concerned with shaking the status quo.
Doctors are targets because we don’t organize and stand up with the law behind us as a group not individually. There is always power in numbers. And focused power with the right litigators Asa group can make change occur.
We have gotten too used to just complaining about the injustice is but never getting around we have gotten to use to just complaining about the injustice is but never getting around to doing something about it as a whole.
I also applaud the doctors in England for striking.
The hours that residents and interns work in the United States has been changed since I was an intern in 1978.
I think that many specialties are underpaid especially emergency medicine and that some specialties are overpaid doctors in this country, but will never get together and strike.
This country is built on greed. It’s all for one, not one for all. The only doctors that make out now are doctors that do multiple procedures and those that have figured out creative billing and how to rob the system. Whaaatttttt!!!
I for one am glad I’m nearing retirement. I see medicine in this country falling apart. I see years from now most doctors in this country will be trained in Third World countries. This is not a profession that Americans are clamoring to get into especially when one lawsuit can run your career and take away your license.
It’s a sad situation!!!
Maybe physicians unionizing will be the only way to protect we the health care delivery team!!
Oh, and thank you to my orthopedic surgeon and anesthesiologist for the great experience that I had Friday.
Musings of a Doc with an MBA 