Any docs unionized out there

[nexus73]

Little by little I hear about physician unions popping up. Sounds like there are more residency unions than attending physician unions, but hearing more about attending docs as well. See this article: ‘We need more staff’: Legacy Health doctors vote ‘overwhelmingly’ to unionize

Just curious if anyone knows of unions in place with attending psychiatrists as members. And also just hoping to spur some discussion. From my position, employed by a health system for the last 10 years, and all the headache from admin (seemingly both from their complete ignorance to what psychiatry entails, but also I think they are just bottom line focused rent seekers), a union seems like a great idea and really the only way to have any leverage against the hospital negotiating basics like salary/rvu rate, call rate, midlevel supervision rates, vacation, etc.

I for one would love to have a union that could advocate for these basic aspects of employment. I think with internal medicine hospitalist unions forming, it would make sense for hospital based psychiatrists to be included as the work is relatively similar in regards to compensation and coverage.

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[splik]

It is very common for county docs to be unionized in california. The strength of the unions and usefulness seems to vary quite a lot (and this is reflected in the contracts negotiated). I'm less convinced about physician unions in non-government jobs however. I think we should just go back to the old model where doctors weren't employed by hospitals. That still works very well and is common in some places.

 

[nexus73]

It is very common for county docs to be unionized in california. The strength of the unions and usefulness seems to vary quite a lot (and this is reflected in the contracts negotiated). I'm less convinced about physician unions in non-government jobs however. I think we should just go back to the old model where doctors weren't employed by hospitals. That still works very well and is common in some places.

Doctors not being employed by hospitals, rather forming their own groups is certainly an option, and functions like a de facto union when you are able to exclusively staff the psych unit with your doctors I suppose. But also seems a bit pie in the sky considering the ever-increasing barriers to starting a group, and the discrepancy between physician and hospital reimbursement clearly favoring the facility. Plus the economy of scale the hospital enjoys where it can employ an army of workers to maintain various business requirements and compliance with various government regulations across the entire organization, while supporting themselves with highly lucrative procedure revenue that a private psychiatry group can never hope to mimic. Clearly a private group even is at a notable disadvantage.

I'd question why you are less convinced about physician unions in non-government jobs. Especially since there don't seem to be that many examples of unionized doctors from which to draw opinions about the utility of a union. It seems with the increasing corporatization of healthcare and increasing percent of doctors in employed positions, a union is one of the only practical ways to find any leverage against the health system behemoths.

 

[Dantes]

Considering how effective nursing unions are in some areas, I think it's worth a shot.

 

[comp1]

Unions work well for the feds as well. It might be easier for the OP to seek out a government job than to try to change all of privatized healthcare.

 

[nexus73]

Unions work well for the feds as well. It might be easier for the OP to seek out a government job than to try to change all of privatized healthcare.

It's about improving working conditions for employed doctors. From what I can tell, doctor unions pop up here and there with 100 hospitalists signing on at one hospital, or a few hundred across a health system. Hardly all of privatized healthcare.

I don't see the downside of a physician union, given the trajectory of corporate healthcare over the last 20 years.

 

[comp1]

If they were spontaneously generating, there wouldn't be a downside. Such as it is, the main downside is the effort to get one going.

 

[MacDonaldTriad]

I was forced to pay union dues until Trump was president. This was the only good thing I can point to that I agreed with during that strange 4 years. As far as I'm concerned, we are professionals, and if we don't like our jobs and feel underappreciated, there are plenty of jobs that will give us what we think we deserve because we are professionals and not widget manufacturers. Unions are for laborers who need job protection because they have limited options because of their limited transposability to have enough options when things change in the labor market. This isn't the case for physicians. If we need unions, we should look at doctors around us and wonder what company we are keeping. Most physicians do just fine and vote with their feet when needed.

 

[dl2dp2]

I'm unionized. It's completely useless.

 

[nexus73]

I'm unionized. It's completely useless.

what type of job and can you comment on how it's useless

 

[Ironspy]

My last job was unionized working in a state run setting. Union was useless and it represented a number of non MD clinicians whose interests were different from mine. Salaries were very low and the union took ~1% of my pretax salary to boot

 

[comp1]

There's moderately good evidence that unions are less helpful for people in higher income brackets and particularly less helpful in situations where employment benefits are already significant or industry leading, such as governmental employment.

 

[dl2dp2]

what type of job and can you comment on how it's useless

state employee job
as above

 

[psych_0]

Yet to hear a convincing argument for physician unions, much less physician unions for a job like psychiatry which is already hard to come by. My current job has been trying to hire an addiction trained psychiatrist for >10 years. When I was hired, the people already working there said I was the first person they were able to hire in 8 years. Why on earth would I want a union negotiating for me when the field is begging people to work?

 

[comp1]

Yes, there is that too. We are in dramatically short supply. It's just very different than say Starbucks or Amazon. It SEEMS similar because we earn W2 income, but the actual amount of that income is more similar to executive management.

 

[nexus73]

Perhaps my local region is coloring my positive view on unions. Just had a psych unit close. Increasing jobs going to np's. More telehealth np's moving in. Local multispecialty clinic with employed doctors is increasing the number of patient contact hours from 32/week to 35/week, with no increase in comp. It seems the nurses everywhere have unions and are getting 30% pay raises. Jobs exist, but nothing is that great locally to me. Things are ok currently, but the trajectory is concerning. I'd rather have a union now while things seem ok, to keep them ok or make them better.

 

[tr]

It's about improving working conditions for employed doctors. From what I can tell, doctor unions pop up here and there with 100 hospitalists signing on at one hospital, or a few hundred across a health system. Hardly all of privatized healthcare.

I don't see the downside of a physician union, given the trajectory of corporate healthcare over the last 20 years.

I'm all for unionization generally, but the down side of actually being in one is you have to pay the union dues and participate in whatever collective actions the union decides to take, whether or not you agree with them or feel they benefit you.

Collective bargaining is important for workers who don't have negotiating power as individuals. We're not in that position.
Given the level of existing demand for psychiatry, I think we are probably better off negotiating for what we each want on an individual basis and voting with our feet, rather than taking the strength-in-numbers tack.

 

[comp1]

There is a cartel aspect to medicine that is kind of unique to physicians (and particularly psychiatrists). Indeed, the demand is very high and not abating (NPs or no), but also the supply is artificially limited. It's just very different from most unionized jobs. Our individual negotiating power (outside of government jobs which are already unionized) is massive.

 

[nexus73]

I'm not sure I fully agree we have the leverage you're talking about. Maybe I've just been employed by stone cold administrators who won't give an inch. I've seen doctors leave my hospital, neurosurgeons even, when the hospital wouldn't allow sabbatical of 3 months. I've seen child psychiatrists resign over frustrations in scheduling and no effort made to retain them. I saw an entire specialty group fired, replaced by locums and slowly replaced by employed doctors over a couple years. So maybe my employment experience is unique. But when hospital admin's approach is we don't negotiate, we see everyone as replaceable, take it or leave it, you have no leverage. You as the individual can leave, but all the problems it creates for the physicians staying are borne by the physicians, not admin (so what do they care). Everyone else is busier, on call more, higher patient load, etc. So you can leave as your leverage, which makes things bad for the remaining doctors, and admin really doesn't care.

 

[Merovinge]

I'm not sure I fully agree we have the leverage you're talking about. Maybe I've just been employed by stone cold administrators who won't give an inch. I've seen doctors leave my hospital, neurosurgeons even, when the hospital wouldn't allow sabbatical of 3 months. I've seen child psychiatrists resign over frustrations in scheduling and no effort made to retain them. I saw an entire specialty group fired, replaced by locums and slowly replaced by employed doctors over a couple years. So maybe my employment experience is unique. But when hospital admin's approach is we don't negotiate, we see everyone as replaceable, take it or leave it, you have no leverage. You as the individual can leave, but all the problems it creates for the physicians staying are borne by the physicians, not admin (so what do they care). Everyone else is busier, on call more, higher patient load, etc. So you can leave as your leverage, which makes things bad for the remaining doctors, and admin really doesn't care.

I see both sides because I worked 3 years for an organization like you describe (that sued doctors on the regular, made sure everyone knew it, would tell you something in-person or on the phone then pretend they didn't when it came up - get everything in writing lesson - no flexibility on any contract terms, etc.). They had a unique setup in that they provided visa's for doctors and this made up a large percentage of their workforce so there was always more doctors who had to be yes sir docs.

On the other hand, where I work now, is more akin to what others are describing. It's a metro, so there are always other jobs available, and many places really do need more docs to function optimally. The folks that work for these large systems tend to fit into a certain personality/values type that has a low value on autonomy, want a lot of structure, and just want to see patient's all day for an average paycheck. Certainly nothing wrong with that, but it does lead to administrators having the power you mention. Conversely when large groups of doctors walk, it has a big impact, we recently had a hospital have major accreditation concerns following a flight of doctors, which they fixed by dramatically overpaying what the docs previously were paid.

I think this tends to be very geographic, where in larger metros with enough competition the market actually makes things work fairly well. In smaller markets or places with more monopoly concerns their might be more rational for unionization or at the very least being part of an independent physician group.

 

[comp1]

If there are visas involved, you've lost all your negotiating power indeed. I don't think a union can fix visa issues.

 

[lol.psych]

If there are visas involved, you've lost all your negotiating power indeed. I don't think a union can fix visa issues.

I’ve worked at a hosp with a physicians’ union, which I think was particularly important because we had a lot of fantastic docs there on visas who would otherwise have no choice but to be screwed over in one way or another. There were also a lot of ****ty admins who tried to make an otherwise lovely job a huge pain in the ass. I also appreciated that we had a clearly written and super-long contract that specified, like, everything (it was hard for leadership to take too much advantage of any/all of us without the union rep making a fuss about it until it stopped — it was impressive). Now you’ve got me all nostalgic for a job I have no interest in doing anymore (but a workplace/coworkers that I really liked). The union part of it was a really positive experience for me.

 

[Merovinge]

If there are visas involved, you've lost all your negotiating power indeed. I don't think a union can fix visa issues.

Ironically I think that would be one of the instances in which they would be most useful...

 

[nexus73]

Another perspective to keep in mind for hospital employed doctors is the jobs within the hospital that are unionized are more likely to come out on top as hospital budgets are strained with increased costs for travel nurses and general expenses related to inflation, in the face of flat insurance reimbursement.

For example, if there's a nurses union pushing for cost of living raises and better benefits, the hospital is inclined to give into those demands as the entire system's nursing staff can strike and grind hospital operations to a halt. The hospital must make up the increased costs on the back of the non-union doctors and other non-union employees. Hospital budgets are only going to get worse as nurses demand cost of living increases, and insurance reimbursements are flat or getting cut.

 

[Ceke2002]

I am a strong Unionist across all fields of work, including healthcare. If you are able then you guys should absolutely unionise and be fully prepared to engage in industrial action to try and ensure a better, safer, healthier work environment, that then hopefully helps to improve patient care.

This is the mental health workers union in Victoria, Australia, if anyone is interested in having a look at the sorts of thing a Union like this does.

HACSU: Your union for disability, mental health, and alcohol and other drug services

Join HACSU, the only specialist union for the disability, mental health, and drug and alcohol services in Victoria.

hacsu.asn.au

There's also the general Health Workers Union and the Australian Salaried Medical Officer's Federation.

 

[comp1]

I'm not sure Americans would appreciate what unions have done for Australian physicians that much...their salaries are almost half that of Americans.

 

[nexus73]

I'm not sure Americans would appreciate what unions have done for Australian physicians that much...their salaries are almost half that of Americans.

Can you really claim that's because of unions? Every country pays doctors less than the USA, union or not. There's no way to know what Aussie salaries would be (or benefits, or work life balance, etc) without a union. And collective bargaining intuitively would serve to improve all of those things for doctors. I think you need more evidence than just saying the pay is lower than USA.

 

[mistafab]

I think residency unions make sense - across specialties. They have the N to make a meaningful impact within a system.

I don’t think physician unions make a lot of sense for psychiatry in the current climate.

 

[lol.psych]

I think residency unions make sense - across specialties. They have the N to make a meaningful impact within a system.

I don’t think physician unions make a lot of sense for psychiatry in the current climate.

What do you mean by the current climate? (actual question)

 

[mistafab]

What do you mean by the current climate? (actual question)

There is extremely high demand for psychiatry.

There are typically very few total N of psychiatrists at a single system.

There are very few places, even large corporations, where one location is similarly run/ closely associated with the others - bringing it back to the N problem and not having common things to fight for.

Perhaps a place like Kaiser where it is more integrated across specific locations it may be viable. But even VAs are very different from site to site so a union doesn’t seem useful - people at each specific site would be wanting very different things.

 

[Stagg737]

I am a strong Unionist across all fields of work, including healthcare. If you are able then you guys should absolutely unionise and be fully prepared to engage in industrial action to try and ensure a better, safer, healthier work environment, that then hopefully helps to improve patient care.

This is the mental health workers union in Victoria, Australia, if anyone is interested in having a look at the sorts of thing a Union like this does.

HACSU: Your union for disability, mental health, and alcohol and other drug services

Join HACSU, the only specialist union for the disability, mental health, and drug and alcohol services in Victoria.

hacsu.asn.au

There's also the general Health Workers Union and the Australian Salaried Medical Officer's Federation.

That union doesn't make sense to me. Why would physicians and techs all be part of the same union? Our job duties, pay, hours, pretty much everything is so dramatically different that it doesn't really make sense. The only similarities are that we work with the same patients in the same buildings (sometimes). It would be like pilots and steward/stewardesses being in the same union but imo makes even less sense. There are also already places in the US that have physician or other MH related unions. Some docs on this thread are part of them and all had negative experiences. I honestly can't see an upside to psychiatrists joining a union in the US unless they just don't understand anything about the business/administrative side of medicine here given the climate as Mistafab described above.

Also, there's the ethical side of medical unions and striking that I just can't get behind. If I were unionized and they told me to strike I'd tell them to shove it. Why handcuff myself and give a union then key when I could just be employed and keep the key to walk away whenever I want, or just not be handcuffed at all?

 

[nexus73]

That union doesn't make sense to me. Why would physicians and techs all be part of the same union? Our job duties, pay, hours, pretty much everything is so dramatically different that it doesn't really make sense. The only similarities are that we work with the same patients in the same buildings (sometimes). It would be like pilots and steward/stewardesses being in the same union but imo makes even less sense. There are also already places in the US that have physician or other MH related unions. Some docs on this thread are part of them and all had negative experiences. I honestly can't see an upside to psychiatrists joining a union in the US unless they just don't understand anything about the business/administrative side of medicine here given the climate as Mistafab described above.

Also, there's the ethical side of medical unions and striking that I just can't get behind. If I were unionized and they told me to strike I'd tell them to shove it. Why handcuff myself and give a union then key when I could just be employed and keep the key to walk away whenever I want, or just not be handcuffed at all?

The doctors who are in unions in this thread all seem to be in government jobs, and we really have no idea if the unions are helpful or not. Maybe they don't realize things would be worse without the union and there's no way to know. The government unions have probably been in place for decades so there's no memory of what it was like a generation ago. And we can't extrapolate from this if a union for a public sector job would be better or worse.

We do see the nurses with unions are better off than those without. I don't understand why physicians think this would somehow not be an advantage for them.

This idea that the market for psychiatrists is so great that a union isn't helpful is not fully thought out. The market isn't necessarily so great with hospitals hiring more and more np's, and the future of the market may likely get much worse. Plus the option to walk away from a job is always there, but would you rather leave a job because the administrators are forcing bad changes on you, or be able to reasonably negotiate to stay at the job and have it function more fairly.

Leaving because of bad admin is akin to taking your ball and going home. Not everyone wants to leave the game. Many people like their jobs, their city, their coworkers, and leaving the job as the only leverage if other options could be created with a union makes no sense.

 

[Stagg737]

We do see the nurses with unions are better off than those without. I don't understand why physicians think this would somehow not be an advantage for them.

My co-workers who have been traveling nurses would adamantly disagree with this. However, the nursing lobby also functions very differently and has very different goals than what a physician lobby would. Just ask the NPs who are involved...

This idea that the market for psychiatrists is so great that a union isn't helpful is not fully thought out. The market isn't necessarily so great with hospitals hiring more and more np's, and the future of the market may likely get much worse. Plus the option to walk away from a job is always there, but would you rather leave a job because the administrators are forcing bad changes on you, or be able to reasonably negotiate to stay at the job and have it function more fairly.

This is not true everywhere at all. I'm in a FPA state in a large hospital system and our department is actively trying to hire physicians and not NPs. Yes there are plenty of bad hospitals, but this isn't universal. Imo PE is a much bigger threat than anything you've mentioned, and physicians are the often the ones partnering with investors to drive this.