The Biggest Barriers To Physicians Standing Up For Themselves: Self-Image, Social-Image, Income.
Self Image
One thing most physicians pride themselves on, whether consciously or unconsciously, is our self-image as being hyper-successful at rule following. We literally spend decades doing nothing but that: Read book chapter, learn rules/laws/concepts of (insert subject), rinse and repeat until we're blue in the face. We pride ourselves on doing that better than the last 10,000 people we passed in Walmart. Combine that with the fact, that in the physician academic culture we are molded in, we beat any streak of rebellion out of ourselves and our trainees and make them beg for mercy and a second chance for stepping out of the herd. This impairs our ability to stand up for ourselves as effectively as we should and those in control use this a leverage against us.
All along our life cycles, from birth as pre-meds, to medical students, through residency and into practice, we expel the rebels, we cast out the firebrands, bully anyone on the edges into compliance, all while breeding and rewarding, compliant and robotic sheep. Show up to a pre-med interest group with purple hair, and you're mocked, cast out. Show up to a medical school interview with a nose ring and an attitude; sorry, reapply next year. Show up to residency match interviews with a neck tat that says, "Fight the power," and guess what, you're not going to match. Show up to job interviews on a Harley, with sleeved arms, and brag about how you excel at rebellion, upsetting the apple cart and questioning authority and, "Thanks, but no thanks. We're continuing to interview." We've effectively purged ourselves, our profession almost entirely of the traits and the people we would most need to harness and rely on to stand up for ourselves most effectively.
The act of collective bargaining, and using that power to create chaos, panic, disruption in the system your trying to change, in by its very nature a rebellion. It is not the act of pleasing your supervisors, as we are trained to do. It is not the act of negotiating in good faith. It is the opposite. It is not the act of raising your voice at the negotiating table. It is the act of turning the negotiating table over. It is not the act of watching negotiations break down. It is the act of making them break down. It is the act of being more pissed off, than wanting to go forward another minute as things stand. It's the act of saying, "No! ---- you! I'd rather have no job, than this ---ty job, on your s----y terms. I'd rather get 6 months behind on my house payment or get fired, than bow my head down and say, 'Yes, Sir. Thank you, Sir,' one more day."
If you're not willing to walk away from negotiations, walk away from your job, and risk it all for a new way forward, because you're too afraid to break the perceived "rules," then your negotiating power just drops 10 fold. The people making the rules that govern us, know this.
So it's no surprise that when we expect ourselves as a group, to do what comes naturally to the Steel Workers, Teamsters and Auto Workers Unions, we fall flat on our faces before even getting started. When put up next to those groups in a competition to stand up for ourselves and fight the power, they beat us 100-1, dunking right over us, laughing, mocking, trash talking, all day long, with no fear of a brawl even breaking out.
Income
Hospital CEOs, insurance company executives and government players also know that doctors, 99 out of 100 times, give up at the first threat of losing their job or pausing their upper class, hyper-spending lifestyle for even a day. They know the lifestyles we live and they know many of us, after many years of living on a shoestring budget in training, quickly ramp up our lifestyles to levels we struggle to support, even on our high incomes. They know this, and they use this as leverage against us. A doctor that has 6 months of living expenses to fall back on, is an entirely different animal to be backed into a corner by, than one how lives paycheck to paycheck and is over-leveraged, just hoping he will still be able to make the next payment for his boat, private-school, kids' camp, McMansion, vacation house, luxury car, golf-club, student loan or lawn service.
Social Image
The powers that be know, maybe even more than we know, how much we value our public and social image. They know at the first threat of losing our reputation as being a 'pillar of the community,' as altruistic, blue-ribbon, rule-following, patient helping, white-hat/white-coat, good guys and gals, which we would lose in a strike that has the perception of putting patients at risk, that we back down. They’re also happy to feed our belief in an outdated, extinct, social-structure, that we're in charge of anything more than what a nurse, patient, administrator, government regulator or insurance company clerk decides they'll allow us to be in charge of, on any given day. They're happy to play along with that mass hallucination, as long as we (you guess it!), follow their rules.
Whether or not we need to do better at standing up for ourselves as physicians, is without question. How do most effectively do so, is the question, whether from within the system or by revolting against it. And in general, we're absolutely terrible at standing up for ourselves. For everything we get an A+ at, we get F's all day long for standing up to a bully, whether it's a CMG, hospital, government or insurance company bully. And if you're not ready for a fight, to stand up to the bullies in healthcare-business, government, the insurance companies, and if you're not ready or willing to be called bad names, in public, in the press, by those who you're used to kissing your ---, then you might as well just suck it up, drop your head down, collect your check and be thankful for what you have, while trying to make changes within the system, and without having to tear down the system. And despite having plenty to be irritated about, I honestly think that's where most physicians are at today, with incomes being what they are. I don't think the majority of physicians, not even 5%, have the will or guts for a mass revolt, a strike or meaningful collective bargaining.
That being said, people are starting to get angry about pointless metrics, MOC over-reach, over-regulation, cuts in reimbursement, Obamacare and the corporatization of Medicine. That's a good sign. If these got bad enough, I expect attitudes may change.
But, before you decide you're a rebel, a renegade, ready to risk it all to stand up for yourself, ask yourself if you truly are. And ask yourself if the other 10,000 doctors you'd need to stand by your side have what it takes, to fight the power, and take the onslaught of slings and arrow that would come their way from something like a regional or national physician strike, truly are. Realize, that until the masses of your hyper-compliant physician colleagues also are pissed off enough, to do the exact thing, that's been bred, beaten and bullied out of their personalities and ranks and risk what they consider the most important benefits of their careers (self-image, social-image, income), that you’ll likely have to also find your own solutions and adaptations, that work for you on a personal level.
