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Doctor Strike May Be Harbinger of Reform Era Labor Problems

Doctors at University of California student health centers are on strike this week — part of the first full-fledged strike by doctors in the U.S. in 25 years. Is this a harbinger of new labor struggles in the post-health reform era?

Maybe, said Stuart Bussey, president of the Union of American Physicians and Dentists, which staged the UC walkout.

“Doctors are becoming factory workers, and there’s going to be more of this kind of problem as long as organizations are more attuned to the business side of health care instead of the medical side,” Bussey said.

“I’m getting calls from all over the place from docs who are frustrated with the lack of control and usurping of decisions by administrators and bean counters … by people who see these lives as widgets on a factory line,” Bussey said.

Physicians at 10 UC student health centers are striking this week over alleged unfair labor practices. Doctors at Northern California campuses walk out on Thursday and stay off the job until Tuesday. Doctors at Southern California campuses will leave Saturday and return next Thursday. In January, UC physicians staged a one-day walkout over the same contract. That was the first labor stoppage by U.S. physicians over a contract since 1990.

UAPD, formed in the San Francisco Bay Area more than 40 years ago, has been working toward a contract for about 150 UC physicians for two years.

The union claims UC administrators will not divulge financial information, which the doctors say is needed to justify what they say are lower-than-standard wages.

“Salaries really are the subtext of this thing,” Bussey said. “The big picture is what the employer does and doesn’t want the practice of medicine to be.”

The UC Office of the President did not respond to requests for comment.

Unionization of Doctors ‘Unlikely’

Joanne Spetz, director of the UC-San Francisco Health Workforce Research Center and professor at the Institute for Health Policy Studies at UCSF, said unionization may grow among the ranks of some providers such as nurses and some hospital workers, but it’s less likely for physicians because they are rarely employees in the traditional sense.

“It seems unlikely to me that we’re going to end up with a scenario with doctors as true employees on any large scale,” Spetz said.

“I do think we may see more movement toward exclusive physician groups like the Permanente Medical Group working exclusively for Kaiser, but that’s much different than a true employer-employee situation.”

Spetz said consolidated physician groups in some specialties may be more likely to form unions than others.

“I think with docs getting into larger more powerful medical groups like hospitalists and emergency room docs, you could see some unionization down the road, but probably not any time soon and not on any large scale,” Spetz said.

UC Officials ‘Disappointed’

UC officials released a prepared statement saying UC students will receive medical care they need during the strike, according to published reports last week.

“UC is taking appropriate steps to ensure our students will have uninterrupted access to the medical services they need at our campus health centers during these strikes,” Dwaine Duckett, UC vice president for human resources, said.

“We urge our employees to come to work during the strikes and continue serving the students who rely on them for care. Strikes that negatively impact our students will not resolve a labor dispute,” Duckett said.

Duckett said UC officials are “disappointed” by the call to strike.

“We are disappointed that the union has chosen to stage strikes for the second time in three months instead of negotiating to resolve the remaining issues,” Duckett said.

Since starting negotiations more than a year ago, UAPD has filed several unfair labor practice charges against UC with the Public Employment Relations Board. The key claim, according to union officials, is that UC officials refuse to provide financial information.

“For more than a year, UC said it could not afford to make the changes needed to attract and retain student health center doctors. Recently they admitted they can afford to improve health care on campus, they just choose not to,” Bussey said.

“We continue to push hard for this financial information because we believe UC has enough resources to improve student health care,” Bussey said.

Assembly Line Health Care

Bussey compares the health system at UC student health centers to a famous candy factory assembly line scene from “I Love Lucy.”

“Ethel and Lucy were doing all right until they speeded up the belt,” Bussey said. “We’re not going to speed things up just to satisfy the needs of the people who run this factory.”

Bussey said student health center clerks knock on exam room doors to tell physicians to hurry up.

“We’ve lost sight of what medicine is supposed to be about,” Bussey said.

Bussey, who also operates a private family practice in Walnut Creek, predicted the evolving health system will create more pressure on private practice and more physicians will become employees of larger organizations.

“And along with that shift there will definitely be labor issues like this one,” Bussey said. “I’ve been practicing medicine for more than 30 years, and I’ve seen the changes that managed care is bringing.”

The employer-employee relationship can work in health care, “but it has to be a partnership, more along the lines of what Kaiser does,” Bussey said.

“That’s a big difference between Kaiser and UC,” Bussey said. “There’s no partnership at UC.”

Without shared decision making and transparent financial workings, Bussey predicted more labor problems between providers and employers.

“I believe we’ll see more of these kinds of labor disputes unless the management-labor relationship is formed more as a working partnership,” Bussey said. “It can work in the private sector and in the public. I worked with county and state government for many years and I worked for Kaiser for four years. I know it can be done.”

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