- Geoff Bennett:As recently as the early 1980s, roughly 75 percent of doctors in the U.S. worked for themselves, owning small clinics.Today, that same percentage of physicians are employees of hospital systems or large corporate groups. Some physicians worry that trend is taking a heavy personal toll and leading to diminished quality of care.As Fred de Sam Lazaro reports, doctors at one large Midwestern health provider decided to unionize.
- Fred de Sam Lazaro:Hours before sunrise, Kate Martin shepherds her daughter to the ice rink.While her daughter perfects her balance on the ice, Martin uses the time to seek her own work-life balance.
- Dr. Leah Duvor, Allina Health:I currently have about 86 things in my in-basket.
- Fred de Sam Lazaro:For family practitioner Leah Duvor, the best time to catch up with backlogged work is after her small children are in bed.
- Dr. Leah Duvor:It will depend on my kids, whether they wake up and come down or cry, or the baby needs a bottle.
- Fred de Sam Lazaro:For many primary care clinicians, work stretches far beyond clinic hours, notes from clinic appointments, lab results, medication orders, messages from specialists.For some, it’s reaching a breaking point. On this recent morning, Martin, a nurse practitioner and colleagues, doctors and physician assistants, all employed by the Allina Health system, gathered in an unfamiliar setting, the Minneapolis offices of the National Labor Relations Board, here to witness the ballot count in a historic vote to form a union.
- Dr. Matt Hoffman, Allina Health:We can’t rely on corporations, we can’t rely on health care executives to do the right thing for our patients.
- Fred de Sam Lazaro:Dr. Matt Hoffman, a leading organizer of the drive, says primary care providers have borne the brunt of a relentless drive to squeeze profits by increasingly large corporate owners, all at the expense of patient care.His employer, Allina, is a $5-billion-a-year health system, with 60 primary and urgent care clinics across the Twin Cities area and nearby Wisconsin communities. Hoffman says that the problems here are hardly unique.
- Dr. Matt Hoffman:You could go to any city, you could find a health system where the same issues exist. The main problem is, we have so much paperwork, so much administrative work that really isn’t about delivering care to patients. The victims of that are really the patients we see. It’s waiting on hold.It’s not getting to see your normal doctor. It’s having to see someone that doesn’t know about you.
- Fred de Sam Lazaro:Pediatrician Jennifer Mehmel said she’d had enough and took an early retirement from Allina to strike out on her own.With a psychotherapist colleague, she was just settling in a new small clinic above a St. Paul strip mall targeted at adolescent patients.
- Dr. Jennifer Mehmel, Collegiate Mental Wellness:I have a luxury of controlling my own schedule. I can spend the amount of time I need.
- Fred de Sam Lazaro:She began her career in a provider-owned group which was later bought by Allina. With the merger came centralized scheduling and standardization in everything, from how much time is spent with each patient, even to hand sanitizers, she says.
- Dr. Jennifer Mehmel:They were putting them all at kind of waist level right as you came in the room. And I went up to the fellow doing it and said, this is the pediatrics department. How about if we put them up a little bit higher, because I could see kids really enjoying these?He said, no, I have been told they have to all be at this level. A week later, of course, they had to come and move them all.
- Fred de Sam Lazaro:Dr. Hoffman was among those who protested an even graver policy at Allina, one they took to The New York Times.The policy instructed staff to stop providing care to patients with more than $4,500 in overdue bills, going beyond the more common practice of turning such debts over to collection agencies.Did you have personal experiences with patients that you could no longer see?
- Dr. Matt Hoffman:Yes, absolutely. These are the patients are really need the care the most, people that can’t pay their bills. A lot of these people are children.
- Fred de Sam Lazaro:Allina announced it has since discontinued the policy.The company declined to be interviewed for this story, but, in a statement said — quote — “While we are disappointed in the decision by some of our providers to be represented by a union, we remain committed to our ongoing work to create a culture where all employees feel supported and valued.”When all the ballots were tallied, the 500-plus providers voted 2-1 in favor of the union.What do you expect if you get to the bargaining table?
- Dr. Matt Hoffman:We need more staff. We need better paid staff to help support us, so that we can spend our time in the exam room with patients. We need help with our paperwork, with the administrative tasks, so that we can focus on patient care.That’s really what were looking for.
- Paul Clark, Pennsylvania State University:Things have to be pretty bad, I would argue, when physicians do try to organize, because this has never remotely been a part of their professional culture.
- Fred de Sam Lazaro:And Paul Clark, a professor of labor and employment relations at Penn State, says the doctors’ vote is hardly the final chapter.Your guess is that we won’t see a contract between Allina and this group of doctors anytime soon?
- Paul Clark:If there was it would be highly unusual. They have sent a signal that they’re going to fight this. They have hired one of the top anti-union law firms in the country and paid them a tremendous amount of money.
- Fred de Sam Lazaro:The same law firm has represented Starbucks, he notes, where employees at more than 300 outlets have voted to unionize over the past two years. Not one has reached a contract.
- Paul Clark:The strategy is delay, delay, delay. If you can delay signing a contract for a year, then there’s a provision of the law that allows the workers to basically reverse their vote.It’s called decertification. Workers expect a contract that’s going to improve things. The hospital delays. A year goes by. The employees there are saying, well, we’re not getting what we thought we would get. We’re paying dues. And we went to all this trouble. And it’s not producing anything.
- Fred de Sam Lazaro:On the other hand, he says, physicians do have more leverage and less job turnover than baristas. And the vote comes as a recent Gallup poll showed a majority of Americans, 71 percent, approve of unions, the highest level since 1965.Whether these doctors get a contract and how far, if at all, the Allina model spreads, Clark says, may become clearer in a couple of years.
- Woman:Solidarity.
- Fred de Sam Lazaro:For the “PBS NewsHour,” I’m Fred de Sam Lazaro in Minneapolis.
- Geoff Bennett:And Fred’s reporting is a partnership with the Under-Told Stories Project at the University of St. Thomas in Minnesota.
The corporatization of health care
and how doctors are fighting back
As recently as the early 80s, about three of every four doctors in the U.S. worked for themselves, owning small clinics. Today, some 75 percent of physicians are employees of hospital systems or large corporate entities. Some worry the trend is leading to diminished quality of care and is one reason doctors at a large Midwestern health provider decided to unionize.
75%
of physicians are employees of hospital systems or large corporate entities.