Over the last several years, I've had 8 Commentaries in these pages under the general heading of “Negative Secular Trends in Medicine,”
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things that I thought made it less likely that the smartest kids in the class, the ones we want to provide our care, would choose medicine as a career.In January, House Staff and Fellows at several institutions voted to unionize.
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This Commentary will be in two parts. The first is why I believe it would be terribly unfortunate for physicians to unionize. The second is what I believe are the reasons that caused these doctors to take such a drastic, potentially disastrous, step, and what can be done to correct the situation.I was a member of the Retail Clerks Union at my high school job from 1967 to 1969 and a member of the United Steel Workers for the 15 months I worked at Granite City Steel between college and med school from 1970 to 1973. Considering that fewer and fewer of our current medical students and young physicians have held jobs in the real world,
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I have a perspective of working in heavily unionized industries that few of them have.I started at the steel mill as a laborer in Yard Maintenance. On Friday afternoon of my first week, a man came up, put his hand on my shoulder, and said “Doc, you're working too hard.” I responded “I need this job bad. I'm paying my own way through college, and my dad says I have to work hard.” He replied, “Doc, you're making us look bad.” Think about that. Trying to excel is discouraged.
Several times workers came in inebriated. The supervisor sent them home—with pay. They just didn't want to put up with the hassle. I discussed this with my grandfather, who worked at “the Mill” from 1923 to 1963. The basic industries, steel, autos, and the mines, unionized in the mid-to-late 1930s. He said that prior to the unions, if you showed up 1 day and the boss didn't like the color of your eyes, you could be fired, and that was it, with no recourse. He said “when the unions first came along, they protected the job of the hard-working man. Now (the early 70s) they protect the job of the lazy man.”
I was an inspector on the quarter-inch line. Steel coils would be unrolled and chopped into pieces, which would stack up at the end of the line. The last several pieces went off gauge. I put on my work gloves and pulled the pieces off the stack. A man comes up “Doc, what are you doing?” Me: “Those pieces went off gauge.” Him: “Doc, that's not your job.” Me: “Oh, it's nothing.” Man: “Doc, you do that again, and I'm going to file a grievance against you.”
Me (thinking); I'm just a temporary employee, I don't need this. So the next time pieces went off gauge, I had to stop the entire production line, find a laborer, who would come over, put on his gloves, and take the defective sheets off the pile.
I fear that physicians, and their patients, will only discover that unionization was a mistake when:
- 1)They hear “Doc, you're working too hard.”
- 2)Patients appreciate that unions are protecting the job of the lazy doctor.
- 3)A patient's life is in the balance. A physician is about to perform a life-saving procedure, such as intubation or insertion of a chest tube, and someone comes over, taps you on the shoulder, and says, “Doc, that's not your job.”
I believe the reason these young men and women have become so frustrated that they voted to unionize is because we have turned our physicians-in-training into heavily indebted professional students. These physicians are in their early or even mid-30s, still in financial purgatory, while their college contemporaries who pursued careers in engineering or law or business, have become partners and hold prominent, financially lucrative positions. Although I disagree with their methods, I think these young doctors have a legitimate beef.
For decades, the university-industrial complex has raised tuition far faster than inflation. Training periods keep getting longer and longer—and longer. If one starts med school at the average age of 25 and trains in internal medicine, then cardiology, and then pursues a cardiology subspecialty, they could be elected President of the United States before they would be eligible to sit for their board examinations.
This vote to unionize should be a wake-up call for the academic medical establishment that our young doctors have reached their “Popeye moment,” that they say “This is all we can stands, ’cause we can't stands no more.” We have shown that every year a physician's training can be shortened increases the value of a career in medicine by 1 year's final salary.
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Allowing students into med school after 3 years of college, or even better, a combined 6-year college med school program, decreasing the time of medical residency for those who pursue a specialty, and decreasing the time of specialty training for those who wish to pursue a subspecialty, would increase the value of a career in medicine by $1,000,000 or more.Will the academic medical establishment get the message that they have made a career in medicine so unrewarding that physicians are going on strike? Watch tuition: If it continues to rise faster than inflation, I would consider it an act of bad faith that they just don't care. It pains me to say this, but don't hold your breath.
A majority of the physicians in the US are employees. Now many also want to unionize. These doctors don't realize that they will miss out on one of the greatest allures of being a physician, that is, being your own boss.
References
- Negative secular trends in medicine: student debt.Am J Med. 2016; 129: 8-10
- Negative secular trends in medicine: high CEO salaries.Am J Med. 2016; 129: e1-e2
- Negative secular trends I medicine: the American Board of Internal Medicine. Maintenance of certification and over-arching bureaucracy.Am J Med. 2016; 129: 238-239
- Negative secular trends in medicine: prolonged training periods.Am J Med. 2016; 129: 352-353
- Negative secular trends in medicine: summary.Am J Med. 2016; 129: 459-460
- Negative secular trends in medicine: high hospital profits.Am J Med. 2016; 129: 1141-1142
- Negative secular trends in medicine: training needs more emphasis on maturity, independence, and self-reliance.Am J Med. 2021; 134: 423-424
- Negative secular trends in medicine: part VIII: practicing physicians posting on social media.Am J Med. 2021; 134: 1317-1318
- Medical residents unionize over pay, conditions.Wall Street Journal. January 17, 2023; : A3
- Come down from the ivory tower.Barron's. September 22, 2014; : 43
- A medical education as an investment: financial food for thought.Am J Med. 2014; 1227: 7-11
Article info
Publication history
Published online: February 22, 2023
Accepted:
January 25,
2023
Received:
January 24,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: None.
Conflicts of Interest: None.
Authorship: The author is solely responsible for the content of this manuscript.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
