Though Romantic, Unions Are Harming Patient Care In Medicine

I understand the purpose of worker’s unions. They offer protection against unfair employment practices. And when a large group of people come together they have more bargaining power. They  can demand a better work environment and they can protect themselves against wrongful terminations.

That said, unions also make it damn near impossible to make changes on the fly. In my medical group the MA’s and nurses are unionized. If we change the hours of the urgent care we need to notify the union, bargain with them and have them agree before proceeding. If we want to add new workflows to the nurses such as screening patients we yet again have to sit down with the unions and bargain.

The situation is complicated by the lack of expertise by those in power when it comes to dealing with unions. Different individuals in the chain of command have a different understanding of union rules. One person says “No, that can’t be done, the union won’t go for it!” and another person says “Oh it’s okay, we don’t even have to notify the union of this.”

There comes a point when a system is made so complicated that it just putts along inefficiently. Then, finally, when it has gained so much momentum that it bulldozes over important and necessary changes to keep a company competitive it tends to fall apart. A bunch of people quit and everything has to be renegotiated. This cycle is very common in large organizations and is sometimes the only way major changes take place.

Medicine changes very quickly. We have to deal with things like Ebola scares and antibiotic-resistance. A medical group may suddenly get a large bolus of patients such as through Medicaid. In order to roll with the punches plasticity and adaptability are critical.

And what do you do about incompetent staff? An incompetent nurse who is unionized or an inefficient affiliate clinician, such as a PA/NP, could be outright dangerous. Getting that individual terminated is a lengthy and exhausting process. And let’s face it, in an industry where there is already so much change to deal with who has the time to go through those steps? It’s easier to just shuffle those individuals around.

Soon, the clinicians who are hired on become aware that no matter how hard they are willing to work their competence is curbed by the incompetence of the support staff. A bottleneck develops and frustration sets in. The once-efficient doctor realizes that s/he might as well just function within the competency of the support staff. The docs will still earn their paycheck and even though patients are hurt by this bottleneck it’s out of his/her hands… so why bother trying.

How come physicians aren’t in unions? We all know why. Once you reach the top of the food chain and once your paycheck is high enough it’s somehow assumed that you don’t need equal rights. Overtime? Go fuck yourself. Depression, alcohol addiction, burnout? Tough shit. Protected lunch breaks? Deez nutz.

I’m quite disappointed to see that even PA’s and NP’s are now in unions. In the future I will write about the culture of medicine in regards to DO’s, MD’s, PA’s and NP’s. But for now I enjoy witnessing the same group of people who hide behind their ‘union rules’ demanding equal recognition as their MD/DO counterparts.