Doctors now unionize like factory workers. Care only gets more compressed and standardized.

“Why Doctors and Pharmacists Are in Revolt” appeared in yesterday’s New York Times written by Noam Scheiber. If you subscribe to the Times, read it. If not, I’ve pulled out a few highlights below, but I cannot do it justice because the piece is long and multi-layered.

The overall message, as you can imagine, is due to recent mergers of chain drugstores and clinics, the exodus of health professionals during and post covid, the focus of profit over care, managers who are business executives, not medical professionals, care is becoming ever more bled out of the system and the system is ever more standardized.

Health professionals are increasingly overworked and have less access to resources and staff. Those at the top are seen, and treated, as efficiency managers. Those under them, cogs in a wheel. As a result, patients get less time with their docs and pharmacists, less personal attention, health providers who are exhausted, and increasingly are recipients of policies that are profit, rather than care, based.

I know this is not a new story. If you follow our industrialized medical system and the plight of health professionals, as I do, you’ve been reading about this over the past several years. Somehow, however, this article really struck a nerve. Perhaps it’s the fact that health professionals now feel the need to unionize – no longer given the respect of their years of education and training, they are seen as ‘Human Resources.’ That title invented by management in business years ago. The irony of people being resources, while you’re trying to say that you respect people, is thick.

Dr. John Wust, an obstetrician-gynecologist featured in the article talks of how little input doctors are given regarding the practices designed for and around them by health corporations. Once he could have never dreamed of being in a union but now he feels it’s his only recourse.

Both CVS and Walgreens say they have made significant investments in their workers’ staffing needs. But as Scheiber writes, “A longer-term consolidation of health care companies has left workers feeling powerless in big bureaucracies. They say the trend has left them with little room to exercise their professional judgment.” Professionals feel micromanaged and everything has become about the metrics.

Pharmacists described being held to measures as to how quickly they answer the phone and how many scripts they fill for 90 over 30 and 60 day prescriptions as the 90 day fills mean more profit. One cited pharmacist gave up his position as district manager to become a frontline pharmacist again. He couldn’t inflict on others what he saw as unconscionable, including weekly calls when a budget for tech hours exceeded by 10, nothing much, but a warning call its required.

I will close with this quote, “Corporate tells you how to manage your patient,” said Dr. Frances Quee, president of the Doctors Council, which represents about 3,000 doctors, most of them at public hospitals. “You know that’s not how you’re supposed to manage your patient, but you can’t say anything because you’re scared you’re going to be fired.”

What world have we created? Why is money almost always more important than how we treat each other, the planet, the other species that live here?

I have no answers. I just wish more people were asking and asking more fervently. I think at some point this movement by health professionals will cause a change I hope so because it frankly scares me to see so blatantly, so openly and so glaringly the profitization of healthcare, the thing we will all be relying on more and more as we age.

2 thoughts on “Doctors now unionize like factory workers. Care only gets more compressed and standardized.

  1. t’s odd because I had a conversation a while back with Matt Benessere, the head of strategy at Bigfoot Biomedical (which sold itself to Abbott earlier this year) which was based on my criticism of the company’s requirement for doctors to subscribe to Bigfoot’s “Clinic Hub” in order to even make Bigfoot Unity available for sale at those endocrinologists. The same is not true for the Companion Medical (now Medtronic) InPen. My conversation was essentially that according to the AMA (see https://www.ama-assn.org/about/research/employed-physicians-now-exceed-those-who-own-their-practices for details), as of 2018, 47.4% of practicing endocrinology physicians were EMPLOYEES of some entity, while just 45.9% owned/operated their own practices. Today, more doctors of all specialties are employees of someone than stand-alone doctor’s practices. That means these doctors couldn’t simply subscribe to Bigfoot Clinic Hub even if patients wanted it because it would need to go thru an RFP at their employers (many are large group practices owned/operated by large regional hospital systems, although many are now owned by United Healthcare’s Optum business). My point was that Bigfoot lacked and would never be able to sell Unity to patients of those doctors. In the end, Bigfoot ended up selling to Abbott because the venture capital dried up and the company couldn’t keep running. On February 13, 2023, we started to see the first signs of financial distress when Bigfoot sold the company’s intellectual property assets related for Bigfoot Biomedical’s pump-based automated insulin delivery technologies to Insulet in order to strengthen the company’s balance sheet (see https://www.businesswire.com/news/home/20230213005076/en/Insulet-Acquires-Insulin-Pump-Patents-from-Bigfoot-Biomedical-as-Both-Companies-Prioritize-Improved-Insulin-Delivery-Technologies/ for the press release), although Bigfoot (and presumably, now Abbott) retained a lifetime license to those patents, they were assets which could be sold to raise money. But that was kind of our first clue that things were not looking so healthy at Bigfoot Biomedical. Anyway, I thought you might appreciate knowing the AMA says that today, more endos are employees of someone else than independent practices.

    • Thanks Scott. My endo is at Mt. Sinai so I guess he’s an employee. I don’t know how Mt. Sinai docs are treated but I know I’m lucky I found him. Yes, it’s never pure when money and business tactics find their way into health “care.”

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