Thursday, May 23, 2024

““html Dr. John Wust does not come off as a labor agitator. A longtime obstetrician-gynecologist from Louisiana with a penchant for bow ties, Dr. Wust spent the first 15 years of his career as a partner in a small business – that is, running his own practice with colleagues.
Long after he took a position at Allina Health, a large nonprofit health care system based in Minnesota, in 2009, he did not see himself as the kind of employee who might benefit from collective bargaining.
But that changed in the months leading up to March, when his group of more than 100 doctors at an Allina hospital near Minneapolis voted to unionize. Dr. Wust, who has spoken with colleagues about the potential benefits of a union, said doctors were at a loss on how to ease their unsustainable workload because they had less input at the hospital than ever before.

“The way the system is going, I didn’t see any other solution legally available to us,” Dr. Wust said.

At the time he and his colleagues voted to unionize, they were one of the largest groups of private-sector doctors ever to do so. But by October, that distinction went to a group that included about 400 primary-care physicians employed in clinics that are also owned by Allina. The union that represents them, the Doctors Council of the Service Employees International Union, says doctors from dozens of facilities around the country have inquired about organizing over the past few years.
And doctors are not the only health professionals who are unionizing or protesting in greater numbers. Health care workers, many of them nurses, held eight major work stoppages last year – the most in a decade – and are on pace to match or exceed that number this year. This fall, dozens of nonunion pharmacists at CVS and Walgreens stores called in sick or walked off the job to protest understaffing, many for a full day or more.
The reasons for the recent labor actions appear straightforward. Doctors, nurses and pharmacists said they were being asked to do more as staffing dwindles, leading to exhaustion and anxiety about putting patients at risk. Many said that they were stretched to the limit after the pandemic began, and that their work demands never fully subsided.
But in each case, the explanation runs deeper: 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.
““People do feel put upon – that’s real,” said John August, an expert on health care labor relations at the Scheinman Institute at Cornell University. “The corporate structures in health care are not evil, but they have not evolved to the point of understanding how to engage” with health workers.

Allina said that it had made progress on reducing doctors’ workloads and that it was partnering with health care workers to address outstanding issues. CVS said it was making “targeted investments” in pharmacies to improve staffing in response to employees’ feedback, while Walgreens said it was committed to ensuring that workers had the support they needed. Walgreens added that it had invested more than $400 million over two years to recruit and retain staff members.““professionals in a variety of fields have protested similar developments in recent years: Schoolteachers, college instructors and journalists have gone on strike or unionized amid declining budgets and the rise of performance metrics that they feel are more suited to sales representatives than to guardians of certain norms and best practices.
But the trend is particularly pronounced in health care, whose practitioners once enjoyed platinum-level social status at high school reunions and Thanksgiving dinners.
For years, many doctors and pharmacists believed they stood largely outside the traditional management-labor hierarchy. Now, they feel smothered by it. The result is a growing worker consciousness among people who haven’t always exhibited one – a sense that they are subordinates constantly at odds with their overseers.
“I realized at end of the day that all of us are workers, no matter how elite we’re perceived to be,” said Dr. Alia Sharif, a colleague of Dr. Wust’s at Allina who was heavily involved in the union campaign.

“We’re seen as cogs in the wheel. You can be a physician or a factory worker, and you’re treated exactly the same way by these large corporations.”

““We were all partners.’ Then came the metrics.The details vary across health care fields, but the trend lines are similar: A before-times in which health care professionals say they had the leeway and resources to do their jobs properly, followed by what they see as a descent into the ranks of the micromanaged.

As a pharmacy intern and pharmacist at CVS in Massachusetts beginning in the late 1990s, Dr. Ed Smith found the stores consistently well staffed. He said pharmacists had time to develop relationships with patients.
Around 2004, he became a district manager in the Boston area, overseeing roughly 20 locations for the company. Dr. Smith said CVS executives were attentive to input from pharmacists – raising pay for technicians if there was a shortage, or upgrading clunky software.

“Every decision was based on something that we said we needed,” he recalled.

Dr. Wust looked back on his days in an independent practice of about 25 doctors with a similar wistfulness.

“We were all partners,” he said. “It was relative workplace democracy. Everybody got a vote. Everybody’s concerns were heard.”

But in the early to mid-2010s, both companies elevated the importance of these indicators, several pharmacists said.
At Walgreens, many pharmacy managers began reporting to a districtwide retail supervisor rather than a supervisor trained as a pharmacist. “It coincided with more pushing of the metrics,” said Dr. Sarah Knolhoff, a Walgreens pharmacist from 2009 to 2022.““Asked how labor budgets were applied, CVS said managers were “provided guidance” based on expected volume and other factors, with adjustments made to ensure adequate staffing.

Dr. Smith and other current and former CVS and Walgreens pharmacists said their stores’ allotment of hours for pharmacists and pharmacy technicians had dropped most years in the decade before the pandemic.
The pharmacists also described being held to increasingly strict performance metrics, such as how quickly they answered the phone, the portion of prescriptions that are filled for 90 days rather than 30 or 60 days (longer prescriptions mean more money up front) and calls made urging people to fill or pick up prescriptions.
““CVS said that performance metrics were needed to ensure safety and efficiency for patients but that in recent years it had reduced the number of metrics it tracked. Walgreens announced last year that it would no longer rely on “task-based metrics” in performance reviews for pharmacy staff members, though it still used them to track store-level performance.

‘Corporate tells you how to manage your patient.’
The transition for doctors and nurses came around the same time. As independent medical practices found they had lost leverage in negotiating reimbursement rates with insurers, many doctors went in house at large health care networks.

“““Corporate tells you how to manage your patient” said Dr. Sarah Knolhoff, a Walgreens pharmacist from 2009 to 2022.

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