If there are any lingering doubts about the disconnect between health care workers in the trenches and administrators in the C-suite, one need only look at recent headlines.
In March 2020, emergency physician Ming Lin, a 17-year veteran of PeaceHeath St. Joseph Medical Center in Bellingham, Washington, was terminated by his employer TeamHealth. The reason? Lin publicly criticized the hospital for failing to protect staff with adequate personal protective equipment. A few weeks later in Idaho, physical medicine and rehabilitation doctor Neilly Buckalew was fired over her insistence to wear her own protective face mask while treating patients. In Mississippi, two hospital physicians said they were fired for “disruptive” behavior when they advocated for increased safety measures.
And in April 2020, nurses at Providence St. John’s Health Center in Santa Monica, California, were suspended when they refused to treat patients with active COVID-19 infection without proper personal protective equipment.
These brave men and women were punished for nothing more than asking to protect themselves—and their patients—from an infectious disease that is ravaging our nation. Moreover, their request is not based on paranoia or imaginary fear. As of April 2020, more than 9,000 U.S. health care workers have contracted COVID-19, and 27 have died.
Administrators tone-deaf to physician concerns
As health care workers in New York begged for more protective masks and donned garbage bags due to insufficient hospital isolation gowns, Mount Sinai Health System executives Kenneth Davis and Arthur Klein reportedly left the city to work remotely from their ocean-front Florida homes. At the same time that thousands of health care workers were being laid off, furloughed, and given pay cuts, administrators at Denver Health Center granted themselves sizeable performance bonuses “ranging from $50,000 up to $230,000.” Partners HealthCare, the largest health care system in Massachusetts, notified physicians that they would not be receiving hazard pay for their work in a letter signed by CEO Anne Klibanski, who reportedly earns up to $6 million per year.
While executives work from the safety of their homes and give themselves raises, medical students and resident physicians are being graduated early to help out in the fight, losing educational opportunities and without hazard pay. Doctors who speak out are threatened with termination or scolded for a lack of professionalism. For example, residents at NYU Langhorne who asked for hazard pay were accused of not being “compassionate and caring” physicians.
Other hospital administrators have made it clear that employees need to show up and keep quiet. In a video posted on Reddit, the chief operating officer of New York-Presbyterian Hospital called complaints about safety “incredibly dispiriting,” and told hospital employees, “you have a job because of the work that New York-Presbyterian does.” She further instructed staff to “stop sending emails, cards, and letters saying that we are disrespecting you. If you feel that way… it raises for us whether you, in fact, want to keep working for New York-Presbyterian.”
Bridging the chasm
What can be done to bridge the chasm between health care workers and administrators? In some cases, shining a media spotlight on unfair practices has resulted in a public outcry, forcing organizations to walk back policies. For example, after media reporting and statements from the American Academy of Emergency Medicine and Washington State Nurses Association condemned the firing of Ming Lin, TeamHealth officially announced that Lin was no longer terminated and that they would be working with him to “find the right location for him.” And following media scrutiny and a petition signed by 3,400 workers, Denver Health CEO Robben Wittenstein apologized to hospital employees for the timing of executive bonuses.
While it may be difficult for individual workers to respond to corporate policies, coalitions can often effect change. Nurses and other non-physician health care workers have successfully worked through unions to negotiate with employers and ensure adequate protections during the COVID-19 pandemic. For example, when HCA Florida, the state’s largest private hospital system, restricted the use of protective masks for health care workers and prohibited staff members from bringing their own protective equipment from home, the nurses’ union sent HCA a letter demanding better safety measures for workers.
While very few physicians are currently part of a labor union, safety issues related to COVID-19 have inspired an increased discussion of unionization. The Facebook group The Physician Collective, described as “a group of physicians who are standing united for our safety, autonomy, the right to practice our profession and care for our patients,” was founded on March 21, 2020, and already includes 26,000 members. Bunmi Agboola, MD, one of the founders of the movement, believes that now is the time for doctors to come together, noting that “the current COVID-19 crisis has highlighted how vulnerable physicians are.” Agboola says that more doctors are also recognizing that as employees, they lack protection under the current health care system, something that unionization may be able to help.
Another step that physicians can take is to report unsafe practices. The U.S. Department of Labor released a statement on April 8, 2020, reminding health care organizations that it is illegal to retaliate against health care workers who report unsafe conditions during the pandemic. According to the news release, “workers have the right to file a whistleblower complaint online with OSHA (or 1-800-321-OSHA) if they believe their employer has retaliated against them for exercising their rights under the whistleblower protection laws enforced by the agency.”
Is it time to walk away?
Maya Angelou said, “If someone shows you who they are, believe them the first time.” Physicians and other health care workers may choose to respond to unresponsive leadership by changing employers once life returns to normal. After all, some health care companies have shown a strong response during the pandemic, offering support, adequate supplies and prepared facilities. Many have gone above-and-beyond to protect staff, like chief physician executive of Baystate Health in Springfield, MA, Andrew W. Artenstein, M.D. Artenstein wrote to the NEJM about his organization’s herculean efforts to obtain personal protective equipment for staff members, including international negotiations, surreptitious meetings in unmarked vehicles, and last-minute political interventions straight out of a spy thriller.
Another option for physicians is to consider leaving an employed model of practice altogether. While physicians have been attracted to employment to free themselves from the burden of day-to-day practice management, many are realizing that increased consolidation and private equity arrangements prioritize profits over patient care. As an example, TeamHealth, the company that employed emergency physician Ming Lin, is owned by private equity company Blackstone, a worldwide investment firm.
But what choices do doctors have? According to physician career coach Stephanie Freeman, MD, MBA, physicians should consider working as an independent contractor rather than a W2 employee. “Contract physicians—those who work as locums physicians/1099 physicians—often have more options when they find themselves in undesirable work conditions than employed (W-2) physicians do.” Freeman notes that independent contractors are not bound by the typical restraints found in an employment contract, such as prolonged notice or restrictive covenants. “If a [contract] physician finds themself in an undesirable work condition for any reason, all they have to do is leave.”
Physicians may also consider a return to self-ownership in the form of private practice. While physicians have increasingly sacrificed the autonomy of practice ownership for the promises of financial security, the COVID-19 pandemic has demonstrated that employment does not necessarily protect physicians from economic downturns. One practice model that has proven to be somewhat resilient to the downturn in business associated with the coronavirus pandemic is direct patient care, a model that eliminates third-party payers.
The time for physicians to take back control of the profession of medicine is now. While the COVID-19 pandemic has created serious challenges for the health care system, it has also brought a wave of public support and empathy for physicians and health care workers. The media and patients everywhere are paying attention. This is our opportunity as physicians to bring the focus of medicine back where it belongs –away from the business of making money for shareholders and back to the care and safety of patients.