Labor Day and the Physician
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Colleagues:
Labor Day, an annual celebration of workers and their achievements, in recognition of the men and women whose labor built our communities, strengthened our economy, and continue to sustain our nation. We celebrate the contributions of those who work in factories, offices, schools, construction sites, farms, stores, transportation, and countless other settings. But there is another group of workers whose labor is often discussed differently: physicians.
Medicine is a profession grounded in education, expertise, ethical obligations, and a commitment to patients that extends far beyond a conventional job description. Yet we as physicians also work. We work long hours, carry significant responsibility, and increasingly find ourselves subject to the same forces that affect workers throughout the American economy. Perhaps Labor Day is therefore an appropriate time to reconsider what it means to be a physician in today’s healthcare system.
The traditional image of the physician is one of independence: a doctor who owns or works in a practice, makes clinical decisions based upon professional judgment, and develops a long-term relationship with patients. That model has been steadily eroded. Consolidation of hospitals and health systems, growing insurance company influence, private equity investment, and increasingly complex administrative requirements have transformed the physician’s workplace.
For many physicians, the ability to determine how they practice medicine has diminished. Someone else may determine how much time can be spent with a patient, which tests can be ordered, which medications can be prescribed, and whether a treatment will be approved. Prior authorization, utilization management, documentation requirements, productivity expectations, and increasingly complex electronic systems consume enormous amounts of physicians’ time. Increasingly we are employees within a system over which we have limited control.
If physicians are increasingly treated as employees, should we also begin thinking about physicians as workers who need greater collective power to protect our professional interests?
Organized medicine has traditionally attempted to address these problems through advocacy. Medical societies have worked with legislators and regulators, testified before government agencies, negotiated with insurers, and developed policies intended to protect physician autonomy and patient care. These efforts remain important. But after years of advocacy, many of the same problems remain unchanged, some have worsened.
Physicians continue to face declining autonomy, administrative burdens, inadequate reimbursement, increasing liability exposure, and pressure from organizations whose financial interests may not always align with the interests of physicians and our patients. As individual physicians we have relatively little leverage when confronting a large hospital system or insurance company.
The labor movement arose in part because individual workers recognized that they had little ability to influence the conditions under which they worked. Collective action provided a means to negotiate with organizations that possessed substantially greater economic and institutional power. Medicine has historically been reluctant to embrace that concept. Physicians have viewed themselves as independent professionals, and many have understandably resisted being characterized as labor. But the healthcare system has changed dramatically. Perhaps our thinking must change with it.
This does not mean abandoning the professionalism that distinguishes medicine. Nor does it mean reducing the physician-patient relationship to an employer-employee contract. Rather, it means recognizing that we as physicians cannot effectively advocate for our patients if we lack the ability to advocate for ourselves. We entered medicine to care for patients, not to spend our professional lives fighting bureaucratic systems. We should not have to choose between being a good physician and being a successful employee. And we should not accept a healthcare system in which those who deliver care have the least influence over how that care is delivered.
Labor Day reminds us that workers have historically gained a stronger voice when they stand together. Physicians should take that lesson seriously. Perhaps the most important message of Labor Day for physicians is therefore not that we are laborers. It is that we are stronger when we stand together.
Organized medicine has spent decades advocating for physicians. If those efforts are no longer sufficient to protect physician autonomy and the practice of medicine, perhaps Labor Day provides an opportunity to ask whether we need to think differently about how we organize, negotiate, and advocate.
All the best,
Mark J. Adams, MD, MBA, FACR
MSSNY President
