Physician Assistant UNION (Let's talk about what use to be unthinkable)

[Katera]

The biggest waves start with the smallest ripple.  24 years as a PA, mostly conservative business views, and a generally negative view of most unions over my lifetime.  Yet....here we are.  In my tenure I have seen the role of providers utterly collapse in regards to ANY form of self-determination (this goes for doc's as well).  Is it time to begin considering radical changes to how we as a profession interact with CORPORATE OWNED MEDICINE?  

 

Practice after practice, specialty after specialty has or is falling to Corporate Medicine.

 

So......

 

 

1.)  What would it look like?

 

2.)  Have we come to it?

 

3.)  Any other ideas on how not to be treated as an MA with a DEA license that does not require organizing?

 

 

 

Please, keep it civil.

[sk732]

We came to it here in Manitoba - actually had not much choice because a health care union actually decided to take us under their wing without out permission, so we formed our own.  Helped a bit, since the new entry grads were actually getting less and less money each year and the folks that had been practicing for some time  had maxed out on pay incentive increases and hadn't even had a cost of living increase for several years.  It has also helped with call stipends and such.

 

SK

[Katera]

We came to it here in Manitoba - actually had not much choice because a health care union actually decided to take us under their wing without out permission, so we formed our own.  Helped a bit, since the new entry grads were actually getting less and less money each year and the folks that had been practicing for some time  had maxed out on pay incentive increases and hadn't even had a cost of living increase for several years.  It has also helped with call stipends and such.

 

SK

 

Wow that is interesting.

[jlumsden]

I know of at least one hospital whose PAs are obligated to join a union because they are supervised by nursing administrators.  I don't know the particulars of their union membership.

[sk732]

They joined the union becuase the nursing administrators made them OR because of the nursing administrators FULL STOP?

 

SK

[8404PA]

I know of at least one hospital whose PAs are obligated to join a union because they are supervised by nursing administrators. I don't know the particulars of their union membership.

What?! Nursing admin in charge of PAs.......

 

 

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[BruceBanner]

I know of at least one hospital whose PAs are obligated to join a union because they are supervised by nursing administrators.  I don't know the particulars of their union membership.

 

I'll offer some insight here.

 

I'm part of a union. It's a big union (UCFW), and we (the PAs) are members of their healthcare branch along with all RN staff where I work. 

 

Administratively, we are "managed" by nurse managers, but in practice this doesn't amount to much more than time-off approvals, setting up meetings, and other admin tasks you would see in a big HMO. Clinically we always answer to our lead doc.

 

The benefits of being in the union are amazing, no joke. Two hourly raises per year automatically, shift differentials for anything outside of the 9-5 norm, OT for anything over 8 hours in a day, a week of paid CME, paid holidays, PTO, 2 weeks paid sick time, STD, LTD, life insurance, 98% paid healthcare, retirement, etc. The works. Best benefits I have ever had, by far.

 

Our jobs are reasonably protected. Any changes to work duties or structure have to go through union negotiation, which is good and bad. There are no arbitrary firings or layoffs. Any terminations have to go through a long arbitration/grievance process unless you rob a bank or something.

 

As an employee I can say it is wonderful and well worth the dues. There are some minor drawbacks, however, such as the often ridiculous seniority principle, having to ask for time off months and months in advance, not being able to clock out even 1 MINUTE early, that sort of thing.

 

The union structure here has been in place for many decades and is separate from the physicians (who are a for-profit group), and health plan/foundation itself. There have been talks in the past of merging with the physicians group, but from what I hear PAs have unanimously refused because they know the docs would sh!t all over them if they were under their auspices.

 

I think a nationwide PA union is a great idea and could potentially be implemented, but I would not even know where to begin. The politics of unionizing a workforce of 100,000 is daunting.

[treejay]

I think unionization makes sense in the era of corporate medicine.  The admin of these corporations or large not for profit multi specialty groups are in it to maximize profit and that often leads to squeezing the practitioners by adding more patient volume, more responsibilities, and more hours.  Additionally, I think practitioner burnout stats are absolutely appalling.  Unionization would lead to improved quality of life and decrease burnout, I have absolutely no doubt.  I suspect for it to work well, the union would have to be together with NPs, otherwise they will be favored even more.

 

Here are 2 articles about a physician hospitalist union:

http://www.nytimes.com/2016/01/10/business/doctors-unionize-to-resist-the-medical-machine.html

http://www.modernhealthcare.com/article/20160609/NEWS/160609915

[MarcPA]

This story should raise eyebrows and chills up your spine. I'll spare the gory details but want to present this to show that the little guy (read a single PA-C or NP for that matter) has ZERO bargaining power against a monopolistic malignant corporation. Here's my example:

I've been in practice 7 years working in some very demanding high volume areas with very little support so I have learned to make sound conservative medical decision and rarely (but when needed) call my supervising physician. Because of my experience and background, a recruited pursued me for a nocturnist hospitalist position where there would be little oversight. I was told it was a 'sleepy hospital' where I would be 'sleeping for dollars effectively'. I spent a lot of time with the HR guy to get a decent offer. They gave me $8,000 for a 2-yr commitment, 40 hours of extra PTO (both are not prorated so much work 2 yrs to have them forgiven or else entire benefit must be refunded).

 

I have worked at the hospital for almost a year now. I have kept detailed logs of all the calls and admissions. What the recruited conveniently left out was that when I was hired there were 47 physicians that the hospitalist service covered. Two months later, they picked up 19 more physicians. The day team had 2 physicians and three midlevels (PA/NP). When the 19 physicians were added, they added another daytime physician (so 3 physicians and 3 midlevels for days).

 

At night, no changes were made. Out night time admissions grew from 3-5 to over 10 and as high as 15 on some nights for a single providers. I have presented graphs, time based statistics pointing out that a single provider taking a page/call ever 6-10 minutes and admitting 5-15 patients over the 12 hour ship is unsafe and provides poor patient care and satisfaction. That has been presented for over 8 months beginning in August 2017 to date with no change in night time staff.

 

So, finally in January I said enough and want to move to another position effective mid April. They hired a green PA and have him in training. I put in a request to take off two weeks (I work 7-on and 7 off so that is a month off) to travel after mid April. First I was told I couldn't take off 14 days due to a limit of 80 hours. Also I couldn't take off two weeks in a month. So, I responded I would take off a week end of April and a week in May only to be told I couldn't take off two weeks in a row and that it would compromise patient care!

 

I get almost one day of vacation per bimonthly paycheck but can't take it. Here's their policy.  The policy is a very classic example of denial of ability to use benefits based on contrived circumstances (intentional understaffing). The above scenario of intentional understaffing show the predatory nature of the corporation. Additionally, zero PTO will be paid if you leave employment under 3 years!

This is a classic example of why the little guy is a victim and we as professionals need to stand together - a union is just that vehicle.

Notice in the attached policy file the

Procedures for requesting time off:

1. 1. All APP’s are subject to the current Human Resource policies for paid time off.  For more information, please reference Policy HS-HR0720 – Paid Time-Off (PTO).

   2. No more than two (2) weeks of consecutive PTO may be taken at any given time.

       

   3. PTO will be granted on a first-come, first-serve basis.  It may be necessary to cap vacation/CME requests during times of heavy requests.

       

   4. PTO requests must be submitted and approved at least 90 days in advance.  Please do not make travel arrangements before receiving approval.

       

   5. Only one APP can take time off (5 or more consecutive days) at any given time, unless approved by site chief (must be extenuating circumstances).

       

   6. Accommodations will be made to permit one full week (7 days) of time off (using 40 hours of PTO).  The time off will be counted towards your personal request maximum per month and will be approved in advance.

   7. *Requests for four (4) consecutive days or less must be submitted as “personal off time” via Tangier Web to the site medical director.

       

   8. *Requests for five (5) consecutive days or greater must be submitted as “vacation off time” via email to UPPEM administration.

       

   9. All time off requests are due in Tangier two months prior to the scheduling period (whether or not PTO will be applied), unless the provider may locate a swap, or the site medical director approves. Requests should be submitted by the 15^th of the month.

       

   10. If the provider will not meet his/her standard hours for the pay period due to time off requests, PTO will be applied.

        

 

[CAdamsPAC]

BOHICA.........It's time to cut that place loose, they seem to have zero respect for your professional circumstance nor your personal life or desires.

[MarcPA]

Yep, interviewing :D

[Cideous]

Old thread, but prob more relevant now in 2018 then it was when it was started in 2016.  I wish Texas had a PA union.  Simply stated though it will never happen, and if it did...that would be the end of the PA vs NP debate.  PA's would loose.

[MidwesternTexan]

In general, Unions- Not good.

Public worker unions?- SHOULD be outlawed!  Along with all lobbyists.

[sk732]

The right union for the right reason - the one that tried to pull all the PA's in a certain health region here was only looking at the amount of money they could get in dues from a combination of 170 odd folks.  When questioned about those of us that were outliers in other regions, they basically didn't care, since you could count on 2 hands how many of us there were at that time.

Our current PA union has upped the minimum entry level wage that was actually going down each year instead of up, increased the maximums on the end of the scale and ensured cost of living increases for each of the last 4 years - the folks at the high end of the pay scale hadn't seen a cost of living increase, much less a raise, in over 7 years for the older folks.  As a result, even if you go into a private practice, the minimums are set as to hourly wage, PTO, CME budgets, call pay, shift diffs, etc - other benefits are negotiable if you're not a public employee with a regional health authority (medical/dental are through the RHA and there is a provincial health care worker's pension plan for public employees).  If I were to go to Ontario or Alberta at present, I'd be losing up to $15-20/hr at worst and $9/hour at best, depending on specialty and work hours - what's worse is that those provinces have higher costs/standards of living than where I am now.

Incidentally, being ex-military, not a big union fan...also not a big fan because I lost a volunteer work experience position because of a union knob that didn't actually work for a living sticking their nose into something they shouldn't have.  There have been more than a few times where it would have been nice to be able to pull out the card and say "Nice try" when someone tried frigging me around - now I can and do.

SK