Could Healthcare Reform Result in NP Unionization?

Democrat, Republican, Independent or indifferent, I think we can all agree healthcare reform has not brought the promised cuts to healthcare spending and clarity to health insurance plans it promised.  Really, it has just made everyone mad- patients and providers alike.  The stage is now set for healthcare providers to unite across party lines in their distaste for what is coming to healthcare.  

As with any massive and sweeping reform, Obamacare has brought unintended consequences of change.  The Affordable Care Act, for example, has spurred new businesses dedicated to helping individuals navigate this new health insurance world.  Other entrepreneurs are set on advising companies regarding the best way to deal with healthcare law.  New business is decidedly good for our country.  How, though, will unintended consequences of the Affordable Care Act affect you as a provider?  Unionization of healthcare workers seems to be one of the unintended outflows of Obamacare.  

Healthcare Workers Aren't Doing Well on Their Own

Sad but true, the healthcare industry is the only field that has experienced a labor productivity decline in the past 20 years.  When my husband confronted my with this tidbit of information I explained that personally, it has to be because my hospital still runs on an MS-DOS based computer system (I'm not joking).  Seeing everything I type come out all neon green and pixelated distracts me from my more pertinent job related duties.  Whatever the reason behind this dismal yield among the healthcare workforce, healthcare workers are producing paltry return for their wages.  While the manufacturing sector boasted a 4.7% annual increase in labor productivity over the past 20 years, healthcare productivity has declined steadily by 0.6%.  

Productivity among healthcare workers may be on the decline however salaries for healthcare workers are on the rise.  In fact, labor represents over half of all healthcare related expenses.  To economists, this is a red flag.  Employers are paying medical workers increasingly more for doing less and less work.  The natural fix if you're an employer?  Experts recommend decreasing wages and reducing number of workers.  Not good news if you're the employee. 

We Don't Want to be Own Our Own in the First Place

Historically, physicians have been self-employed.  You know, the stereotypical family doctor operating his own clinic including a small staff of nurses, receptionists and possibly a clinic manager.  The historic family doctor was the person you could call at all hours of the night for any assortment of medical problems big or small- and he would be happy to help.  He birthed your children and was at your grandmother's death bed.  Not so anymore.  The way of the traditional family doctor is fading.  Now, physicians and therefore other healthcare employees are becoming increasingly employed by large hospital systems. 

Providers are willing to sacrifice income and autonomy for a better quality of life.  An on-call shift once every six weekends sounds like a vacation compared to the 24/7 model ambitiously taken on by a solo doc.  Researchers estimate that over the next few years, 80 percent of physicians will be employed by large health systems.

Unions are Peddling Hope for Healthcare Workers

Hospitals are putting the heat on employees to become more productive, becoming stingier with salaries and demanding more from their workers.  What can employees do to fight back in these situations?  Unionize.

As medical providers join larger hospital systems in massive numbers as opposed to going solo, how will they get what they want from these hospital systems?  Possibly unions.  

As the healthcare workforce becomes more consolidated, for a variety of reasons, unionization becomes likely.  With union membership declining thoughout the country as a whole, union leaders are eager to get a jump on the plight of the healthcare sector, primed for collective bargaining.  Healthcare union membership is already becoming a trend with 13.6% of healthcare workers unionized in 2009.  Currently, most of these members are not providers (MD's, NP's and PA's). 

It's yet to be seen just how far unionization will spread in the healthcare sector.  But, it seems that within near future, more than just a few nurse practitioners will become unionized.

What are your thoughts on the unionization of healthcare providers?  Do you think this is good or bad for you personally?  For our healthcare system as a whole?

Comments

I don't know where you got the half of all expenses are labor number from but the hospital budgets I have seen, including ones that are supposed to represent typical hospitals actually list labor as 1/3 of the hospitals costs. Supplies and equipment are another third. Of course, the labor costs also include C ring compensation.

I also have to say that I don't think productivity declining is a bad thing. Studies show that the more patients a nurse is assigned, the more likely it is that one of them will die. Thus, I guess it depends on what kind of productivity outcome you want. Less productive may actually mean better outcomes.

As for the ACA, this nurse has personally met patients who's lives have been saved by gaining access to care due to changes in health care laws. Pull up a seat in triage and listen to some compelling stories of people who's lives have been made better by the exciting changes already available. Its not perfect and personally I would've preferred universal coverage but we've got to work with what we've got.

vicedrn