Emergency room physicians, physician assistants and nurse practitioners at Ascension St. John Hospital in Detroit, Michigan, voted to authorize a strike on April 18 if their demands are not met.
The 43 members of the newly formed Greater Detroit Association of Emergency Physicians union are contracted by Ascension St. John Hospital but employed by a private equity-funded staffing company called TeamHealth. The clinicians have been in negotiations with TeamHealth for their first contract since last July.
TeamHealth, purchased by the Blackstone financial group in 2017 for $6 billion, took over management of the Ascension St. John Emergency Room in 2015. Since then, clinicians at St. John report worsening staffing levels, firing of experienced clinicians and dangerously long wait times for patients.
The Greater Detroit Association of Emergency Physicians is not associated with any larger union and currently just has members at Ascension St. John Hospital. Clinicians have been reporting on their struggles, conditions and demands on their website, SaveOurEmergencyRoom.com.
St. John clinicians report that patients are forced to wait 10-15 hours to receive emergency care. They also report chronic staffing shortages for clinicians, as well as nurses, transporters, radiology and laboratory technicians, which render timely and safe patient care impossible. St. John clinicians state that they can be fired for speaking out against these conditions and have no control over how patients are billed under their own names.
They also report being constantly floated to different zones of the ER during a single shift, making it difficult to focus and perform their jobs properly.
Clinicians are also fighting for the most basic benefits, like paid time off and sick days. Without sick days, clinicians take on the additional burden of making the choice to either work while sick, possibly introducing illness to immunocompromised patients, or lose a portion of their paycheck.
These are conditions are not limited to Ascension St. John but are universal across the United States. Hospitals which had been underfunded and understaffed for decades have been further decimated by the uncontrolled surges of the COVID-19 pandemic.
Significantly, Ascension St. John clinicians are connecting their conditions to the broader impact of private equity on healthcare, a phenomenon that has accelerated across the country since the start of the pandemic. In the opening of a statement featured on SaveOurEmergencyRoom.com, clinicians write,
We believe there is a sacred relationship between physicians and patients that is in direct conflict with the goals of a corporate organization. The primary obligation of a corporation is to its shareholders and creditors, while the oath of the physician is to provide the patients with quality, evidence-based care. The conflicts between these two often place physicians in a difficult ethical position and risk patient safety and physician wellness.
TeamHealth is the largest staffing firm outsourcing physicians in the country. It employs 15,000 physicians, and manages staffing in emergency rooms and other departments at over 2,900 facilities across the country.
In 2020, TeamHealth lost a class action lawsuit and was forced to pay $15 million to over 3,000 physicians, who had been cheated out of a portion of their pay. The company is currently in the midst of a class action lawsuit in California for fraudulent billing and another in North Carolina for significant up-charging of patients in an HCA hospital. TeamHealth also has a history of suing thousands of patients for unpaid bills, even patients who qualify for free care under the hospital’s charity care programs.
Last October, Henry Ford Health also announced that it would purchase all eight of Ascension Southeast Michigan hospitals, which includes St. John. If the acquisition, which is pending regulatory approval, is finalized, the takeover will have a long-term negative impact on St. John and potentially even lead to its closure. Research has shown that mergers and acquisitions raise prices for patients in the area, funnel a larger share of profits to CEOs and top hospital executives, and result in layoffs and hospital closures, especially for rural and unprofitable hospitals.
The terrible conditions which exist at St. John are reflected throughout the privatized American healthcare industry, the most overpriced and dysfunctional of all advanced economies.
According to a financial analysis by STAT News, hospital and healthcare CEOs have reaped enormous profits during the pandemic, with CEOs making an average of $15.3 million each in 2021 and in 2022. In 2022 alone, the pay of some 300 healthcare CEOs was a combined $4 billion. The fact that such vast wealth has been generated amid the deaths of millions from COVID-19 is proof enough of the irrationality of a healthcare system that prioritizes profit over the lives and safety of patients and healthcare workers.
Dominated by giant hospital monopolies, pharmaceutical, medical equipment and insurance companies, the for-profit healthcare system is based on the exploitation of healthcare workers and the sacrifice of patient health to the bottom line of the medical corporations and their investors. Under these conditions it is impossible for healthcare workers to provide high quality healthcare to the population.
As a result of the breakdown of the American healthcare industry, the role of physicians in the hospitals and in the class struggle has changed. Resident physicians, faced with crushing debt, are pushed to join healthcare systems rather than forming or joining a private practice. The pandemic also accelerated the trend of healthcare systems acquiring existing physician practices, which are increasingly squeezed out by healthcare systems and the insurance companies.
A study by the Physicians Advocacy Institute showed that since 2019, an additional 108,700 physicians have become employees of corporate healthcare systems, and an additional 36,200 independent physician practices were purchased by corporate healthcare systems. In all, 74 percent of all US physicians are now employed by a healthcare system or corporate entity, representing a 13 to 24 percent increase since the onset of the pandemic.
As a result, a majority of physicians are no longer in charge of their own practice, of their own schedules and patient loads. Previously a better-off layer of professionals, most physicians are now employed by health systems as wage laborers, squeezed by Wall Street for additional surplus value through stretched hours, overburdened workloads and reduced wages.
The fight against TeamHealth and its relationship with Ascension St. John is a political struggle against the entire corporate healthcare system in the US which is dominated by significant financial interests. Time and again the struggles of nurses and other hospital employees have been betrayed by union bureaucrats who seek to narrow the fight and then allow workers to let off steam while working with hospital management to prevent strikes and make deals behind their backs.
Recent examples of strikes where healthcare workers were betrayed by the unions are at Kaiser Permanente in California, Blue Cross Blue Shield in Detroit and nurses in Staten Island, New York. These experiences throw the duplicity of the trade unions into sharp relief.
The fight of physicians requires a political perspective that lays out clearly who are their allies and who are their enemies. Physicians now have far more in common with every other worker in healthcare and other sections of industry who are engaged in a struggle against layoffs, falling wages, rising inflation and worsening working conditions. The struggle of Ascension St. John emergency room clinicians must be connected with the growing wave of strikes and protests of healthcare workers around the world with a united goal to take profit out of medicine.