At first glance, John Wust doesn’t seem like a labor agitator. An experienced obstetrician-gynecologist from Louisiana with a preference for bow ties, Wust spent the first 15 years of his career running his own practice with some colleagues. Even after accepting a position at Allina Health, a large nonprofit healthcare system based in Minnesota, in 2009, he didn’t see himself as the type of employee who could benefit from collective bargaining.
But that changed in the months leading up to March, when his group of over 100 doctors at an Allina hospital near Minneapolis voted to unionize. Wust, who had spoken to his colleagues about the potential benefits of a union, said that the doctors didn’t know how to alleviate their unsustainable workload because they had less influence than ever at the hospital.
“With the system as it is, I didn’t see any other legal solution available,” Wust said.
At the time they voted to unionize, they were one of the largest groups of private sector doctors to do so. But by October, that distinction belonged to a group of about 400 primary care doctors employed in clinics owned by Allina. The union representing them, the Service Employees International Union Council of Doctors, claims that doctors from dozens of clinics across the country have inquired about the possibility of organizing in recent years.
Doctors are not the only healthcare professionals who are unionizing or protesting in greater numbers. Healthcare workers, many of them nurses, held eight major strikes last year—the highest number in a decade—and are on track to match or exceed that number this year. In the fall, dozens of non-unionized pharmacists working at CVS and Walgreens called in sick or walked out mid-shift to protest understaffing, with many doing so for a full day or more.
The reasons behind the recent labor actions seem simple. Doctors, nurses, and pharmacists said they were being asked to take on more tasks as staffing levels decreased, leading to exhaustion and anxiety about endangering patients. Many said they were pushed to their limits when the pandemic began, and their workload never fully decreased.
But in all cases, the explanation is deeper: the consolidation of healthcare companies has made workers feel powerless against large bureaucracies. They say this trend has left them little room to exercise their professional judgment.
“People feel overwhelmed. That’s real,” said John August, an expert in labor relations in the healthcare sector at Cornell University’s Scheinman Institute. “Corporate structures in healthcare are not evil, but they haven’t evolved to the point of understanding how to interact” with healthcare workers.
Allina stated that it had made progress in reducing doctors’ workload and was working with healthcare workers to address outstanding issues. CVS said it was making “specific investments” in pharmacies to improve staffing levels in response to employee feedback, while Walgreens stated that it was committed to ensuring workers had the support they needed and had invested over $400 million in two years to hire and retain staff.
Professionals in various fields have protested similar situations in recent years. Teachers, university instructors, and journalists have gone on strike or unionized amid increasingly tight budgets and the rise of performance metrics that they believe are more appropriate for sales representatives than for upholders of certain standards and best practices.
But the trend is particularly pronounced in the healthcare sector, whose professionals used to enjoy a platinum social status at high school reunions and Thanksgiving dinners.
For years, many doctors and pharmacists believed they were largely outside the traditional hierarchy between management and workers. Now they feel suffocated by it. The result is a growing labor consciousness among people who haven’t always had it, the feeling that they are subordinates in constant conflict with their superiors.
“In the end, I realized that we are all workers, despite the elite perception people have of us,” said Alia Sharif, a colleague of Wust’s at Allina who is heavily involved in the union campaign. “We are seen as cogs in a machine. You can be a doctor or a factory worker, and these big companies treat you exactly the same.”
“We were all partners” until performance metrics came along
The details vary across the healthcare field, but the trends are similar: a time when healthcare professionals say they had the leeway and resources to do their job well, followed by what they see as a descent into the ranks of meticulously managed day laborers.
As an internist and pharmacist at a Massachusetts CVS in the late 1990s, Ed Smith felt that the stores were always well-staffed. He said pharmacists had time to build relationships with patients.
Around 2004, he became a district manager in the Boston area, overseeing about 20 stores for the company. Smith said CVS executives listened to the pharmacists’ opinions: they increased technicians’ salaries if there was a shortage or updated outdated computer programs. “Every decision was based on something we said we needed,” he recalled.
Wust reminisced about the days he worked in an independent practice with around 25 doctors with a similar nostalgia. “We were all partners,” he said. “It was a kind of labor democracy. Everyone had a voice and a vote. Everyone’s concerns were heard.”
Over time, however, consolidation and the rise of increasingly larger healthcare service companies left workers with less influence.
As so-called pharmacy benefit managers, who negotiate discounts with pharmacies on behalf of insurers and companies, acquired rivals, retail giants like Walgreens and CVS also made acquisitions to maintain market power.
The chains closed many of the newly acquired locations, leading more customers to existing stores. They tried to cut costs, especially those related to staffing, while benefit managers controlled drug prices.
Around 2015, Smith left his district manager position and became a frontline pharmacist again, unwilling to supervise coworkers in conditions he considered subpar. “I couldn’t ask my pharmacists to do what I couldn’t do,” he said.
Among his frustrations, he said, was the need to strictly limit the number of workers each pharmacy could schedule. “Every week you go over your direct labor budget, you get a call, regardless of the volume of prescriptions, from your district manager,” Smith explained. “If your budget for technician hours is 100 and you’ve used 110, you get a call. It’s not a lot of money, maybe $180, but you get a call.”
When asked how labor budgets were implemented, CVS responded that managers received “guidance” based on expected volume and other factors, and adjustments were made to ensure adequate staffing.
Smith and other current and former pharmacists at CVS and Walgreens said that the allocation of hours for pharmacists and technicians in their stores had decreased most years in the decade before the pandemic.
Pharmacists also described increasingly strict performance metrics they were required to meet, such as how quickly they answered the phone, the proportion of prescriptions filled for 90 days instead of 30 or 60 (longer-term prescriptions translate to more upfront money), and the calls made to…