NYC Doctors Urge ‘No’ Vote On Proposed Contract
By Steve Wishnia
Doctors in the New York City Health + Hospitals system reached what their union called a “groundbreaking new contract” agreement Jan. 13—but a group of members is urging a vote against ratifying the tentative deal, saying it doesn’t do enough to address the system’s “physician staffing crisis.”
The proposed contract “will not attract doctors to fill the hundreds of physician vacancies across the H+H system,” an unidentified member of the union’s bargaining committee said in a statement Jan. 16. “It does not address our primary concerns: transparent and equal pay for equal work across the system in order to recruit and retain experienced physicians, an end to benefit cuts, and working conditions.”
The more than 2,500 Doctors Council SEIU members who work for private affiliate contractors at 10 of the 11 municipal hospitals will vote Jan. 21-24 on whether to ratify the proposed four-year deal. It was reached just before a strike deadline set by doctors at four hospitals, after Mayor Eric Adams persuaded the union, NYC H+H, and the three affiliates to go into mediation.
The tentative agreements—there are separate ones for Physician Affiliate Group of New York (PAGNY), which employs doctors at seven hospitals; Mount Sinai, the affiliate at two; and NYU-Langone—would increase doctors’ pay by $25,000 a year if they hadn’t gotten raises of at least $20,000 a year since 2020, and $19,000 if they had. It would also give “recognition bonuses” of $3,000 to $10,000, depending on seniority, set up a $12 million pool to raise salaries as needed to hire more doctors; and restore cuts to paid sick days that PAGNY imposed in October.
“It does not address the issue of the subspecialists, who are fleeing like crazy,” says “Dr. Blue,” an Elmhurst Hospital physician who asked not to be identified out of fear of retaliation.”
“I am proud that this tentative agreement puts us on a path to enhance care – for our patients, our communities, and the dedicated doctors they entrust,” Doctors Council President Dr. Frances Quee said in the union’s announcement.
The contract’s critics, however, argue that the pay increases are not enough to reduce the shortage of doctors; that while the deal would be retroactive to August 2023, raises wouldn’t; and that there would still be wide disparities in pay and benefits between different hospitals.
“It does not address the issue of the subspecialists, who are fleeing like crazy,” says “Dr. Blue,” an Elmhurst Hospital physician who asked not to be identified out of fear of retaliation.
At Harlem Hospital’s obstetrics & gynecology department, says Dr. Roona Ray, a former general practitioner with NYC H+H’s Virtual ExpressCare telehealth service, there are no doctors on staff in subspecialties such as infertility, gynecological cancers, and maternal fetal medicine—diagnosing and treating high-risk pregnancies.
The “pregnancy-associated mortality ratio” in New York City, a Department of Health study reported in 2023, was 42.9 deaths per 100,000 live births—but 101.1 deaths for Black women. Of the 29 deaths in 2020 that were directly pregnancy-related, it said, 21 were preventable.
That is why Dr. Vijay Palvia, an obstetrician and gynecologic surgeon at Lincoln Hospital in the Bronx, said she’s against ratifying the deal. If it’s accepted, she said in a statement, “the physician staffing crisis driven by PAGNY employment practices, especially at Harlem Hospital, will worsen. H+H is not living up to its mission of racial equity when it allows PAGNY to defund frontline maternity care at Harlem Hospital.”
The shortage also results in long waiting times for appointments to see specialists, says Dr. Blue—four to 12 weeks for a patient just diagnosed with cancer to see an oncologist.
When she worked at Virtual ExpressCare, Dr. Ray says, staff were instructed to stop referring patients to specialists, because the waits were so long. At Jacobi Hospital in the Bronx, it took a year to get a colonoscopy, she said. At Queens Hospital, someone just discharged after a heart attack typically has to wait three months to see a cardiologist, when they should be seen within two to four weeks.
“I can’t do that,” she says. “It’s bad medicine.”
The proposed $12 million hiring fund, she says, is a drop in the bucket compared with the hundreds of vacancies at NYC H+H hospitals and clinics, including 64 at Jacobi Hospital alone.
Rewarding delay
That the pay increases are not retroactive also irks doctors. First, because 17 months’ worth of raises is a significant sum. Second, in December, NYC H+H agreed to give the about 500 doctors it employs directly raises retroactive to 2021. Finally, said “Dr. Green,” a Queens physician who also asked to remain anonymous, it gives the affiliates “a huge reward for unfair labor practices and delay tactics.”
It also leaves the disparities in pay and benefits among hospitals and affiliates. Doctors who work for Mount Sinai, Dr. Blue says, have to pay 40% of their health-insurance premiums, while PAGNY covers the full cost. PAGNY gives one month of parental leave, while Mount Sinai gives none, says Dr. Ray.
As for pay, “our starting proposal was to be paid 20% less than the benchmark,” says Dr. Green. At NYC H+H, he says, primary-care physicians start at about $160,000 a year, while “hospitalists,” who see patients being considered for admittance, make about $170,000. At a private hospital such as Montefiore in the Bronx or Maimonides in Brooklyn, they’d make in the $300,000 range, although H+H is a “much harder job.”
Many are “locums,” working as temps, though often for semi-permanent stints. After four hospitals voted to authorize a strike in December, says Dr. Ray, recruiters were offering $3,600 a shift for those willing to scab.
She questions why the city needs to pay billions of dollars to the affiliates. She herself was laid off in September, when she was 37 weeks pregnant with her third child. She says she later saw her old position advertised as an hourly-wage job with no benefits—converted to “gig work.”
Another issue is that the tentative agreement doesn’t address the policy of halving the time primary-care doctors can spend with patients from 40 to 20 minutes.
That policy, Dr. Ray says, amounts to “we don’t care what the patient’s needs are, we don’t care about the doctor’s assessment of what the patient’s needs are.”
The way to decrease waiting time, she adds, “is to hire more doctors.”