‘Good Doctors are Getting So Demoralized’: How Corporatized Medicine is Hurting NYC Physicians, too
NYC Health + Hospitals doctors tell Work-Bites their health care is “god awful.”
By Steve Wishnia
Editor’s Note: This is part two of a special two-part Work-Bites Report. Click here for part one.
The city public hospitals’ system of hiring doctors through private affiliates is devastating morale and endangering patient care, several doctors tell Work-Bites.
“Good doctors are getting so demoralized,” says Dr. Melanie MacLennan, an alcohol and drug-abuse specialist at Elmhurst Hospital in Queens. The city’s public hospitals never paid that well, but they were a good place to work, she explains. But now, “the conditions are so difficult and the pay is so crummy that they have a lot of trouble retaining and recruiting people.”
At Jacobi Hospital in the Bronx, all four rheumatologists quit last December, says former Elmhurst attending physician Dr. Roona Ray. At Woodhull Hospital in Brooklyn, two of the three oncologists left, and at Elmhurst, two of the four urologists did.
The result is severe understaffing, Dr. MacLennan adds. “We have anesthesiologists rolling babies into the NICU [the intensive-care unit for neonates, newborn babies],” and waiting times in the emergency room can be as long as eight hours.
At hospitals including Lincoln in the Bronx and Elmhurst, a significant percentage of doctors work on a temporary part-time basis, often coming in only one or two days a week. “That’s why Elmhurst was such a shitshow during COVID,” says a Queens physician who asked to be identified as Dr. Y out of fear of retaliation.
All this, they say, violates the traditional bargain for public-sector employees: They take lower salaries—a rough guideline is 80% of what they’d get in the private sector—in exchange for strong health benefits, pensions, job security, and doing the public service of treating the working-class, poor, and uninsured people who make up most of the NYC H+H system’s patients.
“I thought I was going to do something to give back to the community,” says a Bronx doctor who also asked to be anonymous out of fear of retaliation. “Now, you don’t get the benefits and you don’t get the pay. Patients don’t get the care.”
Benefits & Negotiations
Pay and benefits vary significantly from hospital to hospital and among different departments. The Doctors Council union negotiates contracts separately with the three affiliates, Physician Affiliate Group of New York (PAGNY), Mount Sinai, and New York University.
“We’re all having these parallel bargaining sessions without sharing information. It’s a good way to keep us divided,” says Dr. Y. “We have one union, and we all basically have one employer. H+H chooses my working conditions.”
That system is “designed to evade accountability,” he adds.
“There should be parity and transparency, and there’s none,” the Bronx doctor says.
Both NYC H+H and Mount Sinai are refusing to negotiate a joint contract that would cover both Elmhurst and Queens Hospitals. Mount Sinai won’t negotiate pay, says former Elmhurst physician Dr. Roona Ray, because H+H is the one funding salaries. In general, says Dr. Y, the affiliates are refusing to bargain over both hours and health care, but they want to increase premiums, deductibles, and copays.
Meanwhile, says Dr. MacLennan, “our health insurance is god-awful. It’s so expensive.” It costs $15,000 a year for a family of four, she adds, and there are additional charges such as a $50 “facility fee.”
“They get a large tax break for taking care of underserved patients,” she adds. “They get to fund their own insurance program and force us to use it only and the costs go up annually.”
Another issue is continuing education, which is important so doctors can deepen their knowledge and keep up with new developments. NYC H+H has given doctors 10 days off for that since 2008. PAGNY’s imposed terms reduce that to seven.
The lack of job security is another problem. “There were waves of firings and turnover at PAGNY during the past year,” says Dr. Y.
“You can be fired summarily,” Dr. MacLennan says. At Elmhurst, she adds, a lot of doctors fear retaliation because they are supporting others or are in the country on work visas.
Dr. Ray was laid off from Elmhurst when she was 37 weeks pregnant with her third child. “I think it was retaliation,” she says.
Mount Sinai fought giving her even unpaid maternity leave, she says. She suspects that was because it didn’t want to continue paying her health benefits. Lots of women end up using their accrued sick days and vacation time for maternity leave, she adds.
‘Corporatization of Medicine’
Morale was already battered by the COVID epidemic, when the system was overwhelmed by critically ill people and a chronic lack of supplies, and doctors worked 100 hours a week. In their last contract, in 2020, says Dr. Y, they agreed to a small raise, about 2%-2.5%, because “we were all busy intubating COVID patients.”
The deeper problem is what he calls the “corporatization of medicine,” with doctors essentially subject to production quotas. “I’m not used to being told to click boxes and go faster,” he says.
“I don’t think the H+H board has any idea of what our working conditions are,” says the Bronx doctor. The affiliates “put a lot of pressure on their doctors to make a lot of money for them,” she explains. “You’re not even a professional. You’re working in an industrial chain.”
“Doctors take care of the most marginalized people in the city,” says Dr. Y. “It’s just crazy that we don’t get city benefits.”
He believes that having a high-turnover workforce for the affiliates and NYC H+H, because they don’t want people emboldened enough to stand up for patients, to say “it’s not right that there are 60 people on stretchers in the emergency room.”
That turnover means patients suffer because “we don’t have continuity of care,” says the Bronx doctor.
Erosion of Public Services
Several say that the decline in working conditions for doctors and the resulting erosion of care at city hospitals amounts to institutional racism, given that most of the patients are black, Latino, or immigrants.
NYC H+H is by far the largest city-owned hospital system in the country, and one of the few remaining. The others are in Los Angeles, Chicago, and San Francisco, despite San Francisco General Hospital being renamed for Facebook owner Mark Zuckerberg in 2015 in exchange for a $75 million donation. Philadelphia’s public hospital was closed in 1977, and Boston’s was privatized in 1996.
NYC H+H should appreciate that many doctors choose to work in city hospitals because they “want to serve the poor and uninsured,” Dr. Ray says.
“They should be pro-union,” she continues. “We all want a good system of care for our patients. It’s really sad that H+H is resorting to this. We need a leader who demands more for it.”