If New York City is a ‘Union Town’ Why Does it Prescribe Union-Busting for its Ailing Doctors?

Members of the Doctors Council delivered a petition signed by more than 1,000 physicians last July warning Mayor Eric Adams that working without a  contract is undermining recruitment and staff retention.

By Steve Wishnia

Editor’s Note: This is part one of a special two-part Work-Bites report. Click here for part two. 

The prolonged contract dispute between doctors at the city’s public hospitals and the three private affiliates that New York City Health + Hospitals has outsourced their employment to is coming to a boil.

The contract with the Doctors Council, an SEIU affiliate that represents 2,800 attending physicians (doctors who have completed their residencies) expired in August 2023, but was periodically renewed as talks continued.

But on Oct. 17, Physician Affiliate Group of New York (PAGNY), the affiliate that is employer of record at seven NYC H+H hospitals, declared an impasse in bargaining, and said it was imposing its last contract offer.

Mount Sinai, the affiliate at Elmhurst and Queens hospitals, was prepared to declare an impasse earlier this month, according to doctors with knowledge of the proceedings, but was dissuaded after more than 80% of the doctors at Queens signed strike-pledge cards. New York University, which hires doctors at Woodhull Hospital in Brooklyn, has not acted yet.

The affiliate system emerged during then-mayor Rudolph Giuliani’s attempt to privatize the 11 city hospitals in the 1990s. Previously, while NYC H+H had contracts with medical schools to supply residents and some more senior staff, that was an academic affiliation; doctors in the system were city employees. Bellevue in Manhattan is now the only city hospital where doctors are still directly employed by the city. PAGNY is the affiliate at Harlem and Metropolitan hospitals in Manhattan, Kings County and South Brooklyn in Brooklyn, and Jacobi, Lincoln, and North Central Bronx in the Bronx, although some doctors at Kings County are city employees.

As a result, there are separate contract talks between the Doctors Council and each affiliate, along with a voluntary “coordinated table” with NYC H+H and the three affiliates.

That arrangement is making the negotiations difficult, Doctors Council President Dr. Frances Quee told Work-Bites in late October. The union, she says, wanted NYC H+H at the table, but “they just kept bouncing us back and forth.” The three nonprofits, she adds, tell the union “we don’t control the purse strings,” but NYC H+H, which funds the hospitals, says, “we’re not your employer.”

She added that she hoped an agreement could be reached without a “job action.”

“The city tells us they’re not a joint employer, we don’t work for them,” says a Bronx doctor who asked not to be named for fear of retaliation. “They hire these shell companies.”

PAGNY is being represented by Seyfarth Shaw, one of the nation’s most notorious union-busting law firms. It was one of several firms NYC H+H engaged for labor and employment-related matters in a five-year contract for $51.3 million in various outside legal help its board approved on Sept. 26. The others included Jackson Lewis and Morgan Lewis & Bockius, two of the largest firms that specialize in “union avoidance.”

Seyfarth Shaw accused the union of refusing to accept that in order to raise pay and achieve parity in benefits among the different hospitals, “some things would go up and others would minimally decrease.” The terms PAGNY is imposing include a pay hike, but also raise health-care premiums to between 3% and 6% of income, depending on salary, and increase some copays by $5 to $10.

“We’re in New York, where you have the best hospitals and are supposed to have the best care,” the Bronx doctor told Work-Bites. “They’re spending our tax dollars to fight physicians who want better care for their patients.”

The Doctors Council filed an unfair labor-practice complaint with the National Labor Relations Board Nov. 13, accusing PAGNY of illegally making unilateral changes to the contract and bargaining in bad faith. It had already filed ULP complaints in early October charging that PAGNY was refusing to negotiate over the compensation of doctors who work on a temporary per-diem basis, and that Mount Sinai had refused to provide requested information and to bargain over “a key component of doctors’ wages.”

“Our physicians are a valued part of NYC Health + Hospitals,” an NYC H+H spokesperson said in a statement to Work-Bites. “However, as we and our affiliates are currently engaged in collective bargaining with the Doctors Council, we can't comment on the details of ongoing negotiations.”

Neither PAGNY nor Mount Sinai responded to messages from Work-Bites.

Several doctors who spoke with Work-Bites said their main complaints are that under the affiliate system, they don’t get the solid benefits and job security that they would as city employees, while getting paid substantially less than they would in the private sector. That, they said, has led to high turnover among staff and a workload that makes it impossible to give patients adequate care.

Particularly egregious, they say, is NYC H+H’s September move to reduce the amount of time doctors can spend with a first-time patient from 40 to 20 minutes. That policy was intended to reduce the time people had to wait to get an appointment, but it makes it much more difficult to evaluate patients with complications from ailments such as diabetes or disabilities such as cerebral palsy, or to diagnose whether a patient’s shoulder pain comes from a rotator-cuff injury or is a symptom of a heart attack.

That’s especially true for the large proportion who don’t speak English fluently. When doctors have to communicate through a translator, “20 minutes is enough to say hello,” says Dr. Melanie MacLennan, an alcohol and drug-abuse specialist at Elmhurst Hospital in Queens.

The system also lacks translators for less common languages, says the Bronx doctor, such as Soninké, a West African language spoken by some of the city’s estimated 25,000 Malian and Gambian immigrants.

Many immigrant patients also have no medical-history records in the U.S., says Dr. Quee.

The affiliate system, however, has one ironic advantage, some doctors said. As they are technically private-sector employees, they are not covered by the state Taylor Law, which prohibits strikes by public-sector workers. As of Nov. 20, more than 80% of the doctors at Queens and Jacobi had signed strike pledges.

Part 2 will appear tomorrow.