Dr. Roger Wu’s Analysis of San Francisco County Tentative Agreement

Dear Colleagues:

Last week marked the end of two months of negotiations between the UAPD and the City that no one wanted to have—and were completely and utterly necessary.  In brief, we gave the City a concession (four unpaid holidays in 2009 and another four in 2010) in return for saving our raise (3.75%; the escrowed funds should be in your accounts in 3 weeks) and to buy time;  a layoff-free period and an extended contract date that won’t have us bargaining at the bottom of a terrible recession.

All four of us (Roger Wu, Deb Brown, Jon Smith and Derek Kerr) and both our Union professionals urge-OK, plead—that you vote in favor of the holiday concessions we are trying to make when you get your ballot.  We think it’s pretty simple; four unpaid holidays for saving the raise and buying us time.  Please vote in favor.

In more detail:

Those four unpaid holidays this year bought a no-layoff period (to November, 2009) to keep MDs from being the first on the chopping block as the Mayor and Supervisors start desperately cutting this spring for next year’s budget.  The idea is to save our skills and patient care abilities and a no-lay off period was one partial way to get there.  It is also true that any union without a no-layoff period would be completely exposing its members by offering a route to full-year salary savings as they were laid off.

2010’s four unpaid holidays bought us a contract extension.  None of us have a crystal ball, but no one wanted to be negotiating a contract in the spring of 2010, at what our best guess promises to be only a worsening recession—A spring 2010, recession-bound contract would have made large, unpleasant givebacks (think lessening health care coverage, increased cost-sharing, much lower pay) entirely possible.    Being in front of a mediator as the City lamented its finances and talked about give-backs—well, we would lose—and lose big. When the City has no money, it doesn’t matter how good a case we generate with talk, charts and negotiation—the City wins. So we gave up the four days in 2010 to by the contract extension to 2011.  May better times will come to all of us by then.

Let me explain what we gave up and what we got in more detail.  First and foremost, we saved our raise—the 3.75% increase to all of our salaries, which has been in escrow and “lock-box” has been released as of Monday; with the City’s normal speed and efficiency, you should see an extra-large paycheck with back-pay dating to the raise date of April 4th date in your accounts in about 3 weeks.

It should be no surprise to learn that the City is deep in a financial crisis—We have no reason to doubt and every reason to believe that the deficit going into the next year will be somewhere in the hundreds of millions of dollars—and unlike in years past, there is no rabbit to pull out of the hat, no shell game that suddenly makes things turn out magically well.  Thus, there was a real need for us to do something—and therefore, four unpaid holidays in 2009-2010 and four more in 2010-2011.  We put in language that will make it so that if you are supposed to be working on those holidays, you’ll get paid for them, but be expected to take an unpaid day later; and also language so that if you retire during that period, your retirement pay will be grossed up as if you had been paid—so no one that retires in the next two years will take a retirement pay hit (and may Prop F make your golden days even better if that’s the pathway you go down).

Frequently Asked Comments and Questions (FAQ):

But SEIU didn’t vote for any concessions!  How come we gave up something?

o     Ah yes, indeed, SEIU 1021’s membership chose to vote down their first tentative agreement.  And with that, any such similar deal was off the table for all other, necessarily smaller, unions.  Instead, SEIU 1021 made no concessions, took a pay increase, gave no furlough or unpaid holidays and refused to start contributing to the retirement fund.  However, the story isn’t over yet.  SEIU and the City are at the table again this weekend, so we hear, trying to work something else out—and so, SEIU may indeed still be making concessions in the near future.  Time will tell and their members would have to decide they wanted to ratify.

Well, what was the case for making concessions if SEIU didn’t?

o     Well, first, SEIU may STILL be making concessions. That story isn’t done yet.
o     Second, our concessions saved our raise.  Yes, the four unpaid holidays mean that for now, effectively, it won’t feel like a full raise; but eventually, it will!  And in a long-standing commitment, your negotiating team tries to do what is right in the long-run for the City, it’s patients and UAPD members—in this case, the City’s short term savings still give us an eventual increase in pay; and for retirement calculations, that increase in retirement pay will be long-reflected and paid into our member’s retirement kitties (and yes, if you retire during the next two years, you will be retirement pay credited for the unpaid days as if they had been paid! See? We didn’t miss a trick)—and remember, in stark contrast to Marin, San Mateo, Alameda and even, yes, Cal-PERS, Social Security and Medicare—the City’s retirement fund, so far,  has been so well run that it can pay the funds it has promised (you can thank Clare Murphy, a retiring Civil Servant at Retirement for that small miracle)
o     Third, our concessions bought us time, short term and long term.  Why buy time?
o     Short term, we have a no-lay off agreement through November 15th, 2009 (along with Fire and Police and perhaps others to follow).  That means that when the Mayor and the Board start to cut budgets—and cut they will—then cutting a doc, normally something that saves the City twice as much “salary” will suddenly be an equal proposition for desperately needed cost savings needed in this year (lay off protection means that any lay off would only offer savings on 6 months of Doc salary versus a full year’s).  Therefore, there will be no special incentive to layoff MDs.  And our services and patient care abilities will be on equal par as a budget savings instead of being disadvantaged as “expensive”.

You must have had to made concessions because you guys are terrible negotiators; somebody else could have done better.

o     You know, maybe.  And sometimes, that’s a thought we all have.  But here’s the record for this team of 4 docs and the Union professionals for the past 6 years of work:

1.  Substantive increases to the base salaries that started to get us somewhat caught up with surrounding Counties and Government entities
2.  Lay off language that offers severance pay to members according to their years of service IF they are laid off
3.  Termination rights, though we still remain grossly at the pleasure of the “appointing authority”—something that isn’t going to change unless the City Charter changes
4.  Saved the 3.75% raise which started April 4th, 2009.
5.  Full funding of the CME benefit (and yes, we gave that up eventually, but for tactical reasons—see below)
6.   Saving of the primary care clinics in 2008 with timely concessions as well as
7.  For 2008-2009, even as the world started to crumble around us, no actual MD layoffs—even as 433 real people were laid off from positions and other unions all around us.  The City knew we had seen the storm coming and that we tried to help save clinics and services—and reacted, amazingly, accordingly.

1.  At the beginning of the recession, we gave up some CME funding and took 21 hours of furlough to help the City out (we still have 21 hours of furlough to take in 2009-2010)—and saved the clinics and took no layoffs
2.  We are giving up 4 unpaid holidays in 2009-2010 and then again 4 more in 2010-2011

So in sum—we think we’ve done OK.

Every other union did better than us; you are giving more than anybody else, this deal gives up more than that (fill in the blank).

o     Hmmmm. Well, no.  MEA (the administrator’s union) is giving up more than us total, with unpaid and furlough days.  The nurse administrators are giving up about the same amount as us.  Most strikingly, two unions that don’t, by City Charter, have to give up ANYTHING, are giving up something in the range of the same amount (sometimes it’s hard to make direct comparisons, but this is roughly true).  Fire has a charter amendment that mandates how many fire houses have to be open and staffed—and they gave up last year with us and again this year, gave up more and different stuff.  Police, even more strikingly, have a charter amendment that states what their staffing level should be (and they’ve never reached it), essentially making them layoff proof—and they came to the table this year (but not last) and cut an agreement for givebacks.  Public Safety made concessions; wages, salary, giving up night time pay, etc, etc, etc—-in order to get what we did; buy time, short and long—because even the people who are short term protected could see what was going to happen to the City and their members if they didn’t.  Yes, the City is supposed is supposed to have so many firemen and so many policemen and obviously with less of them, we would all be at more risk; but in addition, nowhere does it say they have to be paid well, have their health insurance covered, get dental, have as many sick days or overtime/night time pay differentials as they do—you get the idea.  And so, Public Safety made concessions.   You know, even though there is a certifiable shortage of nurses—-it looks like even the nurses will come to the table within the week with a tentative agreement offering give backs as well.

Doesn’t the City realize that doctors are important? And that we are part of the budget solution (because we bill) and it would be ridiculous to cut us because every time you cut a doc, you make the budget problem worse?

o     In brief: no. The City, when it is negotiating, recognizes no one as being important (every gain this negotiating team has won over the past 6 years required hard work and sweat—and in one case, 50 hours of sleepless negotiation in a windowless conference room.  Fun times).  It’s not any one from DPH in the room when we are talking—it’s Human Resources, accountants and actuaries, sometimes a City attorney.  So while we think of ourselves as important, to the City, we aren’t, plain and simple, when it comes to wage and benefits negotiations.

OK, why didn’t we just put in for Furlough days?  I wouldn’t mind some more relaxing days on the beach this summer.

o     Right now, the City can’t make up its collective mind if we are a profit center or not.  Or at least, if our billings offset some or all of our costs (and this confused thinking changes every time we meet).  Last year, when the City asked for furloughs, we pointed out that furloughs were a bad idea because of breaks in patient care and decreases in billing.  They sat with us for about a month, never really understood what we were saying and went away.  This time, the City started out in essence saying, we don’t think you are telling us the truth about furloughs, you can’t be that important—then suddenly switched positions and said, wait, furloughs are a terrible idea if it makes the budget position worse!—and then switched back again; and then back again.  Quite frankly, they just don’t know and they ended up not being able to get their heads around furlough for docs.  In contrast, we know that that docs’ services and their billings (as always) are part of the solution to this fiscal nightmare (imagine a world without ANY doc billings, decertified by MediCal and Medicare and what is being talked about suddenly makes sense).
o     Therefore, as part of this agreement, we hammered out language to set up a 3 doc, 3 City manager panel to sit down and get to the bottom of all this—and, to set up training for City docs so that we can capture as much legitimate billing as we can (I mean, has anyone actually ever trained any of us formally on how to do billing well?)  Personally, I can tell you that my brother, in private practice, makes darn sure to be up to date on billing coding, the best billing practices and how well his practice is capturing payment for his services and bills—There are initial reports, at some sites, that we are only capturing 25% of the revenue we should be—that’s ridiculous.

We could have turned out concessions because no one would ever cut someone as important as doctors.

o     Hmmm.  In a burning house, all the fine artwork goes up in the same smoke that the stuff waiting to go to the Salvation Army and Goodwill does.  And we’re not in a burning house; we’re in firestorm.  There have already been layoffs of non-UAPD docs in the system (yes, there were some); there will be more before this is over.  We wanted to protect our patients and services as long as possible—and November was as far as we could get with concessions we thought we could be comfortable making.

Well, we shouldn’t have made any concessions because what I do (fill in blank) is so important that the City would never cut my position; they’d get rid of all the other MDs first and that way, I would keep my four unpaid holidays each year.

o     Other than the obvious sociopathy of this statement, following it to its most logical conclusion yields some interested conclusions.  For example, the most perverse possibility is that the City could probably retain some eligibility (until the Feds investigated) for the Federal funds we bill for (MediCal and MediCare) with just three doctors (one single Laguna Honda doc; one outpatient psychiatrist; one outpatient primary care doc) and although homicide trials would stretch out to 20 year delays, one medical examiner for homicide determinations; and one of each other kind of doc/dentist.  Call it 7 docs total, instead of the 220 full-time equivalents, or about 300 people all up (including part-timers) that we actually are.  So if the Mayor’s office suddenly became delusional, truly no one would be safe.  But why would anyone think they were sacrosanct?  Remember; we aren’t truly Civil Service (except for the 2233s); we don’t layoff by seniority; most of us are all temporary exempts who serve at the pleasure “of the appointing authority” every single day.  In any case, we make decisions for all of us, not just one of us.  “We must hang together; or surely, we will all hang separately”.

So, how is this all going to turn out?

o     Our best guess is that the City and SEIU will try to fumble towards a second deal this week; only, it will have to be in a rush, because any possible agreement has to be submitted, by law, by May 19th, Tuesday from Human Resources to the Board of Supervisors.  The way they will probably do it is to get SEIU leadership to hammer out an agreement and file it as a “temporary agreement”, with a date by which SEIU can notify the City to “pull” it from becoming contract language if needed.  Then SEIU leadership will ask its membership to vote again—and try to ratify. If they ratify, they’ll join all the rest of us; the administrators, the police, fire, docs, nurse administrators, crafts and soon, the nurses—-who made concessions.  With concessions, there will be layoffs, but not nearly 1000.  If they don’t ratify; well….And remember—there’s still next year’s budget to get through.

OK, so now I can relax because I won’t be laid off this year.

o     Nope.  Can’t guarantee anything after Nov, 2009.  Why? Because if the City decides that to save money it has to lay off everyone who isn’t a doc in a certain unit or clinic or service, effective July 1, 2009—then by November, there won’t be anything for that doc/dentist/vet/examiner to do except sit in an empty room—and they will lay off that doc as a result.  I hate to be scary, but this isn’t done yet.  We’ve done the best we could to save our services and patients and buy our members some shelter and we tried to bargain for more—but more of anything and in particular, more time for the economy to get better, just weren’t there for the taking, for anything we felt we could reasonably offer to the City.

What should I do?

o     Vote for this agreement.  And hope things get better in a hurry.  Good luck to us all.