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The UAPD Pulse – By Stuart A. Bussey, M.D.

Doctors: Independent Professionals or Government Agents?

April 2, 2018

By Stuart A. Bussey, MD, JD, UAPD President

The sad look in my patient’s eyes reached down to the pit of my stomach “I only want to drive a couple of miles to my friend’s house” he lamented. But Carl’s progressive dementia and arthritis couldn’t allow me to sign his DMV driver’s license form.  Increasingly, we physicians have been placed in the often uncomfortable position of being both the investigator and enforcer of privileges involving health issues. Driving, adoption, school and sports participation, employment, disability, competence, and conservatorship are only some of them.  Institutions, especially our governments, look to us for guidance and assign liability to our decisions.

This holds special relevance for our UAPD doctors who are employed in various levels of government. What happens when our professional judgment and scientific reasoning collide with the protocols of an agency or a supervisor with a personal agenda? We have all experienced conflicts regarding patient care or disposition with our supervisors and administrators. Debates about appropriate medications at CDCR, discharge decisions at County hospitals or claimant disability at DSS often make us feel that we are mere tools of government, not independent practitioners.
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UAPD Pulse: Looking Back and Ahead… UAPD 2018

December 26, 2017

By Stuart A. Bussey, MD, JD, UAPD President

We can all agree that 2017 was a memorable year-both outside and inside of our union. Donald Trump was sworn in as our 45th president and has used an executive style from his TV show “The Apprentice”. This year global warming became all too real.   Drought, fire and hurricanes spread around the world. Senseless mass shootings continued. Sexual harassment cases abounded.  But…there were also bright spots in 2017.  Unemployment reached an all time low and our economy is booming. Scientific and technology breakthroughs surprise us daily.  A high school senior in Texas bought his special needs classmates new shoes.   A customer in Washington left a $3000 tip for his $39 dinner.  A 5 year old from Mississippi called 911 to arrest the Grinch.  An ophthalmologist in Michigan carried his elderly patient through the snow to his office. The human spirit continues to amaze.

2017 also saw lots of changes and successes at UAPD. In February, after 35 bargaining sessions, UAPD reached an agreement with the State of California and ratified a new MOU.  While the general salary increases were moderate, we scored significant pensionable salary adjustments for hundreds of our members.  This was due in no small part to the strike ratification vote we took in January.  There were many other developments in the state sector which UAPD met with skill and tenacity—“lift and shift” of our DSH psychiatrists to CDCR, telehealth policy changes, ensuring laptops are optional on call, creating research to support the legal case for higher physician salaries, protecting Medical Consultant scope of practice, fighting timekeeping and retaliation issues, and, of course, member grievances.  We also fought against gender discrimination at CSU, contracting out and bullying at our UC clinics.

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California’s Climate Change: Single-Payer

June 7, 2017

By Stuart A. Bussey, MD, JD, UAPD President

Two seemingly unconnected events last Thursday remind us that we live in a progressive, independent-minded state. First, the California Senate passed SB 562 (Lara/D), the Healthy California single-payer bill. This bill purports to solve our state’s health care access problem, which has been partially relieved by the ACA and is now threatened by the new AHCA bill. The California Assembly is preparing for the weighty debate on how exactly to pay for SB 562’s universal coverage. Cost estimates range from $330 billion/year (UMass study) to $400 billion/year (legislative analysis). These figures are comparable to the 2016 estimate of California’s health care cost of $370 billion. Much of this money would be available as repurposed Medicare and Medi-Cal money — and the Feds would have to agree. The State, under Healthy California, would take on the role of single insurer. The plan would be governed by a nine member board of experts who would authorize payments to hospitals, doctors, ancillaries and pharmaceutical firms in a hybridized and collectively bargained fee-for-service paradigm. The collective bargaining part of the bill could elevate UAPD as a preeminent representative of many of California’s providers. Physicians probably would be working at discounted rates of reimbursements, but they would at least be paid promptly and by one entity (the State). They would not have to play tiresome reimbursement and authorization games with dozens of profit-motivated insurance companies. Doctors should spend less time billing and more time with their patients.
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Good Things Come to Those Who Wait…

March 14, 2017

By Stuart A. Bussey, MD, JD, UAPD President
Believe it or not, this phrase was coined by a British advertising agency to emphasize the virtue of  patience in waiting for Guinness ale to be correctly poured into a mug.  But it also applies to our UAPD members who wait patiently while their bargaining teams negotiate contracts for them.

Late last month the UAPD State Bargaining Team reached a Tentative Agreement with the State of California.  While the team strongly recommended ratification of the agreement, we all knew that not everyone would be completely satisfied by what the contract contains.
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State Negotiations: Chess or Chicken?

November 30, 2016

By Stuart A. Bussey, M.D., J.D., UAPD President

First things first. I hope that you enjoyed a well-deserved Thanksgiving holiday.

The game of chess requires clarity of mind, the ability to think ahead and effectively guess what moves your opponent will make. The same cannot be said for the game of chicken. Less reason, more nerve and resolve. Which player will blink and give in first? With over half of the twenty-one State bargaining unit negotiations stalemated, both of these games are being played by the State and by its employees right now.

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April 6, 2016

The irony of it all… After a year of union hand wringing, soul searching and bracing for a body blow, the Supreme Court unexpectedly and abruptly handed us a reprieve. A month after Judge Scalia’s death and by virtue of a tie vote, the Supremes upheld the Ninth Circuit Court of Appeals’ decision  to reject  Friedrichs v. CTA. Public unions in 25 states , including California, breathed a collective sigh of relief.  At least for now, we can continue collecting agency or “fair share” fees from nonmembers.

Make no mistake though…this relief may be only temporary.  Last month  President Obama nominated Merrick Garland to fill Scalia’s seat, but leading Republicans have stated their intention to withhold consent on any nominee until the next president takes office. Depending on the outcome of the November election, the Court will swing pro- or anti- union. Democratic President Clinton or Sanders would undoubtedly nominate a more liberal judge, a Republican President definitely not. The Center for Individual Rights (CIR), who represents Rebecca Friedrichs, has already filed a petition for rehearing her case. They reason that a tie vote does not settle a legal question, but only reserves it for a future case. If not the Friedrichs case, then another clone will come before the Court in the next few years.

We seem to be heading for a tipping point in history as far as union health and survival. Will the erosion of unions accelerate with a more conservative Court, or will State Legislatures and Congress create laws that ensure healthy employee environments and a resurgent middle class? California’s new $15 minimum wage act is a good start. Let’s hope that the ball keeps rolling in that direction.

2015 State of Our Union — Evolution by Natural Selection

December 21, 2015

By Stuart A. Bussey, M.D., J.D., UAPD President

Over 150 years ago the naturalist Charles Darwin published his now famous treatise, “On the Origin of Species.” At that time and going forward, it caused quite a stir amongst Creationists. Darwin described a process by which organisms evolve over time as a result of alterations in physical and behavioral traits. He reasoned that the changes that allow an organism to better adapt to its environment will help it survive and produce sturdier offspring. Complex creatures evolve from simpler ancestors over time. Natural selection is the preservation of beneficial mutations, changes and functional advantages that enable a species to better compete in the world. Why am I bringing up this topic of natural selection? Because like any complex and successful species that evolve from a single cell, our own Union of 4,300 doctors and healthcare professionals started with an idea from a single doctor, surgeon Sanford Marcus, and a few of his colleagues.

By definition a labor union is a group of two or more individuals, committed to bargain collectively. Within a few weeks of its birth the UAPD grew to a small union of 200 private physicians in the SF Bay Area. A few years later they integrated County doctors into our Union, then our large State units in the 1980s. Acknowledging the Darwinian principle that variation favors survival, UAPD has welcomed dentists, nurse practitioners, PAs, podiatrists and veterinarians into our group. In 1997 we began a symbiotic affiliation with our Big Brother, AFSCME International. That was another functional advantage. And just this year, utilizing our new Constitutional authority our Board approved the addition of 300 Los Angeles County pharmacists. UAPD has indeed become a MELTING POT. In today’s healthcare jungle, where half the physicians and most of the other health care professionals are employees, it is imperative to strengthen our union by both numbers and diversification. Before I discuss how to continue to survive and thrive, let’s look closer at the hostile landscape that we live in.

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UAPD’s 2020 Vision…in Three Dimensions

September 5, 2015

By Stuart A. Bussey, M.D., J.D., UAPD President

The US Presidential primaries are just beginning to heat up and political outsiders Trump, Carson and Sanders are making their vision of America known to the voters. From the opinion polls the electorate is hungry for straight talk and multidimensional thinking. Now that the 2015 UAPD elections are in the books, the new UAPD Board of Directors and I are determined to convert our 5 year strategic plan into immediate action. Our 2020 vision will have at least three dimensions.

First, let’s look in the mirror and reaffirm who we are. We are a group of doctors and health care providers who decided 43 years ago to organize into a professional union. We have been very successful at this, with scores of lucrative MOUs to be proud of, a strong steward system and parent union. In the immediate future, however, we face legal challenges from factions who want to destroy public unions.  The upcoming Friederichs v. CTA Supreme Court case challenges the decades old right of public unions to collect fees from their fair share payers.  Losing this right would be disastrous for UAPD and the services that we provide to our members—unless we make a concerted effort to convert all of our fair share members into full dues paying members. Internal organizing over the next six months will be crucial to our survival. All of our full time members must do their part to encourage our fair share fee payers into convert to full members.

Another initiative in our 5 year strategic plan is to enhance our visibility and brand. Our goals will include stepping up our  patient centered advocacy for health care reform, sponsoring social legislation to improve our image as a public service union, creating training programs and “owner’s manuals” for new members, stewards and board members, and developing an overall public relations strategy. We may even consider a name change for our Union at the October 24th Triennial Convention.

To diversify and grow our union, we must look at organizing both doctors and other types of professional health care providers, in both public and private sectors, in California and in other states. The truth is, we cannot limit ourselves to California counties and the State of California when we consider the future direction of our Union. California is one of only a handful of states that have corporate bar on medicine, i.e. private hospitals and other non-physician employers cannot directly hire physicians. Because the corporate bar limits the number of employed physicians in the state, and only employed physicians can organize and bargain collectively, it creates a real limit to unionizing beyond our current base. We must challenge the current foundation models of Kaiser, Sutter and the like in order to increase membership here in California, while at the same time we must begin to unionize doctors in neighboring states without the corporate bar. We must consider organizing non-doctors as well. With the recent inclusion of hundreds of Los Angeles County pharmacists, we can cautiously evaluate where this inclusiveness will take us. The original charter of our union was for physicians only, but the landscape in 2015 has significantly changed. Let’s embrace this change and grow in multiple dimensions.

Have a great Labor Day weekend!

More Political Victories for UAPD

July 6, 2015

By Stuart A. Bussey, M.D., J.D., UAPD President

Thanks to all of you who took the time to complete the political attitude survey.  You can view the survey results here.  I’m happy to report that yesterday in Sacramento, we had two big victories on issues important to a majority of our membership.

First off, SB 277, the bill introduced by UAPD Member Richard Pan to limit the types of vaccination exemptions, was signed into law.  In his signing message, Governor Brown wrote “The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases. While it’s true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community.”  Those same sentiments were conveyed by the majority of the doctors who answered our political survey. 74% of you supported SB 277, our survey showed.  UAPD was proud to sponsor the bill and lobby for its passage.

A majority of you also want the union to work against bills that expand the scope of practice for Nurse Practitioners.  76% of you opposed SB 323, the bill to grant full practice authority for NPs.  Today that bill failed in the Assembly Business and Professions Committee.  While it will have a courtesy reconsideration, for all intents and purposes the bill is now dead.  We know that Nurse Practitioners play a critical role in the healthcare system, but our survey showed that most of us believe that medical school training makes doctors better suited for some tasks. That was the crux of the testimony UAPD gave in committee last week as well.

When you have a moment, I encourage you to explore the survey results more thoroughly.  Some things did not surprise me. From our most recent CME class in San Francisco, I knew that our members are not in agreement when it comes to doctor-hastened death. However, I was unaware that most of our members opposed recreational marijuana use, even though a majority of Americans now favor it.  Is that because we’ve seen its ill effects in our offices, even if those effects are relatively rare?

A group as large and well-educated as UAPD will never be of one mind on any issue.  But we will continue to identify points of common interest and develop a legislative agenda around those issues.  And as this last week has shown us, when we take on a political issue, we can get things done.

Strategic Planning, Strategic Policies

June 15, 2015

Our UAPD Board of Directors is putting the finishing touches on a five year business plan.   At our recent planning meeting, we did a lot of thinking about our “brand” and ways to improve our image in the public eye.  We want everyone to know the truth about us — that UAPD members care about the “big picture” issues in health care, not just about our own wages and benefits.

One way for us to send that message is to take a stand on more of the hot-button issues in the legislature.  There are many public health issues to weigh in on—obesity, end of life, medical marijuana, immunizations, the environment and health. We touched on some of these in our recent CME/CE activity in San Francisco.  Now I would like your input and opinions so that we can go forward with a consensus on legislative policy in Sacramento.

Here is an anonymous survey to gather your opinions on a variety of public health questions:  https://www.surveymonkey.com/r/politics2015

I encourage you to complete this questionnaire as an initial step to making our union a leader in health care policy.  I will share the results with you in a future edition of the Pulse.

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