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


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.

Read more …

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.

Shouts Across The Bow

January 29, 2015

16391668915_5a49e25c7a_k The frustrated, barely audible voices of dissent from US doctors adrift in a roiling sea of medical care have been recently rising on sonar  scopes. Since the HMO administrators wrested the helm from us in the 1980s, doctors have meekly accepted their roles in the boiler room or as deckhands.  It seems no coincidence that the last full-fledged physician rebellion preceded the managed care armada over a quarter century ago. Back then, brave NYC physicians laid down their stethoscopes to protest oppressive management policies.

Now history is repeating itself. From San Diego to Davis the murmurs of protest rose to shouts on Tuesday as UAPD doctors staged a successful one day work stoppage. Hundreds of physicians, students, legislators and health care workers from the University of California student health care centers across the state marched, picketed and chanted in solidarity over their displeasure with UC’s unfair labor practices. UC Office of the President (UCOP) has negotiated with us for over a year and 42 sessions without fully disclosing the significant chancellor funds that could be used to improve the 10 student health centers. They reneged on a written promise to roll back our pension contributions. They even refused to allow our docs simple meeting rooms in their own health centers.

UAPD has negotiated hundreds of contracts with employers in our 43 year history without having to resort to a work stoppage. UC, however, has driven several unions to strike in the recent past. Our union leadership and the UC doctors felt it was the right time to protest. Our members explained their desire for transparency in negotiations to the curious reporters from the papers, TV and radio. The feeling of brother and sisterhood with other workers was in the air. It felt good and empowering.

We have already received support and congratulations for our strike from our comrades — individual doctors, physicians groups, and medical organizations in California and other states. They were heartened by our actions. Doctors are struggling to maintain control of a once proud profession and to stay afloat, whether rowing a small private practice boat or stuck in the slave galley of a corporate cutter. On Tuesday, shouts of defiance and camaraderie were clearly heard across the bow of the UC tanker.

Check out the Press Coverage of the Strike

Pictures from the Picket Line

2015 Forecast: Cloudy With A Chance of (Union Busting) Meatballs

December 23, 2014

If the past year of our union could be described in terms of a weather report, I would say it was mostly warm and sunny with a rare thunderstorm.  On the bright side:

  • We started the year with a new bargaining unit comprised of student health center doctors from all ten University of California campuses.
  • We ratified several strong contracts, including new agreements for both the physician unit and the dentist/psychiatrist unit in Los Angeles.
  • We faced down an oppressive Santa Clara County administration with a physician strike campaign. The Santa Clara strike was enjoined by the County at the last minute, but our doctors eventually received an excellent economic package as a result of those efforts.
  • We were an integral part of a coalition that defeated two deeply flawed propositions, 45 (insurance rate reform) and 46 (MICRA reform).
  • UAPD began organizing several new groups into our union, and we’re at the brink of recognition in the largest of those campaigns.
  • We avoided major layoffs at CDCR during its downsizing.
  • We had an outstanding annual meeting and two well-attended CME presentations.
  • In Bargaining Unit 16, all of our doctors actually received their full CME money from the State.
  • We passed several bills increasing employee safety at the Department of State Hospitals.
  • We helped get four of our UAPD members elected to the California Assembly, Senate and the US Congress.
  • Most importantly, we stood up for our members when they needed our help.

But in the forecast for 2015, winds are rising and clouds are forming.  Santa Clara officials recently retaliated against a member of our bargaining team, and we are fighting for his reinstatement. Excessive work load, long hours, and inflexible schedules are putting pressure on our members, especially in the counties, the Department of Corrections, and the Department of Social Services. New sign-in and sign-out procedures exacerbate those problems in BU 16.   UC refuses to offer the student health doctors the contract they deserve, and getting a strong first agreement might require that they strike. Pensions for new hires were reduced by the legislature in 2012, and that’s hurting the recruitment efforts of many employers, not to mention the workload of the remaining doctors. All the aforementioned phenomena are serious challenges for our union.

But the most ominous storm predicted for 2015 is a nor’easter that comes courtesy of anti-union forces and the US Supreme Court.  Friedrichs v. California Teachers Association is a case appealed from California’s Ninth District Court which challenges the legitimacy of fair share fees for publicly employed teachers. If fair share fees are not upheld by the Supremes, it would have devastating consequences for all public unions, including UAPD. Our union must act decisively and swiftly to defeat this potentially union busting decision. Both the UAPD staff and Executive Board have meetings in January to discuss a new “organizing” model and a strategic plan. We need to work together to increase membership in all of our bargaining units, especially in case of a bad outcome in Friedrichs. Our union will continue to provide a legal and political umbrella for us. But if the raindrops turn meatball sized, we will need more members–and your help–to keep it open and sturdy.  Happy Holidays!

We’ll Get By With A Little Help From Our Friends

November 20, 2014

Remember these old Beatles’ song lyrics?

How do I feel by the end of the day?
Are you sad because you’re on your own?
No, I get by with a little help from my friends.

This sentiment especially applies to UAPD and the imminent legislative session.  Our union, along with others in the state, helped propel several of our own UAPD members to important wins in the recent California and US elections.  Richard Pan, M.D., a pediatrician, won a Senate seat in the 6th District (Sacramento).  Jim Woods, D.D.S., a private practice dentist, won an Assembly seat in the 2nd District (North Coast).  Ami Bera, M.D., narrowly won a US House seat for the second time in the 7th Congressional District (Elk Grove).  Also, our friend, Chief San Francisco Supervisor David Chiu, won a narrow victory in the 17th Assembly District.

At the end of each day of the legislative session, we won’t be on our own.  Whether challenging the nurse practitioner prescribing bill, clarifying the definition of a public employee, adding the title “forensic” to State hospitals, or improving the ACA ,our UAPD member politicos will be doing all they can to make our union stronger.  We helped them win by manning phone banks, walking precincts and giving them political support.  All of that is necessary to help candidates to victory.  And with our own members and friends in power, we hope to move our union forward.  If there is any legislation you would like to see introduced, please contact me or our Director of Political and Legislative Affairs Doug Chiappetta as soon as possible.  Bills are being conceptualized and drafted now, and are due to the Office of Legislative Counsel for bill analysis by January 30 and to the California Legislature by February 27, 2015.

Re:Union Memories

November 7, 2014

The past couple of weeks have been filled with nostalgia for me. I just began my 25th year as a UAPD member and celebrated my 30th year in solo Family practice. I also attended my high school reunion in Miami. That was a real shocker. Everyone had changed so much that we really did need our nametags to identify each other. Although my classmates had physically changed, their spirits were intact. After all this time, though, life had become a great equalizer. The beautiful and popular weren’t so confident. The meek and the nerdy were now the lives of the party. Memories of my childhood were immediately rekindled when I saw some of my old buddies. It turned out to be a good time. Reunions can be a bit scary, but they serve an important  purpose—to act as a milestone and a time to evaluate how you and your colleagues have fared. Have you accomplished what you set out to?

Our annual UAPD meetings are reunions, including the one we just completed in Sacramento (see photos here). We had a productive board meeting Friday night, a fascinating ethics CME Saturday morning, and the annual meeting in the afternoon. We gave the Marcus service award and a proclamation from the City of San Francisco to Dr. Deborah Brown. Later, our staff reps detailed our accomplishments and obstacles, and got feedback from our members. One of the most important outcomes of the weekend was the initiation of our strategic planning committee. Over the next few months we will incorporate our UAPD business plan into a broader strategic action plan. Every successful organization needs self assessment and concrete goals, and UAPD is no exception. Our union memories of past growth and accomplishment must be balanced with vision and direction for future success.


When 45 + 46= 0

October 2, 2014

In the coming weeks California voters will cast ballots on a number of referendums which will reflect “the voice of the people.” But if they pass, Propositions 45 and 46 will amount to nothing but trouble for doctors. Take Proposition 45. Up to this point California’s insurance rates have been regulated by an independent commission.  Prop 45 would shift that awesome power to one political figure, the Insurance Commissioner. He or she would undoubtedly become the pressure point from a variety of political and special interest sources. From a human and organizational perspective this model  is unfair and  unstable. In the health care insurance arena carriers are already restricted by the ACA to 20% administrative fees. Anything more than 20% must revert back to patient services. Under Prop 45 Covered California, which arduously negotiated rates for millions of lives, might have to reboot all their negotiations. But from the strictly self-serving perspective of doctors, the biggest danger of 45 is the probable reduction in our reimbursements. This would undoubtedly occur if rates to health plans were ratcheted downward.

As for Proposition 46 you probably have already heard all the arguments against it in the media or in our Spring UAPD CME. That it is a money grab by trial attorneys that will pad their pockets via more frivolous lawsuits. That higher malpractice awards will spawn higher insurance premiums for both patients and doctors. It could drive specialists out of practice. That the random drug testing policies under Prop 46 are capricious and potentially mischievous. That the mandatory use of the CURES database would be cumbersome, expensive and potentially compromise patient privacy.  There are other, more practical ways to provide consumers medical care at lower cost, as well as restitution for bad outcomes. These two propositions, as written, are a null set.