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

The Last Lesson of Robin Williams

August 19, 2014

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

The unexpected suicide of comic Robin Williams last week gave me pause, as a fan, a person, and as a health care provider, to contemplate the phenomena of stress, burnout and depression.  Though the risks and rewards of entertainers and health care providers are not exactly the same, both populations are involved in emotionally stressful occupations. Statistics bear out higher than average rates of substance abuse and depression in both groups. With access and patient encounters gradually going up and reimbursements and professional control gradually going down, doctors often reach burnout stage without even realizing it. Depression and ensuing burnout manifest themselves in physical health problems, deteriorating relationships, and disruptive professional behaviors.

The first step in mitigating these feelings of stress and depression is to recognize the problem early and overcome the stigma associated with getting help. It is not easy for the average physician or dentist to be an obedient patient. For a variety of reasons, including independence and embarrassment, we doctors make all sorts of excuses not to seek help from family, friends, religious sources, employer assistance programs, etc. But seek help we must! It is not enough to care for oneself. We all need someone for support and to care for us, to diagnose and to treat us back to a healthy state of mind and body.

To prevent burnout we need positive coping behaviors, not substance abuse—hobbies and interests, vacations, humor, good food and rest. We need to be part of social networks and communities. Depression and loneliness can kill. Even the greatest of comedians.

Back from the AFSCME Convention

July 28, 2014

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

I just returned from the 41st AFSCME International Convention, held at McCormick Place in Chicago last week.  A delegation of eight UAPD doctors and staff were among over 4,000 union members from across the country who attended.  I believe that I can speak for the entire group when I say that the proceedings were exciting, inspiring, educational, and fun.  We heard reports and speeches from labor leaders and public officials like AFSCME President Lee Saunders, US Secretary of Labor Tom Perez, gubernatorial hopefuls Charles Crist of Florida and Mary Burke of Wisconsin.  Especially exciting was Reverend William Barber, head of the North Carolina NAACP, who exhorted the crowd to hold “fusion” rallies with diverse constituents and observe “moral Monday” demonstrations in state legislatures.

Throughout the convention the need for increased union organizing was stressed.  AFSCME has signed up over 92,000 new members this year.  Many of these new members are home health and domestic workers, who are at the center of the anti-union Harris v. Quinn decision handed down last month by the US Supreme Court. AFSCME challenged members of its affiliates to donate $100 or more per year to become an MVP in the PEOPLE program.  This valuable program will increase UAPD’s political power in Sacramento and Washington. Eight dollars a month—I urge you to join if you haven’t already done so.

There were a hundred resolutions brought to the Convention floor, including many involving health care: “Safe Staffing Levels in Health Care Settings,” “Providing Nutritious Meals in Our Schools,” “Protecting Medicare.”  UAPD offered two resolutions of its own: “Creating an AFSCME Health Care Alliance” and “The Advisory Council for Patient Advocacy.”  Both involved the creation of health care coalitions to lobby more effectively for medical issues and patients.

The next AFSCME International Convention will be held in Las Vegas, July 2016. It should be a hot affair. Consider nominating yourself for a slot.

Supreme Court Takes a Shot at Unions

July 7, 2014

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

Welcome to the first installment of the UAPD Pulse, a bimonthly monitoring of UAPD’s health status, its strengths and its vulnerabillities.  I encourage our members and non-members to share their thoughts and ideas about their lives, jobs and anything relevant to UAPD and the health care environment.

Our union dodged a bullet last week when the United States Supreme Court issued its decision on Harris v. Quinn (full decision here). By a 5-4 vote it ruled that Illinois home care workers who choose not to be union members cannot be assessed fair share fees to fund collective bargaining and contract administration.  The decision immediately prohibits unions from collecting these fees from home care workers or other independent “quasi” employees who are not full-fledged public employees.  Fortunately, this decision does not affect UAPD.

This was a partial victory for the National Right to Work Foundation (RTW), who asked the Court to expand its ruling to all public employees.  It urged the Court to overturn the 1977 Supreme Court case Abood v. SEIU, which held that fair share fees and exclusive representation in the public sector did not violate First Amendment rights of free speech and association.

Judge Samuel Alito, the majority author, is clearly against the concept of fair share fees.  In his opinion he even ranted about the Illinois public union pension liabilities and bashed the Abood decision.  No doubt the RTW Foundation will return to the Supreme Court with more cases challenging the legitimacy of fair share fees.  As an attorney my counter argument goes to the essence of the term “fair” share.  If a union non-member does not have to pay for collective bargaining and other union benefits, he or she is receiving “unjust enrichment” at the expense of those who do pay their union dues.  Long live the concept of fair share fees!  What do you think?  Email me your thoughts on the subject at sbussey@uapd.com.

The Countdown Continues

December 26, 2013

For those of you who attended our “Countdown to Obamacare” CME in October, many thanks for your valuable time and participation. Thanks go as well to our UAPD Staff and Boards for their efforts. Meanwhile, the countdown continues…

Like other ambitious programs of social change —Social Security, Medicare, etc. — we are seeing fits and starts, political blowback and Monday morning quarterbacking with the rollout of Obamacare. The initial ACA reforms—coverage of preexisting conditions, extended coverage of young adults, no caps on benefits—have been laudable.  But it should be no surprise to anyone that the insurance industry is in no hurry to bail out President Obama from his now infamous and erroneous statement, “If you like your health care plan, you can keep your health care plan.” Because of the stringent requirements of the ACA, millions have had their plans cancelled and many will lose their doctors who have been excluded from networks. Yet the ultimate good in this law is worth the myriad of corrective “cleanup” bills that are being proposed in state and federal legislatures.

At the CME our speakers addressed the effects of the ACA rollout on doctors in general and our union in particular. Dr. Beth Capell described the need for our state prisons to coordinate health care for inmates about to be paroled. Dr. Mitch Katz, Director of the Los Angeles County Department of Health Services, spoke of the need for County and other public health systems to compete with the private sector for the flood of new patients.  Dr. Ron Zodkevitch discussed the positive aspects of increased access for the mentally ill, but also  the diagnosis categories the ACA doesn’t cover. Dr. James Stephens, the California Dental Association President, described the innovation of the virtual dental home, while Congressman and UAPD member Dr. Ami Bera offered alternative solutions to the provider shortage.

For UAPD the doctor shortage will become increasingly important for all of our sectors. If potential or current state and county doctors are lured into private employment, there will be pressure to fill these public job slots with ancillary providers. Despite the glitches in the federal website, new patients are signing up; the California insurance exchange “Covered California” had 360,000 applications as of November 19th, including 80,000 who have selected private health plans. With at least a dozen plans vying for these patients, and MediCal reimbursement at parity with Medicare, the Kaisers, Sutters and other ACOs of the world will pay a high premium for energetic primary care providers.

Meanwhile, UAPD must continue to collaborate with other doctor groups to create solutions for this shortage and keep us at the forefront of healthcare delivery. We need to increase the supply of physicians and dentists and correct their geographic maldistribution with creative incentives. I would appreciate your help in coming up with ideas for the upcoming legislative session. Feel free to contact me or the staff. Until then, thanks for your work and loyalty and have a great holiday season.

Cigarettes, Seatbelts and Guns

April 29, 2013

We need more light instead of heat.

I’m not referring to global warming, but the emotionally charged arguments between those on opposite sides of the gun issue.  Everyone, including doctors, has differing opinions about gun access, hygiene and behaviors, and the role of government in regulating them.  What will help clarify this debate is thoughtful and comprehensive research on firearm violence in America.  Ever since medical minds analyzed TB and smallpox and developed strategies of quarantine and immunization, the scientific community has guided policymakers in important areas of public health.  It is time for our politicians to reframe the gun violence conversation from one of constitutional rights to one of solving a public health epidemic.  They have done this before.

Take the tobacco and cigarette problem.  Tobacco in America has been a staple since the 17th century, and cigarettes since the 19th.  They were smoked first by Southerners, soldiers, then everyone, as advertising flooded 20th century media.  But doctors began examining the data and speaking out.  In 1938 Dr. Raymond Pearl of Johns Hopkins reported in a scientific paper that smokers do not live as long as nonsmokers.  This triggered a line of epidemiological research that culminated in the 1964 Surgeon General’s 387 page report.  It clearly demonstrated that cigarettes were causally related to cancer in both men and women.  Federal and State regulations have since followed, which have helped protect the public from the effects of first and second hand smoke.  As a result morbidity and mortality from smoking has decreased.

Another public health campaign culminated with the installation of seatbelts and airbags in cars.  As early as the 1930s physicians equipped their own cars with seatbelts and urged others to do the same.  The AMA came out with a formal policy statement in 1954.  As more motor vehicle accidents and deaths occurred, public and private research by universities and the National Highway Transportation Safety Agency (NHTSA) increased.  By identifying the exact mechanisms of injury–ejection, head and neck trauma, etc.–the researchers helped legislators enact the best corrective measures.  The NHTSA has credited the use of seatbelts with saving over 15,000 lives every year.

Collecting relevant and accurate data is essential before suggesting solutions or regulating any public health problem, especially one as sensitive as firearm abuse.  The rights of responsible gun owners must not be abrogated.  Largely due to NRA pressure in the ‘90s, Congress eliminated research money earmarked for gun violence studies.  But after the recent Sandy Hook shootings, President Obama has charged the Center for Disease Control (CDC) to resume analyzing data on the who, when, and where of gun violence.  We need to use multivariate analysis and other statistical models to identify the actors and circumstances of homicides, suicides and accidents as a result of firearm use.  Then we can treat the problem with a more logical paradigm.  To that end, UAPD is sponsoring State legislation with our own member, Dr. Richard Pan, an Elk Grove pediatrician and Assemblymember.  We are seeking to collect data from every County in California to detect trends in firearm violence.  We will also be discussing similar studies with another UAPD member, Dr. Ami Bera, a US Congressman from the 7th District of California.

Regardless of our personal views on gun ownership and use, we doctors have a duty to keep our patients and their families healthy.  Unlike the state of Florida, which prohibits doctors from asking patients about their gun use, California allows us that freedom of speech.  We must continue to exercise  that right by educating our patients on safer personal and public health habits regarding cigarettes, seatbelts, and guns.

The State of Our Union in 2012: Life Begins at Forty

December 19, 2012

Good morning, Brothers and Sisters of UAPD and  AFSCME and honored guests. Welcome to  San Francisco, the birthplace of our union in 1972. Life Begins at Forty was the title of a book written by psychologist William Pitman, about all the possibilities of middle age. But the deeper meaning  of the phrase was supplied by the 19th century philosopher Arthur Schopenhauer.  He wrote:    

” The first forty years of life give us the text…the next thirty supply the commentary.”

And that seems to be the case for the Union of American Physicians and Dentists. Four decades have passed since Surgeon Sanford Marcus sat at his kitchen table with wife Hannah, stuffing  and addressing thousands of envelopes, inviting surgeons, internists and others in the Bay Area to do the unthinkable –to form a labor union for doctors.

A true visionary, Dr Marcus wanted doctors to fight together against the hospitals, administrators and bureaucracies that were already beginning to erode doctors’ decision making power. As the preamble of our charter so eloquently states, “…to enable doctors to give of themselves, unhindered by extraneous forces…” UAPD’s founder, Dr. Marcus, is gone. But we are deeply honored to have in our presence Dr. Marcus’s wife, Hannah and their children, Richard, Susan and Carol. Mrs. Marcus,  If not for your husband’s insight, courage and determination we would not  be part of this wonderful organization, this family that he created to better the lives of physicians and dentists. So, in essence, all of us at UAPD are your children as well.

Read more …

Come to the 40th Anniversary Triennial Convention

July 26, 2012

I encourage all union members to join me in San Francisco this November 2-3 for the UAPD Triennial Convention and 40th Anniversary Celebration.

To attend, send back the registration form that has been mailed to your home or register online here.  Exact event times are listed on both registration forms.

All events are free for UAPD members.  Members are responsible for paying their own hotel and transportation costs, though UAPD will cover those costs for stewards, bargaining team members, board members, and elected delegates.  If you have a question about whether you qualify, contact your labor representative.

What is the Triennial Convention?

As required by the UAPD bylaws, every three years the Union holds a statewide meeting that brings together elected delegates from all sectors of the union.  All UAPD members are welcome to attend the Triennial Convention, but only the elected delegates may vote on the matters at hand.  Any UAPD member hoping to serve as a delegate to the Triennial Convention must be nominated by three other UAPD members before August 3, 2012.  Here is a Delegate Nomination Petition to print out and return by fax or mail and here is more information about the delegate election process.

In addition, any UAPD member can submit resolutions to the Triennial Convention.  All resolutions must be received before the October 3, 2012 deadline and will be considered by the UAPD Resolutions Committee in advance of the Triennial Convention.  Here is a Proposed Resolution Form to print out and return by fax or mail.

More Events Than Ever Before

In recent years, UAPD has expanded the Triennial Convention into a weekend of member-focused activities.  This year, on the morning of Friday, November 2nd, we’re offering a free CME/CE course entitled “Addiction and Recovery:  Strategies for Practitioners.”   We’ll be bringing together experts in the field to give frank advice about how physicians, dentists, and others might approach this exceedingly complex topic.  We will mail out the full course description and list of presenters soon, but you can reserve a seat now by using the online registration form.

On Friday afternoon, you’ll want to stay for the statewide membership meetings that will be held for each UAPD sector (State BU 16, CSU, County and Clinic, Private Practice, Retirees).  This is your chance to have very focused discussions with staff members, elected leaders, and colleagues from around the state.

To commemorate the 40th Anniversary of UAPD, we’ll be holding a fabulous party on Friday evening featuring the music of the Swingin’ Blue Stars of the U.S.S. Hornet.  We are also lining up a number of special guests to participate in our Friday and Saturday events — previous speakers at UAPD functions have included John Garamendi, Gavin Newsom, and Jerry Brown.  There will be ample time for food, music, and socializing with your fellow Union doctors. We will be meeting at the Sir Francis Drake Hotel in San Francisco’s Union Square, at a beautiful time of year.

I look forward to seeing old friends and meeting new ones at the 2012 Triennial Convention and 40th Anniversary Celebration!   If you have any questions, feel free to call the UAPD Oakland Office at 1-800-622-0909.

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

UAPD Turns Forty

April 18, 2012

April 18th: An Earthshaking Date in SF

People in San Francisco recently remembered April 18th as the anniversary of the Great 1906 Earthquake. But an important aftershock occurred in SF on this date in 1972, exactly 40 years ago…the UAPD was born. Dr. Sanford Marcus, a local surgeon supported by 250 private physicians and dentists signed the Charter of the Union of American Physicians and Dentists. This excerpted mission statement rings truer than ever today   “…to enable doctors to give of themselves, unhindered by extraneous forces, for the welfare of their patients…” Dr. Marcus was angry at the way doctors were “pushed off the pedestal” and manipulated by hospitals and insurance companies.

As health care has evolved into a $3 trillion enterprise these forces have become more complex and ubiquitous. Pharmaceutical and durable companies, ancillary competitors, EHR and telehealth technologies, managed care administrators and execs all seek their share of the pie. The cornerstone of our profession , the doctor- patient relationship, has been compromised. The largest force of all is Government. Regulations, forms, oversight, healthcare lobbies and class action suits. And importantly for UAPD, Government as our Employer.

UAPD has had its share of successes over the decades fighting for our members. In 1975 we orchestrated the Anesthesiologists’ strike which led to MICRA reform. In the 1980s we formed SEPA and established collective bargaining  for State employees. We stood alone and stood down Governor Pete Wilson in his attempt to destroy unions and collective bargaining. In 1997 under President Weinmann we affiliated with our influential parent union, AFSCME. We formed our own Private IPA. We showed great resolve in regaining our LA County unit after they were discriminated against. Our détente with the prison receivers resulted in great salary increases for our members. Our coalition with other unions has exposed the safety problems of DMH. We continue to organize other California counties and nonprofit clinics. Our efforts to grow now extend into Oregon and Arizona. In numbers there is strength.

And yes, there have been bumps in the road.  The Terminator. Furloughs and layoffs.  Hospital closures.  Adverse publicity. Professional jealousy.  Increasing workloads. But none of these tarnish your sacrifice and dedication to society and your colleagues, the wisdom,vision and courage that you all possess in doing your difficult and noble jobs as doctors. Doctors with the foresight to belong to UAPD, still great after 40 years.

In Solidarity,

Stuart A. Bussey, MD, JD, UAPD President

Message to State Doctors from UAPD President Dr. Stuart Bussey

December 7, 2011

Dear  UAPD Colleague:

As we move  towards year’s end, I want to wish you, your family and your friends a peaceful and healthy holiday season.  Even with a sputtering economy, we still have much to be grateful for.  We make a good living in a free country in a respectable profession.  We perform our jobs with dedication, integrity and professionalism.  Others in the banking, insurance and political arenas would do well to follow our example.

Nonetheless, times are hard.  Read more …

US Supreme Court Orders California Prisoner Release

August 7, 2011

From UAPD President Dr. Stuart Bussey:

You have undoubtedly heard about the US Supreme Court’s recent ruling that 33,000 CDCR inmates must be released over the next few years from California’s overcrowded prisons.

What this means for UAPD’s physicians, psychiatrists and dentists is unclear at this time.  We have not yet discussed the ruling with CDCR administration or the Federal Receiver. It is unclear where the released inmates will go or who will provide their medical care.

If any of the medical or dental positions are to be reduced, it is possible they could be absorbed by the current vacancies within CDCR, especially in psychiatry.  There may well be new appointments of our doctors in the parole agencies or in the new acute care facilities which are now being built across the state.

While there is still much uncertainty, one thing is for sure:  UAPD will endeavor to keep the responsibility for the medical, psychiatric, and dental care in the hands of our union doctors.  We will update members as more information becomes known.

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