March 2011

Collective Wisdom

By Michael J. Katin, MD

The past few weeks have seen turmoil in multiple locations and throughout the world: Tunisia, Egypt, Bahrain, Libya, Yemen, and even Wisconsin. In the Badger State, Governor Scott Walker (also known as Hitler or Stalin) is being denounced for trying to deprive state government workers of the God-given right to collective bargaining for benefits. In contrast, in Libya, Colonel Muammar el-Gadaffi (also known as Scott Walker), is trying to prevent his people of being deprived of their right to be suppressed and tortured by someone wearing a designer hat .

The importance with which the American labor movement is taken is illustrated by the sacrifice of thousands of Wisconsin public school teachers to give up going to work for several days to allow them to litter and deface the Wisconsin state capitol building area, which would result in suspensions if done by students in their own school buildings and would not have been tolerated in Tahrir Square. They were joined by thousands of state workers, non-Wisconsin state workers, non-state workers, Jesse Jackson , and students happy to do anything other than have to go to school and making Ferris Bueller look like an amateur. In addition, there were well-meaning physicians generating medical excuses on the basis of anything they could concoct in order to legitimize absences. The irony is that these same physicians are in a profession that is, for the most part, banned from collectively bargaining for anything.

It is embarrassing that when funding for IMRT reimbursement is on the line that our efforts to express our opinions are limited to e-mails and letters to members of Congress who pass them along to staffers who don't know the difference between high energy x-ray therapy and high colonic therapy, and between a photon and a crouton . It is somewhat of a miracle that IMRT reimbursement has remained at any type of viable level without the spectacle of thousands of irate radiation oncologists cluttering the steps of the Capitol building, without an outpouring of support from the AFL-CIO or even Michael Moore . Unfortunately, it is possible that with their assistance payment for IMRT could be considerably higher and, certainly, any self-respecting labor negotiator would have not considered a compromise position to represent at least a 50% increase. It is a matter of time before the reimbursement question comes up again and, with cuts in government spending being endorsed by nearly all politicians, and with third-party payers desperate to reduce payouts now that they are under more and more restrictions, we need to think proactively. This is the time for groups of radiation oncologists to come together to form negotiating units (e.g., Local Ir-192 of Greater New York) and then into a national organization . Since our specialty is too small to make enough impact, it will then be necessary to join with a larger group. Since most of our patients are covered by Medicare and Medicaid, and since our duty is to serve, it would be logical to try to become an affiliate of the Service Employees International Union (SEIU).

The advantages would be numerous. Organizational support would be valuable, such as promoting favorable coverage from the media and learning how to deal with physicians who want to try to work around the system ( scabs , or, more appropriately, eschars). The ultimate threat would be the shut-down of all radiation therapy facilities until a collective bargaining agreement is reached. It would be very important to place the blame on the shut-down with the government rather than on the union, but this should be able to be accomplished with favorable coverage by the press (as long as Charlie Sheen or Lindsay Lohan aren't having a big news day). A successful outcome would allow our specialty to more securely proceed with planning for the future, except, of course, for having to come up with money to pay union dues and expenses of union personnel.

This is a theoretically desirable plan but we have to realize that, frankly, most people really don't care what happens to radiation oncologists. There's no guarantee with SEIU will want anything to do with us. At the present time the National Football League is about to enter a period of intense deliberations to determine a new Collective Bargaining Agreement and I think it would be guaranteed that the country would sooner settle to avoid missing a season of NFL football way ahead of whether anyone ever gets treated again with radiation therapy. Maybe there's some way we can get in on this. If not, there is perhaps one last labor group with which we could join, which performs essential public services and which is also usually taken for granted.

Or maybe, as was told the patient with an hysterical pregnancy, this is just laboring under a misconception .