We live in an interdependent society. There was a time when people had to have a collection of skills — people lived in caves so there was no need to build houses, and hunter/gatherers to supply food. The hunters also supplied pelts for protection against the weather. As society developed, some people provided goods and services to others as part of a barter economy. There is still evidence of this period by the use of occupations in common surnames: Smith, Miller, Baker, Shepherd and Farmer. It can be many generations since the Fishers went to the sea in ships, and Earl Stanley Gardener, who didn’t have a garden, wrote fiction about a character named Mason who had nothing to do with the building trades. Somewhere, a few branches down in the family tree, the Miller family may have had a mill, and Captain Cook (according to a great deal of misinformation) wound up being dinner instead of simply preparing it.
As our society and economy became more diverse, and occupations were more specialized, some skills required more training than others, and we developed a hierarchy of occupations. A physician or attorney needed more training than a Solid Waste Collection Technician. Occupations that dealt with health ranked near the top in respectability, and perhaps had more control of their work. One of the criteria for a profession was autonomy. Richard Sennett, in his book “The Craftsman” (2008), argued that throughout history, skilled manual labor and having autonomy in your work were highly valued and associated with high social status.
The New York Times (1/12/24) had a report “Why Doctors and Pharmacists Are in Revolt.”
The subhead reads “Once accustomed to a status outside the usual management-labor hierarchy, many health professionals now feel as put upon as any clock-punching worker.”
While some professions, nursing and teaching, have been controlled by corporations or government for a relatively long time, medicine and pharmacy, at least in low population density areas, have had a great deal of autonomy, and now find themselves treated like assembly line workers.
Professionals who feel that they have a moral responsibility not to join a union, and that their role in society precludes going on strike, are faced with the reality that their working lives are increasingly controlled by administrators and politicians who have no experience in the practices they control.
The Times reported, “… doctors are not the only health professionals who are unionizing or protesting in greater numbers. Health care workers, many of them nurses, held eight major work stoppages last year — the most in a decade — and are on pace to match or exceed that number this year. This fall, dozens of nonunion pharmacists at CVS and Walgreens stores called in sick or walked off the job to protest understaffing, many for a full day or more.”
In the past, hospital administrators were physicians, who understood the role of the physician, and in chain pharmacies, the managers were trained in administration, with no idea of what resources were needed, including staffing levels and types of service was needed. One physician interviewed by the Times said, “I realized at end of the day that all of us are workers, no matter how elite we’re perceived to be. We’re seen as cogs in the wheel. You can be a physician or a factory worker, and you’re treated exactly the same way by these large corporations.”
The passing of the Affordable Care Act in 2010, along with federal rule-making efforts, rewarded bigness by tying reimbursement to certain health outcomes, like the portion of patients who must be readmitted. Physicians are told what they should say to their patients – advice on healthier life style, even if the advice isn’t necessary, because the lecture is reimbursable. Pharmacists are told to prioritize giving immunizations over filling prescriptions because the injections pay better.
Teachers and librarians have been micro managed for decades, and perhaps gotten used to it. Now they’ve come for the healing arts – and it can be a matter of life and death.
Sam Uretsky is a writer and pharmacist living in Louisville, Ky. Email sam.uretsky@gmail.com
From The Progressive Populist, February 15, 2024
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