Thank you, Arnab. My name is Kusum Lata. I'm an interventional cardiologist. I'm also in the board of trustee for the Sky. And I learned a lot in last four years with the government relation in the Sky. And it's really privileged to be here. And if you feel like unionization is a little bit condescending word, we can definitely choose it and improvise this word a little bit later, because in the past, we just got burned by some of these words. So I don't have any disclosures pertaining to this talk. So what are the learning objectives? I'm just going to discuss some of the legal barriers that have historically precluded physicians from unionization, or maybe this was deliberately imposed on us. And what are the cultural barriers for the unionizations, and why unionization is the right way to move for the physicians today. Basically, what we are talking about togetherness, if you don't want to use the word. So some of the introduction. So three decades ago, a national labor and relation board that held the doctors ineligible to unionize because of their supervisory role. Eventually, what we found, and we amended this after many decades, that we have no role in that. We don't have any saying when we get our staff or when we get a new physician or so. And finally, somebody looked into that, and it was amended. And then we found that making now the change of circumstances, we can form and we can make a union together. So that's a little bit changed at this point of time. So what are the legal barriers that have historically precluded us from unionizations? So are we eligible? Any doctors or any employee that they have right to join a labor union and bargain collectively over salary, benefits, and working conditions? And this also includes doctors that are employed by the state or county, and both for-profit and non-profit employees. Who are the workers who are not consented to this? They are some of the domestic worker, independent contractors, agriculture workers. They are not covered by federal law to allow a bargain together. But different states have different rules, and there are some selective states that still have some rules about these things. So there comes the antitrust reforms. So it says that, basically, in the older days, there were many self-employed physicians. And they were the most important people, and they were more vulnerable to the economic leverage of the health plans. And they were the one who will gain most by these kind of changes. But the antitrust law that prohibit to bargain them, and they precluded them. So that was a problem. So the effects that their unionization, and they say by saying that if they form the union, they will have an effect on the patient care, patient population, and they have responsibility towards the patient care. And we'll talk a little bit about that. So now there was a very ethical conundrum that whether selfless patient advocacy versus self-advocacy. We have responsibility of taking care of the patients. Think for a second. If we cannot take care of ourself, and what we mean by ourself also includes the patient care. So if we cannot protect the patient, we cannot protect ourself, first of all, which includes the patient care. How can we protect entire society? So this is a really big ethical question that we have to remember when we go to the flight. First, put your mask, and then put. They don't say put your kid's mask, even though you're a kid. First, do it yourself. So this is really different for the physicians, or it made it different deliberately so that we can be worker forever. So in increasingly corporalized medicine, should physician, we should join the nurses, or just together do the self-advocacy. But they say that we have more impact on the patient care, so we should not be doing that one. And that was the reason in the past. What are the cultural barriers? So now you know that hospital system, I really don't like in last many years of my career, I feel like physicians are the holy grail. I just don't like the words of health care administration, health care business. I just don't like provider. I want to be a physician. They are the provider because you're providing the care. I'm a physician. I'm taking care of patients. But the hospital doesn't want you to form the union because now they have to share their profit to them. So they don't like it. Of course, unions are not perfect. Over the years when I was reading through, I couldn't find one of the union which is very safe and effective. And there is a reason for that one because we just let them run the service. And with the time, as Dr. Naidoo was talking about, we get more complacent, and they empower us. That's the main reasons. So without unions, hospital would have nurses working twice. And we know that because in the recent, who is the largest workforce in the medical society? It's the resident. And you know that was their pay and how much they're getting paid. And recently, they were able to work through, and they got a really good bargaining. And if you see their work life, it was really, very sad to see. So what is the concern? Are they really concerned? Or is it a way to dominate? And when I see all the medical cart and everything, I say that aren't they share the same responsibility as us about the patient care? So they feel like all this responsibility, they put it on physician. But they will make all the decisions about the physician and the cart. So they share equal responsibility as us. What is the physician psychology that precludes us? So we have a culture like we want to be autonomous. We have individualism because we are very smart. Everybody has the way to form. And they think that that precludes us from going towards the organization because everybody thinks that we are perfect. But we can be much better if we are together. Reluctance of the doctors to stand up against the big hospital because they have a better lawyer, they have lots of money, and they are together than us. And we are not together. So also, negotiation to the contract. When they go to the hospital, larger system, they have leverage, they have better lawyer, they have better representation, they have more to offer. So they can negotiate better than us. And then the power imbalance that gains all this because of this, the hospital dominance enables them to negotiate higher reimbursement rates. And that gives the individual physician not much reimbursement. So we don't have that much money. So then it goes into the vicious cycle. And that's a disadvantage. So the advantage and disadvantage of unionization is first, collectively bargaining. We can be able to work in conditions, fair compensation, greater control over our professional lives. And then some of the disadvantages, like we will lose some of the autonomy. Of course, there will be an imbalance in the payment model. We will not have much incentive about working more or less. But we can change those. We have to amend and participate in those changes. And of course, the seniority and all those values, that is the matter of concern, which we can definitely address eventually. So why this is right move for the physicians today? Because the bargaining power will be better. We will have better advocacy for reimbursement. And we will protect our integrity of the clinical practice. We can be effectively engaged in negotiation with the insurance companies, hospitals, and working more towards the balanced healthcare system. United States, the expenditure is too much. And yet, we are not the best in providing the patient care. Did you see our, we are pretty much in the middle of the, like in the last two third of what kind of healthcare we are giving. And yet, we are spending so much of the money. We will improve the working condition by negotiation, shorter work hours, staffing better, and get a control of residuals. When I go, I work for such a system. When I go and ask for this thing, I feel like I'm begging to ask for vascular tech, one radiology tech. I'm begging, can you give me? And I was, this is just too much. We don't have any control. And then also, it will alleviate the burnout. Two third of the physicians are burnout. And burnout from what? From doing the inbox without any kind of reimbursement, calling the patients without any reimbursement after hours work, and then lots of paperwork up. But there's no incentive for that one. So those things will help. So this is a trap. So the trap is that they are paying you a little bit and they want you to bargain a little bit of wages, while I was giving you a chair, giving you a laptop, talking about the patient care and patient satisfaction. Like a patient was not satisfied because the chair was not right. And that goes against the physicians. And then you will have a big meeting with your president or your CMO. And so physicians should lead on behalf of our patients, on community, and we should be a part of public policy. Not part of that. We should be the one who should be making because we are the one who are providing. So it's our right. So we will make the policy and you have to follow. So that will change the market dynamics and the corporate of the medicines. And then that will only happen if we are together. And we have to have a clear purpose for immunization that is often misunderstood. That's why I don't want to use that word. But this is kind of the same thing with some improvisation. And that will transform the entire American health care. And we should take a lead in that one. So who should be leading the physician unions? And remember that we say transplant is a trade of one disease to another disease, not a treatment. So we don't want administration for administration. Learn from the history. So when you learn from historical perspective, East India Company came to India as a like, we will help you running your business. And by the time they found that you got complacent, you got reluctant, they took over. So learn from the history. This is what happens. We just don't pay the attention. And we give them absolute power over us. And that's how they run the system. So the physician society should be led by physicians. I think it should be by the physician for the physicians. And that will give a true representation. We should be a part of that and this diverse relationship. So in conclusion, no systems or arrangements are perfect. In the current era, being unionized is much needed. Disruption for the patient care is decrease of the health care imbalance and prevention of physician's burnout. Doctors should actively participate in day to day in dynamic change. Tell me one person has spent 30 minutes a day on your improvement of the society and this one. They will be so much busy because they made you so busy that you don't have time. And prevent the absolute empowerment. Physician organizations like SKY should take a lead because that's I feel like more represented and more better representations. I will leave you with the quote. This is really important. At in most of the US doctors are still just complaining. Perhaps the doctors are like a woodsman in the tail who is working extra hours due to dull saw going about his or her work but is unwilling to take an hour to sharpen it saying he or she has no time spared due to his or her overwhelming workload. Thank you.

interventional cardiologist

physician unionization

legal rights

antitrust laws

physician advocacy