Are Doctors Unique -OR- New Members of the Working Class hoi-polloi?

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United We Stand – Divided We Fall?

By Dr. David Edward Marcinko MBA

BC Dr. MarcinkoPhysician blogger Kent Bottles MD recently asked if doctors are really different; a special class of folks?

And, some colleagues are shocked when an authority like Uwe Reinhardt PhD, of Princeton University, points out that collectively many MDs act just like any other worker in the domestic economy.

LinkAre physicians really that special?

In fact, the classic 1986 letters between the Princeton professor, and former New England Journal of Medicine editor Arnold Relman MD, highlight the tension between how we think of ourselves and how we act.

Medical Labor Unions

Now, also recall that healthcare journalist William F. Shea, opined more than a decade ago, that there were numerous psychological barriers against the formation of physician unions [personal communication].


These included (1) the public perception of doctor’s as a “cut above” ordinary workers; (2) doctor’s attempts to wrap collective bargaining in a mantle of patient’s rights that lacked credibility; and (3) the highly educated physician’s ability to re-engineer and seek alternate employment opportunities rather than accept the salary scale or lack of autonomy present in restrictive managed care entities.

Professional Wake Up Call

Tincture of Time

Time has proven Shea both correct and incorrect, as MD resignation through individual re-deployment and/or innovation has been more effective than any “union strike” if called by one practitioner at a time.

On the other hand, more than 40% of all physicians are now collective employees … So, what gives?

Link: Legal Strategies for Doctors Sheltering Employment Income


And so, are doctors really different than the man-in-the-street; or more like union workers and the OWStreeters? Did we stand united, or have we fallen individually since the comments of Shea, Reinhardt and Relman?


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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact:



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7 Responses

  1. Union woes continue as membership shrank again in 2012

    According to Allison Linn, TODAY, the number of American workers who belong to a union fell yet again last year, as both government workers and those in private industry saw their ranks shrink.

    Ann Miller RN MHA

  2. Physicians May Become ‘Union Docs’

    Agreed – Increasingly trending in health care – and becoming more common as we move closer to the 2014 implementation of the Affordable Care Act – is the physician moving from a self-employed, small business owner to a hospital-owned employee.


  3. On American Workers Day

    As employees of hospitals, physicians may actually start seeing fewer patients as their hours shrink, and they start working more like hourly employees. It is possible that we may see a disruption in the continuity of care as physicians adopt this new schedule.

    Ironically, an increase in the percentage of employed physicians could actually have an effect contrary to the intent of the Affordable Care Act to increase access to healthcare.

    Dr. David Edward Marcinko MBA

  4. The American Middle Class Hasn’t Gotten A Raise In 15 Years

    In 1988, the typical American adult was 40 years old, white and married, with a high school diploma.

    If he was a man, he probably worked full time. If she was a woman, she probably didn’t.

    More on Middle Class Struggles:

    But, what about the docs?


  5. Dr. Marcinko,

    Well, medicine could be “middle-class” worse.


  6. Middle class docs?

    While most Americans have benefited from recent stock market rises and current economic trends, the real gains have been made among the wealthy, according to the Federal Reserve.

    So, the median household net worth (the middle point between the wealthiest and poorest households, not the average) was only $81,200, a level that’s fallen 2% since 2010. And, the current average debt load for a US household was $203,067, including credit cards (up 2.2% in the past 12 months), mortgages and student loans, according to


    Now, compare and contrast these figures with your situation and tell us how you feel – medical colleagues?

    Dr. Rick

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