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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10 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


  7. Love Work

    Do financial and personal success go hand in hand with doing work that you love? While I can’t cite research to prove it, there’s plenty of anecdotal evidence that this may be true. Warren Buffet, for example, claims he tap-dances to work every day.

    A recent post from a colleague on one of my professional networks took this one step further. In addition to loving your work, he suggested the ideal career includes loving the people you work with and the clients you serve.

    Sadly, I know very few people who could say all three of these concepts are part of their work. Many of them “fell into” their careers by happenstance and a good paycheck. Fear of starting all over again has kept them stuck.

    If you don’t love your job, there are two basic choices. One is to learn to “love the one you’re with;” in other words, change yourself and the environment at your current workplace. The other is to “look for somebody to love” by finding a company that offers a better fit.

    To find work and an environment you love, you may want to look for a company with a culture of building careers rather than providing jobs. Here are a few characteristics to help you identify these companies:

    1. They evaluate. The best-practices companies assess potential employees for both competency and personality. Competency evaluations are often specific to the skills needed to perform the job; some firms also include IQ and Emotional Intelligence evaluations. A plethora of personality evaluations can go a long way to help candidates and companies determine if a person is a right fit for a career or a position. A few of them are: Strengths Finder, DISC, Kolbe Index, Emergenetics, Caliper, ProScan, the Enneagram, and the Myers-Briggs Type Indicator.

    All of these evaluations have their uses. None ought to be relied upon in isolation. All can be wrong or misinterpreted. Properly aggregated and interpreted, evaluations like these can eliminate 50% of the guesswork as to whether a candidate is potentially a good fit. My firm typically uses four to six of them.

    2. They interview. While there is no tried and true test to predetermine whether a company’s culture is a fit, many best-practices companies use a tool that’s proven itself to be incredibly effective: the two-day interview. Besides job-specific sessions, this may include social gatherings and one-on-one interviews with everyone that will be on the candidate’s team.

    3. They make a team decision. Companies that underscore and protect their culture don’t leave the hiring decision up to one person. Several times in my career, after copious evaluations and interviews, a candidate I saw as a perfect fit was soundly rejected by my staff members. It didn’t mean the applicants weren’t outstanding; it meant they were not a fit for our unique culture.

    4. “It’s all about the culture.” For every job there are scores of people who can adequately execute its tasks and accountabilities. There are very few people, however, who fit the culture of the company.

    Of course, assessing whether a candidate and a company are a good fit has to come from both sides. You probably can’t tell a prospective employer, “I’d like you to complete these four personality evaluations,” but you can pay close attention to the company’s culture as you interview.

    Finding a company that fits your values, life purpose, and personality takes determination, perseverance, and time. In the long run, it’s well worth the effort to build a career that means more than a paycheck. Just make sure there’s room under your desk for your dancing shoes.

    Rick Kahler MS CFP®


  8. Fewer Americans are earning more income than their parents

    Research led by Harvard and Stanford University professors found that today’s 30-year-olds are half as likely to make more money than their parents.

    In contrast, children born in 1940 had a 92 percent chance of earning more than their parents at the same age. Some say the rise of income inequality is to blame (CNBC).



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