Allina doctor on vote to unionize

[MUSIC PLAYING] CATHY WURZER: Allina Health is one of Minnesota's largest health care providers. And now their doctors are believed to be the largest group of unionized private sector physicians in the country. Doctors in the Allina system have voted to unionize in a vote of 385-200. More than 150 nurse practitioners and physician assistants also voted in the election and are eligible to join the union.

Dr. Katherine Oyster is a family medicine and OB doctor at Allina Health Cottage Grove Clinic. Doctor, welcome to the program.

KATHERINE OYSTER: Thank you so much for having me.

CATHY WURZER: I think it's a good idea to look at how we got to the point of physicians and other health care professionals unionizing over the last, oh, gosh, several decades. More primary care clinics have been bought out by larger corporations. How has that led to this moment?

KATHERINE OYSTER: So what that has done is basically taken the power of taking care of patients away from the people who are actually doing it to thinking about it more from a profit generating or how can we make or save the most money with each patient.

Ultimately, it means that there's larger groups, more centralization, which means a lot more attempts at standardization, which ultimately is not good for primary care. Because each patient is so unique, and we want to be able to tailor our care to each patient's unique needs.

And that's harder and harder to do in these larger and larger corporations, where the bottom line is the bottom dollar. And that's not really our bottom line, never will be. So we organize to try and address changes to help fix that.

CATHY WURZER: You mentioned primary care. Primary care so important. It is not the revenue generating area of the health care business like it is with, say, surgeons or other subspecialists, right? Are the physicians now in this union mostly primary care docs, or is it across the board?

KATHERINE OYSTER: So this union is specifically about Allina primary and urgent care. So these are the doctors in the clinics around the city. There are about 60 clinics, I believe.

And we are primary care-- so family medicine, internal medicine, pediatrics, doctors, nurses, and-- I'm sorry, nurse practitioners-- and physician's assistants. We also have our urgent care colleagues as well, who do more of the same-day care, treating more of the acute issues that don't necessarily need the emergency room.

CATHY WURZER: So a substantial swath of Allina's health care practitioners.

KATHERINE OYSTER: For the primary care wing, absolutely. There are surgical specialties and OB-GYN and other medical specialties like cardiology that are not included in our union. But we are a substantial piece of the physician and provider workforce at Allina, yes.

CATHY WURZER: I was doing a little bit of background research before you and I started to talk. And most unionization efforts thus far have focused on residents and fellows. This looks different in that it involves doctors and nurse practitioners and physician assistants. So why is it important to include everybody in this?

KATHERINE OYSTER: Well, because we're, at least in the Allina system, we are all working with the same patients, doing a lot of the same work. The physician assistants and nurse practitioners have their own patients, see their own. Can be considered their primary care provider. See, do all of the same medicine or a lot of the same medicine that we do.

And so we felt it was really important that they be included since we're all working as a team to care for our patient populations anyway. So it just made sense to us to do it that way.

CATHY WURZER: You did it-- it was interesting to listen to you kind of lay out the situation at the beginning of our conversation in terms of how we got to this point. But was there a specific tipping point to where you felt there really needs to be a change here?

KATHERINE OYSTER: Yeah, like in a lot of businesses and a lot of industries, the pandemic really did kind shine a light on the need for this for a lot of places. Because at first, with the beginning of the pandemic, we were-- we still are ready to jump into action and do what is necessary to take good care of patients.

But there were a lot of changes that happened pretty quickly and unilaterally from the top down, things like closing certain clinics because we were doing a lot more digital care, really, really pushing digital care as an option to limit exposures.

But unfortunately, as that transition happens, since the pandemic has calmed down significantly, we still end up doing a lot of digital care. And a lot of that has changed kind of where the burden lies in terms of the majority of our job.

It's not so much seeing patients face to face anymore. It's medical messages. It's phone calls. It's fighting with pharmaceutical companies. And that got much, much more intense with the pandemic and really hasn't improved.

If anything, it's gotten worse. And the organization has not been flexible to really adjust to the changing needs of our population to help support us to take care of them.

CATHY WURZER: There's been a lot of talk, Doctor, about burnout. But I wonder is this also leading to some sort of disillusionment over the field of medicine?

KATHERINE OYSTER: Yeah, that's a big thing that we're dealing with in the medical community in general. We had a huge mass exodus of providers with the pandemic as is.

But also just in general, we get into this field in order to do good, make connections with patients, take care of patients. As primary care, we definitely are doing that because it's very-- it's pretty well known that we're not in it for the money. We're not paid nearly as well as the surgeons, like you said.

This is more for love of the game. But I didn't become a doctor to fill out paperwork or the like. I did it because I wanted to have meaningful conversations and encounters with patients.

We're definitely seeing a big amount of burnout and disillusionment. Actually, we prefer to call it moral injury, just because it's antithetical to what we are. We are doing a lot of things that are antithetical to what we feel is right and appropriate to take care of patients.

CATHY WURZER: But there's always been a ton of paperwork for physicians, right? But there seems to be something that is different now.

KATHERINE OYSTER: Yeah. And I think some of that is that, yes, there's paperwork, but there's not a lot of support staff to help us with said paperwork. And that has changed quite a bit.

And some of that has been, again, just not as many people in the health care workforce. But also that it's not as many people in the workforce, but also just honestly not paying our support staff enough to keep our good staff here or to keep, frankly, any staff here.

So there has been a huge piece of it. And honestly, one of the biggest things that we're hoping to gain with being in a union is being able to set some staffing ratios to help us come together with a good idea of what exactly is needed to take care of patients safely and effectively. Because right now, that's not, not happening as well.

CATHY WURZER: Final question. I know you're busy. There were still about 200 individuals who voted against unionizing. What does that say to you?

KATHERINE OYSTER: So that says to me that this is-- that we have differing opinions. That's going to be the case all the time. We're physicians. We're kind of like herding cats sometimes.

But in general, the people who I've spoken to who have not been enthusiastic about the union have had concerns such as losing flexibility or presence or absence of use of seniority in the organizing in terms of union representation and benefits, and that sort of thing.

Worrying about changing the status quo, which they are concerned that this is just too drastic of a step. But ultimately, we had been trying to change the status quo within the system and trying to follow the proper channels, and it just wasn't working. So this is what we-- this is the route we ended up taking.

CATHY WURZER: All right, Dr. Oyster, thank you. I appreciate your time.

KATHERINE OYSTER: My pleasure. Thank you.

CATHY WURZER: We've been talking to Dr. Katherine Oyster from Allina Health. Now in a statement, Allina Health expressed disappointment with the vote to unionize, saying in part, quoting now, "While we are disappointed in the decision by some of our providers to be represented by a union, we remain committed to our ongoing work to create a culture where all employees feel supported and valued."