CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
June 2021—Several CAP fellows have reached out to me recently about a topic many find controversial: whether pathologists should unionize. Some of this interest stems from concerns about employment models and how pathologists are treated in various situations. Some of it comes from concerns that pathologists are not being compensated appropriately for the risks and responsibilities they bear daily.
The COVID-19 pandemic has also fueled increased interest in unionizing among many types of health care workers. According to the U.S. Bureau of Labor Statistics, people who work in health care and social assistance are a little less likely to belong to unions than people in other fields. In 2020, 7.1 percent of workers employed in health care and social assistance were members of unions, compared with 10.8 percent for people in all industries. But the pandemic has led to an uptick in unionizing interest for many in the health care field, from nurses and respiratory therapists to many other providers as well as physicians.
Dr. Godbey
My great-grandfather was instrumental in bringing the United Mine Workers of America to the coal mines in Appalachia at a time when that was one of the most dangerous jobs in the country. Many miners were paid by the number of tons of coal they dug. The more they dug, the higher the pay. For some, this draws a similarity to the 88305. They felt that decisions concerning not only their worth but also their well-being were being made by outside interests whose focus was strictly profit. Does this sound familiar? They needed a union.
The face of unions has changed a great deal since those days. Police have unions. Teachers have unions. While many still associate unions strictly with occupations such as coal mining, it is worth remembering that some of the highest-paid people in the world—professional athletes, for example—are union members. They have their own agents but still are unionized.
For pathologists, there are two key questions to consider as we discuss this topic. The first is more straightforward: Can we? The second and more important question: Should we?
For an increasing number of pathologists, I believe the answer to “Can we?” is absolutely yes, if you’re employed. This typically means you are being paid a salary reported on a W-2 form. Pathologists who are supervisors are excluded. If you truly have the capacity to make employment decisions, then you probably won’t be able to be a member. In many cases, interns, residents, and fellows can. For other pathologists, the answer is no. My group is an independent contractor with insurance companies, which would disqualify us from forming or joining a union. The most important regulations in regard to this issue are the antitrust ones that the Federal Trade Commission and the Department of Justice enforce, and they do enforce them. You can negotiate for your group, but you can’t call the other group across town and ask how much they charge or are getting paid by the Blues for an 88305. This is one reason why I believe larger groups will, in the future, have an advantage. Still, more and more pathologists are becoming employees rather than independent practitioners, consultants, or contractors.