“The Rubicon Was Several Rivers Back.”
In a deadlock with the bosses and the city over contract negotiations, one thousand doctors across New York City are fighting for their rights and those of their colleagues and patients. Left Voice speaks with one of the organizers about conditions for NYC doctors and how healthcare workers are joining a resurgent labor movement against profit-making at the expense of human need.
Nearly 1000 doctors in NYC Health and Hospitals (H+H) are ready to go on strike. They may work at public (H+H) hospitals, but their employers are corporate health systems, such as Mount Sinai, NYU, and PAGNY. The doctors — who are organized with the Doctors Council, an SEIU affiliate (DC-SEIU) — are denouncing chronic understaffing. They understand this problem to be the result of uncompetitive contracts, both in terms of salary and benefits. Since the announcement on January 2, Mayor Eric Adams interceded to ask for a 60-day “cooling-off” period, trying to avert the work stoppage, and negotiations are still underway.
On January 13 — after the following interview was conducted — the union leadership announced a Tentative Agreement with the bosses. The rank and file will now read the contract and vote on whether to ratify or reject it.
Left Voice’s editor Juan Cruz Ferre sat down with Dr. Gray Ballinger to discuss doctors’ working conditions and the looming strike. Gray Ballinger is a primary care physician at Queens Hospital. They are a union member with DC-SEIU. They spoke with us as a physician, not on behalf of DC-SEIU.
Please tell us a little bit about you and about the current conflict.
GB: I am a primary care doctor at Queens Hospital Center. I completed my residency in Internal Medicine in Manhattan from 2018 to 2021, which was certainly an interesting time to do residency in Manhattan. And this is my first job out of residency. I adore it.
Three and a half weeks ago, my clinic, specifically at my hospital, got fed up with the recent implementation of cutting our new patient visits from 40 minutes to 20 minutes. We had been in a lengthy — and at that point, completely stalled — 16-month contract negotiation, if you can call that a negotiation, because it was not being conducted by the other parties, our employers, in good faith. This was the last straw. We spent the night texting each other and, even though this only applied to primary care, we reached out to the other physicians and were surprised to find that they were with us. We voted among the global physicians in our hospital — without even telling our union — for strike authorization, and we got a 97 percent supermajority on the first vote.
Three days later, I was appointed to the strike committee and, after arguing about the timeline quite fiercely (some of us were more moderate and wanted to announce in eight weeks instead of two weeks), we voted with a 90% supermajority to announce in two weeks. We did that unilaterally. We surprised our union rep, though he did attend that meeting, and we didn’t expect to be joined by anyone. We are a 200-bed hospital, which, in the grand scheme of things, is tiny. There are 140 attending physicians. Yet five days later, we were joined by three other hospitals for a total of 1000 physicians within our system, and counting.
It seems that there was a lot of pressure building up in New York City hospitals, especially since many other medical centers and hospitals have now joined the struggle. Can give us an idea of what doctors are demanding right now and why they are going on strike?
GB: If you’d asked the general physician population of the United States 20 years ago if they thought they needed to be in a union, they would have looked at you like you had two heads. Not all of them would have said unions weren’t important or useful for many professionals. But we always thought that the degree of respect that we have from our patients would somehow translate to our employers. With the increased corporatization of medicine, we find ourselves up against these sprawling leviathans with infinite money, and they are perfectly happy to subjugate us the same way they do unlicensed professionals within the hospital.
The city hospital system is a system where we have insurance options for people regardless of documentation status. So this is essentially socialized medicine in the United States. It’s not a pipe dream. It’s literally happening right now, and unfortunately, our corporate masters are trying to choke the system to death. Physician salaries are so low, benefits are so meager, the retirement plan is completely absent, and there are no opportunities for increasing your salary. With increased years of service within the system, you get “cost of living raises,” which don’t even cover inflation, and we can’t recruit new physicians.
This is the job that I want to do. I would do it for less. But the fact of the matter is, if we don’t ask for more money, we’re not going to get what we actually want, which is not more money or more benefits. It is more colleagues. We need more people to come to this hospital. In the past year, at my 200-bed hospital, two elderly physicians decided not to retire, and only vacated their positions by dying because they understood that they would not be replaced, that no one would take the job. And sure enough, neither of those positions are filled. One of those people passed away almost a year ago.
As a consequence, the wait time to see a cardiologist, even if you just had a heart attack, is currently three months for a referral, it’s nine months for a rheumatologist who treats serious autoimmune diseases that can kill you in short order, like lupus or rheumatoid arthritis. It’s similar for any surgical subspecialty, sometimes 12 months, and our patients are suffering. They are not getting the care that they desperately need.
How many physicians are needed? Would you say the system needs twice as many?
GB: I would say a blanket statement of twice as many would be erring on the side of caution. That is definitely true. In some departments, it is much more critical than that. For example, a sub-specialist surgeon — who lost his visa mysteriously — was one of two. There is now one surgeon who can do those surgeries, who is on call 24/7. I have two patients who are booked with my colleague with the visa issue. One of them has a very serious, life-threatening medical condition, and one of them is in constant pain. They both had their surgeries bumped out by six weeks.
LV: You work at a public hospital, but your employer is a private company. This is the case for all the doctors that are now threatening to go on strike. Can you explain how this works?
GB: Well, that’s one of the points of contention: how little explanation we get as far as how this works. In the late 90s, under the Giuliani administration in New York, they privatized the contracts of physicians. It was part of a Republican privatization trend that started around that time and continues today. The contract between the city and my employer, Mount Sinai, or the two other pass-through organizations, PAGNY and NYU, is not available to the public or to the physicians. We do not know how this money is being spent. We just know that the dollar amount being received from the city suggests that there is enough money to go around. If they wanted to focus on physician salaries, they absolutely could. There are plenty of other things that could be cut down and that could be cost-saving measures, such as, for example, overstaffing primary care and under-staffing the emergency room. Then if you come in sick, you can be seen in seven to 14 days. My waiting list is currently four months for a scheduled patient in primary care, and 12 months for a new patient. And I have a panel of 600 patients.
LV: Can you explain how this private management instills a market logic into your everyday practice, and how that affects patient care?
GB: Market logic always figures into medical care, because in the United States, unfortunately, even if we’re providing free care, we are buying from all the suppliers that are charging steep prices in this sort of dystopian system. Any hospital system is affected by this, regardless of if we were direct city employees, which is what we would prefer, or if we were [Mount] Sinai, if they were playing fair. The market logic gets very problematic with [Mount] Sinai in particular. Mount Sinai is a huge health system, and most of their doctors work at their private hospitals in New York, a 15-minute Uber ride away from us.
So you have their hospitals, where they make tons of money, where patients have good insurance that pays well — they can pay the co-insurance, or co-pays, [in other words] the thousands of dollars that people frequently get charged out of pocket. And then you have a city hospital where they don’t get any of that. They get managed Medicaid plans at best, usually city health insurance, which doesn’t compensate nearly as well even as Medicaid. Additionally, the patients can’t pay anything out of pocket, and so they don’t. So why wouldn’t they try to starve us to death? Why wouldn’t they make it so that people who have a need for a procedure but can’t afford co-insurance decide to go to a city hospital and get it done there?
People won’t do that right now, not because our surgeons aren’t excellent, but because the wait time for a necessary surgery is exactly what I described to you before. Mount Sinai, PAGNY, NYU — these are private hospital systems that are being put in charge of doctor staffing in socialized medicine that is competing with them.
LV: The conditions in all these facilities are unbearable, and this obviously hurts patient care. The mayor and the employers are trying to avoid the strike and negotiations are still underway. Last week, the Doctors Council postponed the strike for ten days. Are rank-and-file doctors in all these facilities ready to go on strike?
GB: After almost 17 months of stalled negotiations, and choosing to be the first ones in the system to notify our employers of an impending strike action, we remain committed to our goals. We’re excited about the ongoing flurry of negotiations, but if they stall again, Queens will go on strike. The Rubicon was several rivers back; we’re willing to do what it takes.
You are on the strike committee at your hospital. Can you tell me a little bit how decisions are made and how you’re organizing within the hospital and within your union?
GB: Currently, there’s only two significant committees at the hospital. The bargaining committee is that one that has informed us, to the extent of their full knowledge, where bargaining has been over the past year, and where it is now. They have always been dissatisfied with the level of information that they get from the main bargaining teams. Our employers have really used secrecy as a huge weapon against both us and our union as a whole. They have always refused to participate in anything that is recorded, they always bring a bunch of attorneys and give us very short notice before bargaining.
As for the strike committee, there are people from every department, but we’re a small hospital. We all know each other really well. There’s not really any rank or disagreement with who gets appointed to whatever. And as for how we’ve organized overall, using electronic means has been vital for us. We all rely on WhatsApp, and we have multiple groups. This is how I have met hundreds of doctors at other hospitals in the past three weeks, and I now communicate with several of them daily. Dr. Patel and I are in the media work group for the entire system right now. We’ve been producing videos, and we’ve been liaising with SEIU International and our PR staff to get those up on social media.
There are working groups for everything, from the actual strike planning to picket captain work-groups. It’s just been incredibly active. And what’s really incredible about it is that we tasked some of our union reps with things — and in particular, SEIU International has been very helpful with a lot of the higher level PR stuff — [but] we have been doing this as physicians. There is nobody who has been directing this overall.
LV: If I understand correctly, there’s a larger negotiation committee at the city level, right? This committee is negotiating with the city and with the private employers. How does this negotiating team get input from the rank and file? Is there a flow of information or voting system to exert your right to decide on the direction of the strike?
GB: Essentially one of the benefits of this is that everyone has ended up more or less at the same table with the city, which does fund the pass-through organization.
I would say that Doctors Council has existed for a while, but this is a really big growth moment for our union, and for leadership, and for us. This is the first time where this union has been thrown into a sudden crisis. We didn’t start the crisis. We finally reacted. This is the first time when we have been challenged, and our organizational structure has been challenged, and even the staffing of the union. But you know, right now our poor union reps, it’s not that we don’t want them. They’ve been awesome. It’s just like, there’s three or four of them available to us, and we’re on a really short timeline. We joke when they call it the People’s Republic of Queens Hospital, which we committed them to.
But hey, this union has not been tested like this before. The communication structures were what they were, and now we’re starting to see — I’m sure the leadership is seeing it too — that we need a more active say. The way we’ve been running things at the individual centers [is] so that everything gets put to a vote. There’s really not anyone in charge, because we don’t think that anyone deserves to be. We’re all representing our departments and our personal practice styles. And I think that our union has, over the years, become a lot more top-down than is actually preferable to us. And I think that those are changes that our union leadership is totally going to be receptive to. It’s just that right now, I think all of them are getting about two hours of sleep a night, which is pretty understandable. So we’re making a lot of discoveries and changes on the fly to how our union functions.
LV: I want to take a step back a little bit and ask you about the larger picture. There are residents organizing in unions. Just yesterday, Temple Hospital voted to join CIR-SEIU. They won by 450 votes to 11. And there are five other hospitals in Philadelphia alone that are having a union vote this month. There’s this threat of doctor strikes in New York. There’s a strike in Oregon, involving thousands of health workers. Do you think there’s something larger happening in the health sector?
GB: I think that there is something larger happening in America right now, with unionization and with workers fighting back. Our hearts go out in solidarity to the workers at Amazon. One of the groups of people that I see are Amazon employees, and I could spend hours and hours explaining to you their working conditions and how it impacts their health. Upton Sinclair’s The Jungle has nothing on it. Employees, citizens: we are all being faced by larger and larger corporations who are no longer respecting workers, and that is the only way we are going to stop the systematic abuse of workers worldwide.
Any time they tell me residents are unionizing, I tell them, yes, do it. It could make my job very hard for a month and a half, but it will make your lives better. These doctors don’t have a choice of when they are scheduled. They don’t get a choice of when their vacations are. They get two weeks of vacation every year, two to four, if they’re lucky, and they work 80 hours a week the rest of the time, mandatorily, days, nights, that’s up to the boss. These young people are the best and brightest. They deserve better than this system. We have complete solidarity with residents. But the other thing is that, when one system goes on strike, others look in our direction, whether or not we are in direct contact.
Residents at my hospital have asked if they can wear the strike buttons if they’re not going on strike. Nurses, nurse managers, front desk staff, they’ve stopped by my office to get information, and ubiquitously, they’ve said, well, we’re glad you guys did it, because we didn’t want to do it first.
Regarding recent events in Midtown, there was this outpouring of American rage across the political spectrum. We were cheering on a horrible event that none of us would want to have happen to anyone, simply because that is how angry we [are]. A physician much older than me came into my room the day after the death of the United Healthcare CEO and said, “Did you hear what happened?” and I said, “Yes;” I didn’t want to be crude. And she said, “Couldn’t have happened to a nicer man,” and walked away. I have never seen this woman frown. I have never heard her say a mean thing about anybody. And it shocked me, because, in my private conversations, I had been far less pleasant than that. But the idea that someone who is such an exemplary… kind of a person would have that amount of anger towards any human being… it tells you that we are at a tipping point.
Everyone needs to do something. If you are a patient, if you are a nurse, if you are a doctor, if you are a resident, a trainee, an assistant, a janitor in a hospital, if you are understaffed, underpaid, overworked, abused: unionize! We’re with you.