Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Physicians' Unions

Episode Date: January 21, 2025

Imagine if your doctor could go on strike in the middle of a treatment. That’s the most popular argument against physicians’ unions, but there’s a lot more to the issue. Dr. Sydnee talks about the process of training doctors in the United States, why doctors would want to unionize, and what a doctors’ union might look like.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/Palestine Children's Relief Fund: https://www.pcrf.net/

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. Alright, this one is about some books.

One, two, one, two, three, four. We came across a pharmacy with its windows blasted out. Pushed on through the broken glass and had ourselves a look around. The medicines, the medicines, the Escalant Macabre for the mouth. Oh, it's been a while. Hello, everybody. Welcome to Sawbones, a meritorious misguided medicine. Oh, me? I'm just your co-host, Justin McElroy. And I'm Sydney McElroy.

Mm. I'm excited about this one, Justin. Oh, I just had the podcaster's nightmare. I realized that I needed to pee a little bit right when the episode started. So it's going to be a really tight one for me, Sid, but I'm gonna find a way to focus on the show. Justin, I think that is a great intro

to this specific episode. Wow, that's amazing. We had a thing about this in theater, we would not pee before an audition. It was a well-known thing where none of the guys would pee before we had to do an audition because there was a superstition that it would make your audition go better

if you had to pee while you're doing it. Presumably because the pace, you would keep the pace up and it would be high energy. You're faster, sure. Yeah, well, okay. I've never heard that. So we'll do this one rain pace, folks. Rain pace.

Rain pace. I was referencing that as a physician, especially during my years in training, I often worked with a full bladder and counted the seconds until I would be able to take a break and pee. So I thought that was good because we're gonna talk about physician unions and the lack of ability to pee

when you need to is probably part of what led to this. Yeah, I mean, I that's I think it's a little dehumanizing if you can't go use the potty whenever you need to potty. I think that everybody should potty whenever they want to. That's how I feel pretty strongly about that. You know what honey? I'm gonna tell you that not being able to pee when I needed to was one of the less dehumanizing things that I think I experienced during my medical training, if that gives you a scale. Thank you to Melina for suggesting this topic.

I wasn't, so I'm familiar, of course, with the concept of doctors unionizing, but I didn't realize how trendy this is becoming, how there are more and more physicians who are taking this route, which is really exciting. And it is a huge deal to people within the medical community in general. And I think especially physicians, obviously, the idea of physician unions. And it might not be immediately apparent why, but I wanna walk us through sort of the history

of unions of doctors, doctors unions, and why is it such a big deal? I mean, do you have a sense, Justin, right off the top of your head, why is it a huge deal if doctors unionize? Yes, obviously, because unionization, one of the big strengths of that is collective action. And it seems like to me that,

and we've seen this in some parts of the hospital system already, but when people strike, then it creates some big gaps. And you would, obviously it was huge for nurses in our region when they were striking at Campbell. And you can imagine those problems being more just because of the price of that, you know, fewer of those doctors and the specialists and even harder to replace.

It's a big issue and it wasn't always necessarily apparent why physicians would want to unionize. Now I think, and I think you need to understand a little bit about training. We've done some episodes where we've talked about the process of training physicians in the past in the US. I'm only talking about in the US, systems are different country to country. But I think it is probably relevant for me to review that a little bit for this episode.

Justin, I know you're intimately familiar with it because you experienced it with me. But if you yourself have never experienced physician training in the US or you don't have a loved one or friend or someone, if you're not familiar with it, it can be a little shocking, the way we train doctors. It's very intense.

There's not like a good, it doesn't really relate one-to-one to like grade school or a regular job or really any other thing. So after you finish your undergraduate education, you in this country, you go on to medical school, or what we consider our undergraduate medical school. So it's kind of like there's undergraduate, undergraduate, and then there's undergraduate

medical education, which is the four years of medical school you're going to attend, and that can be either an MD, medical degree program, or a doctor of osteopathic medicine, DO program. So you're gonna attend those four years of medical school and those four years are challenging but in a way that probably is a little more predictable like you would guess. You spend the first couple years mainly in classrooms, lecture halls, maybe an anatomy lab, learning and then you spend your second two years out in

doctors offices and hospitals and in healthcare settings, doing clinical rotations where you're shadowing doctors, doing work, out there in the world learning things. And those can be arduous years, certainly especially the third year of medical school can be really challenging. I wouldn't say it is outside the realm again of what you would think training a doctor would look like.

I think it's when you finish those four years and now you have moved on to graduate medical education or residency and then perhaps even beyond to fellowship. That is when, if you're not familiar with the process, you can see how someone might want to strike while they were going through it. So in the US, a medical resident, and your first year, by the way,

can be called an intern, no matter what specialty you go into. And then after that, you're a resident, and it depends on what year you are and different programs or different years. I'm not. You're still a resident when you're an intern, right? Yes.

It's just, I got you. Yeah, you still have to finish your step three of your boards that year, and then you become a resident after you finish that. So that's why it's differentiated. And there also used to be a way that you could just do an intern year and then practice medicine,

and you'd be a GP, general practitioner. Nowadays, most people don't take that route. But that is also why that first year was sort of distinguished. And then after that, you complete your residency in your given specialty. So for me, family medicine, three years and I was done. Surgery is five years and then you could do fellowships

that could be one, two, three, more years on top of that. So it can be a really long time. During that time period, you're paid much less than you would think a physician in the US makes. Right. Because it is much less than a physician in the US makes. And you are also- That is a correct assumption that you have made.

It is quite a bit less. Yes, it's quite a bit less. It is exciting because you've only been losing money up to that point. You've just been sinking into debt. And so it's exciting to get a paycheck. But you're paid much less. And your work hours can be up to 80 hours a week,

on average. I say on average, because you could, especially if you have a weekend off, the week before that, you could work 120 hours. Certainly many of us did. Obviously that includes overnight shifts in the hospital. That can be as frequent as doesn't violate work hours. There's specific rules about like,

if you've been there for 24 hours awake, you have like six hours, I think now it's four hours to complete your work, but you're really not supposed to engage with new work. Like I'm not supposed to take on a new patient if I've been awake 24 hours. I can only take care of the patients I already had, but not new ones. So like there's some other rules around it. But it's extremely difficult. And historically has been a period in physician training where hospitals can really utilize residents

to the best benefit of the hospital and not necessarily to the best benefit of the physician or the patient. Right. You are having, it is like a weird, oh man. It is a weird gap in like the capitalist system that we understand to this point that where people are getting a lot more work and there is no, you can't quit.

Like you can't like, I mean you can, but like it not in all go find another place to work. Like you are stuck there. You're stuck there. You're stuck there. You're not, you know, you're not getting paid enough and you're forced to do it and you have no choice. And you're usually in.

It is a, almost certainly someone in the chain is profiting off of that very low cost labor that you're providing. Well, the hospitals are. Yes. And we're also, during that time period, most of us are in six figure debt. And so the idea of quitting is so terrifying.

How will I pay back this money if I don't finish my training and become a full-fledged physician? So anyway, despite that, despite the fact that, I mean, I spent those years, I didn't pee, I didn't eat, I didn't sleep, I drank so much coffee that I gave myself an arrhythmia temporarily. Self-care is not a concept that existed,

I think things are changing, but certainly not in my residency training. And it was worse before me. The people who came through medicine before me had it even worse than I did. So despite these issues, physicians historically didn't unionize for a couple of reasons.

One, I think it's more of like the way we see ourselves. Physicians tend to see themselves as management, even though we really aren't. Fellow physicians, have you thought about it? We're not. But they tend to see themselves that way, like, no, I wouldn't need to unionize, I'm the boss. I bet you have a boss, most of us do these days.

And I think the other thing is that the idea that medicine was supposed to sort of traumatize you is kind of baked into the culture. I mean, it really, if you think about even the shows that I love, MASH or ER or House or even Scrubs, everyone on it is cool and works so hard all the time and they are kind of miserable and kind of traumatized, but that's medicine and that's what it is to be a doctor.

And so I think part of it is our own, the way like we think that this is what we're doing. There's a mythologizing of that, like suffering and that intensity and the hardship. This is our calling. We're not supposed to be human. It's dehumanizing because I'm not a human. Well, it's like a lot of hardship where like,

I mean, I think motherhood is a good example, right? Where once you go through this incredible pain, you are an owner of that pain, right? So like you are a guardian of that pain and there are some people who I think that pain to them is, I wouldn't say this about motherhood, but like for those doctors, I think they feel like you need to go through that

to like be part of the fraternity. You know what I mean? Yeah, I do think there's a hazing element if that's kind of what you're saying. Yes, that's like really more succinctly put in it. I think that that is part of it. And for older physicians like I did it, do you have to do it too to prove yourself?

There's a truth that being a physician is always going to have this element to it that feels unfair. You're gonna see really sad, heavy, hard stuff on a regular basis. Now it's not affecting you, so I would argue it's worse for the person who it's affecting, but it does affect you.

It is, you are gonna carry it home, and you do have to bear that, and then go to work the next day. And that's intractable. But then there's a lot of it that is tractable, and we just haven't fixed it. The other thing is that doctors were typically, historically, independent contractors.

You either had your own private practice or you owned yourself. You were your own boss. You were not an employee, historically. We're gonna get to why this is shifting. But the history of residents specifically trying to unionize is a little older than when we get to people who've completed their medical training.

And it makes sense as why, why would residents be the first ones to unionize? Well, for all the reasons I just said. Right, it makes perfect sense. Yes, I mean, I think the word abuse is a heavy word and so I don't wanna say that we abuse resident physicians, but do we ask them to deprive themselves of basic human needs and underpay them and overwork them

for the privilege of being a physician. Yes, we do that. That sounds like, I mean, if we're talking in literal terms, that certainly sounds like abuse. And this is back to the 1940s. And by the way, resident physicians, the reason they're residents, they used to reside at the hospital.

They live there. Attracts, that's still sort of, like not obviously they don't, sometimes there's little bedrooms and stuff. Where you can sleep. Where you stay overnight. Yeah, the call room. Yeah, well, and I will say, even though we don't reside in the hospital,

at least in this area, pretty much you know where all the residents live. It's right around the hospital. Yeah. Because they walk to the hospital, because they have to be there. No matter how much snow's on the ground, they gotta get there.

So we reside around the hospital. Anyway, so the first one, there were interns from 26 New York hospitals that organized as the intern council of Greater New York back in 1934. So a long time, yeah, like back early days of unions at all, there were physicians who were attempting to organize. And a lot of it was for salary adjustments.

To give you an idea, by the way, so they were trying to get salaries of $15 a month, this was 1934, but to give you an idea, I did the math, my intern year of residency, do you know what my hourly wages were? What? A little under 12 bucks. So it's not lucrative to be an intern.

Now that has shifted, residents are paid a little more, obviously than they were back when I went through. So it's not lucrative to be a physician, to be an intern. Now that has shifted. Residents are paid a little more, obviously, than they were back when I went through. But you're working those hours and you're making, I was making like $11.75 an hour for what I was doing. So there was this first move back in the 30s. After that, there wasn't much else until in the 50s,

the Committee of Interns and Residents was formed, which is something that still exists to this day. And then a few years later in LA in 1965, there was another Intern Resident Association sort of formed. But all of these were like pretty small organizing efforts. And there wasn't, it was mainly like, we want you to pay us a little more.

There wasn't a lot, like what are our principles? What are we, you know, pretty small efforts. And also not like designed to be regional, right? It sounds like these were all sort of like, this is a big enough area that we can get enough people together to get something like this going. No aspirations to being a national thing. That didn't come until the 70s.

And in 1971, the first national effort took place in St. Louis. There were representatives from all over the US. They had a bill of rights for patients, a bill of complaints for themselves. They approved a contract, a minimum wage, the kinds of stuff that unions do, right? So it really wasn't until the 70s that you see this kind of national effort. And this is around the same time where in the 70s, you see a lot of kind of we're hitting the height of union, like the moment where the union busting really started, like the unions were pretty strong through the 50s and into the 60s.

And as we ease into the 70s, you start to see unions in general across the US be undermined and more efforts being made legislatively to try to stop unions. So right as I think residents were trying to make themselves a force, a labor union force, was the same time that a lot of rules were being passed specifically like Taft-Hartley, which more or less, the language of Taft-Hartley, prevented hospitals from striking. Now just like you said, Justin, this gets to, I think, the meat of the question. When doctors started organizing, everyone asked the same question.

Well, if doctors are in a union, can doctors strike? And if doctors can strike, what happens to the patients? Now I want you to think about that question. I think there's a lot more nuance than just that. I think it's a very simplistic view of the actions you can take. But this is why- Sorry, I mean, you asked me why I thought it was and I just told you. No, you were exactly right.

Simplistic. But I think anytime that you say, I think this is a huge force for good and something that's really important for us to do, and somebody gives you like a one sentence like, no, because then you could strike and patients would suffer and that's it. I think that it behooves you to stop and say,

well, surely we could serve both. There's gotta be something in between there. Right. But I think that argument was used on a national level and legislatively, and I can imagine there were a lot of blustery speeches given about the fear, what if your doctor's all walked out? You're hooked up to machines in the ICU,

your loved one is, and the patient's family is all around the bed, and then you watch your doctor drop their stethoscope on the ground and march outside. Terrifying. You can imagine the kind of rhetoric that would have been, it would have been very easy to undermine a physician union effort by, by kind of leveraging that fear. So we really didn't see like in the seventies, this kind of, this attitude towards unions permeated

any efforts to really start physician unions. And you didn't see the resident organizations grow much, but they continued to exist. Now I do wanna talk about the flip side of that, which is what about the doctors who are already done with their training? Because this has been really focused on the concerns of residents, which a lot of them,

not all of them, depending on your specialty, but a lot of them do go away. When you finish your training, you make a grown of them, not all of them, depending on your specialty, but a lot of them do go away. When you finish your training, you make a grownup salary, you get to pee when you want to, you have a little more control. Anywhere you want to. Well, no, you still gotta go to the bathroom, but you get to pee, you get to eat,

you get a little more freedom, you get a little more autonomy, depending on where you work that's still limited, but you get a little more of a personhood back. So why did attending physicians, why did physicians done with their training strikes? So I want to, or why did they unionize? So I want to talk about that,

but first we got to go to the billing department. Let's go. The medicines, the medicines that escalate my cough for the mouth. Well, Sid, why are those, why are the old dogs, why are they so upset? Aren't they happy with their fat paychecks? So they, they aren't. Oh no! The first strike that included all doctors, not just doctors in training, was in 1966

in New York and it was to protest low wages from the Doctors' Council. But in the 70s, the SEIU announced that there was going to be a Physicians Union formed in Nevada. So it's a big deal to get the SEIU to recognize this is an entity that's organizing. So that's very exciting. And the Union of American Physicians and Dentists were founded, which is also bridging that divide between physicians and dentists is so exciting too. Anytime we can do that.

Because again, I don't know about teeth and dentists, I need you. Because I don't know. They won't teach us. They refuse to tell us anything. Okay. So in... I think you should leave teeth to them. I think that they're territorial and I understand it.

They don't want you meddling in there in those weird bones. No, they don't want us doing it because they know we don't know what we're doing. No, you make them explode. They explode on their own. We've established this. That's true. Yeah. So...

Unless it was something that doctors did. It might be something doctors did. You don't know. So the problem is that basically, when they established this in the 70s, the AMA was a little concerned because the idea of, so the American Medical Association is its own lobbying organization.

It's not a union, right? Like they're not, it is not a union of physicians. They're a political lobbying group. They're, you know, you can, they will advocate on mainly national levels for policies that benefit physicians, but it's not the same as a union. But they felt like, like we're here. I mean, we exist. Why don't we just have sort of a department of negotiations?

And then you can just, like if you're part of the AMA, we can help with that too. And so I would say at that moment, a lot of doctors who may have been sort of thinking about unionizing and like, well, we could form one of these too, the SEIU is recognizing this, you know, there's a chance that we could have a little more control over our destinies as physicians.

I think a lot of them probably turned to the AMA instead and said, well, the AMA will be that for me. And that really, honestly, until the 90s, you don't really see much else movement. There are a couple of resident unions here and there throughout the country. Mainly once they're done with training, physicians don't join unions. If you talked about resident unions, I mean, even when I went through just talking about the idea of unionizing,

everybody was just ready to scream, like, don't even say it. Like, this is not even, which is relatively recently. But what started to shift in the 90s were HMOs. So as these huge healthcare management organizations started buying up smaller systems. So you've got hospitals, you know, joining forces. You've got big systems buying private practices and smaller healthcare groups.

Conglomeration and things being rolled up into one another. Yes, exactly. And this was, it started in the 90s and then actually in response to the Affordable Care Act, which is, was wonderful and transformed, especially in this area, healthcare in such a positive way in so many ways. So this is not me slamming the Affordable Care Act. But there was even more after that. It was profitable for these systems to buy up these smaller little offices, primary care

got gobbled up in there as well. All of a sudden hospitals weren't just for hospital medicine. A hospital system has multiple different specialties, outpatient practices, primary care and subspecialties and all that within it, right? Like that didn't, if you think about it, that's not what hospitals used to be.

They used to be hospitals. They used to be hospitals. They used to be hospitals. And what came with that is a lot of monopolizing, right? In a lot of areas. You're trying to lock down the entire medical market. Yes, your healthcare system is essentially a monopoly. Think about the healthcare system in your area and it probably is, a lot of them are.

So anyway, what you saw is that back in 2012, about 29% of US doctors were either directly or indirectly employed by a hospital. By 2022, 10 years later, 74% of doctors were employees of hospitals or some sort of corporate entity. And the problem with that is that all of a sudden, as a doctor, I was kind of educated to believe that I was the boss. I literally write things that we call orders to give to people. And what comes with that is a lot of responsibility. That's the double-edged sword they always teach you in medical school. You are the one in charge.

You make the decisions, but also you get the blame. So if things go wrong, you get all the fault. So be really careful with your decisions. My uncle told me something about this. He said, with great power, buddy, sometimes there's gonna be a little bit of responsibility with that pal and you just gotta deal with it. I'm sorry, but that's the way it is.

Is that what he said? He did. He used to say that to me all the time. What was he doing when he said that? Was he laying on a sidewalk? Trying to keep me from wrestling, actually. I told him I had a futures wrestler. He said I wasn't ready for bone saw,

so he told me I wasn't ready for wrestling. But it's true, it's really weird when I think about the fact that it was impressed upon me that I was the boss, and then I began working in a healthcare system where I was not, in that I was the boss. And then I began working in a healthcare system where I was not in any way the boss. And when you have a systemized, like when you have a system, what you're talking about is the power

of the individual hospital is now subsumed by like an even bigger entity, right? So you matter even less in the, you think about shows like, it's funny we were talking about Scrubs, and it's like, the joke of that show is how small they were in comparison to the hospital. And now it's not even that,

it's how small you are to the like corporation that owns the hospital and the six other hospitals in the state. And I think it is that that has driven this shift shift because I can tell you that, you know, in residency, the bargain they're always trying to convince you of is that you won't have a life for this period of time. You are owned by the hospital and you will give everything to the hospital. But you'll get a life when it's all over.

And I think the problem is that when the hospital continues to be your boss forever, when the system, these giant healthcare systems, not just hospitals, but these giant, you know, high, really big money-making healthcare systems are your boss, you don't really ever get control. Your hours, the number of patients you have to see, the amount of time you get to see your patients, everything is so micromanaged. There is so much paperwork and administrative stuff laid on us now as physicians. I spend so, I mean, I don't because of the kind of medicine I practice, but prior to where I am now, you spend so many more hours doing the administrative tasks around medicine

to satisfy insurance companies and pharmaceutical companies and your hospital administration, so much more than you actually spend taking care of people, which is what you wanted to do. And eventually you get to the point where you realize other than that I get paid more money than I did in residency, is my life really any better? Am I still just, you know.

Right, a cog? Yes, a cog. And I think that that sort of internal conflict, like I've lost my autonomy, I no longer work at a private practice, I no longer am able to make these decisions on my own. I think that's really why we started to see in recent years, unions have started to rise among the medical community.

So if you look from 2014 to 2019, the number of physicians who belong to unions grew by 26%. It's still only a tiny percentage of doctors that are in unions. It's like 7% as of the last count. It is still growing, I will tell you. And that was why, actually that was the impetus like 7% as of the last count. It is still growing, I will tell you. And that was why, actually that was the impetus for doing this topic right now, is that there

have been a lot of news articles that have come out just in the last couple months about physician groups in Rhode Island and Massachusetts and New York and Pennsylvania. A lot of Northeast school-based, university-based programs and then outside of those that are unionizing and being recognized as a national union. There are so many more resident physicians and now more and more attending physicians,

doctors who have finished all their training, who theoretically should have control over their own practice and don't, who are joining these unions. And I think what's really fascinating about that and exciting, well, I don't want to say it's exciting because the flip side is that other types of unions have been steadily declining since the 70s. Since that peak, since we saw that union busting in the 70s, you see that union membership has declined to nearly 10% today, from a peak of 35%.

So at the same time where I think the US government has done a lot to suppress unions, and entities have, the US government has allowed entities to suppress unions. At the same time, doctors all of a sudden are flocking to unions. The AMA, by the way, does, they've had to issue briefs and papers and there's a roundtable and a webinar you can watch on

collective bargaining pros and cons should you do it. Which I think is interesting that it's presented that way, but what they're saying is we don't, we support your right to unionize. If you wanna unionize, you can. They're not really gonna weigh in positive or negative. They are gonna tell you that they can do a lot of what unions do, but if you wanna unionize, you can. Why would it be good?

Well. Why would it be good for physicians to unionize? I mean, I think the big one is when you talk about workload, if physicians are happy and they're not being put under like really huge, intense workloads and intense stuff they got to deal with so often at work, we know that like a physician suicide rate is dismal. And I think that aside from that, if you have physicians that are happier, then you have better care for everybody.

And I think that you don't want a doctor who is fried and exhausted and at their wits end and distracted by paying their bills, etc. But that would be my argument, Pro. I think, I think. For everybody. Yeah, well, I was gonna say, that's an excellent argument for unions in general, right? I mean, you are absolutely 100% right.

Unions mainly do three things. They advocate for you politically, they provide mutual aid and welfare, and they collectively bargain. Physicians for a long time, I think our welfare has been at stake. We talk a lot about in the medical world, there was burnout, physicians were experiencing burnout,

and then we decided that wasn't a good word for it. So we started saying compassion fatigue, which I think might be worse in some ways. And then we started talking about moral injury. And what that means is I'm working in a system that doesn't allow me to feel or to act in accordance with my own morality and values. The system is making me do things that contradict my values. And that's the healthcare system. I want you to have this medicine, your insurance won't approve

it. I can't give it to you. So I'm going to give you something else that I don't think is as good a choice. The system is making that happen. The system made it happen, I feel bad about it, you're upset, no one's happy, I go home with that every day. The system is doing that, and unions would give us an opportunity

to fight that system, to make that better, to relieve that moral injury that we're experiencing by giving us some sort of power over the system in general. Obviously, collective bargaining, so that we're experiencing by giving us some sort of power over the system in general. Obviously collective bargaining so that we work together. The strike thing is always going to be

the thing people throw in your face. We don't want doctors striking. There are a lot of creative ways to hold healthcare administrators accountable without walking out of patient rooms. I would strike but not bill. That's what I would do. I would strike but not bill. That's what I would do. I would work but not bill.

That is, that was done, I believe in the UK, there was a, was that where it was? There was a group of residents at one hospital who did that for one day. They took care of all the patients, they just didn't submit any billing. And it took one day for the administration to meet all of their demands.

So yeah, I mean, I think there are creative ways to take care of patients while still fighting for the things we know are right. And it's important because what our welfare, what we are able to be and do as doctors, obviously directly impacts the patients we're taking care of. We can be better and do better

and our healthcare system can improve. And we can get more primary care doctors and make sure that if you can't get in with your doctor because they're being expected to carry a patient load that's unreasonable. Yeah, you also attract the better people, more people, better people to the profession. It's a more desirable field.

Yeah. The other thing people will tell you is a reason why, because I was reading through all the pros and cons. What did the AMA tell me were the pros and cons? The other con they will tell you is a reason why, because I was reading through all the pros and cons, what did the AMA tell me were the pros and cons? The other con they'll tell you is that if we collectively bargain for a certain wage, and then your hospital wanted to do performance-based incentives, they couldn't do that.

I think that's just a capitalism argument. That's what they're always trying to tell you, right? But what if you could earn more? Right, what if they want to get you with more money? They're just dangling a carrot, but there's always a stick. So I think that's important to remember. And I will say the final thing about this. I think this trend is happening exactly when it needs to

for all the reasons we've talked about because being a physician shouldn't mean that you go through training where you can't pee when you need to, that's ridiculous. That shouldn't be part of it. You should be able to be a whole human and be a doctor. I think that the generationally we're shifting from this view of being a doctor is all I am

and I'll sacrifice everything for it to being a doctor is my job and I love it and I'll do it really well but I also have other things. I think that's happening across all disciplines. And then right now, you know, we talk about how our ability to practice medicine is limited by like prior authorizations we have to do, you know, length of stay, throughput time, all the stuff that insurance companies and hospitals put on us. But what about the legislative overreach? Is the AMA lobbying

effectively enough to stop government entities from preventing us from practicing ethically appropriate medicine, from living up to our oaths. Because I would say that in our state, the governor has issued, the brand new newly elected carpet bagger governor has issued a religious exemption for vaccine mandates as an executive order. He wants it done. Undoing one of the things West Virginia can be proudest of, which is that we have excellent vaccination laws and mandates and rates,

and we protect kids in this state. He undid it with one swift executive action. Imagine if West Virginia had a nationally recognized physician union that could fight that. We could stop that in a day with our collective voices. That is the power if doctors work together. We can protect abortion rights, we can protect transgender health care, we can protect vaccine mandates. With unions, we could have that kind of power and leverage. We can protect transgender healthcare. We can protect vaccine mandates. With unions, we could have that kind of power and leverage.

So at the end of the day, I think right now, if there was a union here I could join, I'd be very excited to do it. Yeah. Thank you so much for listening to our podcast. We hope you've enjoyed yourself and learned something, a new wrinkle in your, your noggin there. Thanks to taxpayers for use of their song,

Medicines is the intro and outro of our program. And thanks to you for listening and coming along for the ride. We sure appreciate you. That's gonna do it for us for this week. Until next time, my name's Justin McRoy. I'm Sydney McRoy. As always, don't chill. You're in. Take it away from me! Music

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