The Valley Physicians Group of Santa Clara County, California, one of the largest independent physician unions in the country, has reached a labor agreement with the county that employs them and averted a threatened strike, which was scheduled to begin Nov. 1.
The resolution to strike, approved by 93% of the union’s 450 members, came after two years of stalled contract negotiations, during which the doctors said the county failed to address poor working conditions, including high caseloads, reduced resources and a burned-out workforce at Santa Clara Valley Medical Center. Commonly known as Valley Medical, it is a 731-bed public teaching and research hospital and one of five Level I trauma centers and one of three pediatric trauma centers in northern California. It also operates the only federally designated spinal cord injury center and the only traumatic brain injury center in northern California.
“We care for everyone, regardless of insurance or ability to pay,” said Valley Physicians Group (VPG) chairman Steven Harris, MD, a pediatrician who served as the chair of pediatrics at Valley Medical for 12 years. “At some point in their lives, about one in three Santa Clara County residents will use our services.”
Money was not the key sticking point in contract negotiations, according to Dr. Harris. He noted that even after VPG reached an agreement with the county to establish a standardized, equitable and transparent salary structure for physicians—the only union employees in the county that previously had not had such a structure—they continued to advocate for working condition improvements affecting patient care and physician mental health. A survey conducted by VPG in the summer of 2022 had found that 69% of physicians contacted planned to leave the system within the next three years, the majority of them citing poor working conditions and lack of respect from county management as the reason.
“When the power went out in our hospital and three of our generators failed, the county’s press position was that no one was ever harmed,” said Greg Adams, MD, the chair of the Department of Surgery at Valley Medical and a clinical associate professor of surgery at Stanford University, in California. “That’s because the VPG membership came in in the middle of the night and moved ventilated patients from the ICU to places where there were working plugs.“
In the negotiations, VPG was able to reach agreement with the county on decreasing patient caseloads in primary care from 11 to 10 patients per half-day, hiring more specialist physicians, and additional time allotted to manage the burdens of administrative work.
“The parties look forward to focusing their efforts on the shared commitment to provide the highest-quality care to the patients we serve. As we did during the COVID-19 pandemic, we continue to deliver the excellent healthcare that all members of our community need and deserve,” said a joint statement issued by VPG and the county on Oct. 28, 2022. “We are committed to working together to tackle a number of difficult challenges that all those who provide healthcare in this nation face, especially those who serve a safety net population.”
“Our patient workloads and staffing levels hold a direct relationship to the quality of patient care we can provide,” Dr. Harris said. “I’m hopeful that what we’ve been able to do for primary care is going to make Valley Medical a more attractive place for physicians to work, helping us retain the people we have and recruit more. We’re in competition for a short supply of physicians, especially in primary care.”
Before reaching the labor agreement, VPG’s entire staff was exhausted and demoralized, according to Dr. Adams. “There are only so many ‘healthcare heroes’ signs you can see before you start getting nauseated. We do not wear capes or leap tall buildings. We’re humans; we get exhausted, frustrated and depressed. One of our nephrologists died by suicide and a neurologist attempted suicide.”
Never before in the 12-year history of the union had VPG’s physicians seriously considered a strike. “We were always passive, believing we needed to live up to our Hippocratic Oath even if we were not given the tools and capabilities to do so,” Dr. Adams noted. “But that was based on a model where we were treated as, and allowed to act as, professionals. As things continued to get worse during and after the height of the COVID-19 pandemic, we pulled up our ‘big union pants’ and started doing what other unions do: We got a lawyer, we got a PR agent, and began applying pressure and collaborating with the other unions represented in our hospital, such as the nurses and the service employees.”
The possibility of physicians going on strike is so rare that the negotiations made national news, with the VPG physicians standing alongside leaders of the Registered Nurses Professional Association and Service Employees International Union at press conferences in front of the hospital. “We finally became a true union in that moment,” Dr. Adams said. “Our members now understand that we have to keep our focus on the goals of the entire group, and collaborate with other unions who supported us when we needed it.”
John Maa, MD, a surgeon and the former chief of the Division of General and Acute Care Surgery at Marin General Hospital, in Greenbrae, Calif., called the agreement a bellwether for other physician groups across the country. “It’s a win for the patients and the physicians simultaneously, because at its heart it wasn’t about salaries but about improving working conditions and patient care, and finding ways to protect both patients and healthcare providers,” he said. “I believe it’s a tipping point. I hope there will be other ways of achieving mutually satisfactory patient, physician and hospital-directed goals without the need for a strike, but this case highlights the power we have when doctors unite and speak with one voice. That’s the most important lesson here.” Dr. Maa is a member of the editorial advisory board of General Surgery News.
Dr. Harris agreed. “What the last year and a half of endless contract negotiations has really achieved is a unity among physicians and other healthcare workers that I think is an important example and lesson for other places. It can be done and should be done.”
This article is from the December 2022 print issue.
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