Organizers are pushing hard for the 10,000 or so attending physicians in University of California health systems (UC) to unionize, citing excessive workloads, insufficient staffing, and a troubling focus on revenue generation.

If UC doctors can organize to demand better…why can’t workers’ comp doctors?

California providers who treat injured workers are subject to frequent payment abuse, legal and regulatory violations, excessive bureaucratic and administrative requirements, and absurd obstacles to care delivery.

While current data on the number of comp providers is scant, thanks to the California Division of Workers’ Compensation (CA DWC)’s ineptitude, the most recent statewide figures indicate that over 70,000 providers accepted workers’ comp patients as of 2016. Even though the system has profusely bled providers since then, comp doctors still represent a sizable bloc of providers that encounter substantial friction when trying to treat injured workers.

Obviously, comp providers don’t share an employer with which they can bargain. But acting in concert, they can command media attention and wield the political clout needed to spotlight bad actors in the system and potentially prod state government and regulatory agencies to protect provider and injured worker rights.

As a unified group, comp doctors can stand up to claims administrators, Medical Provider Networks (MPNs), Preferred Provider Networks (PPOs), network payers, and other well-funded interests currently making their jobs more difficult than they need to be.

UC Physicians Push to Unionize

Physicians at the University of California’s six health systems have launched a campaign to unionize roughly 10,000 attending physicians, which organizers say would be the largest union of employed doctors if successful.

The effort follows a tentative statewide contract that UC’s 6,400 residents and fellows won earlier this year.

UC doctors cite hiring freezes, vacant positions, rising patient loads, and burnout, with one occupational medicine physician reporting injuries from doctors having to “run instead of walk” just to meet the demands of the job. Organizers need about 3,000 signatures before applying to the California Public Employment Relations Board. Next, they would need a majority vote of eligible physicians, to realize their plans.

UC physicians aren’t alone; unionization movements have hit healthcare systems across the country, as providers push back against policies and practices that they allege put profit over patients.

CA Comp Doctors, Stand Together

California providers who treat injured workers face a uniquely burdensome, even prohibitive, set of challenges that doctors treating group health and Medicare patients simply don’t have to contend with.

Physicians in multiple UC health systems, including UCLA and UCSF, surely understand; they discontinued treating injured workers outright.

Treating a single injured worker requires navigating onerous reporting and paperwork requirements, including obtaining formal authorization from the payer for every treatment, from an X-ray to a splint to surgery and psychotherapy. That authorization process is riddled with obstacles and operates largely in the dark thanks to the CA DWC’s refusal to collect Utilization Review data, in open violation of state law.

Doctors are also hamstrung by the MPN system, in which providers may find it impossible to determine whether they’re allowed to treat a given worker. Payers can deny reimbursement for authorized care by claiming that it was “out of network,” even when the network in question doesn’t exist, isn’t active, or includes the provider.

Major payers, including the state’s largest workers’ comp Third-Party Administrator, persistently violate state law and regulations with the CA DWC’s full knowledge and face no consequences, leaving providers unpaid or saddled with overwhelming administrative work resulting from payer non-compliance.

Most of these abuses are already illegal; state agencies simply fail to enforce the rules already in place.

Perhaps if a large, vocal contingent of providers were willing to raise a little hell, payers, networks, assorted vendors, and the private equity firms bankrolling the chaos would be more inclined to be careful. At the very least, a unified front of workers’ comp doctors would have a better chance at cajoling the CA DWC into action, with strategic pressure on Sacramento to staff regulatory agencies with leadership that’s up for the job.

The systemic problems are real and well-known. Many of the solutions are apparent, but they need only the political will to enact them. It might not take a labor union, per se, but an organized group of tens of thousands of providers, all on the same page, could wield enough power to force real change.

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