Does it seem a little dark around here to you? Could it be the cloud of discontent and disillusionment that is hovering over many of America’s physicians? There is a lot for doctors to fret about … the uncertainty associated with the Affordable Care Act, time gobbling and attention diverting electronic medical records, and the ever-present threat of a malpractice suit – to name just a few.

Among the complaints that I hear most often is “Medicine is becoming a business.” Well, folks, let’s rethink this. Practicing medicine has always been a business. Of course, medicine is a bit of an odd duck – 30% science and 70% art. And while we may like to believe that our goal to alleviate suffering is nobler than are those of other professions, medicine is still a business. Very few of us have the luxury of practicing without hope of financial return.

However, what has changed over the last quarter-century is that many of us have sold the business. For a variety of reasons, many of them falling under the umbrella of “quality of life issues,” we have changed roles from being owner to that of employee. Not surprisingly, most of us are chaffing in the traces of that new role. Individuals who aspire to be physicians are generally not the kind of people who will happily give up control of anything. But becoming an employee means giving up control of a big chunk of one’s professional life. As health care delivery entities continue to grow in size encouraged by the Affordable Care Act, that increase in size will shrink what little power the employee has even further.

A few physicians are trying to buck the trend by remaining owner/operators of either “slow medicine” or “boutique” practices. However, the massive burden of medical school debt will continue to crush the entrepreneurial spirit of even the most idealistic young graduates, and I don’t foresee a time when the majority of physicians will again own their practices.

Even if there is a revolutionary change in how we fund medical education, it’s time for physicians to accept the fact that they are employees. But instead of quietly grumbling about the situation, maybe it’s time for physicians to join together and become activist employees.

I can hear you gasp, “Is he talking about forming unions and going out on strike?” Well, kind of. I know that sounds so ugly and is beneath you as a professional, something the French might do, but not us here in “the Land of the Free.”

Organizing and taking action is not totally foreign to American physicians. You may feel you were underpaid as a house officer. But your compensation would have been far less robust had it not been for a group of 450 residents at the Boston City Hospital who in 1967 organized a work action that resulted in a raise in the base pay for interns from $3,600 to $6,600. Instead of a strike, the house officers initiated a “heal-in” in which they were more liberal in admitting patients and raised the intensity of the care for inpatients. The resulting congestion in the hospital forced the administrators to yield to their demands for a reasonable salary.

You may not be sufficiently dissatisfied to feel like joining other physicians in a work action, but I sense there are some pockets of physician unrest in this country such that forming a union may begin appearing on their list of options.

While you may tend to see strikes as being mostly about the money, employees are often more concerned about their working conditions. If the company you work for has just “upgraded” your computer system so that it now takes you an extra hour each day to see just twenty patients, you might legitimately complain that your working conditions have become so intolerable that you are ready to join up and take action.

Remember, it doesn’t have to be a strike. It could be a “slowdown” or a “speedup” designed to create enough chaos for your employer to get its attention. Could it negatively affect some patients? The honest answer is yes. I doubt that there has ever been a successful work action that hasn’t resulted in some collateral damage.

But is it worth the risks? That’s for you to decide. I’m simply observing that the shift in the landscape has given physicians who want more of a say in their work environments few options. Maybe it’s time for you to think beyond the familiar boundaries of the profession and add a little bite to your growl.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” E-mail him at


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