Subject: Unionization, the UConn Health Center --- and You
Dear Colleague:
The ongoing national debate about health care reform has, at the least, established consensus understanding and belief that this problem is systemic -- it is much more than cost, quality and access though I do not minimize their individual and collective importance. During the past two decades under the guise of "managing care," we not only failed that, but also failed to even begin to manage cost, creating the very core elements of today's health care crisis.
Moreover, many new state and federal systems, designed in the ideal to enable smooth, simple transitions and effective management, in reality created a confused, complex, costly, cumbersome, indeed almost chaotic bureaucratic nightmare for providers and patients alike. No active clinician in medicine or dental medicine would deny this. Today no process in health care delivery is simple or straightforward -- a result, I believe, of much too much management and much too much regulatory interference. I also believe that academic medicine and dental medicine have, perhaps more than any other health entity, suffered the most from these new onerous burdens.
Given all this, is there any evidence anywhere that adding more organized regulation, more competition, more time-consuming debate or more expense to any aspect of academic medical and dental administration, patient care, research or education will alleviate the problem even the slightest? As a now retired, but very proud former Dean of the School of Medicine, I sincerely doubt it, and that is why I am very much opposed to any faculty union.
You may be asking yourself why I am going to the personal expense and trouble to send you this letter. The answer is simple: I cannot stand by and say nothing in defense of the school I love so much while the potential exists to add yet another layer of numbing bureaucracy to our already complex institution. As many of you are aware, I was Dean of the School of Medicine during the last two union organizing campaigns, and I strongly feel now, as I did then, that a faculty union is not the answer to what ails us. I therefore ask you to consider in depth the following.
Any union:
1. CANNOT strengthen the voice of the individual faculty member or even handedly represent minority group opinion. Unions must represent the faculty's interests as a group, and not the many interests that are exclusive and unique to very diverse faculty constituencies.
2. CANNOT force the UConn Health Center to resolve issues related to appointment, retention, promotion, clinical practice areas or governance. Strategic initiatives to expand, align or reduce services are not a union prerogative.
3. CANNOT impact the number and selection process of management and administrative positions.
4. CANNOT define job duties and responsibilities of faculty members.
5. CANNOT guarantee job security. Management has the absolute right to set the scope and size of the workforce, and to offset excess expense relative to revenue by workforce reduction.
6. CANNOT promise, especially in the State's current fiscal climate, sufficient political clout to obtain faculty salary increments through increased general fund support.
7. CANNOT impose equitable performance-based compensation plans for faculty. In my experience with non-faculty unions, union contract language traditionally protects weak/problem performers in the bargaining unit, and favors seniority rather than quality performance when downsizing is required.
8. CANNOT guarantee that the Health Center can aggressively and quickly compete for patients, grant funding and auxiliary revenue services. Contractual restrictions have significant potential to dramatically impede the ability of the Health Center to be competitive, efficient and effective. Unions will also add significant expense at every level further impacting already strained finances.
9. CANNOT assure the continued recruitment of outstanding, high quality faculty. I believe that unionization is a major threat to our individual and collective professional reputations, and is a move that could be a very negative factor when talented faculty are considered elsewhere for other career opportunities.
10. CANNOT assure the collegiality so critical to the success of any academic health center. Competing faculty constituencies vying for union attention and resources would likely lead to divisiveness and dissension.
I could go on! There are many other risks. But let me switch gears a bit and ask the key questions:
WHAT CAN OR MIGHT A FACULTY UNION DO FOR YOU?
State labor laws specifically empower unions to "bargain collectively on questions of wages, hours and other conditions of employment.”
I believe that the public demands and deserves that physicians and dentists be held to a unique, very different and higher standard than haggling over these issues, and that our collective academic, clinical and administrative activity be characterized first and foremost by professionalism. This core competency must be defined by commitment, or a sense of duty, and altruism, or a willingness to often give of time, talent and resources for the higher collective good. We are stewards of a special trust which I believe, in this context, would be greatly marginalized by any faculty union.
I further ask:
IS ANY ADDITIONAL VOICE REPRESENTING ANY FACULTY INTEREST REALLY NECESSARY?
I think not!
In 2003 and 2008, the Schools of Medicine and Dental Medicine received full unconditional accreditation of their academic programs. In the School of Medicine, it was suggested that every attempt be made to allow more broad input by the faculty into governance of all issues. The bylaws were rewritten and six Councils were established. These included the Clinical, Educational, Research and Public Issues Councils, an Oversight Council and a Dean's Council. The duties, authority and responsibilities of each group are clearly defined at http://medicine.uchc.edu/faculty/governance/. I believe that the scope and opportunity for engagement with management in each domain is uniquely very broad. The opportunity to impact strategic planning across all efforts in the Health Center is real. More than 40 elected faculty from the School of Medicine populate these Councils representing every rank and professional track. In the School of Dental Medicine Senate, there are 25 elected full, part-time and alternate members representing clinical science and basic science departmental faculty. If elected Council and Senate faculty exercise their by-law mandated authority, there should be no Health Center issue beyond their jurisdiction for honest debate, planning, even constructive and effective implementation.
Finally,
WHAT ABOUT COMPENSATION AND CONDITIONS OF EMPLOYMENT?
I know that Health Center faculty salaries are competitive with AAMC/ADEA published guidelines for faculty compensation at all ranks and in all specialties. Further, only the very naïve, or completely uninformed and disinterested, would deny that the public we serve, and the members of the state's General Assembly to whom we must be responsible, believe that in today's economic climate the Health Center faculty, when one considers short and long term their total compensation including direct reimbursement and fringe benefits, are very well compensated. It is very much unreasonable to believe today, and in the foreseeable future, given the State's dreadful economic problems, that any bargaining unit could ensure significant increases in our compensation or benefits! In the absence of any uncommitted revenues, generalized salary increments are impossible. This is today's fiscal reality.
On an individual basis for faculty that disagrees with their current base and/or merit compensation, recourse to address this grievance is simple and straightforward. Any faculty member has access to a faculty controlled Compensation Merit Plan Appeals Committee, beyond that to the Health Center Appeals Committee, and then to the Board of Directors. I know from experience that appeals of this nature have frequently been easily adjudicated in the faculty member's favor early in the appeal process.
In conclusion, I ask that you carefully consider what I have written above. Your vote in this election is critical. If you are eligible, PLEASE VOTE!!
That said, I hope I have convinced you that the immediate and long term negatives of faculty unionization far outweigh any perceived positive outcomes. Despite troubled times in health care delivery, our academic Health Center has grown dramatically in all domains during the past two decades as a direct result of creative, collegial, for sure sometimes argumentative, but always constructive dialogue between faculty, management, staff, state government officials and our Board of Directors. Such dialogue needs to continue unfettered by outside influences pushing their own very narrow agendas not ever before tested in academic medicine or dental medicine in the State of Connecticut or New England.
Sincerely yours,
Peter Deckers
Peter J. Deckers, M.D.
Professor of Surgery
Dean Emeritus, UConn School of Medicine
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