Strike of ER clinicians begins at Ascension St. John in Detroit

St. John physicians on strike outside of Detroit, April 18, 2024.

Emergency Room clinicians at St. John Ascension hospital just outside of Detroit began their strike Thursday afternoon, walking out of the ER to protest worsening staffing levels, long patient wait times, unsafe conditions and the subordination of the healthcare industry to corporate profit.

Dr. Romajit Yatoome told the WSWS, “The big reason we are on strike is because we are feeling the pinch of the staffing shortages. It’s not just the physicians but the nurses, the techs, social workers as well. We are all so overworked and patients are waiting 10 to 15 hours just to see a physician.” 

She added, “There’s always been cracks in the system but definitely the pandemic has unveiled how bad those cracks are, how deep in the foundation of the system they are. Many people actually left the field because of the pandemic, so now it’s even harder to get staff.”

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The St. John Emergency Room clinicians are taking a courageous stand against TeamHealth, a private equity staffing firm, which they state is not concerned with the safety of patients or physician wellness, but with the company’s financial bottom line. The clinicians told World Socialist Web Site reporters that there is a direct conflict between their desire to treat patients and the corporation’s desire to maximize profits. St. John clinicians report unsafe staffing levels, lack of sick and vacation days and surprise billing for patients under their names.

St. John Emergency Room clinicians formed the 43-person Greater Detroit Association of Emergency Physicians union last July and have been in negotiations for their first contract since then. The clinicians are in a struggle against TeamHealth, the private equity staffing firm that manages the St. John Emergency Room. 

When asked about the impact of private equity staffing firms on healthcare, Dr. Yatoome continued, “The unfortunate thing is that physicians aren’t a for-profit occupation and profit is the main goal of private equity. So it’s not cohesive. … The people of Detroit and anywhere would want their medical care geared by their true medical need and not by profits.” 

Another physician told WSWS reporters that they are receiving enormous support from the other ER workers and described how conditions have worsened over time. “I’ve seen a lot of changes over the years. Before COVID we had 200 to 250 patients a day. Now we have half that number, but we’re overburdened because the staff is so short. Before we had 25 nurses. Now we are down to 10.”

He continued, “We now have 200 beds [in the entire hospital] and we are bursting at the seams. We cannot handle it because of the nursing shortage. It’s not uncommon for patients to wait over 10 hours [in the ER]. We had one person in the waiting room an unbelievable 21 hours before they were seen by a doctor. I can’t imagine my own loved one going to the hospital under those conditions. In many ways, it’s kind of killing us.”

The demands and concerns of St. John clinicians express the frustration of clinicians across the country with the state of the US healthcare system and the increasing use of medical outsourcing staffing firms, also called contract management groups (CMGs).

Dr. Michelle Weiner told WSWS reporters, “These issues are all across the country. It’s everywhere. I think when people see [this strike] they aren’t surprised because they can’t get in to see their doctor, they can’t get in to see a specialist. A lot of people in the community can’t afford to go to urgent care so it drives everyone to seek care in the emergency department.”

TeamHealth was purchased by BlackStone financial group in 2017 for $6 billion and took over the management of Ascension St. John ER in 2015. TeamHealth is the largest physician staffing firm in the country, employing 15,000 physicians and managing hospital departments across over 2,900 facilities in the US. 

Healthcare facilities have long outsourced services to specialized companies for nonclinical tasks like laundry, cybersecurity and food services. Yet, since the early 2000s, hospitals have rapidly embraced outsourcing clinical services especially in emergency departments, radiology, anesthesia and lab services as a way for the hospital to boost efficiency and profitability. In 2017 alone, the use of outsourcing in the healthcare sector grew by 36 percent. Over two-thirds of emergency departments across the US use some amount of outsourcing. 

A majority of CMGs are owned by private equity firms. The model for private equity CMGs is to buy medical practices, consolidate them, increase their value at all costs and then sell for a sizable profit. This severely undermines patient safety, clinician pay, and employee satisfaction and morale. 

To increase profits, the firms seek to run facilities at a bare minimum, increase physician productivity metrics, take a larger share of physician’s fees, encourage unnecessary and expensive diagnostic tests and procedures and decrease less expensive care, including patient follow-up visits. It is also not uncommon for CMGs to utilize cheaper labor in emergency departments, firing well-established physicians and replacing them with inexperienced residents or even non-board-certified providers. 

Physicians who work for contract management groups have reported being pushed to make medical decisions based on the profit motives of the CMG. This includes taking on unrealistic and dangerous patient loads, and being offered financial rewards for ordering often unnecessary high-cost tests and procedures. In one study, physicians report being pressured by the CMG to admit patients who they believe could be treated outpatient, or conversely, to discharge or transfer patients who they believe should be hospitalized. The same study noted that physicians have also reported concerns over losing their jobs when raising safety concerns or questions about over-testing and patient treatment. 

Physician outsourcing has led to patients receiving unexpected and outrageously high hospital bills, as many outsourced physicians will be out-of-network despite working in a hospital that is in-network for the patient. A study looking at patient billing data from 2001-2016 found that patients receiving out-of-network bills for emergency care were charged an average of 10 times more than other emergency patients. 

Outsourced clinicians, such as those at St. John, have no ability to see, dispute or change any of the bills. TeamHealth’s rates specifically were found to be 68 percent higher for patients even when in-network.

Jerry White, the Socialist Equality Party’s candidate for US vice president, joined striking clinicians and issued the following statement:

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As the Socialist Equality Party’s candidate for US vice president, I fully support the fight of Ascension St. John emergency room physicians in defense of their jobs and patient safety. Their stand against outsourcing and the private equity-funded staffing company TeamHealth should be supported by all health care workers and the entire working class.

Today’s strike by members of the Greater Detroit Association of Emergency Physicians at St. John has universal significance. It highlights the clash between health care professionals who are sworn to provide the best possible care and a medical system completely subordinated to corporate profit.

This was summed up by the striking clinicians themselves who stated: “We believe there is a sacred relationship between physicians and patients that is in direct conflict with the goals of a corporate organization … whose primary obligation is to its shareholders, which in this case is Blackstone financial.”

The business model of Corporate Management Groups (CMGs) like TeamHealth is to buy up medical practices, consolidate them, increase their revenue and sell in five-ish years with a significant profit. This means that the facilities they staff are run in the leanest way possible and physicians are pressured to take more and more patients and to run unnecessary tests to boost profits. These physicians are often out-of-network, so patients end up with astronomical bills. The physicians have no control over this billing.

Ascension has already privatized lab work. If the merger with Henry Ford goes through, hundreds, if not thousands, of jobs will be at risk and patient care for working class communities in the Metro Detroit area will be further undermined.

Both Biden and Trump defend the for-profit healthcare system. Obamacare was not a progressive social reform but a blueprint for cost cutting against healthcare workers. Both parties have systematically dismantled the public health system and allowed 1.4 million to die from COVID and millions more to be debilitated by long COVID. At the same time, the corporate-controlled parties find trillions for corporate bailouts and funding war, including the genocide in Gaza.

The Socialist Equality Party insists that healthcare is a basic social right not a privilege. Profit must be taken out of medicine through the establishment of a socialist system of healthcare to provide free high quality healthcare to all, not profits for the giant hospital, pharmaceutical, medical equipment and insurance monopolies. This will never be achieved through backroom deals between the unions and the employers. What is needed is a powerful industrial and political counteroffensive by the working class in the US and internationally to replace capitalism with socialism.