Healthcare Workers Asked to Work Without Pay:
Healthcare Systems Profit From Their Altruism
The first time Dylan and I spoke in person, we were face to face but separated by thousands of miles. We had met two days prior to this when I received my first communication from her. Three weeks ago, after an essay I wrote was published detailing the truth of America’s broken healthcare system, I began receiving hundreds of emails from other healthcare workers all across the country recounting horror stories of maltreatment at the hands of the healthcare system. Dylan’s email was among them.
Though we had minimal communication prior to this encounter, she was exactly as I envisioned her: fierce, unapologetic with the mouth of a sailor, and honest as f***. As if her credentials as a critical care physician aren’t enough, her South Boston accent (which as a side is completely reminiscent of Will Hunting), propels her into a whole new category of badass-ness. So much so that with every point she made about America’s healthcare system I nearly expected to hear How you like them apples? roll out of her mouth–though (regrettably) I never did. It wasn’t but a couple of minutes into our conversation when she revealed the reason for our meeting.
“I need someone to write an article explaining why healthcare workers need to stop volunteering to work for free in COVID epicenters, like mine."
I was caught off guard.
"Don’t get me wrong,” she quickly inserted, “we need help, but we can no longer be the scapegoat while thousands of healthcare administrators continue to receive their million-dollar salaries and while insurance companies are collecting premiums yet receiving a minimal number of claims to pay on. This alone is leaving healthcare insurances with monthly surpluses in the range of billions of dollars. Our CEO made over $25 million last year. In what kind of f***ed- up twilight zone do we live where healthcare workers are expected to carry the burden of the system’s financial losses while those in charge continue to make millions of dollars?"
Dylan stopped and took a long breath. She was right. Our salaries are slashed, our altruism exploited, our voices silenced, and our well-being jeopardized, all because of a system that functions on abuse and favors the rich.
We are in a system where those who profit monetarily from illness are also the ones deciding how resources are allocated to treat those who are ill. This means funds used to pay healthcare workers can be cut when steady streams of revenue are down (as they are now during this pandemic) even though the demand for our services has remained the same. This process, in it of itself, is no different than any other example of the open and free marketplace in a capitalistic society. However in the setting of a healthcare system, when profits mean more than lives, this model presents a huge fundamental conflict of interest.
The enormous burden of administrator cost, as well as the disproportionate and unsustainable increase in administrators’ salaries (as seen in the two graphs below), are just two examples of how the rogue behaviors of those controlling our healthcare system are taxing and weakening it. Their rate of growth and rate of compensation outpace most occupations in America. Clearly those controlling the healthcare system have lost their ability to self-regulate, creating a system that lacks transparency and economic stability and places patients in the middle of a monopoly.
The more Dylan and I spoke, the extent to which healthcare workers’ altruism is being exploited became clearer to me. Recently the mayor of New York City called for physician volunteers to help alleviate the COVID crisis but to do so without compensation. What he failed to mention was that this request for volunteers was not because the city’s patient and workload had exceeded the number of physicians capable of providing care but because the healthcare system was not willing to pay them a fair rate to work in such a high-risk location, let alone pay them at all.
When California had massive wildfires in 2019, were firefighters expected to work for free? When multiple major metropolitan areas have large protests, are police officers expected to work for free? The answer is no, nor should they be, no more than healthcare workers should be expected to work for free during a pandemic, yet we are. And further, would fire captains or police sergeants ever expect their subordinates to head into their designated situations without proper protection? When was the last time a firefighter battled a forest fire without wearing appropriate safety gear or the last time a police officer approached an active shooter situation unarmed and without a vest? Can't think of a time? Me neither.
The truth is the healthcare system certainly has the money to pay; they are just not willing to spend it in this way. Money can buy anything in America but only at a cost the buyer is willing to pay and those who control us, our buyer, do not feel we are worth it. The downstream effects of us working for free leads to unintended consequences that negatively impact our colleagues in ways likely never considered.
As Dylan put it, “Every time a physician flies into New York and offers to work a week or two for free, they are unintentionally taking the legs right out from underneath their physician colleagues who live here who can’t afford to work for free. Who have mortgages, student loan payments, and daycare bills, etc. And what CEO would pay an employee to do something that someone else is willing to do for free? The healthcare system has money– just ask the thousands of CEOs, insurance executives, and other administrators who make millions of dollars every year. They are selfishly unwilling to take from their overabundance to give to those risking their lives who already have much less. They know we will never walk away from our patient responsibilities. They have us caught between a rock and a hard spot and are completely aware of it and have absolutely no problem with it.”
Society is tricked into believing that the healthcare system functions as a single unit, as if it is made up of three equal contributing parts: healthcare workers, healthcare administration, and insurance corporations. That the system is fair, operated by a cohesive set of standards allowing a safe place for patients to heal and a safe space for healthcare workers to do their jobs. But the truth is, America’s healthcare system lacks internal checks and balances, giving a free pass for those with authority to exploit those at the center of this system:
THE HEALTHCARE WORKERS.
We will never escape the abusive conditions we face if all of us don’t stand together for fairness. We can be heroes to each other and still be heroes for others but only if we unite to protect the altruism belonging to us, others are selfishly exploiting. If we don’t, our moral injury will lead to nothing less than self-sacrifice. And when that happens, who will be around to protect the patients then?
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