When Medical Workforce Grievances Lead to Strikes

As physicians, we represent the patient’s needs, which are often overlooked in this process. This dilemma was recently eloquently described by a 22-year-old man with ulcerative colitis whose total colectomy may have been hastened by the sluggish and inadequate support for the use of more appropriate therapies earlier in the course of his disease that were requested by his doctor yet denied by his insurer.⁷ Sound familiar?

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The PA process is especially challenging for rheumatologists. Many of the diseases we manage lack randomized clinical trials that could help establish therapeutic guidelines. For many conditions, no generic medications are available. We are not like cardiologists where nearly all of their drugs, such as statins, anti-hypertensives and anti-platelet therapies, have generic options. And now we are faced with a new phenomenon, the litany of mispriced drugs—previously inexpensive products that have soared in price, thanks in part to the concept of some manufacturers buying low-volume generic drugs and driving their prices skyward.⁸ How about $35,000 for 120 capsules of d-penicillamine, a drug used to chelate the excess copper deposition found in patients with Wilson’s disease and formerly used to treat refractory rheumatoid arthritis?

We are left to serve as relatively powerless observers who must contend with the consequences of PA denials. Our thoughtful clinical judgment that has evolved through years of training carries little weight with insurers.

Or what about the realization that came far too late for most of us that our costly EHR systems don’t really communicate with one another and won’t for at least another five to eight years. This situation is analogous to having your smartphone being limited to making calls only to other phones on its network. Verizon could not talk with AT&T. Perhaps this strategy was a shrewd move by the predominant EHR companies that wanted hospitals and offices to avoid purchasing potentially cheaper versions from competitors that would provide a backdoor link to their more costly products. But it has made our lives more miserable as we regularly receive reams of records faxed from other systems that need to be scanned manually, page by page, and placed (or shall I say buried) somewhere in the patient’s record. Who is the winner here?

So are these grievances worthy of a work action? Sometimes I wish I had the power to fight back against these egregious policies. This is why we have RheumPAC and the ACR advocating on our behalf.