Not For Taming - Unionism Of NZ Senior Doctors
NOT FOR TAMING;
UNIONISM OF SENIOR DOCTORS
IN
NEW
ZEALAND
ADDRESS TO
UNION OF AMERICAN
PHYSICIANS
AND
DENTISTS CONVENTION
SAN
FRANCISCO
6 SEPTEMBER 2003
IAN POWELL
EXECUTIVE
DIRECTOR
ASSOCIATION OF SALARIED MEDICAL SPECIALISTS
Thank you for the invitation to address your important
Convention today. The Association of Salaried Medical
Specialists and the Union of American Physicians and
Dentists have been gradually developing a collaborative
relationship that I hope my participation in your Convention
and your decision to send a representative to our Conference
in November will continue to foster. While there are
fundamental differences between our respective industrial
relations and health systems (let alone size, with New
Zealand’s population of four million and our unitary
political system based on proportional representation), this
is much less significant than what we have in common and
what we can learn from each other.
I suspect that both
our unions are rather like a dog with no teeth but with
powerful gums. We both may not be able to bite but we
surely have a strong grip ensuring that we never let go.
Perhaps we are the best grippers in our respective health
sectors?
Our union was formed in 1989 with the catalyst
being a merging of our previous distinct and separate state
sector industrial law into the law that prevailed in the
rest of the economy. This included a requirement that any
organisation that sought to negotiate collectively on behalf
of employees had to be registered as a union. Consequently
we were formed, in part, through a coming together of
earlier looser associations.
Our membership is open to
senior (attending) doctors and dentists, including
specialists, who are employees rather than those who are
independent contractors or self-employed. The nature of our
public system is that, particularly in secondary care, it is
publicly provided through 21 district health boards (DHBs).
Consequently the large majority of senior doctors working in
secondary care are employees, either full or part-time,
employed by the public health system. We also have members
employed outside the public sector, usually not-for-profit,
mainly in primary care.
After our first year our
membership was around 60% of its potential. With two
exceptions, our membership has increased each subsequent
year and now rests at over 90% of our estimated potential
(over 2,100), and higher in the public sector. There is
also a separate union representing resident doctors. We are
affiliated to the peak union body in New Zealand, the
Council of Trade Unions, and participate in their internal
structures and committees. We also have a collaborative
relationship with the NZ Medical Association, which is quite
different from the American Medical Association.
Our
supreme body is our two-day Annual Conference in which a
number of industrial and health policy issues are discussed
and debated. The Conference serves as a cradle and flagship
for membership involvement, through delegates, in the
direction and development of the union. We have a 10-person
National Executive elected for biennial terms and have a
national office in the capital city,
Wellington.
Industrial Law Regime Change
Industrial
law is one of the fundamental differences between our two
countries. As I understand it you still operate under the
Taft Hartley Act passed in the late 1940s. In New Zealand
we had separate industrial law for the public and private
sectors until 1988. In the state sector it was heavily
centralised, based on rigid relativity criteria, and
arbitrationist. Since our formation in 1989 we have
averaged a radical change in our industrial law every four
years, something that Mr Bush might describe as regime
change. We are now operating under our third industrial
law, each fundamentally different from what it replaced.
From centralised arbitration we first moved to national
collective bargaining inclusive of a considerably reduced
influence of arbitration (1989-1991).
Next, from
1991-2000, we moved to new industrial law, based on
neo-liberal ideology, which strongly favoured individualism
and individual contracts rather than collective bargaining.
However, while we failed to retain national negotiations, we
were able to ward off attempts to introduce widespread
so-called individual bargaining and all the vulnerabilities
and weaknesses that go with it by transiting to single
employer collective bargaining, particularly in the public
sector. We were also able to successfully use collective
bargaining in an artificially created market environment to
make considerable gains in issues such as salary increases,
subsidised superannuation, annual leave, CME expenses, and
enhanced remuneration for working on after-hours call
rosters.
Now, since late 2000, we are working under a new
legal regime that is based on International Labour
Organisation conventions on the recognition of unions and
promotion of collective bargaining. These conventions are
imported into our new law both in tenor and explicitly.
This has given us the opportunity to return to national
negotiations in the public sector that are currently
underway, although presently verging on collapse because of
the short-sighted and inflexible position of our
DHBs.
The practical effect of our most recent legal
regime is that we do not face the same hindrances and
hurdles that you face to be recognised by employers for
membership representation and collective bargaining. The
requirements to be registered as a union are minimal and do
not require employer approval or a balloting process.
Further, once registered, unions have rights to collective
bargaining, at both a single and multi-employer level. The
North American concept of good faith has also been adapted
to our law including its application to collective
bargaining. There is, however, no obligation to settle or
compulsory arbitration requirement.
The considerable
obstacles that your union faced over attempting to achieve
and retain recognition with the Los Angeles County are
something that we simply do not have. Nor do we have the
situation, as again occurred with Los Angeles County, where
after a certain period of time and process, the employer’s
last offer becomes binding on affected employees.
Entitlements cannot be unilaterally taken away by an
employer.
Union Coverage
The second major difference
is union coverage. In September 1989 union density (union
membership as a proportion of wage and salary earners) in
New Zealand was 55.7% while union membership was 684,825.
Due to a combination of neo-liberal employment law including
‘free-loading’, unemployment and under-employment, by
December 1999 this density had fallen to 21.4% while union
membership had collapsed by 56% to 302,405. By December
2001 the trend had halted with a 9% increase in membership
(329,919) from the 1999 level and there was also a small
increase in density to 22%.
Most of this membership and
density collapse occurred in the private sector such as the
manufacturing and construction industries. The public
sector was not affected as badly and unions with a
professional occupational base (eg, teachers, nurses)
largely held their own and in some cases increased. Our
union was most unusual given the nature of our sustained
annual growth.
In contrast with the United States, New
Zealand does not have the same degree of membership
contestability, particularly in professional occupationally
based unions. For example, although there are two doctors
unions, ourselves and the Resident Doctors Association, we
have both defined our own membership coverage and boundaries
and are not in competition with or poaching from each other.
This is greatly assisted by the fact that we only have one
peak central union organisation, the Council of Trade
Unions, compared with your often competing internationals,
albeit inside the AFL-CIO.
Coming from a union whose
density is over 90%, I am bewildered by the corrosive and
wasteful American experience of doctors unions, who often
share the same or similar values, and reasons for being
occasionally competing against each other for members, when
your own density is so low and there is such an enormous
recruitment potential.
Health System
The third main
difference is our respective health systems. Apart from the
‘neo-liberal interruption’ of the 1990s, our health system
with its strong British origins is based on the principle of
single payer with the large majority of funding coming from
the state. In essence, the bulk of the system, primary and
secondary, is publicly funded. Secondary/tertiary care is
largely publicly provided through statute based state-owned
district health boards, while primary care is largely
privately provided, but significantly state regulated,
through self-employed general practitioners. User charges
do not apply to access to public secondary care services
while the government is planning to move away from the
current prevalent system of partial user charges for primary
care to a fully capitated system.
As a result of new
health legislation effective on 1 January 2001, district
health boards became responsible for both primary and
secondary care. Previously there was a so-called Chinese
Wall between the bureaucratic structures of the two sectors.
The large majority of secondary care specialists and other
senior doctors are employees (although some are part-time
and also work in the private sector). All our district
health board members are covered by collective
bargaining.
The other key feature of our health system
that differs from yours is our no fault accident
compensation system whose application is not restricted to
workplaces. It includes, for example, sports injuries and
accidents. One of the key features of no fault is the
absence of the right to sue. This means that, while not
unimportant, medical indemnity costs are minimal by
comparison with the United States and it is nowhere near the
same controversial issue as it is here.
Role of
Collective Bargaining
The role of collective bargaining
is critical to our existence and effectiveness. It is the
core and base of our work and has delivered much of the
improvement and new entitlements that we have been able to
negotiate for our members. But we do not look at collective
bargaining from the standpoint of enhancing ‘pay and
rations’. Processes and rights are also important. This
includes rights such as speaking out, research and
publication, mutually agreed job descriptions and
intellectual property.
We are currently embroiled in
national negotiations with the 21 district health boards,
the first national negotiation for senior doctors since
1991. These have the potential to develop for the first
time an effective national recruitment and retention
strategy that recognises the competitive international
medical labour market in which we operate, and also to
jointly develop a new culture of collaboration and
cooperation between senior managers and senior doctors that
offers significant benefits all round in areas such as
workforce development and planning and actively engaging
senior doctors in the engine-room of
decision-making.
This is part of our membership
empowerment strategy, initiated at our Annual Conference
last year, in which the expertise and professionalism of
senior doctors can be utilised to improve organisational
effectiveness and efficiency, something that our health
system desperately needs and would greatly benefit from. We
do not know whether our health system is adequately funded
or not but we do know that it is ineffectively funded.
Membership empowerment would help resolve the issue of
effectiveness and help clarify the question of
adequacy.
Unfortunately these exciting opportunities are
being undermined by a short-sighted employer strategy that
attempts to put a concrete lid on what we as a union might
seek to negotiate and, further, to achieve claw-backs.
While claw-backs can only be achieved if we as a union
consent, and we will not, it nevertheless sours the tone and
undermines the ability to develop a more collaborative and
cooperative culture in the health system.
Linkage with
Health Policy
Our union is probably more publicly known
for the health policy issues that we speak out over. During
the 1990s we were strongly critical of the attempt, as part
of New Zealand’s ‘neo-liberal interruption’, to impose
market forces through an adaptation of the then British
internal market and American managed care on our publicly
funded health system. This historical ‘interruption’
included several scraps over privatisation attempts,
including by American Health Maintenance Organisations.
Aetna, for example, attempted to control the funding for one
of our main provincial public hospitals. We were among
those who successfully opposed this. There is nothing like
a slogan such as ‘the Americans are coming’ to galvanise and
activate New Zealanders into stroppy opposition.
We have
also been actively involved in debates over the adequacy and
delivery of health funding, endeavouring to scratch beneath
the surface of political claims over funding levels and the
need for workforce development and planning that was
unfortunately neglected during the 1990s. I like to think
that we have helped influence government decisions in recent
years to at least officially recognise the importance of
workforce development, move from time-limited to permanent
baseline funding, and announce longer term funding packages
providing better opportunities for district health boards to
plan.
We also strongly contested the government’s recent
successful attempt to replace our medical registration
legislation with new legislation that increased political
and bureaucratic control over medical practitioners at the
expense of professional self-regulation.
The important
point is that active engagement in health policy matters is
central to our work as a union, is what our members expect
of us, and contributes in no small part to our current high
membership levels. Collective bargaining alone is
insufficient to explain this level and is integral to
medical unionism in New Zealand.
Conclusion
I do not
want to give you the wrong impression about New Zealand. It
is not the land of milk and honey except in a narrow
agrarian context. As discussed above, we are faced with
threatened claw-backs and a short-sighted industrial
relations strategy in our current round of national
collective bargaining while we have also seen for the first
time medical registration legislation adopted despite the
contrary advice and express opposition of the medical
profession. We also suffer from inefficient bureaucratic
decision-making, policy development divorced from the
reality of the clinical frontline, the excessive export of
many of our medical graduates due to high student loans and
debt, and critical shortages in the medical and nursing
workforces.
But we need to be positive and constantly on
the front foot. Medical unionism needs to be flexible,
adaptable and wide-ranging in its approach. Without
concretizing it too much we should be mindful of, but
broader than, the principle of the late Jimmy Hoffa senior
who said that principles are important but they should never
get in the way of a good deal.
Medical unionism provides
key linkages between membership interests and rights to
wider health policy issues. They are connected and unionism
is the connection. Medical unionism provides the means by
which the health system can tap into the collective
contributions, influence, strength and wisdom of the most
skilled, critical and specialised part of its workforce and
the glue that holds so much of our respective health systems
together.
Medical unionism should adapt the expression of
former Conservative Prime Minister Margaret Thatcher that
‘this lady’s not for turning’ to ‘medical unionism’s not for
taming’.
Ian Powell
EXECUTIVE
DIRECTOR