#1: The Decision Making Gap: John August with the Scheinman Institute

John August of Cornell joins us as we dive into "The Decision-Making Gap," a critical issue in healthcare where decisions impacting patient care are often made by those who are not directly involved in providing it—like insurance companies, administrators, and policymakers. John August is a seasoned expert in labor relations and healthcare. He joins us to explore how this disconnect creates challenges for both healthcare providers and patients, and what can be done to bridge the gap.

We also discuss the unique struggles physicians face in their efforts to unionize and take collective action in a system where the stakes involve life and death. Drawing parallels between doctors and other professions like professional athletes, we’ll delve into why doctors struggle to unify despite a shared commitment to patient care, autonomy, and fair compensation.

John shares insights on how unionizing isn’t just about addressing grievances but creating community-based solutions that ultimately improve healthcare delivery. He brings lessons from physicians across the globe who have successfully organized without resorting to strikes and offers a vision for how doctors in the U.S. can lead the change.

Discover how decision-makers outside of healthcare impact care quality and patient outcomes—and why it’s essential for physicians to have a collective voice in shaping the future of medicine.

What is The DocNation Podcast?

A movement founded by doctors, for doctors, dedicated to empowering medical professionals to reclaim control over healthcare decisions and advocating for their fair share of the industry's resources.

This is The DocNation Podcast. We are a movement founded by doctors, for doctors, dedicated to empowering medical professionals to reclaim control over health care decisions and advocating for their fair share of the industry's resources. Please note, the views expressed are those of DocNation and not necessarily those of our guests or reference health centers.

John, it's great to be with you again, talking about doctors' voice and what's been happening in multiple decades leading up to this point. I'd love to hear some of the recent happenings, as you were sharing with us recently about what's going on in Delaware. We have lots to get into as far as the state of the union with doctors, and what's been happening in health care. But tell us about what are some of the current things that are going on within the landscape as it relates to the labor relations.

Hey, I'm going to interrupt here just briefly. I don't mean this to be flatterous, flattery. How do you say that? Flatterous? In that text right there. I don't mean flattery by what I'm about to say, okay? But John August has been around and done some really, really big things for a very, very long time in the union world. And DocNation is just grateful to have him here. To be a very, to be very, very open. He's here volunteering his knowledge. Really what it is, is passing the torch of knowledge and leadership. He saw DocNation and says, hey, they're doing something significant, but I think I can provide some leadership. And we reached out to John and started picking his brain. And the more we picked his brain, the more we're like, we need this guy on our team. And so we invited him out to where we go, guys. We went to Las Vegas and we were on stage with him. And really, John, I just always think about what DocNation exists to do. We do two things.

We're a service-oriented company where it's like a professional athlete has an agent. DocNation is the agent for physicians.

And people are signing up and we're getting huge individual wins, right?

That's on the individual basis. But what we have you here for, John, and what we have you really as a part of DocNation to do is to help lead the other part of what DocNation exists to do, and that's to create a union for doctors.

Medicine is in shambles right now. 50% plus of our clients are telling their children, do not go into medicine. That number has probably gone up significantly.

And so I just wanted to say, John, thank you. We're humbled that you're here. We're humbled that you've provided leadership and support to us.

The truth is, DocNation is going to need to be like a ground swell company in terms of whether we go 501c3 with the union side of it, it's going to need to be, it's going to kind of need to catch fire, and people are going to need to join in support and help. DocNation isn't building a union for DocNation. It's not going to do anything for DocNation, right? It really isn't. It's the representation. We want to be the leaders that represent the spark to create this union. So without further ado, I just want to say thank you for being a part of a number of things that we've invited you to.

Thank you, Reid. Well, everything that you just said is a fantastic foundation for, I think, our purpose today and going forward. That is to actually put some framing around the idea of the relationship of individual physician's needs as well as the need for some collective voice around needs. That's the reality.

Physicians historically have been independent practitioners, sometimes on their own, sometimes in small groups, sometimes in large groups. But the trend across the country is that the individual practitioner, the small group, even the large group is receding. And the New England Journal of Medicine tells us that about 72 percent of doctors today are employed. And the one data point that I want to make about that, and then we can have some conversation, is that I have never seen, and I'm not sure the history has ever seen in the United States, a larger group of people in a labor market, specifically physicians, somewhere between 600,000 and a million physicians. Who've all lost their collective power at the same time, unprecedented.

You're talking about in comparison to any other industry or class of worker? Never seen anything like it. This is the largest class of worker that has no voice. Well, I want to be very specific about what I mean, and that is that over the course of, say, the last 100 years, there was a time when workers in the United States had no voice at all. They struggled for that voice in the late 19th century, and by the 1930s, you began to see tens of millions of people who were previously voiceless, build a union. So I would say since that time, I have never seen a larger group of people without a voice, I should say, maybe had a voice in a different context, in their own individual practices, to now going to be employed and being employed in an environment where the industry has consolidated in the non-profit, for-profit, and private equity world. The gulf between lack of voice and concentration of power in the industry, I would say, is unprecedented.

I think it back to 15 years ago, and when we started helping doctors and their families, this was not on our radar. We had no idea that doctors were in a downward sloping, like approaching the cliff situation. That point in time was like we were pretty much clueless to the challenge and the obstacles and the burden and the slipping away. Like had no idea. And now it's at the point where... Doctors have no ability to have a centralized voice, or they can't agree on anything. It's like the lack of ability to agree on just some of the core basic pieces of this has caused everybody to become so isolated. Isolated. Isolated, that they're totally on their own. That's right. I think of mindsets. I think of mindsets. The more that we see the cut in physician salary year after year after year, the more it permeates a scarcity mindset amongst the physicians to just take care of themselves, focus on me, focus on me, and my individual contract with the hospital. And I think it's kind of scared doctors away from coming together in any fashion because they don't want to lose the little bit that they currently have. And so my concern, my overall concern, you know, after going to Florida and talking to a group of doctors is, how much worse does it have to get for people, for this not to just catch fire easily? Like, this seems like a no-brainer to us, and maybe it's because we're talking to doctors. It's like a conveyor belt of doctors. Every day, Justin and I sit here, we talk to new doctors every day about the issues they have, and they sign up in some form or fashion with us. And I'm just concerned that people, our heads are in the sand too much, to be honest with you. I think things are slowly slipping away. And is it too far gone? Has the power shifted too far? The physicians are just, there's no chance. Well, I was mentioning the 15 years ago piece of it, Reid. Think about how the idea that we will be talking about supporting unions. Yeah. And how far of a swing that is for us. I mean, we typically come from a conservative background, very much capitalistic in nature, want to see growth, love innovation, love starting companies. Our favorite thing to do is start companies, help people start companies, help them become entrepreneurs, help them be independent as much as possible. And that love that we have, that passion we have to do that is for people that, it's locking arms with those that want to have as much say and control over each day and everything that they're doing. And now we're talking about 15 years later after entering into this industry, going into how much things have changed, where to John's point with, was it 77% or 75% or 72%? 72% of doctors today are employed. Are employed. Like that's such a huge change that has occurred. And we wanted to help individuals, we wanted to help businesses. We started DocNation to go above and beyond what a lot of limitations we had before in some of the previous ventures we've worked on for doctors. And so this is the pathway where we have less strings attached, less shackles, less red tape to be able to try to get doctors to come together. And it's now putting us in a place where we're talking about the union side of things, which is not really a thing that we would normally be doing. And that's what it's come down to. We're at a point now where we're needing to take much different types of steps and moves and measures to see actual reform take place. And this reminds me of what you were saying earlier, John, previous conversation about the big things happening in Delaware. There are things that are going on. Big things have to happen to start to turn the tide. This ship of health care is huge. It takes a long time to change course and to move. And there are some things moving here and there. But, this is serious, this is major. And I don't want to sound hopeless, but we started by helping doctors start their own private practices. You know, it's just going to take way too long. One by one. Yeah, one by one. It's going in the opposite direction. So, just being in it, being on the field, talking to doctors all day long, you just get the sense that there's a very, very small few that have a fight in them to do something about this. And that's my only concern. I actually want to focus less on administration, less on government, and less, I want to focus on the team that we should have and build a team together because if we have a collective voice, all the things that every physician either doesn't know that they want and need or they do know, they can have. Yeah. One of the things that I like to inject into the conversation also is that, the kinds of issues that you're talking about, that doctors face and whether they're individuals or again, in group practices or even in large entities. There's a tendency in our country today for everything to sound super polarized, which really, I think, causes just two things, anger and hopelessness. People say, well, corporate medicine is evil and for-profit medicine is evil. And there's no doubt that there are people and players who maybe are. But the fact is, is that I think most people in health care are there for a general notion that they really want to help people. And I think it's important to keep grounded in that. That's number one. Number two, putting good and evil aside, is that there are certain realities going on that got to get dealt with. And what are they? I would say three major things. One is that, as you indicated earlier, doctor's compensation is on the chopping block. I hear from doctors all the time about how they went to work at an emergency room, they went to work as a surgeon, they went to work as a pulmonologist. And then one day, somebody that they never heard of in the corporate office says, oh, we're going to change your contract. And people go, what do you mean you're going to change my contract? And they say, just watch. And we're only going to give you a certain amount of time to agree or not. And if you don't agree, we're going to implement it anyway. Now, I mean, like people will say, well, that sounds evil. Well, I would say what it is, is that there's a gigantic gap that's evolved now in medicine, whereby decisions are being made at a high level about cost and about compensation and everything related to it. And we have a big problem, which is that there's nothing new about that in a capitalist society.

People who run things make decisions. The problem is, is that when a worker or in this case, a physician feels that they are just being treated completely unjustly, and it's demoralizing, that has an impact on them and it has a tremendous impact on their ability to wake up every day and want to deliver the patient care that they know they're capable of. So that's one thing that's going on. Secondly, what we see is that the reality of this threat to people's compensation and job security exacerbates an already existing problem, which is the intervention, again, of outside parties making decisions about how care is delivered. Might be an insurance company, again, it might be an administrator so that doctors are constantly having their shoulder looked over about decisions that they historically are authorized and trained to make. Now, they oftentimes are not able to do that on their terms or in the timeframe that they think is necessary. Then you add to that what is also happening, and you guys referred to that earlier, which is that people are not so sure that another generation is going to follow them into medicine. Those three things are all related. Is it a matter of good and evil? I think we should stay away from that, and we should just look squarely in the eye of the lack of power that people have to be able to alter those realities. It's just business, frankly, but how can you be in a business when you have no voice? It means you're not really in a business, you're just being told what to do. That's a problem that I think is affecting, I would say it's not an exaggeration to say a majority of doctors practicing in the country today. Yeah, you said something like people in leadership make decisions or people in power make decisions, and that's true, and we don't disagree with that. We're capitalistic entrepreneurs, and I love that Justin brought that up. It's a personal thing that we look at each other and we say, I can't believe we're even pursuing this. When people think about someone who's capitalistic in nature, it has a lot of negative connotations to it these days, and that's sad because all it is is that we're saying we're betting on ourselves, and we're going to go work until it works. So there's a lot of risk inherently in that. But going back to, you say people in power make decisions, that's true, and that's administration. But if you look at pro baseball, pro basketball, pro football, they have a union that balanced that power a little bit. Why is that? You know, the truth is, in Jetson and my companies in the past, yes, we could let someone go and replace them. But we don't have 20,000, 30,000 employees, right? Where if eight of them banded together, we could probably replace eight of them. You can't do that with 20,000, 30,000. I'm thinking about professional athletes and more than that. And if they all band together, the stars of the show, right? Like, do you guys know who's coaching in the Olympics? Who's the basketball coach for Team USA in the Olympics right now? John, do you know? Steve Kerr. Dang it. Do you know that because you know sports well? That's the only reason. He knows sports well. But who's the flag bearer? Coco Goff and LeBron James. Look at that. The players. People know the players, right? You go get work done at the hospital.

You know your doctor. You don't know the administrator. What I'm trying to say is, it's different in medicine. It's different amongst physicians. There is a different level of knowledge and expertise that most people do not have. Just like most people cannot jump and shoot and run like LeBron James, there's power in that too. So the point I'm trying to make here is that this is so close. This could be so close to happening if the stars of the show would band together. It happened and when it happened in Major League Baseball, it didn't take long. Once people got together, it didn't take a very long time. So I don't disagree with the owners of the baseball teams need to make decisions for the organization because they're the ones paying the $700 million contracts to the top players. Where's that money? It's got to come from somewhere. But there's a balance of power wherein the players can say, I want to opt out of this contract and go somewhere else. There's fReidom to do that because you say, hey, if you don't like this new contract, doctor, well, we're going to implement it anyway. It's not so easy to just bounce around for a physician as it is, maybe a professional athlete. Well, I don't want to disagree with you. This is not a disagreement, but- Let's disagree. No, not at all. It's not a disagreement, but I think it's an interpretation on the notion of leadership, decision-making, and the kind of capitalism that we all want. There's an awful lot of data and an awful lot of books that have been written, and an awful lot of very important study that's been done and says that you are not going to have a successful company in today's world unless the company empowers the people who work there to be able to be a participant in the purpose and the direction of the company. Those are the most successful companies in the world. Toyota, Dan and Yoghurt, Mercedes-Benz. In the United States, we have Patagonia, we have many, many examples of successful 100% capitalist-owned and operated companies. But when you demoralize your front line, try to imagine winning the Super Bowl with a demoralized team. It doesn't matter how talented they are.

If they're demoralized, they are not going to win. In fact, they might even work against you. When it comes to doctors, or when it comes to the team that they work with, nurses, technicians, and others, if they are not empowered to have a voice, you are not going to have good patient care, and as a result, you're not going to have a good business because today's world of healthcare is very much related to a transparent, data-driven set of relationships between revenue and quality. That's a lot of what's at the heart of what's going on, where people in C suites see the numbers, they see the challenges, and what they do is instead of taking a chance on trying to step up and improve quality and improve the nature of the work, they try to make cuts as a way of taking a shortcut to be able to achieve success, and that does not work. And that is what is putting tremendous pressure on doctors today. Because the only thing a doctor thinks about is the highest quality of care for every single patient. That's all they think about. That's what they're trained to do, and that's what they believe in. And they're in a situation where that is challenged every day. I think back to when Major League Baseball, they held a strike. One of the things the players did, and it hurt them so bad, and I know this, because we had an older player come to one of our dugouts and talk to us, but they would stop talking to the fans, stop signing autographs. They wouldn't even look at the fans. There was no interaction with the fans. Before they struck, they did a bunch of things to try to open the ears of the owners before they had to strike. And why were they doing that? They were doing that because the fans pay for the tickets. And if the fans don't show and the fans don't like your team, maybe that gets the owners to start thinking. Well, I think there's a different level of care from a professional athlete to a doctor in terms of, I've never seen actually one time any of our clients or anybody that we worked with say, you know what? I'm just so upset with administration. I'm not going to give this next patient the time they deserve. I've never seen that once. And so that's part of, you know, I'm always really hard on the physician because it's the physician side of things like let's just band together and do this. But it's a little bit more difficult for physicians than it is professional athletes, because they've signed their name on a dotted line to provide the best care possible. And it's different when you're playing a baseball game versus talking about someone's life or death situation. And so I do understand the difficulties there to say, hey, let's throw our arms up and we're just not going to show up. We're not going to show up. I understand that. And let's add to what's always in the ringing of the ears, if you will, or the ringing of the brain of the physician. And that's their oath to do no harm. That's right. Which is the other side of the same coin of wanting to give the best quality care all the time. Because if you can't give the best quality of care, you are doing harm. And they know both of those things to be just devastating in terms of the antithesis of why they became doctors. John, talk to us about the things that doctors are unified around that they can't agree on. And then also, let's talk about the things that they are having a hard time agreeing on, a hard time agreeing on, which has led to people being off in their own directions. Because I think, to your point, Reid, the player focuses on their performance and their contribution to the team. They're not having to worry about what's going on personally with the fan in the stands. That's a huge difference. It's a huge difference. And the reason I'm bringing this up is because I was on a phone call last Wednesday. I think it was Wednesday. And someone had heard one of our webinars or watched one of our webinars. And they're like, hey, dude, it's a little easier for professional athletes to strike than it is for us to strike. I just want you to know that. And it really was humbling to me. It was humbling to me to say, okay, there is a difference. And so that's why I bring it up in this podcast, is because I understand the challenges. I understand that there's a significant difference. But I also understand the power in a collective bargaining group, at least to start having conversations, because we're not even really there yet. Well, I would argue it's not easy for anyone to strike. And I think you would agree with that. Because for every $10 million player in the NFL or Major League Baseball, the majority are people who make somewhere between the minimum and maybe a little bit more than that. And there's a lot on the line, not the least of which is that their careers, especially in football and in other professional sports, are shorter and shorter because of injury and other things. So there's always risk. I would say for physicians, that's a big issue and we should address that. Before I do though, to answer your question, Justin, I think that my experience is that doctors agree on a lot of things that need to change. They want to have a direct voice in the way care is delivered. They want to have a direct voice in the support team that they have, because they know that they can't practice without nurses, without technicians, without laboratory, without all of those ancillary services which are oftentimes short-staffed or contracted out, God forbid. So they're very concerned about those issues and they're pretty unified around that. They're unified around wanting to have control over their decision-making about the patients, and they're very unified about wanting to have a voice over compensation. Not so much because they just want to make a lot of money, it's because they want to make enough money that is commensurate with their education and what they're doing. If they're demoralized over that, it's a terrible thing. But what tends to keep them apart? That's a very important question. Couple of things that I've observed is this, and this makes a lot of sense if you think about it. Physicians are scientists and they are academics, and they have relationships with their colleagues outside of the examining room, outside of the operating suite. And what are those relationships? Those relationships are sharing scientific knowledge, writing articles for journals, teaching residents and interns. And so there's a lot of relationships outside the actual practice with colleagues who are at a higher level in the responsibility chain of health care. Might be their department head, might be their chief, might even be the chief medical officer, who they're very close with when it comes to their professional and intellectual and academic work. And so one of the things that I've observed and heard directly from doctors is, do I really want to jeopardize those relationships by unionizing? And I guess the answer always comes down to the fact that you can do two things at once, which is that you can maintain those relationships and build a kind of mutual respect over the need to unionize in the context of that broader set of relationships. So, but I think that that's a factor that doctors think about a lot, that tends to make them a bit more hesitant from time to time about organizing a union. And then of course, there is the issue, the there is the S word, the strike word. And talk about not wanting to do harm. A strike by definition can do harm. It could close down a hospital, it could delay services and so on. But I think it's important to confront that head on and say that there's doctors all over the world who belong to unions. You know, this is not just an American issue. There's doctors in Germany and France and Austria and England, and all over Japan, all over the world in industrial countries, not that different than ours, where all the doctors belong to a union. We're the only country where they don't, frankly. And there are strikes in those countries, not because they want to, but because it's part of a potential breakdown of what I would call social solidarity. In a lot of countries, you have social solidarity, where there's a generalized belief in the common good, and from time to time, there needs to be a reckoning with that. Here in the United States, it's different. We don't really have that kind of culture, but strikes are extremely rare, and I really do believe that doctors have the power, short of a strike, to influence improvement in working conditions. That's frankly why you see so few strikes among doctors, because doctors have been unionized for a long time in the public sector in the United States. New York City, Chicago, Los Angeles, San Francisco, Miami, Florida, Houston, and so on. Many doctors belong to unions in the public sector, and it's very rare that you see a strike. It's not that it's something that ought to be taken lightly, but it has not been a big part of the history here among doctors who have been unionized. I think that's because of their inherent power and importance in the system, and it's better to work things out, even if it's going to cause some additional cost to the employer. sir, there's a lot that can happen before a strike would actually have to be put into effect. Simply by having a rallying of- Well, I'm going to interrupt you because I was going to jump on the same thing that I picked up from what John said. If you don't mind, I want to interrupt John, just putting you on the hot seat, just off the cuff. I'm sure there's doctors out there who are going to listen to this and say, okay, I could think of some things we could do short of striking as well, but I'd like to hear what John has to say. What are a few things that they can do short of striking?

Well, what they do do among doctors who are unionized is that they spend a lot of time educating their community about why they are doing what they're doing in terms of engaging in collective bargaining and organizing a union. They involve important members of the community, including political leadership from both sides of the aisle. They involve community organizations and the clergy, and many advocacy groups for patients, whether it's in behavioral health, pediatrics. I mean, every single area of medicine has advocacy groups who stand up for services in an area to make sure that people get the services they need. So there's a broad network of people who pay attention to health care, whether they're in the public policy realm, meaning legislators and administrators, as well as community organizations, as well as religious organizations who, as you know, play a big role and historically have played a big role in health care in the United States. So building that kind of relationship with the community, I don't just say going out and asking for help from the community when they need it, it's building that relationship over time. That is the most effective way of gaining, quote unquote, leverage in winning a union contract and improving condition. And that's what they do, and that's why they're successful. So that goes way beyond just the doctors themselves within that employer setting. It's totally tied into almost a sub-community within the community at large that's participating and collectively working. So it's almost like what you're saying is the doctors are not on their own, there's a swell of support that surrounds them. Because at the end of the day, what matters here is patient care. It's patient outcomes. And we've seen nothing but the quality of patient outcomes get worse and worse and worse. And a ton of that has to do with the time per patient. And there's a whole upstream aspect to what's going on above, before the doctor even gets to see the patient that's interrupting, what they actually get to do with that patient. So I think that sounds something as an encouraging aspect to this, that as a leader, as somebody who cares about your profession, simply by getting and gathering up some of your colleagues together, there's a community support system that will come in and help you.

And frankly, that's why we exist. We're here to support you as the individual in the workplace to have that voice. John, you were talking about unions all over the country. That's news to me. Can you talk a little bit more? You said San Francisco, you said California. Well, you said, where else did you say? Chicago. You rattled off a few. Right. See, in the public sector, which by the way, we should also remember, there was once a time in the United States when public health was the health system. You look at a place like New York City, Los Angeles, any big city in the United States, and it used to be even in the small towns, that health care was delivered through public services. It's not universal by any stretch, but there are many tens of thousands of doctors who have belonged to unions for many decades in the public sector.

What does that look like? For the resident who just finished their training last month, describe this a little bit more fully to help them understand what they would be experiencing and how that would be different back when that was compared to the now, if you could. Well, what's changed is one of the biggest things that we don't talk about in the United States is how it used to be that 75 years ago, 60 years ago, most health care in the United States was delivered through major public institutions, hospitals, clinics. Then you had a lot of doctors who were in private practice. You did have private hospitals, but for the average person who didn't have a lot of money, and even for people who were middle-class, the public institutions were the best institutions in the United States. San Francisco General Hospital, UCLA Medical Center, Denver Health, New York City Public Hospitals, and so on and so forth. Cook County in Chicago. What's happened is that there's been this tremendous defunding of public health over the last 50 years.

And today, only about 3 percent of all the money we spend on health care goes to the public sector. So the big difference, Justin, is that today, when you come out of medical school, not only are you going to be working in corporate medicine, but you're going to be working in private medicine more and more, where decision-making is much more detached from the community than it was when we had a public health system in the United States. Then this huge shift. I remember my grandmother in Milwaukee, Wisconsin. Every month, she would take a trip to what she called county hospital. Well, guess what? There is no such thing as a county hospital in Milwaukee anymore. Doesn't exist. That's where everyone went, whether it was for a routine checkup like she would go for, or for complicated surgery. They were the best hospitals in the country. They don't exist anymore except in fewer and fewer places.

Doctors were way more plugged in in the decision-making in that setting. Definitely. They also formed unions. The unions were formed not so much out of grievance. They were formed as being part of a social commitment. If you will, just like, you know, that's the whole notion of public health. It's kind of like having an HOA in a neighborhood. Well, in a sense, in a sense, yeah, that there's a sense of leadership group, a decision-making group. If there's ever any discrepancies or questions or people aren't, the physicians can't come to an agreement on something. There's a group, there's a leadership group. Yeah, sorry, yeah. No, so as opposed to out of grievance, it's, hey, this is just what we do. We form a group, a leadership group. That's right.

We all spend two years doing it and then the next person comes in. Exactly. It was not so much that people had grievances with one another, which is often a way people think about unions, that it was more part of the social network of what our communities once were. I think we would all agree that our communities could use a lot more social network than we have today, where it feels like everybody's just on their own. Well, it's wild to me to hear you say, unions were formed not out of grievance. They were formed out of a group meeting of board of directors. Right? In my lifetime, the only reason you have or you participate in a union is because you are being treated unjustly. Not but a year ago, the labor union for the automobile industry, that was like six months ago. They struck. They struck and got what they wanted. And so I just have never heard needing to form a union for any other reason than to fight.

And that goes back to what John said about good versus evil. I think the whole notion of union now has gotten maybe such a branding, sort of a negative connotation associated with it. Rather than it being a community support mechanism, it's now, well, doctors, they shouldn't have grievances. Like, they're the last person that should be having agreements about anything. So everybody else on the outside would say, you know, looking in from that perspective. But what is the pathway forward here, John, do you think? We're talking about this as it's been done before. There's pieces of it being done here and there. The time is now more than ever because of what, two weeks ago, another Medicare cut announcement every single year.

It just continues to happen. What do you see as that pathway and how people who are afraid of unions or afraid of organizing or maybe like the team health doctor that I spoke to yesterday, who has been part admin role, part clinician role, they see both sides, but then there's more work that gets put on his plate because he's trying to be the intermediary. And so he's in a tough spot because he's trying to satisfy admin, but also satisfy doctors. And so he's in a tough place. How can people begin to start to identify that these types of steps are in the patient's best interests and in their best interests? Right. Well, to be honest with you, I'll just build on what you said, which is that you're right. Unfortunately, and incorrectly, a lot of the public has this interpretation of labor union as some sort of good and evil. And the fact is, is that unions were founded on grievance. I'm not, and that's probably true even in health care. I was talking specifically about the public sector.

But it's also the case that I think we can evolve way far away from grievance being the only motivating factor. And that we evolve towards problem-solving on behalf of the community and the patients. And I firmly believe that the more the doctors organize, they are going to move in that direction. Because from my experience with doctors, and quite frankly, with lots of other working people, is that grievance is only, I would say it's a minority of the motivation. The main motivation is to have a voice. And the voice is not just about wages and working conditions, it's about my contribution and my purpose. I think that's true for everyone. And so I think that doctors can really lead that type of union thinking and union organization. And I think that's going to be the key to success. To maybe start with grievance, but move towards a broader social interpretation of why we need to unionize. And I think it's going to happen.

So for the doctor then listening to this, what would be action items, action steps that they should do to do something about this? To not just hear the conversation, but to actually put something into practice and emotion. What are some tangible steps they can take, as you've seen, within the labor movement over a generation? What would you say is your call to action that you suggest that they consider? I think the call to action is that there are more and more organizations like DocNation, some of the professional associations, and then of course, there's the labor movement itself. And I think that it's important that doctors come together, either in their lounge or after work, having a bite to eat, and saying, we're going to make a commitment to reach out to an organization to help us think through how we can regain our voice. And I happen to believe it is going to require unionization because there's a long tradition in this country, and I can't think of any other, you know, not that different than the civil rights movement or other major movements in this country, where people have had to organize themselves for a purpose. And when it comes to gaining voice, the most effective way is through a union. So I think that it's incumbent upon people to think that through, reach out to whether it's DocNation, whether it's their professional organization, even the AMA, or look up one of the major healthcare unions in the country, SEIU, AFT, as examples, and make the call and get started. I think that's a good place to land the plane. This might be a 10-part series, and this might be part one if we could get John. John, that's a lot for John, I think. There's just so much knowledge that you have. And we have a whole slideshow that I think we covered a fraction of it, because I think there's some high-level points that we wanted to make on our first podcast here. But for our DocNation following, this is our first podcast.

We've switched from webinars, our once-a-month webinars at 7 p.m. Central Standard Time to podcasts, so people could listen to these whenever they wanted. So that's just a DocNation update here. But Justin, unless you don't have anything else, I just want to say thank you, John, and I appreciate your time, and we'll be seeing more of you, and so will our following. Yes. Thank you, John. John, any last words? No, just best to all of you, and thanks for all the good work you do. Thank you, John. Have a great day. This has been The DocNation Podcast. If you like what you heard, be sure to subscribe, rate, and leave us a review on Apple Podcasts, Spotify, or wherever you are listening to us. Your feedback really helps us reach more listeners like you. We'd also love to hear your thoughts and any topics you'd like us to cover in future episodes. Don't forget to follow us on Facebook, Instagram, and LinkedIn for updates, behind-the-scenes content, and to join the conversation. Thanks for listening.