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LONG BEACH, Calif. -- Even recognized cardiology leaders have not been immune from threats and abuse by their hospital employers, prompting an emotional discussion on worker's rights at the Society for Cardiovascular Angiography & Interventions (SCAI) annual meeting.

With the majority of doctors now being hospital system employees instead of in private practice, cardiologists here shared their horror stories and recognized that their colleagues, including nurses and residents, already have unions that allow for collective bargaining on employment conditions.

SCAI advocacy committee chair Arnold Seto, MD, MPA, chief of cardiology at Long Beach VA Health Care System, asked the room if the society should sponsor a union.

"Unions are not perfect, but they play an important role in keeping hospitals safe and forcing hospitals to pay their staff adequately. Without unions, hospitals would have nurses working twice as hard with half as much pay," said Kusum Lata, MD, of Sutter Health in Tracy, California. "Any doctor who is an employee has the right to join a labor union and bargain collectively over salary, benefits, and working conditions."

In particular, unionization may help physicians advocate for better pay and protect the integrity of clinical practice while alleviating burnout, she said.

A wave of physician unionization in the U.S. is already underway. Notable examples include organized doctors at Minneapolis-based Allina Health, representing the largest group of unionized doctors in the private sector, and more recently, the union of anesthesiologists at Cedars-Sinai in Los Angeles.

David Tehrani, of Stanford Health Care in California, acknowledged that physician unionization can be difficult, especially with regards to finding a "unifying aspect" across a large group.

During the SCAI session, Amir Kaki, MD, of Ascension St. John Hospital in Detroit, shared the story of his legal battle with his previous employer, the Tenet Healthcare-owned Detroit Medical Center (DMC).

After he and his colleagues blew the whistle on care quality, the hospital retaliated by subjecting him to bad faith peer review of his cases, terminating his directorship of the cath lab, and taking away his hospital privileges. Kaki said he was fortunate to have the support of prominent cardiologists testifying on his behalf during his hearing. His supporters included , and , who both traveled out of state to provide testimony without being paid.

After the accusations against him were deemed baseless, Kaki sued his employer and was awarded $5 million in monetary damages. The favorable ruling also allowed him to return to DMC with a new term of privileges -- becoming the first physician to get court-ordered reinstatement of privileges.

Panelist Mitul Patel, MD, of Intermountain Healthcare in Murray, Utah, was brought to tears by the story and stressed that physicians have to support each other. The "people who wear suits" couldn't care less, he said. "You're a widget to them."

Indeed, fellow panelist Islam Abudayyeh, MD, of VA Loma Linda Healthcare System in California, recalled previously being in the most leadership position he held, director of structural heart disease, and hearing through the grapevine an administrator's comment on him: "We can get rid of [Dr. Abudayyeh]."

"Every single valve case came from me. That's what they think of us," he said.

J. Jeffrey Marshall, MD, chief of Atlanta's Northside Hospital Cardiovascular Institute, suggested that employers threatening their own doctors is a situation that is "becoming quite prevalent" based on his experience being a member of his state medical board. His advice for doctors threatened by their employer: call your lawyer and never resign while you're under investigation because it never comes off the record.

Seto said SCAI is welcoming ideas about how the society can help threatened members.

"I was fortunate that I had people with money behind me," Kaki said. "The hospital can pay anyone anything to say anything they want. Why can't SCAI provide a committee that decides if someone is a good doctor or a bad doctor? It's a small thing that would go a long way [for] adjudicated peer review that is anonymous. If we did that as a committee, that would be a huge service."

As for legal help, Olga Toleva, MD, of Georgia Heart Institute in Gainesville, cited the model of the , a mutual medical defense organization that connects lawyers to members at any stage of their career. "Something like this, led by SCAI, would be a helpful way for physicians to find help in the aspect of malpractice," she suggested.

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