Tribute to Barbara Ehrenreich: Fighting for Labor Through Critical Research Journalism

Abstract

This is a short commentary to accompany the article “Hospital Workers: Class Conflicts in the Making” by Barbara Ehrenreich and John H. Ehrenreich. The article was originally published in the International Journal of Health Services in 1975. We are revisiting it in the current issue of the International Journal of Social Determinants of Health and Health Services due to its continued relevance and significance in the twenty-first Century.

Barbara Ehrenreich (1941–2022), along with her co-author John Ehrenreich, was a notable analyst of the modern corporate health care system in the United States. Her work shed light on the transformation of American monopoly capitalism from a manufacturing to a services sector system, leading to the fragmentation of the working class based on credentials and skills. Notably, she predicted the growth of for-profit sectors within hospitals, which attract capital due to their profitability and division of labor differentiation. Consequently, the management priorities in hospitals have become more aligned with those of for-profit corporations, often conflicting with the goal of improving patient health.

A significant revelation made by Ehrenreich, highlighted in her 1975 article “Hospital Workers: Class Conflicts in the Making,” ¹ was that of the contradictory class position of medical doctors (MDs) in hospitals. She claimed that MDs simultaneously assumed roles as managers and highly skilled workers, a construct that sociologist E. O. Wright explored in his analysis of contemporary capitalism's class structure, ² which is tied to a deterioration in mental well-being.^3,4 The division of labor between MD managers, nurses, technicians and support staff, who were BIPOC working-class individuals, contributed to class conflicts within hospitals. The dominant ideology of professionalism ⁵ clashed with the ethics of service, with workers identifying themselves as “professional” based on their credentials.

In numerous American hospitals over the past five years, a significant divide has emerged between physician administrators and the physicians responsible for patient care. Most doctors providing direct patient care are now functioning as employees and are treated as such (D. Himmelstein and S. Woolhandler, personal communication, 2023). This shift is most prominently exemplified by the recent upsurge in unionization efforts among residents and fellows at some of the nation's most prestigious medical institutions, including Stanford, the University of Pennsylvania, and Massachusetts General Hospital.

In summary, Ehrenreich's research exposed the class conflict between the managerial class and the rest of the workforce in the corporate hospital industry. This conflict encompassed issues related to wages, working conditions, skill development, and control over the labor process. Even today, we witness this conflict persisting in an increasingly privatized health sector, evident in the major strikes by hospital nurses that have occurred in recent years in the United States:

Tenet Healthcare Nurses’ Strike (2019). Demands: improved nurse-to-patient ratios, better compensation, and benefits.

University of Chicago Medical Center Nurses’ Strike (2019). Demands: better staffing ratios, improved wages, and enhanced benefits.

Hartford Hospital Nurses’ Strike (2019). Demands: higher wages, improved working conditions, and increased staffing to enhance patient care.

Strike at the University of California Hospitals (2018). Demands: higher wages, improved nurse-to-patient ratios, better working conditions, and increased benefits.

University of Vermont Medical Center Nurses’ Strike (2018). Demands: better staffing, higher wages, and improved working conditions.

Strike by Massachusetts Nurses Association (2016). Demands: safer patient care conditions, mandatory nurse-to-patient staffing ratios, and better wages and benefits.

Minnesota Nurses Association Strike (2016). Demands: safe staffing levels, improved working conditions, and a pay raise.

Mercy Medical Center Nurses’ Strike in Baltimore (2016). Demands: improved staffing and wages, and the protection of benefits.

Allina Health Nurses’ Strike in Minnesota (2016). Demands: safe staffing levels, preserving health benefits, and addressing workplace safety concerns.

Kaiser Permanente Los Angeles Medical Center Strike (2015). Demands: improved nurse staffing levels, better working conditions, and increased wages.

These examples of strikes over wages, benefits, and working conditions testify to the contemporary relevance of class conflicts identified by Barbara and John Ehrenreich in today's corporate hospital industry.