When I was 11, a sixth grader at Henry L. Barger Elementary in Chattanooga, Tennessee, my life changed. It was 1960.
Jerry Myrick, my best buddy, asked me to play golf. I had never played nor was golf a sport anyone in my family knew. He lived adjacent to the Brainerd Municipal Golf Course where on that fall afternoon, with borrowed clubs I hit my first shots. On number 11, a 165-yard par three that runs along Moore Road, I hit a three wood (not three metal) to three feet and made the putt. A birdie on my first-ever golf outing. In that moment, I was hooked on golf.
That evening, I announced to my parents I wanted to be a professional golfer. They countered in no uncertain terms: “PJ, you’ll have to be a doctor. They’re the only ones who can afford to play golf.”
Jerry confirmed that golf was popular among physicians and that most Wednesday’s, they played since their offices were closed. Wow. Medicine and golf: it made sense.
From that day forward, I pursued both with passion. My summers and holidays were about golf and medicine. I began working at the Baroness Erlanger Hospital when I was 14 in Central Sterile Supply cleaning protoscopes and disassembling Stryker frames. Over the next few years, I worked stints in the Patient Transportation, Housekeeping, the Lab and others—the support functions that were housed in the basement for the most part.
I worked alongside new hires and workers who’d had their jobs for decades. I ate in the cafeteria observing that physicians got free meals and private dining while the rest of us paid. In the hospital’s weekly, I read about the hospital’s new programs and the specialists new to its medical staff dreaming one day I’d be one of those (and a scratch golfer playing every Wednesday and weekends).
I cherish those memories of Erlanger and the lessons I took from those years. What I recall most fondly are my basement co-workers: the support team that served without fanfare, working assigned hours and holidays to keep the trains running at Erlanger. Willis, Sylvester, Margaret and so many others who offered advice and encouraged me toward my career aspirations.
It’s Labor Day. It’s a day we pay tribute to our workforce-- the basement workers who serve with little expectation of recognition or personal wealth so they can feed their families. We’ve celebrated this day for 134 years during which the epicenter of our workforce has changed from farms to assembly lines to retail trade, call centers and knowledge workers.
It’s an important day in healthcare. Our industry employs 17 million. Those who are licensed to provide care—the doctors, nurses, pharmacists, therapists et al—comprise half that number. They’re the ones who earn our highest salaries and receive recognition for their efforts. They get the lion’s share of the spotlight and serve direct roles in the delivery of care.
But behind them is an army of support personnel that deserve appreciation. In the Bureau of Labor Statistics, they’re category 31-0000 “Healthcare Support Occupations”. They’re paid hourly earning an average annual income of slightly more than $29,000. Many qualify for Medicaid and public assistance. Half will be working in our hospitals, clinics and agencies today: working holidays and weekends is part of the job. They’re our basement workers.
They largely go unnoticed. In budgeting, their numbers are fungible as cost reductions are made and overhead is cut. In some organizations, they’re a faceless commodity taken for granted. In others, leaders and clinicians dignify their worthwhile roles and show appreciation.
In the Affordable Care Act, Section Five sets forth an ambitious transformation of the U.S. healthcare workforce. It sets forth principles around team-based care coordination that’s technology enabled and outcomes focused. It expands the clinical focus to include physical and mental health and encourages an orientation toward patients as individuals with unique needs and values. None of these is achievable without our basement workers.
Our basement workers mean more to our organizations than headcount in our budgets: they’re the folks on whom we depend every day to keep the system working. Whether through direct employment or outsourced contracts, we depend on them heavily and risk major dysfunctionality when they’re ineffective or taken for granted. They may be housed in basements or call centers, but arguably they’re no less vital to success than those who diagnose and treat.
I haven’t come close to playing scratch golf and my healthcare career took me to research and policy analysis rather than patient care, and that’s OK. The keys to life, it seems, are how we address Plan B.
But that Birdie on #11 at Brainerd, and the path it began toward healthcare in those formative years is richest because of the basement team at Erlanger with whom I was privileged to work.