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For years, many doctors and pharmacists believed they stood largely outside the traditional management-labor hierarchy. Now, they feel smothered by it.
多年来，许多医生和药剂师认为，他们在很大程度上不受传统的劳资等级制度约束。现在，他们感觉要被这一制度窒息了。
The result is a growing worker consciousness among people who haven't always exhibited one -- a sense that they are subordinates constantly at odds with their overseers.
其结果是，这些并不常常表现出工人意识的人，现在愈加意识到自己是工人，即他们感觉自己是下属，且总是与上级有矛盾。
"I realized at end of the day that all of us are workers, no matter how elite we're perceived to be," said Dr. Alia Sharif, a colleague of Dr. Wust's at Allina who was heavily involved in the union campaign.
"我最终意识到，我们所有人都是工人，尽管外界以为我们是精英。"艾莉亚·谢里夫医生说，她是伍斯特医生在阿尼娜的同事，也深度参与了工会活动。
"We're seen as cogs in the wheel. You can be a physician or a factory worker, and you're treated exactly the same way by these large corporations."
"我们被当作轮子上的一个齿轮。你是医生还是工厂工人都没有区别，这些大公司会以同样的方式对待你。"
As a pharmacy intern and pharmacist at CVS in Massachusetts beginning in the late 1990s, Dr. Ed Smith found the stores consistently well staffed. He said pharmacists had time to develop relationships with patients.
从20世纪90年代末开始，埃德·史密斯医生就在马萨诸塞州CVS担任药房实习生和药剂师，当时他发现药店的工作人员配备一直很齐全。他说，当时药剂师还有时间与患者建立关系。
Around 2004, he became a district manager in the Boston area, overseeing roughly 20 locations for the company. Dr. Smith said CVS executives were attentive to input from pharmacists -- raising pay for technicians if there was a shortage, or upgrading clunky software.
2004年左右，他成为波士顿地区的地区经理，负责公司大约20个地方的业务。史密斯说，CVS的高管很重视药剂师的意见，如果出现人员短缺，就会提高技术人员的工资，或者升级不灵敏的软件。
"Every decision was based on something that we said we needed," he recalled. Over time, however, consolidation and the rise of ever-larger health care corporations left workers with less influence.
"每一个决定都是基于我们的需求。"他回忆道。然而，渐渐地，企业开始合并，规模越来越大的医疗保健公司开始崛起，让工人的影响力变得越来越小。
As so-called pharmacy benefit managers, which negotiate discounts with pharmacies on behalf of insurers and employers, bought up rivals, retail giants like Walgreens and CVS made acquisitions as well, to avoid losing market power.
随着药房福利经理（代表保险公司和雇主与药房谈折扣）收购了许多竞争对手药房，沃尔格林和CVS等零售巨头也进行了收购，以避免失去市场支配力。
The chains closed many of their newly owned locations, driving more customers to existing stores. They sought to cut costs, especially labor costs, as the benefit managers reined in drug prices.
这些连锁店关闭了许多新收购的药房，驱使更多顾客来到它们的现有门店。福利经理要控制药品价格，于是这些药房就努力削减成本，特别是劳动力成本。
Around 2015, Dr. Smith stepped down from his role as a district manager and became a frontline pharmacist again, reluctant to supervise co-workers under conditions he considered subpar.
2015年左右，史密斯卸任地区经理的职务，再次成为一线药剂师，他不愿在他认为不合理的条件下去管理同事。
Among his frustrations, he said, was the need to strictly limit the number of workers each pharmacy could schedule. "Every week that you're over your labor budget, you get a call, regardless of prescription volume, from your district manager," Dr. Smith said.
他说，让他失望的事情之一是他需要严格限制每家药店可以安排的工作人员数量。"只要你的劳动力预算超支，你每周就会接到地区经理打来的电话，不管我们那周开了多少药。"史密斯说。
The pharmacists also described being held to increasingly strict performance metrics, such as how quickly they answered the phone, the portion of prescriptions that are filled for 90 days rather than 30 or 60 days (longer prescriptions mean more money up front) and calls made urging people to fill or pick up prescriptions.
史密斯还说他们被要求遵守越来越严格的绩效指标，比如接电话的速度、90天处方而非30天或60天处方的占比(疗程更长的处方意味着有更多的预付款)，以及为了催促人们完成疗程或取药而打了多少电话。
