Physicians Banding Together for Patient Care
HMOs are making patient care decisions to maximize profits at the expense of patients. And physicians are turning to unions in growing numbers to regain control over patient care.
There’s a revolution in the medical care profession.
Doctors, who mostly have spurned unions, are now realizing that collective bargaining is not only in their own best interest, but also is in the best interest of their patients.
One of those physicians is Dr. Janice Nelson, medical director of the blood bank and transfusion service at the Los Angeles County/ University of Southern California Medical Center. She used to disregard union mailings. “We were always kind of elite. ... We always felt, what’s the need?” she explains.
She feels that way no longer. The change came with her realization that doctors are losing control over patient care to insurers, their powerful health maintenance organizations (HMOs) and other managed care groups.
For instance, she says HMOs forced less-qualified people to handle certain tasks to save money at the expense of quality health care.
“Everybody is just stressed out and strained to the breaking point, being asked to do so many tasks” because of policies aimed at cutting their costs, she says.
Nelson joined the Oakland-based Union of American Physicians and Dentists (UAPD) last June. Not long after, many of her colleagues also saw the light.
UNION TRIUMPH. On May 28, in a major victory for the AFSCME affiliate, UAPD won the right to represent 800 salaried doctors employed by L.A. County — 65 percent of the 523 votes cast were for unionization. The election was “another nail in the coffin of those who would regulate health care based solely on profiteering,” says Dr. Robert Weinmann, UAPD’s president and a San Jose neurologist.
The election’s implications are “bigger than a lot of people realize because the momentum across the country [to unionize physicians] is growing,” says Grace Budrys, professor of sociology at DePaul University in Chicago and author of the book, When Doctors Join Unions.
“The fact that physicians’ unions are most active in the areas where there’s the greatest penetration of managed care tells you something,” she adds. “When a whole group of people like that demand better health care, then the HMO will pay attention.”
In a move that made headlines nationwide, the 300,000-member American Medical Association voted June 23 to organize salaried physicians into a “national negotiating organization” to bargain with doctors’ employers. AFSCME Pres. Gerald W. McEntee said the AMA’s decision “reflects a tidal wave of sentiment that doctors want representation.”
DOCTORS RESTRICTED. Only salaried physicians, such as those employed by hospitals and local government agencies, however, can be represented by unions to bargain over wages and working conditions.
Giving unions the right to represent private physicians in negotiations with insurers and their managed care organizations will restore the balance of power in favor of doctors and patients, Weinmann told Congress recently.
“It is my strong belief that patients will be better serviced when fair and equitable contracts are negotiated by professionals, acting together, who are closest to the needs of their patients,” he said.
Current federal law does allow groups of private physicians to negotiate with HMOs, directly or through unions, as long as a state specifically gives them that right.
PRIVATE DOCTORS WIN. Texas became the first state to do so on June 19, when legislation was passed giving private physicians the right to collectively bargain with insurers and managed care groups, as long as the state attorney general agrees.
“It allows us to negotiate higher fees, better treatment schedules, better referrals and better control over the patient,” says Dr. Tony Brozek, president of Doctors Council of Texas, an affiliate of the Federation of Physicians and Dentists/National Union of Hospital and Health Care Employees/ AFSCME Local 1199.
An effort to push for similar legislation in Florida and Pennsylvania is already being planned. Washington state already has such a law, but on a more limited scale.
Elsewhere, private physicians remain under the thumb of antitrust laws. AFSCME and the AMA are urging Congress to eliminate that barrier to fairness by approving “The Quality Health-Care Coalition Act” (H.R. 1304).
The bill, sponsored by Reps. Tom Campbell (R-Calif.) and John Conyers (D-Mich.), would exempt private physicians, pharmacists and other health care professionals across the nation from antitrust laws so they can collectively bargain with managed care companies.
“With enormous market power, insurers have bargaining leverage which dwarfs that of individual or small group practices,” UAPD’s Weinmann told the House Judiciary Committee at a June 22 hearing. Physicians “are presented contracts on a take-it-or-leave-it basis [and] strong-armed into signing agreements [with HMOs] which often violate professional and ethical standards.”
Judiciary Committee Chairman Henry Hyde (R-Ill.) did not embrace the bill, but acknowledged the doctors’ plight.
“I can understand their concerns,” the former lawyer said. “I would not have wanted an insurance company telling me how to run my cases.”
By Clyde Weiss
