AMA: Unprecedented Vote to Create Doctors Union

      The American Medical Association wrapped up a week of impassioned debate over forming a labor union yesterday with a "yes" vote, marking a "radical departure for one of the oldest and most conservative professional organizations in the country," the Washington Post reports. In setting up a "national negotiating organization," the group's 494-member House of Delegates moved against the recommendations of its Board of Trustees, emphasizing their determination to wrest control from insurers (Goldstein, 6/24). The organization envisions setting up two groups of doctors -- those employed by hospitals, health plans or the government; and medical residents -- which combined represent about one-third of the nation's 620,000 doctors. AMA leaders said that doctors would never strike. The organization also vowed to bring 325,000 self-employed physicians under the union umbrella, but first the group must persuade Congress to exempt health professionals from antitrust provisions. The AMA outlined plans to "set up dozens of union locals over the next five years" (Greenhouse, New York Times, 6/24). However, it will "not dispatch organizers to drum up union support, but will instead respond to requests for help from local medical communities" (Washington Post, 6/24).

California Impact
      California Association of Health Plans head Walter Zelman was quick to play down the likely impact in California, noting that "most doctors in California belong to medical groups or independent practice organizations that function like unions," and that federal law currently prevents self-employed doctors from bargaining collectively. Kaiser Permanente spokesperson Dann Shively said that the "vote will not likely affect the Kaiser Foundation Health Plan ... since Kaiser's doctors own the Permanente Medical Group." He said, "Kaiser doctors are their own bosses. They would be organizing against themselves" (Griffith, Sacramento Bee, 6/24).

We're Different
      AMA President-Elect Dr. Randolph Smoak and AMA President Dr. Nancy Dickey "carefully avoided calling their group a doctors' union" during a news conference yesterday. The Los Angeles Times reports that while Smoak called it a "national umbrella" or a "collective bargaining unit," Dickey spoke of "an additional tool for doctors" or a "legally constituted entity." Nonetheless, the Times reports, when the two spoke of the doctors' grievances, "the complaints could have come from a speech by CIO organizers in the historic labor battles of the 1930s: Doctors are being 'hammered' by health plans, said Smoak, adding that physicians are little Davids in battle with the HMO Goliaths" (Rosenblatt, 6/24). Doctors in the AMA union will likely "play down their financial concerns in favor of emphasizing their needs for professional autonomy and control over patient care," the Chicago Tribune reports. In doing so, they are likely to steer away from confrontations and seek leverage through "bureaucratic showdowns -- stalling on processing insurance claims, for instance -- that do not raise the threat of cutting off medical care" (Franklin, 6/24).

No Sympathy Here
      However, some questioned doctors' motives, with New School for Social Research professor Howard Berliner saying, "I don't really think this is being done for patients. This is happening because doctors' incomes, doctors' sense of autonomy, are getting killed" (New York Times, 6/24). Health Insurance Association of America President Chip Kahn agreed, saying, "The fact is that this is just a power play for money. This is not an issue of quality of care" ("World News Tonight," ABC, 6/23). "This is unprecedented," he said. "There is not another case where a group of professionals who are not employees, but independent, mostly small-business people, are given this prerogative" (Murphy, Investor's Business Daily, 6/24).

Crystal Ball
      "The endorsement of a doctors union by the AMA gives an enormous psychological boost to the movement to unionize doctors," said Dr. Barry Liebowitz, president of the National Doctors Alliance, a 15,000-member affiliate of the Service Employees International Union. Already, 40,000 doctors belong to unions and officials at some unions promised to compete with the AMA, which they said would have weak bargaining leverage "because it was taking its biggest weapon -- striking -- off the table" (Greenhouse, New York Times, 6/24). Indeed, the AMA vote is almost a "belated decision," said Time Magazine senior economic reporter Bernard Baumohl, noting that doctors' groups in about half of the states have already gone down the union road. He said the move "puts the AMA on record as recognizing that physicians need to increase their contractual leverage against managed care companies to regain their role of practicing medicine" (Sanders, Time Magazine/Time Daily, 6/24). Princeton University's Paul Starr called the decision a "watershed," and said that it "reflects a momentous change in the economic position of the medical profession from the time when nearly all doctors were independent businessmen ... to a time when large numbers are either on salary or face very large buyers of their services" (Post, 6/24).