PHYSICIAN UNIONIZATION: Backed By Bill In Congress
Rep. Tom Campbell (R-CA) has introduced a bill that would allow doctors to bargain collectively, American Medical News reports. The proposal would give doctors and other health care workers "the same treatment under antitrust laws as those given to bargaining units recognized under the National Labor Relations Act." The measure would allow doctors to "present a united front against a united front," Campbell said. The measure faces opposition from the Federal Trade Commission, and American Medical News notes that the "dwindling congressional calendar ... makes action this year unlikely." But Campbell spokesperson Suhail Khan said the representative will introduce the bill next year if need be.
Not A Lot Of Choices
"The bargaining power of physicians is dwarfed by the bargaining power of managed care and other insurance companies," Dr. Michael Connair of the Federation of Physicians and Dentists testified at a recent House Judiciary Committee hearing on the measure. "Many managed care insurers have been strong-arming doctors into signing one-sided 'contracts,' which often violate professional and ethical standards," Connair said. The American Medical Association's Dr. Donald Palmisano testified that in some markets managed care companies have saturated the market to such an extent that doctors have no choice than to contract with the companies. "There are simply not enough patients outside of managed care plans to provide most physicians in the market with enough patient volume to have a financially viable practice," Palmisano said. And in many cases, the doctors have no say in contract negotiations, and face a "take it or leave it" scenario, he said. Witnesses at the hearing also noted that contracts dictated by managed care companies often "undermine physicians' medical decision-making authority by requiring that doctors comply with the plans' medical management or utilization management programs."
Back To The 'Good Ole' Days
Critics of the bill contend that giving doctors bargaining power isn't a good idea. Rep. Henry Hyde (R-IL), chair of the Judiciary Committee, said, "We ought not accrete more power to one group, which is capable of abuse. They are not steel workers." Others worry that doctors could fix prices and strike. Robert Pitofsky, head of the FTC, said, "All doctors in a relevant area could join together and insist on higher fees." Stephen deMontmollin, testifying for the American Association of Health Plans, said, "It would result in a return to the good old boy network. If you want to (know) what happens to midwives, nurse anesthetists and osteopaths when the physicians are taken out from under the antitrust laws, you're going to see a return to the bad old days." In addition, opponents noted that doctors already can "challenge HMOs' power" by forming unions. While Campbell conceded that his measure could allow doctors to raise fees, he said the measure would prohibit "anticompetitive behavior against alternative providers and doctor strikes." The AMA agrees that striking should be illegal for doctors. "It is our ethical precept that we will not use patients as bargaining chips," Palmisano said (Aston, 8/24 issue).