PHYSICIAN UNIONIZATION: Controversy Over the Bottom Line
"Money is an important -- if often sidestepped -- factor in the push by some doctors for collective bargaining," USA Today reports. The American Medical Association reports physician income dropped from $166,000 in 1996 to $164,000 in 1997. While a Medical Economics survey revealed that doctors who participated in an HMO in 1997 "netted $33,150 more than counterparts who accepted no HMO contracts," it also noted that "net earnings growth from HMO payments was less than 1%, down from 5.5% in 1994." Medical Economics Editor Jeff Forster said, "Where doctors are feeling the squeeze is in declining reimbursements. Therefore, they have to look at controlling the expense side to maintain their position." Doctors note that income is a key issue, as they often owe $100,000 to medical schools, which require a minimum of seven years of education. Dr. Ed Poole, a Pennsylvania opthamologist, said, "If you look at people who are the giants of industry and finance, they're looked upon as heroes for increasing their net worth. In medicine, I'm looked upon as a villain if I increase my net worth" (Appleby, 7/6).
Despite doctors' frustration over shrinking reimbursements, USA Today notes that their incomes are well above the median household incomes of Americans, at $37,000 in 1997. Health industry researcher Glenn Melnick noted, "Historically, relative to supply and demand, doctors' prices were highly inflated. Now, it's going to start to come down." Dr. Jerry Rogan, who was forced to close his 17-year-old medical practice due to insufficient reimbursement, said, "Without some ability to collectively bargain, I think independent doctors will be out of business" (Appleby, 7/6). However, the Hartford Courant reports that the AMA's decision "won't have the HMOs running for cover any time soon" as federal law prohibits doctors from bargaining collectively, striking and filing grievances, leaving only one in seven doctors "able to organize in a traditional union setting." Additionally, the Courant notes that doctors will bargain with hospitals, not HMOs. Dr. Michael Connair, vice president of the Federation of Physicians and Dentists, noted, "These docs can organize against UConn ... but they can't make demands on Aetna or CIGNA or Blue Cross, where the demands are needed. It's Aetna, Blue Cross and CIGNA who are forcing physicians into one-sided contracts" (Julien, 7/6). Opponents to unionization note that "doctors will be able to set prices and therefore drive up the cost of health care." Daniel Wolfson, president of the Alliance of Community Health Plans, recommended that doctors and health plans cooperate in combatting problems, while health plans retain the "right to monitor physicians to observe their methods of caring for various illnesses" (USA Today 7/6). Other opinions on unionization:
- A Florida Times-Union editorial notes, "Forming unions, without using the threat of a strike, is not likely to do much to help physicians on the lower end of the pay scale, and will do nothing for those at the higher end except diminish the luster of their profession. Moving the health care system back toward fee-for-service, with insurance but with more responsibility and choice for the patient, is in our view the most promising course for the medical profession -- and also best for consumers" (7/5).
- An Arizona Daily Star op-ed, written by Dr. Glenn Flores, a Boston pediatrician, notes that a "doctor's union may be the only way to protect a patient's rights and ensure quality health care for all," particularly in the face of physician productivity requirements, "gag rules," and managed care executives' inflated salaries (Flores, 7/6).
- In an additional op-ed in the Arizona Daily Star, columnist Donald Kaul asks, "But if you're not going to strike, what's the sense of having a union?" He concludes: "I just hope that when the docs' union ... gets to fighting with the ... HMOs over the spoils of health care, they'll remember that it's our money they're divvying up. And our bodies" (Kaul, 7/6).