UNIONS: DOCTORS BANDING TOGETHER TO DEAL WITH MANAGED CARE
"In small but growing numbers, particularly in Florida andThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
California, doctors are becoming dues-paying union members," a
trend the CHRISTIAN SCIENCE MONITOR is calling the "blue
collaring of the white coats." Doctors are now often treated as
"contract labor, with less control over how much they earn, who
they treat, and what tests they can order." The increasing
number of physicians moving "into the union hall is indicative of
the profound and rapid changes under way in the nation's health
care system." Jack Seddon, executive director of the Federation
of Physicians and Dentists Organization of Florida (FPDO), a
member union of the AFL-CIO, said, "Doctors must organize in an
effort to regain control of their practices."
NUMBER CRUNCHING: Seddon noted, "Managed care organizations
are saying there are too many doctors. They want one doctor for
1,400 patients. Now we have one doctor for 450 patients, but
managed care executives say that number is too high." More and
more doctors are joining the FPDO; the union currently represents
33% of the physicians in Brevard County and the statewide
membership totals about 2,500.
FIGHT THE GOOD FIGHT: CHRISTIAN SCIENCE MONITOR reports
that some doctors are joining unions because of "growing
insecurity" about their income, unfair contract terms and other
issues related to being employed by HMOs. Seddon says of managed
care provider contracts, "Really they are not agreements, they
are unilateral statements. The insurer says here is a provider
agreement, take it or leave it. ... And by the way, we have the
absolute right to terminate you with or without cause and pull
patients, and you have no right of appeal. ... [T]he practice of
medicine has been put into the hands of administrators who have
no background in medicine."
NEED SUPERGLUE?: Doctors and unions, however, are "not a
natural alliance," as they face anti-trust laws that restrict
them from colluding on prices and services, according to the
CHRISTIAN SCIENCE MONITOR. Medical associations are "taking a
cautious approach to unions," as many doctors are active in both
unions and the medical societies. "Organizing doctors is not the
easiest task because physicians in general are independent
entrepreneurs," Seddon said, adding, "Because of the restrictions
imposed by anti-trust law, we really have no negotiating power."
NO OTHER CHOICE: Arthur Hall, a doctor with a "thriving
practice" in Brevard County, "insists that the only place to work
against the insurance lobby is through labor law." CHRISTIAN
SCIENCE MONITOR notes that union organizers and medical societies
have been lobbying state legislators to "recognize that many
doctors who work for managed care organizations are similar to
employees and should enjoy the right to union representation and
collective bargaining." Hall said that he believes physicians
will eventually "win recognition as employees because so many are
in effect working" for HMOs and PPOs. In addition to growing
union participation, Hall said that he wants to see "further
development of independent practitioners associations (IPAs) but
acknowledges that" the groups are hard to start "because they
lack clout with insurers." However, he noted that both IPAs and
unions share the goal of ensuring "a basic level of
professionalism" in the delivery of health care (Volz, 8/20).