UNIONS: PODIATRISTS ORGANIZE TO FIGHT MANAGED CARE
Struggling "to cope with the sweeping changes brought aboutThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
by managed care, associations representing most of the nation's
podiatrists announced yesterday that they were forming the first
nationwide labor union for doctors," NEW YORK TIMES reports. The
First National Guild for Health Care Providers of the Lower
Extremities, which will be associated with the AFL-CIO, is
expected to enroll 10,000 of the nation's 14,000 podiatrists.
The union will be based in Harrisburg, PA, as part of the Office
and Professional Employees International Union. The union plans
to "negotiate contracts and lobby in Washington and state
capitals," but does not "foresee engaging in strikes."
REPLY TO HMOS: John Mattiacci, president of the new union,
said that the union will "give podiatrists and other doctors
increased power to joust with managed care organizations."
Podiatrists complain that HMOs have gained the power to "dictate
salaries, dismiss physicians and set conditions of employment."
TIMES reports that podiatrists have been "squeezed" more than
other medical professionals because HMO primary care physicians
often refer patients with foot problems to dermatologists or
orthopedists, despite the fact that podiatrists are trained and
licensed to care for foot problems. Mattiacci said, "In the past
five years, we the deliverers of health care have watched our
ability to control our professions and practices usurped by
managed care organizations. Big business has taken over the
medical field." Jay Porcaro, organizing director for the Office
and Professional Employees Union, said, "These people are no
longer independent contractors. Many are totally controlled by
managed care associations." The podiatrists also said that they
hope to join the 40 million Americans in union health plans "to
pressure health maintenance organizations and state legislatures
to insure that managed care focuses more on quality and less on
profits." Mattiacci added that, as an independent group, the
country's 14,000 podiatrists were often ignored, but now they are
confident they will be heard "because they can ask the 13-
million-member AFL-CIO to lobby for them."
FUNCTIONS AND MEMBERS: Union officials said that "they
would negotiate traditional labor agreements when a group of
podiatrists work as salaried employees of a hospital or
government agency." But, since most podiatrists have
traditionally operated independently, the union will also bargain
with managed care organizations. TIMES reports that negotiations
will focus on "financial issues, including so-called capitation
fees ..., [and] questions involving the doctors' independence and
judgement." Podiatric associations in most large states "have
signed letters of intent saying they would follow suit." The
podiatric associations of Pennsylvania and New Hampshire have
already joined, and associations in New York, Florida, New
Jersey, California and "a dozen other states said they would soon
UNION CONCEPT: Kirk Johnson, general counsel for the
American Medical Association (AMA), said the group "was studying
how feasible and desirable it is for doctors to form unions." He
said, "The fact is the union idea only works because of the
frustration about the loss of autonomy and the interference by
managed care organizations. What doctors really want is some
leverage, because managed care organizations have taken control."
According to Johnson, because doctors are not traditional
employees, "they could run the risk of antitrust problems if they
seek to negotiate fees with managed care plans." He added that
the AMA is trying to increase the collective bargaining power of
salaried physicians at hospitals or private agencies.
MORE?: Local physician unions have already formed in
Florida and California to deal with large contracting agencies
and HMOs. Gary Robinson, director of the Union of American
Physicians and Dentists in Oakland, CA, said, "What's going on
now is HMOs and preferred provider organizations are moving
private doctors closer to the status of being real employees.
These groups are really setting the terms and conditions of
employment, what procedures doctors can and can't do"