AMA union vote alienates hospitals, large groups
AMA union vote alienates hospitals, large groups
Physicians continue to pin hopes on Congressional antitrust exemption for collective bargaining
The count was hardly over on the Chicago-based American Medical Association’s (AMA) House of Delegates vote last week to form a national labor organization before the union’s plans began to further alienate managed care organizations, their long-standing adversaries, hospitals, and large medical groups. Experts say the move represents only a stopgap solution until federal law is changed to allow private practice physicians to collectively negotiate fees.
In addition to the expected disapproval of managed care groups, the American Hospital Association (AHA), usually an AMA ally, has blasted the unionization vote, arguing that it’s likely to create a rift between hospitals and physicians when they should be working together.
In a prepared statement, Dick Davidson, president of the American Hospital Association, says the vote to unionize could "thwart the teamwork" among physicians and other caregivers, implying that patient care could be threatened.
Although the AHA won’t say it out loud, hospitals are also worried that physicians’ unions could hit them up for more money. That fear became reality last month in California, when 800 Los Angeles County physicians voted to join the San Francisco-based Union of American Physicians and Dentists (UAPD), and promptly began pushing for a new contract with the county.
Some physicians groups are also wary of the AMA initiative. The Englewood, CO-based Medical Group Management Association, a strong backer of most AMA projects, won’t comment on this one, with spokespeople claiming the group remains neutral on the subject of unions. Meanwhile, the Washington, DC-based American Medical Group Association (AGMA), which represents only the nation’s largest medical groups, calls the AMA initiative "an inappropriate response" to the frustrations of physicians who feel victimized by managed care.
AMGA’s opposition is significant, since most of its physician members wouldn’t even be eligible for the union. Under current antitrust laws, self-employed physicians are barred from collective bargaining with managed care organizations. The only physicians eligible for the union are those directly employed by hospitals or local government, a pool of 108,000 physicians, or about 17% of the nation’s physician work force.
However, private practice physicians may soon be able to take their own place at the collective bargaining table, if Congress passes a bill sponsored by Rep. Tom Campbell (R-CA) that would create a physician exemption to federal anti-trust laws. The AMA is a strong backer of the Campbell bill.
"The AMA vote just demonstrates the desperate straits that doctors are finding themselves in," says Suhail Khan, Campbell’s adviser. "It underscores the need for some type of legislation, because unionization is still only an option for doctors who are directly employed. That’s where our bill steps in."
The Campbell bill currently has 129 co-sponsors, including a majority of the members of the House Judiciary Committee, where the bill currently resides. The committee is expected to approve the bill before the August recess.
The AMA’s leadership is now trying to put a positive spin on the vote to form a labor organization, despite its historically strong opposition to any type of physician union, says Joe Bader, regional administrator for the UAPD, a 27-year-old union whose membership is focused in southern California. "They’ve had an entrenched bureaucracy and a mindset that reflects an old prevailing view that unions are beneath physicians and are unprofessional for physicians to join," he says. "Plus, a lot of the doctors who are high up in the AMA leadership have had ties to the business community which has been historically anti-labor and anti-union. But now they’ve lost a lot of members, and are under pressure to address some new realities," such as the increasing market shares of a few managed care giants.
Bader argues that the AMA is coming to unionization very late in the game anyway. Already, the push toward physician unionization has gained momentum at the local level, he says. Just last month, 800 physicians employed by Los Angeles County voted, by a two-thirds majority, to join the UAPD, which now represents about 6,000 physicians. The vote was the largest single-union election for physicians in 18 years. And nationwide, the number of unionized physicians has nearly doubled, from 25,000 to 45,000 in just the last two years, according to UAPD statistics.
The trend, Bader says, stems from the growing influence of health maintenance organizations (HMOs) and the belief among physicians that administrators have assumed too much influence over patient care. He denies that money is the main issue. "Nobody works for the county in the public sector in order to get rich," he says. "They work because they have a commitment to take care of the poor and the uninsured of the county." Nevertheless, the Los Angeles physicians who recently joined are now seeking a new contract from the county, with support from the UAPD.
The UAPD’s next goal is to organize 3,300 physicians employed by Kaiser Permanente in northern California.
Not all unionization attempts have been so successful, however. At the same time the Los Angeles physicians were voting to unionize, a group of 650 New Jersey physicians in private practice attempted to form a union under the auspices of United Food and Commercial Workers Local 56 in Mount Laurel, NJ.
Their goal was to bargain collectively with AmeriHealth Inc., an HMO with whom all the physicians contracted. They argued that because AmeriHealth effectively dictated many aspects of their practice, including wait times for patients, whether patients should undergo surgery, and even how large their waiting rooms should be, the physicians should be regarded as de facto employees of the HMO.
AmeriHealth responded that despite the terms of their contract, the physicians remained independent medical practitioners and had no collective bargaining rights. The federal National Labor Relations Board in Philadelphia agreed with AmeriHealth, denying the physicians’ petition to unionize.
AMA officials now have 30 days to report an action plan detailing the specifics of how they will structure the labor organization.
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