LEXIS-NEXIS® Academic Universe-Document

LEXIS-NEXIS® Academic

June 25, 1999, Friday, CITY EDITION

SECTION: NEWS, Pg. 1A

LENGTH: 1011 words

HEADLINE: DOCTORS' BID FOR UNION STEMS FROM FRUSTRATIONS WITH HMOS

BYLINE: HENRY L. DAVIS; News Medical Reporter

BODY:

Doctors are well-paid and highly respected professionals. Why would they want to form a union?

It sounds like Marcus Welby joining the Teamsters, but physicians involved in the American Medical Association's vote to form a labor union say the purpose of the action is to put doctors back in control of medicine.

The vote by the 494-member AMA House of Delegates in Chicago on Wednesday reflects the growing frustration with managed health care. Doctors complain that HMOs have taken away their ability to call the shots in medical care.

"What we did stems from concern among physicians that we're not able to care for our patients adequately because of interference by managed-care companies," said Dr. Nancy H. Nielsen, a Buffalo physician who serves as speaker of the house for the Medical Society of the State of New York.

The AMA wants to form what it calls a "national negotiating organization" to bargain with HMOs and hospitals on behalf of doctors for better pay and more autonomy to make decisions about hospitalizing patients, prescribing drugs and referring patients to specialists and for tests.

Other unions already represent about 42,000 physicians, according to the AMA.

The AMA vote does not apply to self-employed physicians, who are barred by law from bargaining collectively with health-care plans.

Under current law, only employed physicians, such as a those who work directly for a hospital, health plan or government health department, can join a union. An estimated one in seven of the nation's 684,000 doctors fall into this category.

Self-employed doctors have faced the threat of antitrust charges of conspiring in restraint of trade if they tried to unionize. But a bill before the House Judiciary Committee would permit unionization by doctors who work by themselves or in small group practices.

"The AMA vote is about bringing to the forefront in the national debate on health care the issue of who should call the shots -- doctors or health insurers," said William Pike, president of the Western New York Healthcare Association.

Indeed, Dr. Nielsen and others view the AMA measure as an essential foundation to have in place in case the federal antitrust restrictions are eased.

"Our action applies to only a narrow group of doctors. But it's the foot in the door to gaining the legislation we need to help all doctors," said Dr. Nielsen, a delegate to the AMA meeting.

Dr. Franklin Zeplowitz, a former president of the Medical Society of Erie County and a member of the House of Delegates, said the AMA will lobby hard for the bill.

He said that so far, Rep. John J. LaFalce, D-Town of Tonawanda, is the only member of Congress in the Buffalo region to throw his support to the proposal.

Meanwhile, doctors are also taking this fight to the state level.

Gov. George W. Bush of Texas signed a bill on Sunday allowing doctors in that state to become the first in the nation to bargain collectively with health-care plans. Now, physicians in other states, including those in New York, are looking to do the same.

"We're trying to get a bill introduced into the Legislature," Dr. Nielsen said. "You're going to see the same happen in every state."

Although voice votes and a show of hands indicated that the AMA easily approved the formation of collective-bargaining units, the decision was preceded by more than four hours of contentious and passionate debate during the AMA's annual convention.

Many doctors said forming a labor organization would damage the credibility of the 152-year-old association, one of the most recognized in the nation. They said they are an organization of professionals and not employed-by-the-hour laborers.

While embracing the principle of collective bargaining, the doctors took pains to distance themselves from traditional unions.

"We will not strike," Dr. Nielsen said. "We don't intend to get involved in any heavy-handed labor union tactics."

Health insurance companies object to the AMA's efforts and say that doctors are more concerned about their pocketbooks than anything else.

"This isn't patient protection; it's provider protection," said Karen Ignagni, chief executive of the Washington, D.C.-based American Association of Health Plans, which represents more than 1,000 managed-care plans across the country. "The first issue (discussed with a managed-care plan) from a physician's perspective is reimbursement. That's not anything to be ashamed or embarrassed about, but their pay is always the first issue."

An executive of Independent Health, the region's largest health maintenance organization, characterized the AMA measure as a backlash against the for-profit side of his industry, not the non-profit HMO he represents.

"In this region, doctors have an opportunity for involvement in shaping the HMO's policy. That's not necessarily the case elsewhere," said Dr. Michael Cropp, the HMO's medical director.

The AMA vote also came a day after Robert Pitofsky, chairman of the Federal Trade Commission, cautioned members of Congress that giving doctors greater freedom to unionize could lead to higher medical costs, price-fixing and boycotts by physicians.

Doctors' efforts to define themselves as employees reflect a shift.

Just two years ago in Buffalo, for instance, doctors who worked directly for Univera Healthcare (formerly Health Care Plan) cut their employee-employer ties with the HMO to establish an independent medical practice.

Nevertheless, doctors here have spent the last few years fighting with Independent Health and other HMOs about pay and policies, just like their counterparts elsewhere in the nation.

In 1997, for example, as a sign of frustration, a group of Buffalo-area physicians upset about insurance companies meddling in decisions formed their own health-maintenance organization, MDNY Healthcare Inc.

"We've felt powerless," Dr. Nielsen said. "The idea of a labor organization is just one more tool in the toolbox for fixing the problem." The Chicago Tribune contributed to this article.

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