LEXIS-NEXIS® Academic Universe-Document

LEXIS-NEXIS® Academic

June 26, 1999, Saturday

SECTION: Editorial; Ed. FINAL; Pg. 60A

LENGTH: 387 words

HEADLINE: THE DOCTOR AS SHOP STEWARD

BODY:
A generation or two ago, most doctors would have been shocked if the American Medical Association had voted to form a labor union as it did the other day. But back then, of course, doctors were king of the hill. Virtually all were once in independent, private practices, answering to no boss but themselves, and very few were employees subject to all the demands that employers tend to make. It's the change of status more than any other factor that accounts for the change of heart. Doctors now are slightly more like people in other professions; a third of them today are either medical residents or salaried employees, and many of these work at HMOs that, naturally enough, do not grant the degree of autonomy virtually all doctors previously enjoyed.

The AMA says a chief reason for the union is to come to the aid of patients. As an example, an AMA union might see to it that HMO doctors are allowed to spend more time per patient, spokesmen say. A skeptic may suspect that, yes, that might happen, but it could also send prices higher with no clear benefit to the sick. The skeptic might think, too, that the doctors might then seek higher salaries, sending prices up again.

The AMA has said that its union will never strike, which it shouldn't, seeing as how that would be a clear abridgment of the Hippocratic oath. And yet, a union that refuses to strike - or at least to resort to some disruptive job action - is like a hammer without nails, and the pledge, while probably sincere, might be hard to keep in the heat of negotiations.

Despite reasons to worry about it, a doctors' union of salaried employees is vastly to be preferred over something else the AMA wants to do - unionize doctors in private practice. For this to happen, Congress would have to exempt doctors from antitrust laws. It shouldn't, for the door would then be open to the equivalent of price-fixing. Incentives for efficiency and innovation would be decreased. Costs would almost certainly rise.

Health care delivery in America has changed drastically over the past several decades, thanks in part to the role of government, but to a variety of other factors as well. It should surprise no one that doctors might seem rebellious. It's nevertheless more than doubtful that their unionizing is in the public interest.

LOAD-DATE: June 28, 1999