LEXIS-NEXIS® Academic Universe-Document

LEXIS-NEXIS® Academic

June 25, 1999, Friday, Metro Edition

SECTION: NEWS; Pg. 1A

LENGTH: 1303 words

HEADLINE: Doctors aim to regain some of their clout;
To bargain with HMOs, more are seeking unions

BYLINE: Tom Hamburger; Staff Writer

DATELINE: Washington, D.C.

BODY:
Exasperated doctors from Minnesota and other states have shown increasing interest in joining or forming labor unions as a way of gaining more power in negotiating with managed-care organizations.

     That interest reached a peak this week with two events: A congressional panel took up legislation authorizing independent physicians to organize collectively, and the American Medical Association (AMA) formally approved a plan to pursue unionization of the profession.

     "This is a watershed in the history of medicine," said Uwe Reinhardt, a professor of medical economics at Princeton University. "Doctors out there have been feeling so beleaguered, they turned to what they learned in freshman college courses _ that organized labor helps workers who feel fiscally besieged."      So it is that one of the most conservative, independent and well-compensated professions now officially seeks to join the ranks of American workers who collectively bargain to improve their lot.

     Reinhardt believes this week's actions will expand the movement to unionize, as doctors seek to boost their incomes and their bargaining power. The change, he said, could put American medicine on a path toward a German-style health care system, which is governed by negotiations between doctors unions and a few large, private insurers operating under close government supervision.

     The unionization of U.S. doctors is at a very early stage. So far, about 40,000 of the country's   620,000 practicing physicians are in unions.

   Because most doctors are independent practitioners, they are prohibited by antitrust law from joining unions.

     On Wednesday, the AMA voted to try to change that law so self-employed doctors can bargain together. It also voted to organize salaried employees and medical residents, about one-third of the nation's total physician population. AMA officials stressed that ethical obligations would prevent doctors from striking.

     Physicians such as Dr. Robert Weinmann, president of the California-based Union of American Physicians and Dentists, argue that unions benefit patients.

     "Doctors are frustrated that care is dictated by insurers who are more concerned with profits than patients," Weinmann said. "An important tool for protecting patients is giving the physicians the ability to collectively negotiate the terms of patient care."

     But Weinmann's statement this week to the House Judiciary Committee was countered by testimony from the chairman of the Federal Trade Commission who said doctors unions "would be bad medicine for consumers" because they would lead to higher fees, higher consumer costs and a larger number of uninsured.

      Gail Shearer, a health care expert at Consumers Union, agrees. "Doctors unions would not be good for consumers because the doctors would essentially be allowed to get together and jack up prices," she said.

     That is precisely what worries the U.S. Chamber of Commerce, the health insurance industry and Minnesota health care executives such as George Halvorson of HealthPartners.

     'Right now, health plans negotiate on behalf of consumers with physicians," Halvorson said in an interview. ". . . If the physicians form a cartel, which is what the AMA is seeking, then there will no longer be a competitive marketplace." Halvorson estimates that premiums in Minnesota would jump $1,000 annually for a typical family. That, he says, is the difference paid today by non-health-plan customers in Minnesota seeking to purchase health care independently.

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Minnesota view

     While doctors unions have been growing rapidly in California, Florida and the Northeast, there is no such union operating in Minnesota. However, there have been expressions of interest.

     The state sent eight doctors to the AMA meeting in Chicago this week. Because the Minnesota Medical Association has not voted on the unionization question, there was no official state position, said Dr. Stuart Hanson, a pulmonary specialist at Park-Nicollet Clinic, who chaired the Minnesota delegation.

     Hanson is sympathetic to the desire of self-employed physicians to form unions. "Many independent physicians feel they cannot get services covered that they believe their patients need," he said.

     But he worries about what would happen if organizers approached the clinic where he works, where doctors remain in charge of medical decision-making.

     One Minnesota doctor attending the meetings _ a physician affiliated with the Mayo Clinic _ repeatedly expressed opposition to the unionization of physicians, Hanson said.

     The mood was different among 114 HealthPartners doctors who answered a fellow doctor's survey last year that they were interested in the possibility of forming a union to bargain with management. About 400 HealthPartners physicians received the survey, and 176 replied.

     And it was different among University of Minnesota physicians who met two years ago with a doctor organizer for the American Federation of State County and Municipal Workers. Rep. Collin Peterson, D-Minn., said he received calls from several home state doctors recently urging him to support doctor unionization legislation, which he did, along with nearly 120 of his colleagues from both parties.

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Power loss spurs action

     Doctors' salaries have flattened in recent years, but physicians remain among the country's highest paid professionals. Many doctors insisted that the unionization fight was about more than money.

      "What's happened is physicians have lost their power," said Dr. Rebecca Thoman, a family-practice doctor who now directs the Minnesota Physician Patient Alliance and lobbies to improve health-care decision-making. "We're supportive of what the AMA has been doing," she said. "The only other option is to break up the monopoly of power that managed-care firms are asserting" in Minnesota and other states.

     Halvorson agrees that the concentration of power endangers consumers. But he thinks doctors unions would only make matters worse, causing health plans to pay doctors more and raise prices to consumers.

     In making the case for a union, Dr. Karen Ringsred, a former HealthPartners physician, said in an interview published this spring by the Hennepin County Medical Society that HMOs as they exist today are at odds with the goal of good patient care. She surveyed her colleagues in 1998 because, she said, "physicians felt that they had no voice in corporate decisions, which profoundly affected their practice and job satisfaction."

     Halvorson noted that the survey Ringsred administered was completed just after a merger of two organizations. What's more, he said, the proportion of HealthPartners physicians expressing interest unionization hasn't changed over the past 10 years. He was relieved, he said, that the number remained low.

     His organization, he said, prides itself on putting physicians in charge of all medical decisionmaking.

     But many physicians are frustrated that they have lost control to the new bureaucratic imperatives imposed by managed-care organizations.

      Take the experience of Dr. Dan Lawlor, who has taken a four-year leave from his family practice to organize doctors in Minnesota and 20 other states.

     "I think a lot of doctors went to medical school to be captains of our own ship. But nothing could be further from the truth" in the current environment, he said.

     The frustration levels are growing as merging managed-care and insurance companies gain control of more of the market. These days attendance and enthusiasm are up at union meetings and the AMA action will only increase interest. "This," Lawlor said, "is a movement that's going someplace."

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LOAD-DATE: June 25, 1999