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Copyright 1999 The Washington Post
The Washington Post
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June 24, 1999, Thursday, Saturday, Final Edition
SECTION: A SECTION; Pg. A01
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HEADLINE: AMA Votes to Unionize Doctors; Group Acts in Response to Managed Care's Effect
on Rights, Duties of Physicians
BYLINE: Amy Goldstein, Washington Post Staff Writer
BODY:
The American Medical Association voted yesterday to form a labor union to
bargain on behalf of doctors for better pay and working conditions -- a
dramatic attempt to give physicians more clout in an era of managed health
care.
The decision to organize doctors into bargaining units represents a radical
departure for one of the oldest and most conservative professional
organizations in the country. It signals the profound discontent of many of the
700,000 physicians in the United States over the direction of the nation's
health care system.
The AMA's move also appears certain to inflame an already-smoldering debate
over whether patients stand to gain or lose if their doctors can seize more
leverage against health maintenance organizations and other insurers. Such
plans have acquired vast powers in the last decade to dictate most Americans'
care.
In setting up what they are calling a
"national negotiating organization," AMA officials contended that only through collective bargaining can doctors
win back control over which drugs they may prescribe for patients and how much
treatment they can provide.
But the AMA vote came just a day after the chairman of the Federal Trade
Commission cautioned members of Congress that giving doctors greater freedom to
unionize
"would be bad medicine for consumers."
Testifying before the House Judiciary Committee, FTC Chairman Robert Pitofsky
warned that pending legislation to
exempt health professionals from
antitrust provisions would allow
doctors to band together to demand higher fees from health plans, ultimately forcing
patients and their employers to pay higher medical costs.
With its decision yesterday, the AMA would essentially be joining groups like
the AFL-CIO in an
effort to woo the small but rapidly growing cadre of doctors who have already
shown an interest in joining labor unions.
Randolph C. Smoake Jr., chairman of the AMA's board, said the association's new
labor organization will help groups of doctors across the country establish
themselves as bargaining units to negotiate contracts with hospitals and health
plans. He said the AMA will not dispatch organizers to drum up union support
but will instead respond to requests for help from local medical communities.
Under current law, only physicians with a direct employer -- such as a
hospital, health plan or government health department -- are allowed to
unionize, and these are the doctors that the AMA will target at first. About
one in seven doctors are part of such plans.
However, the pool of physicians would expand exponentially under the bill
before the Judiciary Committee, which has strong AMA backing, that would permit
unionization by doctors who work by themselves or in small group practices. But
in several parts of the country, doctors and health plans have been sparring
lately over when exactly a physician is an employee.
Doctors' efforts to define themselves as employees reflect a remarkable shift.
Since its founding a century and a half ago, the AMA has devoted much of its
time to fighting to preserve physicians' autonomy.
Against that backdrop, Paul Starr, a Princeton University historian who is an
authority on the history of American medicine, yesterday called the AMA's
decision
"a watershed" that
"reflects a momentous change in the economic position of the medical position
from the time when nearly all doctors were independent businessmen . . . to a
time when large numbers are either on
salary or face very large buyers of their services."
Starr also interpreted the AMA's action as an attempt to create a counterforce
to the recent consolidation of health plans across the country.
"Each [side] is trying to represent a larger power in order to have more
bargaining leverage," he said.
Yesterday's decision at the association's annual meeting in Chicago was
divisive. The AMA did not release a tally of the vote, but the debate among its
delegates beforehand was impassioned.
In an interview afterward, Collette Willins, a 35-year-old family physician who
works in a four-doctor group in Cleveland, said she welcomed collective
bargaining.
"The problem is, little old me . . . going up against an insurance company," she said.
"I have no negotiating power . . . [to] stand up and fight on behalf of my
patients."
On the other hand, Lanny Copeland, who works in Albany, Ga., and is president
of the American Academy of Family Physicians, said,
"I think I'll be embarrassed when my first patient asks me if I'm a member of
the union." Noting that the typical U.S. doctor's income is just below $ 200,000, he said,
"The average connotation is, the biggest thing unions do is hold out for more
money. . . . It smacks a little bit of greediness."
Even as they embraced collective bargaining, the AMA's top officials sought to
distance themselves from other unions, saying that they would never go on
strike, for example.
"Traditional unions are there primarily to care for their employees' needs," AMA President Nancy W. Dickey said.
"We are looking for a vehicle that will allow us to carry out the covenant we
have with our patients."
FTC Chairman Robert Pitofsky has
warned against exempting health professionals from antitrust laws.
GRAPHIC: PHM,,FEDERAL TRADE COMMISSION OFFICE OF PUBLIC AFFAIRS
LOAD-DATE: June 24, 1999