DOCTORS JOIN UNION TO FIGHT ILLS FROM HMOS
Date:
Sat, 6 Mar 1999 13:39:33 -0500
The Boston Globe
DOCTORS JOIN SEIU TO FIGHT ILLS FROM HMOS
By Diane E. Lewis, Globe Staff
In an attempt to regain clout lost to HMOs, 15,000 doctors yesterday joined a new alliance formed by an AFL-CIO union and promised to fight managed care by spending $1 million over the next year to bring thousands of discontented physicians into their fold. The National Doctors Alliance, a newly formed affiliate of the 1.3 million-member Service Employees International Union, said it would spend the following year recruiting doctors who, because of managed care, are facing longer hours, delayed reimbursements, work speedups, or interference with patient care. The move represents a major step in the growing trend of the unionization of doctors, as it allows physicians to tap into the influence of the giant AFL-CIO. That strength could threaten the power of HMOs and other managed care plans, which employ or contract with nearly 50 percent of the nation's 680,000 doctors, and force them to yield some control over both salary issues and quality of care. The alliance also comes amid growing consumer
dissatisfaction with managed care and its limitations as well as state and national legislative efforts to guarantee patient rights. ''Our major agenda is to organize every employed doctor in this country,'' said Dr. Barry Liebowitz, the new president of the doctors alliance. Under an agreement signed with the SEIU yesterday, the Doctors' Council will join with 11,500 members in two SEIU affiliates - the 9,000-member Committee of Interns and Residents and the 2,500-member United Salaried Physicians and Dentists. Based in Washington, D.C., the SEIU currently represents 600,000 registered nurses, medical technicians, home health aides and physicians. ''This new alliance will bring all of these doctors into the AFL-CIO, forming the largest union for doctors ever,'' Liebowitz said. ''We will not only better represent physicians, we also better represent the interest our patients, which is becoming increasingly lost in today's environment.'' Both labor and medical experts described the addition of the doctors as a breakthrough, noting that other professionals who had shunned unions in the past might now take a second look at the AFL-CIO and its 79 member unions. ''This represents a new kind of futuristic thinking by the AFL-CIO,'' said James Green, a labor historian at the Labor Resource Center at the University of Massachusetts at Boston. ''There was a time when labor felt white-collar workers were too individualistic to be interested. This takes organizing to a new level, to doctors, who were considered an elite group of professionals.'' But while salaried physicians are pushing to unionize, some independent doctors are finding that their hands are tied. These doctors, who represent about half of the nation's physicians, or 340,000, are considered independent contractors and so are restricted by law from joining to form a bargaining unit. A bill now in Congress could change that. Filed by Representative Thomas Campbell, a California Republican, it would allow doctors to form coalitions to engage in contract negotiations with HMOs and health care insurance companies. Across the country, doctors continue to join new associations and unions in record numbers in a push to give themselves more clout when bargaining with HMOs. Many are salaried physicians concerned about reimbursements, working conditions, hours, and patient care. In all, about 45,000 physicians or 6 percent of the nation's 680,000 doctors, are now union members, up from 25,000 three years ago. And the number of unionized doctors is expected to increase as big unions such as the SEIU, the American Federation of Teachers, and the International Association of Machinists look to organize other salaried physicians who, like health care workers everywhere, are struggling to come to grips with managed care. The reason? About half of all US doctors work in managed care systems or earn more than 50 percent of their income from salaried positions, including some who have small private practices, say medical experts. Among new medical school graduates, however, 80 percent work for a salary. ''Basically, the HMOs are paying people slowly, they are decreasing their fees to people, and they are creating incentive systems - almost like the old industrial piece work systems where doctors in clinics and some hospitals must work a certain number of hours and see a certain number of patients to get paid,'' said Mark Levy, executive director of the new alliance.
''This means that if you make, for example, $90,000 as a pediatrician, the HMO will say, `if you see X number of patients, I will pay you $90,000, or if you see more than X, I will pay you $110,000,''' he continued. ''This creates speedup, or a fast-track system. It also means that if you spend extra time with a sicker patient and his family, it could come out of your pay.'' Levy said doctors are also angry because, in some situations, HMOs have reversed doctors' decisions or changed prescriptions for treatment. During a press conference yesterday, Liebowitz sounded more like a labor leader than a doctor when he announced that the new alliance would ''demonstrate, litigate, legislate, and negotiate to make sure patients rights are upheld... Whatever it takes, we will do to stop the denial of health care, the denial of access and the corporatization of medicine.'' When asked whether physicians might actually engage in a strike someday, Liebowitz said the group would never walk out simply because of economic issues but would consider striking to preserve or to improve patient care. Liebowitz told reporters that the alliance's first major effort, aside from organizing, would be to go after managed care plans that override a doctor's diagnoses or decision. Added Andrew Stern, president of the SEIU, ''We intend to organize, but the organizing will be fueled by our concern for patient care. People are beginning to understand that they need to prepare themselves.'' The movement is gaining momentum. This month the American Medical Association is expected to give a thumbs up to a union organizing plan it began reviewing last year. The AMA has said it could, by June, begin organizing doctors at Tulane University's teaching hospital, a move that has surprised some hospital administrators. The AMA, which has seen membership drop from 50 percent of US doctors in 1975 to just 35 percent today, is hoping its efforts will bring in younger residents and interns. ''Currently, physicians and their patients find themselves in a very stressful environment due to mounting pressures in the health care marketplace, including managed care,'' said Nancy W. Dickey, president of the AMA. ''However, we do not believe that traditional trade union practices ensure the integrity of the patient-physician relationship or help physicians achieve the best decisions for quality health care in this country.'' Others hailed the formation of the new alliance. In Boston, a staff member of the House Officers' Association, which represents about 500 interns and residents at Boston Medical Center and Cambridge Hospital, said the alliance would bring physicians together to advocate for better working conditions and better patient care. ''This is a critical time in health care,'' added Sandy Shea, a spokesperson for the HOA. ''Physicians are finding more and more that they cannot take care of their patients the way they need and want to. They need a voice.''