Docs consider unions

Imagine Marcus Welby, M.D., walking a picket line, singing “Solidarity Forever.”

Most doctors still can’t, which may be why they were outnumbered by doctors-to-be at this year’s Thomas Langfitt Jr. Memorial Symposium at the Medical School Feb. 29.

Those who came got an earful of the clash of values that make physician unionization such a hot issue.

The clash was best personified by the two pro-union panelists, Susan Adelman, M.D., president of Physicians for Responsible Negotiation (PRN), the American Medical Association’s bargaining arm, and Robert Weinmann, M.D., president of the Union of American Dentists and Physicians.

Adelman, an AMA trustee, said her group’s new pro-union stance “returns professional values to medicine because it gives the professionals more power.”

Weinmann, on the other hand, used trade-union rhetoric to emphasize the economic issues.

“What about this economy has changed me from a modest editor of a scholarly journal to Mr. Plug Ugly of the union movement?” he asked. A little later, he answered himself: It was because “money is being taken from health care and being put in the pockets of the HMO arbitrageurs.”

John Kelley, M.D., Ph.D., director of physician relations for Aetna U.S. Healthcare, noted that the AMA itself had worried that “unionization would make it difficult for doctors to put patients’ interests first.”

Adelman later responded that things had changed since the AMA made that statement.

The panelists also discussed pending legislation that would allow independent doctors to bargain collectively with HMOs and insurers. Martin Gaynor, Ph.D., an economics professor at Carnegie Mellon University, thought the bill represented overkill and suggested instead that accountability problems with managed care, such as laws that let HMOs off the hook for medical decisions they make, be addressed directly.

“If HMOs are engaged in the practice of medicine, they ought to be liable” for the mistakes they make, he said.

Adelman, on the other hand, said the bill would only correct the power imbalance between doctors and insurers. “All [the Sherman Anti-Trust Act is] preventing are six dentists somewhere down South from conglomerating,” she said.


Originally published on March 23, 2000