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Doctors of the World Unite?

Is collective bargaining positive for doctors and patients?

Doctor?s Dilemma continued...

Practitioners who started prior to the advent of HMOs feel the changes the most, says the internist in New York. "The stress level increases daily as autonomy decreases and as paperwork increases, and morale disappears. Physicians face a catch-22 as they worry that they will be dropped by the HMO for ordering too many tests while at the same time worrying that some [lawyer] will accuse them of not being vigilant enough and start litigation."

There is increased pressure on self-employed doctors to join HMOs, either as full-time employees or as contractors. But by unionizing, some hope to counteract what they see as the "take it or leave it" attitude of the HMOs.

Now, even the traditionally conservative AMA is on their side. Last June, it voted for the first time to "develop an affiliated national labor organization to represent employed physicians" and to advocate federal legislation that allows independent physicians to bargain collectively with insurers and health care plans nationally.

Easier Said Than Done

The problem is that under current U.S. labor laws, only nonsupervisory employees can form unions. Self-employed doctors fall under the heading of independent contractors and are barred from forming unions because of federal antitrust laws.

Joel Klein, Assistant Attorney General of the Antitrust Division, says the official Department of Justice position asserts that allowing independent physicians to unionize "would allow non-employee, health care professionals collectively to raise their fees to health insurers without fear of antitrust liability ... It would be both unwise and harmful to consumers to grant them a special exemption."

AMA chairman Randolph Smoak, M.D., sees things differently. "This will not be a traditional labor union. Your doctors will not strike or endanger patient care. We will follow the principles of medical ethics every step of the way."

What does this mean for physicians? Says the internist in New York: "There's a saying in health care: Monitor yourself or someone else will do it for you. Perhaps physicians are learning this the hard way. They need to come up with a more organized plan to monitor their own quality and cost of care. That will be a big improvement for all."

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