COMMENTARY: Why I Founded United Physicians and Why You Should Join

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APRIL 28, 2020 -- Ever since we set up the National Board of Physicians and Surgeons (NBPAS), I have been asked to start a physician "union." The COVID-19 pandemic amplified these requests. I have always resisted. NBPAS taught me that doctors have strong opinions but rarely agree. Like much of the country, physicians are divided on the big issues: Many support Medicare for all, while a large group believes that Medicare should be boycotted. What would a physician union fight for?

But in watching physicians band together on COVID-related issues, I realized that there are lots of less contentious issues that almost all physicians can agree on, such as requiring appropriate PPE for all healthcare workers, paying physicians to do peer-to-peer preauthorizations, and extending telemedicine beyond the COVID-19 crisis.

That is why I founded United Physicians, and I hope to convince all US doctors to join.

Currently, most physicians believe that they have little voice in healthcare decisions. Despite the existence of the American Medical Association (about 250,000 members) and the American College of Physicians (about 160,000 members), most of us feel disenfranchised. Part of the problem is that these associations are governed from the top down. The leaders set the agenda; and while there may be delegates, does leadership really listen to the delegates? Do the delegates really listen to the physician community?

To avoid those problems, I formed United Physicians with a completely novel structure. There are no delegates, no representatives, and no board of directors; we want "direct" instead of "representative" governance. All meetings will be held openly, on the Internet. All significant decisions will be made by the entire organization, with each member voting. Advocacy projects must be supported by a two-thirds majority vote to move forward. We want every physician to join and to vote on every issue. We will only pursue projects that are backed by a two-thirds supermajority. This means that those issues will represent commonly held, strong beliefs.

Membership requirements for United Physicians are a license to practice medicine and an NPI number. Members will propose "projects" in a dedicated "petition" room on a virtual platform. Projects will be discussed in dedicated chat rooms. If a petition is signed by more than 15% of members, the project moves to a vote by all physician members. If the project receives a supermajority vote, it moves to a dedicated chat room where specific goals and estimated budgets are discussed. If these receive a supermajority vote, the project then moves to a vote on proposed methods to execute the project. If the specific methods receive a majority vote, the project is initiated.

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United Physicians is not a union in the legal or traditional sense of the word. Because we are not all employees, we legally cannot collectively bargain, and the idea of being part of a "union" is a turn-off for many doctors. United Physicians is aggressively inclusive. We want every physician to be involved, no matter their political leaning. Our platform can help discover what physicians care about and agree on. We are not in competition with other professional organizations. On the contrary, we'd love for them to use the platform (it's free). If the AMA is considering a new policy, it could use the United Physicians platform to measure physician support. It might learn that a proposed policy needs a few tweaks to be accepted by most physicians.

Registering at United Physicians is quick (30 seconds) and free. Personal information will not be sold. Future fees will be nominal and must be approved by our members. Physician leadership are unpaid volunteers, and our financial reports will be publically available. Startup costs are supported by NBPAS, but United Physicians is a completely independent organization directed solely by member voting. (For more details , see the bylaws and governance section of our website.).

United Physicians is an experiment that could fail. Most of us have wonderful, engrossing jobs where we get to help patients everyday. Will we take the 30 seconds required to sign up and become a United Physicians member? Will we spend a little time each week reviewing the issues and voting? We will soon discover whether physicians are truly interested in healthcare policy creation or whether they would rather just complain from the sidelines. I think it's an experiment worth watching.

Paul S. Teirstein, MD, is a chief of cardiology and director of interventional cardiology for Scripps Clinic. His frustration with the labor-intensive and expensive Maintenance of Certification process led him to found the National Board of Physicians and Surgeons for more meaningful recertification and lifelong learning.

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