BY TIM BONFIELD
The Cincinnati Enquirer
After several years of frustration with managed care health plans, more than 80 Cincinnati orthopedic physicians have joined the Tristate's first physician union.
The doctors are dues-paying members of the Federation of Physicians and Dentists, a fast-growing organization that already represents doctors in Dayton and Toledo, Ohio, and plans to form a union in Columbus. In addition to orthopedic specialists, the Cincinnati union is attracting interest from urologists, cardiologists and other specialists.
The federation officially launched the Cincinnati union Monday night when it held a meeting to describe to doctors how the new group will work. The group's membership now includes more than 90 percent of the orthopedists in town, said Jack Seddon, the union's executive director.
The unionization move is the latest development in increasingly frosty relations between physicians and managed care health plans. In May, a group of obstetricians and gynecologists made headlines when the doctors decided to stop treating Aetna U.S. Healthcare patients rather than sign a contract they considered unfair. Now, the orthopedists say they need to become more organized to protect their interests -- and to act as patient advocates.
"It's amazing the response we've seen in Cincinnati in terms of interest in this," said Dr. John Larkin, past president of the Cincinnati Orthopaedic Society and co-chairman of a steering committee that invited the union to town. "As an individual doctor, or as a small group, doctors really have no power in the marketplace to do any negotiating with these big, national insurance groups." Doctors say their interest in organizing is a response to contracts that have slashed reimbursement for specialists, annoyed them with paperwork and insulted them by allowing bureaucrats to second-guess their decisions. Doctors insist they are concerned less about money and more about the intrusion of health insurers into the doctor-patient relationship.
"Physicians in Cincinnati are really concerned about quality-of-care issues, such as patient access to specialists and access to medications," Dr. Larkin said.
The Federation of Physicians and Dentists (FPD) is based in Tallahassee, Fla. It is affiliated with the National Union of Hospital Health Care Employees, the American Federation of State, County and Municipal Employees and the AFL-CIO Labor Council. Five years ago, the federation represented about 500 doctors, mostly in Florida. Now, it has 7,500 to 8,000 members in 14 states, Mr. Seddon said. Unlike other unions, those representing doctors are restricted by federal antitrust laws. That means the union cannot sign contracts on behalf of doctors as a single group. Nor can they call a strike. Instead, the union acts as a third-party consultant, reviewing proposed contracts for physicians, then advising them about which terms are advantageous or disadvantageous. When possible, the union actually handles the contract negotiations for individual physicians.
"When we find insurance companies that are unfriendly, we can't boycott them. But we can say to fellow unions that this company is not dealing in good faith with physicians," Mr. Seddon said. Patients could feel the effect of the union in several ways. They may have to find new doctors if theirs refuses to sign an HMO contract, or the HMO refuses to deal with union doctors. Patients might benefit if the union forces HMOs to offer wider choice of physicians or better ways to appeal coverage denials. Patients might suffer if union efforts cause HMOs to increase premiums.
The first flashpoint may occur later this year, when the union tries to negotiate contracts with United HealthCare -- the national managed care company that recently agreed to buy Cincinnati's biggest HMO, ChoiceCare-Humana.
In Dayton, the FPD already has battled with United. The doctors rallied support from other unions and eventually, United changed some of its most objectionable contract terms.
"It will be interesting to see how it plays out in upcoming months. Cincinnati is a different market than Dayton," said Ken Hoverman, director of United's Cincinnati office. "We've offered to sit down with (the orthopedists) to listen to their concerns. Our greatest concern is to provide quality health care for our members."
Ultimately, the union's goal is to achieve full collective bargaining rights for physicians. And it seeks to lobby Congress -- just like other unions -- on health care issues.
For example, the union plans to speak in favor of the Democratic version of a proposed health care "Bill of Rights" -- which would allow patients to sue HMOs for malpractice. The federation also supports a bill introduced Monday by U.S. Rep. Tom Campbell, R-Calif., that would create an antitrust exemption allowing physician groups to negotiate with managed care plans.
