Friday, June 25, 1999
Docs see union as antidote to HMOs
BY TIM BONFIELD
The Cincinnati Enquirer
Smoldering local interest in forming physician unions is likely to catch fire, doctors say, after a vote this week by the American Medical Association.
One new doctor union already exists here, representing most of the Tristate's orthopedic surgeons. In coming months, another even bigger one may be launched - this time through the Academy of Medicine of Cincinnati, the local chapter of the AMA.
“The times they are a-changin'. There are plenty of doctors who feel this is the most important thing to press for,” said Academy president Dr. Marvin Rorick.
At its annual meeting in Chicago this week, the AMA House of Delegates voted to create a union for salaried physicians and medical residents. It also renewed its call for Congress to expand collective bargaining rights to self-employed doctors.
In Cincinnati, the Academy of Medicine had already formed a “collective bargaining task force” to study and recommend action on the union issue. Its first meeting is planned for late July.
“Managed care has intruded on the practice of medicine to such a degree that this has become a palatable idea. Doctors want a level playing field with the insurance companies,” said Dr. James Anthony, president of Riverhills Healthcare Inc., a group of 25 area neurosurgeons, neurologists and psychologists.
The AMA's action comes within days of a Texas law — signed by Republican governor and presidential candidate George W. Bush — that grants collective bargaining rights to some physicians. In Congress, U.S. Rep. Tom Campbell, R-Calif., has proposed a bill to widely expand physician negotiating rights.
The American Association of Health Plans, the main lobbying group for the managed-care industry, claims the Texas law gives doctors “unprecedented special rights.” The group also calls the Campbell bill a “license to collude.”
Some federal officials also have predicted that expanded union rights for doctors will lead to price-fixing that could drive up health costs. But doctors say the union issue is about more than money. They say bargaining rights will help them be stronger advocates for their patients.
Dr. Anthony said something must be done to address the “crazy rules” some health plans place on which medications doctors can prescribe.
For example, Dr. Anthony said he recently fought an HMO for two months to win coverage for an expensive drug to help a patient with multiple sclerosis.
The drug, beta interferon, is the first ever shown toreverse the symptoms of MS, Dr. Anthony said. But the daily injections cost about $900 as month.
Beyond the frustration with managed-care rules and reimbursement rates, the AMA action reflects another trend in medicine: the rising number of doctors who earn salaries rather than own their practices.
Those doctors — an estimated 20 to 30 percent of all practicing physicians — can join unions now, even without Congress passing something like the Campbell bill.
“I know some people in employment situations who are very unhappy,” Dr. Anthony said. “They have administrators coming into their offices and telling them they shouldn't spend more than seven minutes with a patient on a follow-up visit.”
Many doctors have been waiting for the AMA to act because they haven't been interested in joining traditional unions, Dr. Anthony said.
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