AMA Article

March 15, 1999

Alliance of physician unions creates new collective bargaining powerhouse

by Sarah A.Klein

AMnews staff

Three unions representing 15,000 practicing physicians and residents united this month under the label of the Service Employees International Union.

The SEIU, in turn, promised to spend at least $1 million a year recruiting more doctors for the groups, which will be known collectively as the National Doctors Alliance.

The move further consolidates the field of 10 unions competing for the attention of employed physicians with collective bargaining rights.

By unifying the Committee of Interns and Residents, the Doctors Council and the United Salaried Physicians and Dentists, the alliance will represent a third of all unionized physicians. The next largest group, the Union of American Physicians and Dentists, has approximately 5,000 members.

Moreover, the unions plan to recruit salaried physicians coast-to-coast, using offices in five states, including New York, California and Florida.

"This marks the beginning of a major initiative to organize doctors nationwide," said Barry Liebowitz, MD, a New York pediatrician and the group's president. "Our major agenda is to really organize every employed doctor in this country."

Toward that end, they will recruit salaried physicians from public and private institutions, hospitals and HMOs alike. "We will negotiate salaries, we will negotiate hours, and we will negotiate due process," Dr. Liebowitz said. In addition, the union plans to put a heavy emphasis on patient advocacy with legislative drives for managed care reform.

"We are not going to allow our patients, [with whom] we have a sacred trust, to really face the bottom line of a corporate profit so that some shareholder or some CEO can live off the denial of care," he said.

Part of that agenda will be a campaign to hold anyone who overrides a physician's medical decision liable for malpractice.

Capitalizing on physician frustration

The union will be tapping into one of the fastest growing groups of physicians: employees. The total percentage of physicians who were employed in 1997 was 43.3%, not including residents and federal employees. The numbers are likely to go up as recent graduates choose employment over self-employment by 4-to-1, according to labor officials.

They also will be tapping into widespread sentiment that the health care market has deteriorated as an increasingly concentrated group of payers emphasizes cost over quality. That concern, along with frustration over declining reimbursements, has led the AMA's House of Delegates to push for its own collective bargaining unit.

With a directive to present such a guild by June, AMA staff are working on a proposal for one.

There is no indication yet how the cost of the AMA's guild might compare with the $600 annual dues charged to physicians who join unions in the National Doctors Alliance. However it's designed, it will have no affiliation with a trade union.

We do not believe that traditional trade union practices ensure the integrity of the patient-physician relationship or help physicians achieve the best decisions for quality health care in this country," said AMA President Nancy W. Dickey, MD.

"What trade unions generally do exist for are issues for the workers involved in the union: more pay, shorter hours, better benefits. A good bit of what physicians need and want collective bargaining for has to do with our patients. we want contracts that don't dictate unacceptable productivity clauses, for instance," Dr. Dickey said. Those issues "don't fit into the same pattern as the meat cutters or the mechanics."

In particular, AMA officials and AMA ethical policy take exception to the use of strikes as a negotiating tool, declaring that it is never appropriate to risk patient safety through a work stoppage.

The unions in the National Doctors Alliance do not agree. In fact, Dr. Liebowitz said, strikes may be essential.

"Sometimes it is far better to strike than to allow a patient to go into a substandard facility. In other words, there are responsible strikes." Those would occur with a great deal of notice and wouldn't leave hospital patients without care, Dr. Liebowitz said, adding that strikes are unlikely to occur over financial issues.

It remains to be seen how AMA members will respond to the new alliance or medicine's own promised organizing drive. There is clearly a lot of interest in unions, but much of it comes from solo physicians who are hard hit by managed care and are precluded from collective bargaining by strict antitrust laws.

To help solo physicians, both the AMA and the National Doctors Alliance are pushing for the passage of Rep. Tom Campbell's (R. Calif.) Quality Health-Care Coalition Act of 1999, which would give independent physicians the right to bargain collectively.

As organized medicine presses for antitrust relief and makes plans for a national collective bargaining unit of its own, some AMA leaders said they fear members will turn to the union out of frustration with the Association's slow response on the collective bargaining issue.

"Sometimes people on the board- and in the house- don't understand what is happening in the real world," said Robert J. Weierman, MD, an orthopedic surgeon from South Orange, N.J., and an AMA delegate. "I have physicians cursing me out, saying they are getting killed out there and that the AMA is doing absolutely nothing to help them. This is very much a membership issue."

Efforts to organize residents in particular could get a boost from a long awaited decision from the National Labor Relations Board.

In a case involving residents in Boston, the board is reviewing its policy on whether residents qualify as employees entitled to collective bargaining rights. That has remained an open question for the past two decades, as resident groups in some jurisdictions qualified for collective bargaining, while others deemed trainees did not.

Meantime, the SEIU is chalking up new members in health care. Just the week before the announcement of the National Doctors Alliance, SEIU officials declared that after a 10-year campaign, they had organized 74,000 home care workers in Los Angeles. The addition was labor's biggest organizing victory since 1937, when 112,000 General Motors employees joined the United Auto Workers.