Dr. Barry Liebowitz, President of Doctors Council

The new union, known as the National Doctors Alliance, last month announced its formation and its affiliation with the 1.3 million-member SEIU, which counts 600,000 nurses, home health workers and other healthcare employees among its members. The new group plans to recruit salaried doctors across the country, aided by the SEIU's pledge to spend $1 million a year on organizing efforts.

With 15,000 members, the National Doctors Alliance is the nation's largest physician union. It comprises three New York-based unions, the Doctors Council, with 2,500 members; the Committee of Interns and Residents and the Union of Salaried Physicians and Dentists, with 10,000 members combined; and 2,500 members of smaller, local unions.

The respective unions will continue to negotiate on their own members' behalf, aided by the SEIU's resources, says alliance President Barry Liebowitz, M.D. Annual membership dues will be about $600.

"After we interviewed all the unions, we decided on SEIU because it is the predominant healthcare union in the U.S. Healthcare is not an afterthought for them," Liebowitz says.

He says the physician unions had been negotiating "for over a quarter century. SEIU, however, provides us with one of the goals I've had since I've been president for 20 years, and that is to organize every physician in this country."

Liebowitz, who previously served as president of the Doctors Council, says the merger will allow organizers to work from offices in 12 states. "Given the resources, given the bases, given the help of the SEIU locals in those areas, I believe we are well on the way to organizing every employed doctor."

The time is right for a nationwide union, Liebowitz says, because about half the 700,000 physicians in the U.S. are in salaried positions, which allows them to legally unionize. According to the American Medical Association, about 70% of all residency graduates entered salaried positions in 1997.

The 8,500-member Federation of Physicians and Dentists, Tallahassee, Fla., and the 5,000-member Union of American Physicians and Dentists, Oakland, Calif., are now the nation's second- and third-largest physician unions. UAPD President Robert Weinmann, M.D., greeted the alliance's formation enthusiastically.

"The competition will be good for the field because it brings more doctors into unions," Weinmann says.

The alliance's formation was not so warmly received by the AMA, which opposes unionization of physicians. President Nancy Dickey, M.D., issued a statement declaring, "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 healthcare in this country."

The AMA realizes, however, that unions have struck a chord among physicians. In June, the association plans to unveil its own collective negotiating unit to help doctors in their dealings with managed-care companies.

Liebowitz hopes that instead of criticizing unions, someday the AMA will work collaboratively with groups such as the National Doctors Alliance.

"We have a very common agenda, but all of us have knowledge and abilities in different areas. We certainly have demonstrated our abilities over a quarter century. Why reinvent the wheel when someone can offer expertise?" he asks. "They keep calling us an industrial model. We're not an industrial model. We're a doctors' union run by doctors since our inception. . . . The last thing medicine needs is another adversarial relationship."

The AMA and the new union agree it's necessary to cautiously approach organizing private practice physicians to collectively bargain. Antitrust laws prohibit independent contractors (including private practice physicians) from collective bargaining, and government investigators have shown particular interest in physician organization.

Justice Department investigators are especially suspicious of physicians' use of the so-called third-party messenger system. In that process, messengers act as go-betweens in contract negotiations with payers but cannot influence physicians' decisions or share one provider's contract information with another.

The FPD acts as a third-party messenger for about 4,000 physicians nationwide. The union is under investigation for violating antitrust laws in Delaware. In addition, a group of surgeons in Tampa, Fla., that used a consulting firm as a messenger recently settled antitrust charges with the Justice Department after being investigated for illegal collective bargaining.

Meanwhile, private practice physicians in New Jersey's Cape May and Atlantic counties have been waiting since last December to hear whether the National Labor Relations Board will grant them the right to collectively bargain with local HMO powerhouse AmeriHealth. The physicians argue that AmeriHealth exerts so much control over their practices that they are de facto employees.

Liebowitz says the new union does not plan to collectively bargain or act as a messenger for independent physicians, but he does believe unions have a place in the private practice world. For example, he says, unions can help doctors who have been dropped by managed-care companies or they can fight HMO contract terms, such as gag clauses, that doctors find disagreeable.

Organizing doesn't have to mean collective bargaining, he says.

"The first thing you do is get physicians to come together under a topic, in any forum, and start to come together over a common agenda. They do not have to act on costs. We're talking about patient care," he says. "I believe that within one to two years you will see collective bargaining for independent practitioners. What I'm screaming at them and telling them is, `Organize now so you will be ready.' "