COCOA, Fla. -- With the spread of managed-care companies and their efforts to contain costs, many doctors say they are losing control over working conditions, treatments and incomes. In response, some are taking a most uncommon step to protect their interests. They are joining labor unions.
With typically six-figure incomes, private-practice physicians would seem to have little in common with the toilers of office, field and factory. But as they lose their independence, 4,000 of the white- cloaked stalwarts of free enterprise have taken up the union banner.
So far the unionized doctors amount to a tiny number among the 684,000 physicians. But they work in two populous states with dense concentrations of managed-care companies, Florida and California. And as the companies keep spreading, merging and expanding control over health care, the doctors say they expect many colleagues to seek refuge in the unions.
For some it will be a difficult move.
"Most doctors are Republicans," said Dr. Duff Sprawls, 47, a hematologist and an oncologist in Cocoa and, now, a union member. "Most doctors' dads were Republicans. They do not see themselves as proletarian. They see themselves as bourgeois."
The doctors have joined two unions that also represent growing numbers of salaried hospital and public-service doctors who have been joining unions for decades, the Florida Federation of Physicians and Dentists in Tallahassee, an affiliate of a big AFL-CIO union, the American Federation of State, County and Municipal Employees, and the independent Union of American Physicians and Dentists in Oakland, Calif.
Brevard County, where the Florida union says 107 of 563 private practitioners have enrolled and are paying the $520 annual dues, is a hotbed of union organizing.
"The managed-care organizations have economic power," said Dr. Apolinar A. Henriquez, 42, of Cocoa, an internist and a union organizer. "And we have the power of our group."
As unionists go, the doctors are pretty tame. "I wouldn't strike," Henriquez said.
The doctors also lack a vital lever of union power. Most unionized workers can set their wages through collective bargaining with employers. But under the antitrust laws that govern businesses, including doctors' offices, physicians who get together to agree on the fees that they charge could go to jail for illegal price fixing.
Many doctors, however, who contract with managed-care companies to obtain patients, now consider themselves so stripped of their independence that they have become de facto employees of the health care companies.
As a result, the Florida federation is planning appeals to Washington to obtain the same antitrust law exemptions that some musicians, actors and teamster drivers have. Many truck drivers own their businesses -- their vehicles. But they have no control over the rates that they are paid, and they join the teamsters' union, which negotiates their pay.
The unions are helping doctors take on managed-care organizations in other areas.
The president of the Florida union, Dr. Arthur L. Hall, a family physician in Winter Park, near Orlando, cited a typical contract and the changes that the union is negotiating.
The union version gives physicians more freedom to override a company's requirement that surgery patients be admitted to hospitals only on the day of their operations.
The union would require that the company state a just cause when terminating physicians' contracts, let them appeal to arbitrators and pay for the costs of arbitration if the physicians win. The companies would also pay costs associated with making available medical records.
The managed-care companies readily acknowledge their power and the threat that they pose to independent physicians who rely on the fees that they charge patients.
The companies' trade group in Washington, the American Association of Health Plans, says 115 million Americans, or 45 percent of the population, are enrolled with the companies. …