WASHINGTON -- Across the country, doctors who fear they have lost control of patient care to corporate accountants are turning to labor unions for leverage against hospitals, clinics and managed care groups.
"This is not like you're talking to steel workers or auto workers who grew up with this," said Dr. Keith Shelman, who joined a union. "We look at this like it's our last chance."
Shelman was among 92 doctors at the Thomas-Davis Medical Centers in Tucson, Ariz., who voted to join an affiliate of the American Federation of State, County and Municipal Employees this winter. "The major barrier to health care and our success as physicians is no longer the patients' illnesses but the system," said Shelman, who has practiced internal medicine for more than a decade. As long as antitrust rules are not violated, managed care organizations have no quarrel with unionized doctors, an industry spokesman said. "Good patient care relies on good communication between physicians and HMOs. We're all working together in this," said Donald White, spokesman for the American Association of Health Plans, which represents more than 1,000 HMOs. "A process that furthers that communication will be helpful." In recent months, podiatrists nationwide and physicians in New York also have voted to unionize, either directly or by affiliating through professional associations. Inspired by the podiatrists and enthusiasm for unions among some of the 4,000 members of the Philadelphia County Medical Society, society President Dr. Raymond Lodise planned a regional meeting Thursday to discuss unionizing 16,000 medical society members in Pennsylvania and Delaware. "The insurers have taken control of patient care, and we're trying to keep control," Lodise said. "We know that unions have tremendous influence with legislators, and we know that unions deal with people who are affected by managed care." Other movements are afoot among neurosurgeons in Broward County, Fla., and more than 300 physicians in Oregon and in Albuquerque, N.M. The doctors say the conflict at the heart of the debate is obvious: A physician's primary responsibility is to the patient, while a corporate executive is responsible for the bottom line. …