By Reardon, Thomas R.; Kahn, Charles N.,, III | Insight on the News, August 23, 1999 | Go to article overview


Reardon, Thomas R., Kahn, Charles N.,, III, Insight on the News

Q: Is a national labor union for physicians a good idea?

Yes: Physicians need a collective voice to advocate more effectively for their patients.


For too long now, health-maintenance organizations, or HMOs, and other employers of physicians have been able to dictate how health care is delivered. Unfortunately, physicians -- the trained experts in providing medical care -- have little or no say in shaping and determining their patients' care. It is time to remedy this unhealthy situation.

As part of its treatment plan, the American Medical Association, or AMA, is creating an affiliated national negotiating organization for physicians. We do not see this new organization as a cure-all, but it will provide physicians with one more tool to level the current playing field with managed-care organizations and other employers who insist on dictating how medical care is delivered in this country.

Right now, there is very little one physician can do to improve the system so that his or her patients get the care they need. Many large employers of physicians, particularly large managed-care organizations and hospitals, simply do not respond to one physician calling for change. Our national negotiating organization will give physicians a collective voice so that employers will have to respond.

The role of the physician as a patient advocate never has been more important than it is today. We see decisions regarding patient care based increasingly on the bottom line of physician's employers and not the best clinical judgment of physicians. Instead, doctors are told to see more patients, to provide fewer services and to ask permission for most everything we do. Physicians recognize the need for cost-efficient care. In fact, we are on the front lines making it possible. But, clearly, the pendulum has swung too far. Employers of physicians now have a degree of leverage over physicians and medical decision-making that is not healthy for patients or the care they receive.

Working through our negotiating organization, American physicians will put a menu of quality-care issues on the table in their negotiations with their employers. For example:

* They will insist that physicians have sufficient time with each individual patient.

* They will insist that physicians have autonomy to make clinical decisions based on what is medically necessary for each patient.

* They will insist on eliminating so-called "gag clauses" that prohibit physicians from discussing all treatment options with patients.

* They will insist on the ability to prescribe needed and appropriate drags even when they are not included in formularies set up by HMOs.

* They will fight to see that patients have access to needed specialists and the emergency room when they need it.

Now these may seem like reasonable provisions, but they too often are the exception rather than the rule in today's delivery system. Our negotiating organization is aimed at giving physicians the leverage they need to secure these essential provisions and to bring patient care to the level it ought to be.

While the AMA's decision to form a national negotiating organization has received enormous attention, it has ample precedent. Some 40,000 physicians across the country already have joined professional labor unions. Many physicians mm to these organizations only after all other attempts to communicate their concerns via more direct means have fallen on deaf ears.

The AMA-affiliated negotiating organization will give these physicians and other employed physicians another option. Our organization will differ from traditional labor organizations. Most notably, it will honor the AMA's long-standing commitment to medical ethics and professionalism -- a commitment that patients and physicians have looked to and trusted for the past 152 years. As part of this commitment, physicians who choose to join our new organization will not strike or do anything to endanger patient care. …

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