These Doctors Pay Their Dues-To a Union
Lowes, Robert L., Medical Economics
Are they extremists? Or simply desperate? In either case, a doctors' union illustrates the sour side of practice acquisitions.
In 1994, when Rockford Health System acquired the 80-doctor Rockford Clinic in the Illinois city that shares their name, buzzwords like "partnership" and "integration" created an all-toofamiliar drone.
Today, the descriptive phrases being bandied about include "growing pains" and another one that's both spiky and surreal, at least in medicine-"collective-bargaining unit."
That's what Rockford doctors formed last summer to regain some of the autonomy they lost when they became employees. "We're dealing with a system that's running the doctors and not the other way around," says internist Dennis Norem, a former board member of the old Rockford Clinic, who's helping spearhead this medical labor movement.
The collective-bargaining unit, dubbed the Rockford Physicians' Council, wants a voice in decisions that affect patient care-staffing cutbacks and how many patients a doctor should see each month, for example-as the health system tries to cut expenses and maximize revenue in financially trying times. The creation of the council, says Norem, already has pressured the health system to give more say-so to physicians. Administrators contend they were moving in that direction anyway.
Norem, a member of the council's steering committee, says his group isn't a traditional union. Ostensibly, the council isn't trying to negotiate higher pay for physicians-no Teamsters pounding the table for raises here. But pet issues like physician productivity do affect income. The doctors also vow never to jeopardize patient care by striking. Otherwise, it's a traditional labor-management tussle, with all the attendant acrimony. The Physicians' Council already has gone to the National Labor Relations Board, charging a subsidiary of the health system with trying to break the union. Some partnership.
What has emerged is a landmark coalition between the council organizers and the American Medical Association. The AMA is supplying the doctors with two labor attorneys through its new Division of Representation, created to protect doctors from business-suit bullies. Rockford-the hometown of the AMA's just-resigned executive vice president, P. John Sewardrepresents the association's first foray into nitty-gritty labor organizing. AMA officials suggest that more may follow, considering the phone calls they get from other employed physicians.
"They want to know how they can advocate for quality care without being fired," says general surgeon Donald J. Palmisano, an AMA trustee. Palmisano adds, however, that the AMA will assist only those physicians who've taken the Rockford pledge-no strikes, lest patients suffer.
A drop in hospital income sets off a crisis
The turmoil in Rockford was triggered by a financial crisis that illustrates the dangers of hitching your future to another organization's bottom line. Rockford Memorial Hospital, the core of the Rockford Health System, posted healthy earnings in the mid-1990s-$23 million in 1995, for example, according to Medicare cost reports. Earnings fell to $10 million in 1996, however.
More significantly, the hospital lost $2 million on patient services, which the year before had netted nearly $12 million. Tom DeFauw, the health system CEO, attributes the slump largely to shorter hospital stays. But discounting of hospital charges deepened, too.
Physicians protested when, in response to the downturn, the health system in late 1996 eliminated roughly 300 jobs, mostly in the hospital. The cuts made life more difficult for doctors and patients alike, says Norem. "There weren't enough people to draw blood, so you had lines snaking around hallway corners. Transcription of dictation and lab tests slowed down, and it was harder to retrieve patient charts. Sure, the budget had to be cut, but decisions were made by administrators with little input from physicians. …