Magazine article Clinical Psychiatry News

Physician Unionization Is a Difficult Proposition: Insurer 'Monopsonies,' Other Barriers

Magazine article Clinical Psychiatry News

Physician Unionization Is a Difficult Proposition: Insurer 'Monopsonies,' Other Barriers

Article excerpt

WASHINGTON -- Interest in physician unionization is increasing as health insurers become more powerful.

But doctors who want to unionize still face many barriers, several speakers said at a hearing sponsored by the Federal Trade Commission and the Department of Justice.

Organized medicine is less resistant to the idea of unions than it was a few years ago, said Carl F. Ameringer, Ph.D., who is associate professor of political science at the University of Wisconsin, Oshkosh.

"The American Medical Association has essentially gone into the union business with the formation of [its bargaining unit Physicians for Responsible Negotiation]," Dr. Ameringer asserted.

"This tends to undercut previous arguments opposing union formation based on notions of professionalism."

Another strong argument for unionization is the development of "monopsony power" situations in some areas, with only one or two insurers completely dominating the marketplace.

Dr. Michael Connair, who is vice president of the Federation of Physicians and Dentists, said that this problem affects other things besides that of collective bargaining.

He cited the situation in Philadelphia as an example.

"In Philadelphia, 70% of the population is insured by one [insurer], which is intransigent," said Dr. Connair, an orthopedic surgeon in New Haven.

"One reason that doctors are having difficulty paying malpractice premiums is that they cannot negotiate effectively" with such powerful health plans, Dr. Connair said.

"Insurers are strong-arming physicians into signing one-sided contracts that compromise care and squeeze doctors financially," he said.

"Doctors are leaving in part because of the high malpractice rates and the failure of the monopsony to yield."

Even if the malpractice insurance problem were solved, doctors would still have financial problems because of managed care, Dr. Connair continued.

"Medical liability reform, when and if it ever comes, won't prevent doctors from going out of business," he said.

"Doctors must be able to control their overhead without bureaucratic interference."

William Brewbaker, Ph.D., who is a law professor at the University of Alabama, Tuscaloosa, said that even if monopsonies do exist, physician unionization might not necessarily be the answer to them. …

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