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
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,
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
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
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. …