More Than They Bargained for Some Doctors See Unions as Antidote to Managed Care
Culloton, Dan, Daily Herald (Arlington Heights, IL)
Byline: Dan Culloton Daily Herald Business Writer
The 52-year-old woman looked five months pregnant.
Her abdomen, though, was not swollen with life, but with life-threatening fibroid tumors.
There was no question in Dr. Paul Rosenberg's mind the growths had to come out, but before he operated earlier this month, the medical director of the woman's insurance company urged him to delay the surgery. Maybe the tumors would shrink during menopause, he said.
"I said no way. She's walking around with a bowling ball in her abdomen." said Rosenberg, the founder of Female Healthcare Associates Ltd., which has offices in Naperville, Bloomingdale and Elk Grove Village.
The company ultimately approved the surgery, but Rosenberg expects to wait several weeks for reimbursement.
The story is emblematic, Rosenberg says, of why over a 15-year career as an obstetrician and gynecologist he has changed from someone who knew or cared little about unions or collective bargaining to one who favors that kind of blue-collar representation for his blue blood profession.
"We have to be allowed to get to the bargaining table to talk to the managed care providers and to negotiate contracts," said Rosenberg, a board member of the DuPage County Medical Society.
The rise of managed care with its emphasis on containing health care costs has led doctors across the nation to consider banding together in ways they once thought anathema to their once self-reliant profession.
Roughly 6 percent of the nation's 756,000 physicians belong to unions, according American Medical News. Virtually all of them are salaried doctors who work for hospitals, health plans or clinics, because anti-trust laws bar solo practitioners from organizing.
It's still a small number, but one that will grow, those in the labor movement say, as more doctors go to work for someone else instead of themselves after their residencies.
About 36 percent of all doctors draw a salary now instead of run or belong to a practice, says the American Medical Association.
In that last five years, however, as much as 80 percent of new doctors have taken salaried positions, according to Dr. Barry Liebowitz, president of the National Doctors Alliance, which was formed by the Service Employees International Union this year to organize physicians.
Perceived and real hardships have encouraged independent physicians to take a closer look at unions. Once regarded as Marcus Welby-like bastions of strength and independence, some doctors now portray themselves as powerless sheep who need protection from managed care companies.
Managed care providers, doctors contend, drag out reimbursements and infringe on their freedom to decide how to treat patients by imposing gag rules, requiring referrals and denying coverage.
"This is really infringing on their professional authority," said Grace Budrys, a DePaul University sociology professor and author of the book "When Doctors Join Unions."
Most large health maintenance organizations, hospitals and managed care companies have not taken a formal stance on doctors and collective bargaining.
Chris Hamrick, spokesman for the Illinois Association of HMOs, contends while managed care does not cover every procedure and medicine, it does pay for what it covers a majority of the time.
He also said doctors - who earned a median annual income of $164,000 in 1997, according to the American Medical Association - may have more than independence and altruism on their minds.
"Sometimes the line between patient protection and physician income protection gets blurred," Hamrick said.
With varying levels of success, physicians have explored collective bargaining or tried to join unions in New Jersey, Delaware, Connecticut, Ohio, Florida, Arizona, Washington, Massachusetts, New York and even nearby Rockford, according to the journal Medical Economics. …