Experts: Patients likely to get little benefit form doctor unions

Published: Saturday, June 26, 1999


Union supporters say doctors need more negotiating clout to win back control of patient care from health maintenance organizations, which are often accused of unfairly restricting treatment to save money.

That argument helped convince the American Medical Association on Thursday to support forming doctor unions, a move that reversed a long-held position.

On the other side are those who feel the doctors are more concerned about restoring lucrative fees they've lost due to HMO curbs on care.

To some, the fight is similar to sports team owners and their millionaire athletes.

"This is a debate between those earning six figures (doctors) and those earning seven figures (health insurance executives)," said Ron Pollack, executive director of Families USA, a Washington, D.C. consumer health group. "If doctors' salaries escalate, consumers will end up paying a price for that."

Pollack said unions may help restore some balance between doctors and HMOs in making patient care decisions. But he said patient protection legislation now pending in Congress would do more.

The bills would give patients the right to appeal HMO coverage decisions to an impartial review board, Pollack said. They would also encourage HMO coverage of newer and more effective drugs.

Employer groups who pay most health insurance premiums and often side with insurers worry the HMOs would have to increase their premiums if they must give doctors more money.

"Doctors are clearly frustrated, but we don't see this as a solution," said Sally Coberly, director of public policy at the Washington Business Group on Health.

The AMA's vote was largely symbolic because under federal law only salaried doctors such as those employed by hospitals, HMOs or government have the right to unionize. Independent practitioners, who account for six out of seven U.S. doctors, are barred from unionizing by antitrust laws designed to protect the public from price fixing.

Still, the number of unionized doctors is growing. Of the 600,000 doctors nationally, roughly 40,000 belong to unions, up from only about 25,000 two years ago. Experts predict the numbers will continue to grow because of the AMA vote.

In addition, Congress and several states are considering legislation giving independent doctors the right to collectively bargain. Texas this week became the first to pass a law to give doctors that leverage.

The Federal Trade Commission opposes such laws, saying they could hurt consumers. Indeed, the FTC has fined doctors in central Virginia for banding together to block a new health plan from entering their market because they objected to its lower fees.

Uwe Reinhardt, a health economist at Princeton University, said unions have one main goal. "Unions enhance the quality of life for the union member," he said.

Dr. Barry Liebowitz, president of the National Doctors Alliance, a union representing 15,000 physicians, said unions will ensure that doctors get enough time to treat patients and provide appropriate treatment.

In addition, unionized doctors can be more assertive in fighting for coverage on behalf of patients without fearing retribution from the HMO, he said.

"The driving force here has not been the loss of income but the loss of being able to practice their profession," he said.

However, some doctors aren't sure unions are the solution.

"Doctors are at wits end because they can't get the message across that quality care costs money and we are grasping for anything," said Dr. Jana Rasmussen, a West Palm Beach, Fla., plastic surgeon. "The union has been the bright shining star that might turn things around so doctors can be paid appropriately."