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Doctors turn to unions for help

Luis Fábregas
| Sunday, April 15, 2001, 12:00 p.m.


Chances are Dr. Frank DiCenzo will never don a sandwich board and picket in front of a hospital.

But the Sewickley obstetrician has joined a union.

'Almost every day, we're faced with decisions about what drugs we can use and what treatments we can do,' said DiCenzo, who has been in practice since 1989.

'We have to constantly worry about jumping through insurance hoops. It shouldn't have to be that way.'

DiCenzo and some of his western Pennsylvania colleagues believe physicians ought to have more bargaining power against health insurers. Without much fanfare, they are trying to increase the clout of a doctors union formed about two years ago.

If they succeed, they could bring local prominence to the fledgling union movement among doctors. Across the nation, nearly 40,000 doctors belong to unions, according to the American Medical Association, based in Chicago.

'We work in a monopoly in health care in western Pennsylvania, where (Highmark) Blue Cross Blue Shield has 70 percent of the people insured,' DiCenzo said. 'If my practice doesn't like their terms, what choice do we really have?'

As they seek more options and freedom from health insurers, doctors face critical challenges: the inability of self-employed physicians to bargain collectively and the perception that joining a union makes doctors look greedy.

Even union officials acknowledge that the battles will be tough.

'Organizing physicians is like herding cats; it's very difficult,' said Lynda Odenkirk, regional director of the Federation of Physicians and Dentists. The union, affiliated with the AFL-CIO, has about 75 local members.

'They truly want to be their own boss. They have a very competitive nature,' Odenkirk said. 'Plus, it's an occupation that is held in high regard and definitely not the blue-collar profession associated with unions.'

Union advocates have unsuccessfully lobbied to gain collective bargaining rights for independent doctors, which are banned by federal antitrust laws. That means most of the nation's 650,000 doctors can't join a union because they work for themselves.

There have been several attempts to change the law, including one by former U.S. Rep. Thomas Campbell, a California Republican. Campbell's bill passed the House last year but died in a Senate committee. In Pennsylvania, the most recent bill was introduced by state Rep. Lawrence Curry, a Democrat from Montgomery County.

The prospect of collective bargaining pushed Dr. Michael Casey, an orthopedic surgeon in Shadyside, to join the federation.

Casey said he chose to unionize after Highmark Blue Cross Blue Shield last year considered a system that would have curbed payments to orthopedic surgeons and two other specialties in its Medicare health maintenance organization.

Though it is not able to bargain collectively, the union has helped sift through contracts with insurers to make sure they are the best deals.

'They can recommend to us that we accept or deny a contract offer but can't discuss pricing between groups of doctors,' Casey said. 'We're not allowed to do that. That's something we need.'

Highmark, the dominant health insurer in the region, said it is working with physicians to address cost concerns. The insurer recently increased payments by 5 percent to 10 percent for primary care doctors, spokesman Michael Weinstein said.

'We're trying to build better relationships with the physicians,' he said.

Those who champion doctors unions, say their goal is to fight for their patients.

'Doctors are very frustrated with not being able to take care of their patients,' said DiCenzo, who pays about $600 in annual dues to the Federation of Physicians and Dentists.

'If I say some procedure should be covered and it is not, why should the patient suffer?' he said.

Not everyone believes unions will improve patient care.

Jeff Goldsmith of Charlottesville, Va., a nationally known analyst and lecturer in health care economics, said unions are not the best way to fight managed-care companies.

'It's a 19th-century solution to a 21st problem,' Goldsmith said. 'I don't think group force is the answer. This is a more subtle and complex issue. The real leverage is in the political system, where physicians have been very effective.'

The power doctors could gain by unionizing, he said, would not necessarily allow them to deliver better health care.

'It's not clear that when powerful people unionize to keep their power, that is the same as powerless people unionizing,' he said.

The fact that doctors have been unwilling to be controlled by insurers is reason enough to believe they would not want to be controlled by the unions.

'This may just be a vehicle for getting together and talking,' Goldsmith said. 'Other than that, it's going to be a stretch.'

Having a voice is good enough for doctors at Medalia HealthCare in Seattle. In 1998, they became the largest private-sector physicians group to unionize by forming the Northwest Physicians Alliance.

Dr. Dag Vandermeer, a family doctor who led the union efforts, said banding together was the only thing doctors could do to be heard.

Vandermeer dismisses the notion that physicians join unions just to make money.

'A physician doesn't go to med school and get $110,000 in debt and do post-graduate work for eight years for pocketbook issues,' Vandermeer said. 'There is this sort of sacred ethical idea of physician-patient relationships that has been tarnished because of cost-containment issues. When it seems like our management is working more on the side of the insurer than on the patient's, that's what's forcing doctors to organize.'

When the 300 doctors at Vandermeer's three-hospital system unionized, they complained about not having support staff to complete their work and about arguing with insurers over coverage.

'We tell people not to smoke, to exercise and to not work too hard,' Vandermeer said. 'When our system of health care conspires against that and says we're going to deny them the access they need and the medicines they need, that becomes a fundamental health issue of sorts. What are we going to say to the patient - 'Oh, sorry you lost your leg, we can't help you?'

'It's not about the picket line at all; it's about what's right and what's wrong.'

That's also the belief of the AMA, which endorses doctors unions - to an extent.

The nation's largest professional doctors group last year created Physicians for Responsible Negotiations. The union was formed after the AMA decided that health maintenance organizations and managed care companies were placing increasing workload and financial pressures on doctors.

'We're committed to never striking and not to do anything that harms the patient,' said Dr. Susan Hershberg Adelman, the union's president and an AMA trustee.

She said the union helped a group of 27 doctors in Detroit successfully negotiate a contract. Adelman said those doctors, who worked for a Medicaid HMO called the Wellness Plan, unionized because they felt financial pressures were harming patient care.

'There had been cutbacks in staffing to the extent that patients would come in and there would be no staff to do their lab work or fill their prescriptions,' Adelman said. 'That in turn prevented the doctors from doing their work.'

The emergence of doctors unions was inevitable, said Grace Budrys, a professor of sociology at Chicago's DePaul University and author of 'When Doctors Join Unions.'

'It used to be that hospital administrators and doctors shook hands and that was their extent of their agreement,' she said. 'But insurance companies and health systems have become bigger, and doctors can't negotiate with them Much work remains if doctors unions are to succeed, Budrys said.

'Physicians are responsible for defining what professionalism is in the 20th century. In the 21st century, one of the things that could happen is that physicians could define what a union for highly skilled workers is.'

Luis Fábregas can be reached at lfabregas@tribweb.com or (412) 320-7998.

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