Despite high-profile efforts to unionize physicians in recent months, physician unions can't be declared a trend in mainstream medicine.
They still primarily represent public employees and physicians in training.
But some unions do see opportunities to position themselves as a countervailing force against for-profit managed care.
A curious example came last month when 127 physicians at Thomas-Davis Medical Centers, a medical group in Tucson, Ariz., held a vote on joining a branch of the Tallahassee, Fla.-based Federation of Physicians and Dentists.
Because of a management appeal to the National Labor Relations Board, the ballots were sealed. The outcome hadn't been announced as of last Wednesday.
Thomas-Davis was owned by Foundation Health Corp., a for-profit HMO based in Rancho Cordova, Calif., which bought the medical group and a Tucson-based HMO from their physician owners in 1994 for $720 million in stock.
But Foundation lost money on its physician operations. It sold Thomas-Davis Dec. 10, just five days after the union vote, to FPA Medical Management, a San Diego-based physician practice management company.
Like other firms in the fast-growing physician management field, FPA claims to empower physicians by giving them capital, expertise and other tools to negotiate lucrative managed-care contracts.
In a turnabout, FPA, which was created to organize physicians, now finds itself the target of physician organizing.
In a news release, FPA said it's "committed to improving the relationship with the Thomas-Davis physicians by providing strong leadership and the support they need to provide quality care for their patients while enabling them to develop personally and professionally."
Nevertheless, once the NLRB gave its approval to count the votes two weeks ago, FPA appealed to reopen proceedings and again delay the count, saying it never had a chance to intervene.
Union organizers have called FPA's request a stalling tactic.
"I don't see any difference between FPA and Foundation," said Robert Osborne, M.D., the federation's coordinator in Arizona.
Now, the matter rests with the NLRB. Whatever the outcome, Tucson is not alone. The nationwide shift to employment from private practice means more physicians than ever-two in five-have the right to bargain collectively.
Not everyone believes physicians will turn to unions en masse. Physician practice management companies, independent practice associations and medical associations already offer strong clout.
But union advocates predict an increase in demand for their services. John Ronches, executive director of the growing New York-based Committee of Interns and Residents, said physicians are turning to unions because of uncertainty generated by "the rush headlong by the healthcare industry to reduce its costs and to ration the care that's given to patients."