The phrase "physician unions" conjures up an image of physicians in white lab coats walking picket lines. Will patients be lined up outside hospital doors waiting for their doctors to return? The American Medical Association says no.
The weapon that empowers unions is the strike. But physician strikes are unthinkable. For a physician even to threaten to walk out on a patient violates the code of ethics that underlies the profession.
The AMA does not track physician groups that may be contemplating forming unions. But based on anecdotal information and union reports, the number of physicians who have joined physician unions is low. A 1997 AMA report estimates that of the nation's 737,800 physicians, 14,000 to 20,000 belong to such unions, with nearly half being residents.
Still, there is no denying the growing interest in unions. Physicians believe their voices have been muffled, and they are shouting to be heard.
Through the democratic process of our House of Delegates, AMA members have established policies that support physicians' rights to engage in collective bargaining without using patients as leverage.
We do not believe that traditional labor unions are necessary for the medical profession. Employed physicians already have the legal right to negotiate collectively with their employers. Moreover, the AMA believes that state, county and specialty medical societies are in a better position than labor unions, both legally and professionally, to help physicians with collective negotiating.
On behalf of physicians, medical societies can discuss reimbursement issues with payers and provide supporting documentation. They also can express opinions about medical issues and talk to health plans on their members' behalf. What they cannot do is negotiate payment or threaten or imply a boycott.
Unions can't do that either. Contrary to the claims of union officials, physician unions cannot negotiate with health plans or any other entity on behalf of independent, nonemployed physicians. If they try to do so, they are violating antitrust laws. Besides, what do unions know about the practice of medicine and what's best for patients? Physicians are the ones who must speak up and act.
Consistent with this belief, the AMA is conducting a pilot project with a group of employed physicians in Rockford, Ill., to build a model of physician representation. We are assisting the Rockford Physicians Council, which has agreed never to strike or withhold services, through our Division of Physician and Patient Advocacy. The division helps physicians bargain collectively in an effective, ethical manner.
Physicians must work together to gain a collective voice-a voice whose strength is based on professionalism, not pickets.
Wootton is president of the American Medical Association