Employed physicians of the Rockford Health System, which includes Rockford (Ill.) Memorial Hospital and Rockford Clinic, met in spring 1997 to explore forming a collective bargaining unit. Many of us had come from a large multispecialty clinic acquired by the healthcare system in 1994. For three years after the acquisition, the system told us we would become a physician-led organization. That didn't happen.
Instead, the system laid off a significant number of staff in summer 1996 because of budget constraints. As a result, physicians and patients had to wait longer for access to laboratory, X-ray and dictation services. Some of the floors even closed, which made admitting patients more difficult.
These decisions were made without real physician involvement. Many of us realized that the true problems were physicians' lack of control and the fact that we were not dealing with other physicians in seeking solutions.
We tried to work within the existing hospital mechanisms to solve problems. Several physicians even had leadership roles in the system, but they realized they were basically impotent. We also had no due process for resolving disputes over staffing and contracting.
I do not believe that the quality of patient care was severely compromised. But I was concerned about the direction my practice was taking, and I talked to my patients about the changes that made it more difficult for me to take care of them.
With help from the American Medical Association, three physicians founded the Rockford Physicians Council, a demo-cratic, self-governed group of employed physicians. Our goals are to restore the integrity of the physician-patient relationship and establish equitable systems of due process and negotiation. We want to accomplish those goals by working cooperatively with the system.
When the health system learned about the physicians' council, it quickly reorganized its physician leadership group and hired numerous consultants.
Our council thought the changes were acceptable but inadequate. The leadership group had been self-selected by management, not through the democratic process. Ultimate control of physicians remained with the chief executive officer and the board. We also feared that if our council ceased to exist, any concessions would dissipate.
We asked to meet with the system's physician leadership on several occasions but were rebuffed.
The council submitted a petition to the National Labor Relations Board last year to allow us to hold an election on whether to become a collective bargaining unit. We needed the signatures of at least 30% of the system's 180 or so employed physicians, and we obtained 70. Before authorizing our election, the NLRB held hearings to decide which members of our group were eligible to vote.
Employees cannot vote if they are considered supervisors or managers. The system contended that all employed physicians are supervisors or managers. The autonomous nature of medical practice does raise some questions about whether physicians can be members of collective bargaining units. But our group maintained that very few employed physicians meet the criteria for supervisors and managers, such as the ability to hire and fire.
Before the NLRB had determined which employees were eligible to vote, the council decided to defer an election. The employed physicians at large expressed a desire to give the hospital leadership more time to implement changes. Nevertheless, the council will continue to monitor the situation and will reinstate its election petition if Rockford Health System does not keep working toward becoming a physician led, patient controlled organization. Regardless of the outcome of our situation, I believe the time is ripe to combine the protections of a collective bargaining unit with the professional responsibilities of practicing medicine.
Norem is a member of the Rockford Physicians Council