Frustrated by what it calls managed care's interference with the physician-patient relationship, the 17,000-member Florida Medical Association stepped to the brink of union endorsement last month. But at the 11th hour, the organization pulled back.
The flirtation with forming a physicians' guild illustrates not only unions' growing influence within the physician community, but also the lingering reluctance of many physicians to embrace the labor movement.
The number of physicians who join unions is rising, but mostly they are salaried physicians. The FMA would have been the first statewide physician organization to endorse a union.
Managed care dominates the Florida landscape, and growing physician dissatisfaction with managed-care restrictions led the FMA last year to appoint a committee to study unions. When the committee presented its findings and suggestions to the association's house of delegates at its annual meeting last month, it proposed naming the Office and Professional Employees International Union, an AFL-CIO affiliated union, to represent physician members.
Before a vote on unionization could be held, however, FMA president Glenn Bryan, M.D., proposed an alternative: the establishment of an advocacy center to assist patients and physicians with issues of access, choice and quality in managed-care plans. The FMA has not yet finalized the center's mission, organization or funding.
Bryan says that concerns about antitrust laws (which make it illegal for physicians to collectively bargain) led him to suggest a nonunion alternative.
"There just wasn't the support for (the union)," he says. "Everybody talks a big game, but when they started to realize that you can't collectively bargain, and we're not going to strike, (then) any benefits will be indirect ones. When they really understood more, (delegates) said 'why do we need to join a union to do this? Why can't we (FMA) do this ourselves?' "
The American Medical Association, which sent a representative to the annual meeting to discourage members from supporting a union, couldn't agree more. The AMA has long argued that state and county medical societies are the appropriate vehicles for physician advocacy, and recently established a "union-like" division of representation that is staffed by AMA lawyers and is available to review managed-care contracts.
"The reason we don't believe physicians should be involved with traditional unions is they come from a different perspective and they may have different agendas and different positions, and we find the unions can't do any more than the medical societies," says AMA trustee and New Orleans vascular surgeon Donald Palmisano, M.D.
Jack Seddon, executive director of the Tallahassee, Fla.-based Federation of Physicians and Dentists, doubts the FMA's advocacy center will be effective. The FPD has made significant inroads in Florida, particularly among specialists, even though it is under investigation in several states for antitrust activity.
Like all unions, the FPD can't collectively bargain for fee-for-service physicians, but it does act as third-party messenger in contract negotiations.
"The AMA had a department of representation back in the '70s that did nothing," Seddon says. "I think it's a waste of money to reinvent the wheel. You can speak a good game, you can analyze some agreements, but the only way I have found to get a reaction from a managed-care company is to have a doctor say, I'm using an agent, and then they can't browbeat that doctor any longer."