The labor movement continues to make inroads among physicians, this time in the Seattle area.
Last month physicians at Medalia HealthCare, a network of 46 primary-care clinics and 315 physicians run by the Providence and Franciscan Health Systems, voted 104-75 to join the New York-based United Salaried Physicians and Dentists.
Only Medalia's 230 employed physicians were eligible to vote. The new collective bargaining unit will be known as Northwest Physicians Alliance. The physicians are in the process of electing union officials and expect to begin negotiations late this summer.
Medalia has about 100,000 managed-care enrollees and had more than a million patient visits last year. USPD, an affiliate of the Service Employees International Union, is more than 20 years old and has more than 1,000 physician members.
Medalia was formed in January 1995 in response to an anticipated boom in managed care in Seattle. Many of Medalia's current physicians feared that boom and jumped aboard the integrated delivery system bandwagon. Dan Vandermeer, M.D., an Everett, Wash., family practitioner, was among the physicians who sold their independent practices to Medalia and became salaried physicians. That loss of autonomy, combined with pressure to spend less time with patients and salary reductions, has physicians frustrated, and ultimately led them to seek union membership, he says.
Medalia spokesman Budd Wagner says many of the physicians' complaints are being internally addressed and could be resolved given time. "These are the growing pains of a new organization bringing together physicians from a wide background of practice styles," he says. The union "was born out of general frustration."
Chief Medical Officer Dave Bales, M.D., says some of Medalia's problems stem from the fact that the managed-care boom hasn't hit as hard as expected. "The shift to managed care did not happen as rapidly as anticipated. As a consequence, all the assumptions that the business plan was built on were not all there, and we were way off in terms of what the losses would be," he says.
"The knee-jerk response was to go after costs, and 50% of costs is physician compensation. So that naturally took a hit."
Vandermeer says lack of communication with management and pressure to see additional patients pushed him to explore unions. "The answer to every question was 'see more patients.' When I first signed on, I was told to be busy and earn my keep -- I needed to see 22 patients a day. Then I was told to see 30 patients a day," he says.
Vandermeer says patient contact hours (the amount of scheduled appointment time) was also increased to 36 hours a week from 32. In addition, the conversion of patient charts to a new format caused numerous problems.
Bales says Medalia is committed to working with the new union, but he doubts the union is the cure-all some physicians believe it to be.
"My biggest fear is it has raised expectations of those who are in the union movement that this will be the answer, and its not going to be the answer. It's going to add another layer of bureaucracy to another already too bureaucratic system," he says.
Randy Killian, executive director of the American Association of Integrated Healthcare Delivery Systems, says the frustrations physicians at Medalia feel are not uncommon and physician dissatisfaction is a problem at many integrated systems. But, he adds, physician unionization creates opposing viewpoints, when what is needed is a team approach.
"What we're really talking about is change management. A lot of people have the perception that physicians do not want to change. That's absolutely not true," he says.