The American Medical Association last month backed off plans to form its own union, but the effort may get renewed momentum as local medical societies across the country push their own collective bargaining initiatives.
Late last month, members of the Illinois State Medical Society House of Delegates voted almost unanimously to form a collective bargaining unit. How the unit will work has not been hammered out, but society President Clair Callan, M.D., says something may be in place by the end of the year.
"I don't look at this as a union; I look at this as a way we can work to strengthen our members in their practices. It's a way of getting to the table to talk to all of these plans and really get them to recognize what they're doing to medical care," she says.
Although the AMA decided not to form a union now, it acknowledges there is strong interest among its membership in collective bargaining. AMA leaders plan to bring the union issue to the full House of Delegates for a vote in June.
Callan believes Illinois' recent actions could influence that debate. "I think this would add some impetus to that resolution," she says. "For them to know that Illinois, which is a large state, has reviewed this issue in their House of Delegates and the House of Delegates has passed it, is significant."
Meanwhile, a bill backed by the Texas Medical Association that would allow private practice physicians to collectively bargain is working its way through the state House and Senate. Federal antitrust laws currently prohibit all independent contractors, including physicians, from collective bargaining.
The Texas bill would allow independent physicians to collectively negotiate with health plans free from antitrust concerns, if they agree to strict state supervision. That supervision could take the form of pre-approval from the state's Department of Insurance or attorney general.
"Individual doctors could come together, hire a representative, file a request with the state attorney general to meet with plans, then talk to each other and negotiate with the plan as a group," explains Connie Barron, associate director of legislative affairs for the TMA.
"These negotiations are in no way binding, and nothing mandates (that) the health plan must engage in the negotiation; but this at least would allow them to occur."
AMA trustee Donald Palmisano, M.D., recently testified before a state House committee in support of the Texas bill. In his testimony, Palmisano acknowledged that the AMA has been stymied on the union front by antitrust concerns. Until federal antitrust relief is achieved, Palmisano told legislators, physicians must pursue solutions on a state-by-state basis.
As state societies move to the forefront of the collective bargaining issue, physicians are being asked to choose between traditional unions and medical societies. Not surprisingly, traditional unions are billing themselves as the more qualified collective bargaining voice.
Barry Liebowitz, M.D., president of the National Doctors Alliance, a 15,000-member physician union, greeted the AMA's decision to back off unionization with relief. "I think the AMA has made a wise decision," Liebowitz says. "The association is an important educational and professional organization for doctors. However, they have no experience in negotiating collective bargaining agreements."
Anthony Mitten, executive director of the Maricopa County (Ariz.) Medical Society, says his members are interested in negotiating leverage but are not quite ready for union membership. "When you're acting as a union, you act cohesively; and I am not certain doctors are ready for that collective activity," he says. "Collective bargaining, yes; collective decisionmaking and agreements, I don't know."