Marcus Welby may no longer be the icon of America's doctors, but hopefully his replacement won't be Jimmy Hoffa.
It could happen, if physicians persist in their dangerous campaign to bring large numbers of doctors under the union umbrella. The ill-advised effort has been gaining momentum for months, culminated by a "union, yes" vote at the American Medical Association's House of Delegates meeting in June in Chicago. In addition, many state legislative efforts to give doctors greater collective bargaining power are moving forward.
It's not hard to sympathize with physician concerns about the erosion of clinicians' power in today's healthcare environment -- particularly given the concurrent escalation in the importance of bureaucrats and bean-counters. But the answer is not to have private doctors emulating teamsters or auto workers.
For starters, despite their frustrations with managed care, physicians control much more of their work environment than most other workers. That alone makes them unlike truck drivers, assembly-line workers or even school teachers, whose organizing activities undoubtedly and unfortunately have reduced their profession's stature in the public eye.
Physicians' work involves life and death to a degree that is unlike other areas of commerce. Organized medicine understands this difference and, as a result, the AMA has pledged to adhere to a no-strike policy. To do otherwise would run the risk of not only irritating patients but also possibly harming them.
But removing the labor union's ultimate weapon in its power game with employers -- the walkout threat -- makes a union of doctors all but toothless. What are unhappy doctors going to do? Refuse to perform routine exams or to bill insurers?
There's also the income issue. It's no doubt difficult for a middle-class American family with an income of $40,000 and no health insurance to feel sympathy for the financial plight of physicians who, according to the latest data from 1997, are earning $199,000 per year on average and often hundreds of thousands of dollars more.
Now, all this anxiety over unions probably is overblown. Factors such as federal antitrust laws will limit the extent to which private physicians wear the union label. Current organizing efforts apply only to the 15% of the nation's physicians who are employed or who are residents or interns.
Doctors who want to exert their power can find better ways to do so -- many are working to develop organizations that create value and provide systems of care that are accountable for patient outcomes. With a little luck, the spread of these endeavors may help counteract what appears to be another unfortunate public relations stumble by leaders of the medical profession.