The American Medical Association's historic vote to form a national physician union could boost local unionization efforts. Physicians are unlikely to join the AMA union en masse, observers say, but they may open up to local union recruitment efforts as a result of the AMA's decision.
"It legitimizes the dialogue," says Wayne Spiggle, M.D., of the AMA vote.
Spiggle is a Cumberland, Md., internist and president of MedChi, the Maryland State Medical Society.
"Prior to this, when you said 'organize' or 'unionize,' there was a negative connotation," he says. "But now, when we say we must have the ability for collective bargaining in order to be effective advocates for our patients, it will be an argument that is well accepted within the profession."
The 7,000-member Maryland society is considering forming a union, and the 16,000-member Illinois State Medical Society voted last spring to do the same. Several other state societies could follow suit.
At the AMA's June House of Delegates meeting in Chicago, a majority of the 494 delegates voted to form a union to represent employed physician members.
Existing antitrust laws prohibit private practice physicians from organizing. Employed physicians account for about one in seven of the nation's 650,000 practicing physicians.
To help spread its new union gospel and drum up support for the collective bargaining unit, the AMA placed full-page advertisements in several newspapers, including USA Today. The headline declares: "Last Wednesday, we voted to put what's out-of-whack in healthcare back into whack."
"We need to make the public aware that this was a very thoughtful decision, and a very considered decision by the House of Delegates, and very indicative of the huge frustration physicians are up against in carrying out what they think is best," says Randolph Smoak, M.D., chairman of the AMA's Board of Trustees.
Details about how the AMA union will function have not been announced, but Smoak says he expects the AMA to provide more big-picture help than hands-on organizing. "We're not going to seek out people. We're in the business of solving problems. We'll help them facilitate negotiations," he says, noting initial organization and final contract negotiations will be conducted by local members.
Clair Callan, M.D., an anesthesiologist and president of the Illinois State Medical Society, believes the AMA could help state society-sponsored unions by providing guidance and expertise. "Instead of having 50 individual organizations go through the process independently, they could develop a model with bylaws, structure . . . there's no point in all of us reinventing the wheel," she says.
"I hope that as we get into our process and they get into theirs, maybe we can share information and try to work together."
The AMA promises its union, unlike traditional unions, will not engage in strikes. But other physician unions say without that threat, the AMA's collective bargaining union will not be successful. Still, Robert Weinmann, M.D., president of the Oakland-based Union of American Physicians and Dentists, says he's happy to see the AMA endorsing some union activity.
"The main thing is that the AMA has made a complete reversal of its 27-year mantra, during which it said, most pompously, that the AMA is not a union nor could it ever become one," he says. "What they did do was lend their aura of respectability to this movement, which heretofore they had denigrated. This is helpful because it now means that doctors no longer have to worry about whether to join a union, they only need decide which union they're going to join."