The U.S. Supreme Court may have given the American Medical Association a way out of its foray into the collective-bargaining business.
Last week, the AMA revealed it will abandon an expensive and controversial plan to organize privately employed physicians for collective bargaining, saying a recent high-court decision makes the effort almost impossible.
The court ruled on May 29 that nurses at private hospitals can't join labor unions if their duties include supervising other employees, a decision with clear implications for physicians (June 4, p. 36).
Officials with the AMA's Physicians for Responsible Negotiation, which has cost the association at least $3 million during the past two years, say they will continue to "look for organizing opportunities with physicians employed in the public sector."
But Donald Palmisano, M.D., an AMA trustee, said the high court's ruling will "almost certainly make it more difficult, if not impossible, for most employed physicians in the private sector to use collective negotiations as an advocacy tool for addressing important patient-care and workplace concerns with their employers."
The AMA's 547-member House of Delegates, which gathers in Chicago next week for the organization's annual meeting, will consider several options for a future business plan for PRN, officials said. One AMA official, who requested anonymity, said the delegates may even debate whether to close down PRN, which has organized only a single group of 38 employed physicians at a Detroit Medicaid HMO in its 19 months of existence.
"At this point, this is going to be a major decision for the House of Delegates," the official said. "I can't imagine which way it's going to go."
A majority of the AMA's delegates, after heated debate at its annual meeting in June of 1999, voted to form the affiliated national labor union despite objections from some members of the organization's senior management. At the time, a labor group was viewed as a way to attract new members, especially among residents.
PRN President Susan Adelman, M.D., a Detroit-based pediatric surgeon, dismissed speculation about the future of the labor group, which has several union-organizing efforts under way. "We're still in business," she said. "We're committed to our groups, and we will fight very aggressively."
She said the court's decision "leaves an opening" for the National Labor Relations Board to develop "yet another interpretation" of the definition of supervisory personnel, which would then allow PRN to resume its efforts in private-sector collective bargaining for physicians.
The AMA's abrupt decision to scale back its union effort is an admission of failure, said Robert Weinmann, M.D., a neurologist who is president of the Oakland, Calif.-based Union of American Physicians and Dentists. The group has about 6,000 members, about one-third of whom work in the private sector.
"The AMA's unionizing effort turns out not to be as serious as some people had incorrectly expected," Weinmann said. "This is not the time to refrain from organizing; this is the time to break new ground. The AMA has never been committed to unionizing. They don't know how to do it. They should get out of the business; it's too much for them."
Other union leaders say the decision will not force them to suddenly shut down their organizing efforts, because the definition of supervisory personnel is a frequent struggle often decided on an individual basis.
"Employers always raise the issue that certain people we want to represent are supervisory personnel," said Eric Scherzer, associate executive director of the Committee of Interns and Residents, which represents about 11,000 residents in more than 60 hospitals. "And it (often) needs to be litigated on a case-by-case basis at the NLRB. We are continuing to organize."
PRN's Adelman said the labor group will continue to represent the relative handful of private-sector physicians that have signed on with the AMA labor union, including 170 residents at 555-bed Lutheran General Hospital in Park Ridge, Ill. The NLRB is considering an appeal by the hospital's parent, Advocate Health Care, based in Oak Brook, Ill.