Physicians are finding their path to collective bargaining strewn with obstacles. It's a bitter lesson for those medical professionals who thought that simply slapping the union label on large numbers of doctors was the answer to all their problems.
We've repeatedly acknowledged the frustrations of clinicians who feel they must constantly struggle for power against the bean counters and bureaucrats who have turned managed care into a nightmare. But we've also said that helping physicians regain clinical and managerial autonomy is not served by having private doctors emulate Jimmy Hoffa. Now it's time to re-evaluate other options.
The most recent blow was struck in a ruling from the Supreme Court. The justices unanimously held that nurses at a mental healthcare facility couldn't form a union because they fit the National Labor Relations Board's definition of supervisors.
The decision placed PRN, the AMA's "no strike" organizing arm, in jeopardy.
Seeing parallels between nurses and doctors, who also supervise and direct others, PRN halted efforts to unionize any more physicians in private hospitals.
Statewide efforts to facilitate collective negotiations aren't faring any better. In California, a bill giving physicians the right to collectively or individually bargain with health plans has passed the state Assembly, but it faces a floor fight in the Senate. At least one antitrust expert believes the legislation, which is sponsored by the California Medical Association, would violate federal antitrust laws.
Thus far, only Texas has passed a state law allowing physicians to collectively negotiate with health plans, but strict regulations have kept doctors from using it in any meaningful way. Congressional passage of antitrust legislation that would allow collective bargaining by self-employed physicians appears unlikely.
As so often seems to be the case, physician leaders must exercise creativity, not simply raw power, to help themselves and their colleagues regain control of their destinies and ensure quality patient care. In recent issues, we have highlighted diverse approaches ranging from turning doctor-owned surgery centers into full-blown acute care hospitals, expanding practice revenues by focusing on wellness and ancillary services and establishing group office visits to improve efficiency and reduce patient waits.
Quality care, not collective bargaining, will assure that physicians survive and thrive.
Modern Physician, in cooperation with PricewaterhouseCoopers, is conducting its fourth annual technology survey of medical practices.
Watch your mail for your copy of the survey, or fill out the survey online and be eligible to win a handheld computer.
To take the survey online, visit our Web site at www.modernphysician.com or the PWC site at www.pwcglobal.com/healthcare.
Results will be published in our November issue.