Physicians for Responsible Negotiation, unveiled two years ago this month as a national labor union for doctors, is struggling for survival after receiving more than $3 million in loans from its sole benefactor, the Chicago-based American Medical Association.
Competing toe-to-toe with traditional union groups with far more experience in a highly competitive and complex arena, PRN has managed to organize just 38 physicians employed by a Medicaid HMO in Detroit. That works out to an investment of about $78,947 per doctor.
"I hate to predict the demise of anyone-especially another labor group," said Robert Weinmann, M.D., executive director of the Oakland, Calif.-based Union of American Physicians and Dentists, which represents about 6,000 members. "But the real question with PRN is this: How long will the AMA be willing to back this group-how much money will they pump into this thing?"
A recent UAPD newsletter, headlined "AMA in Turmoil," said the Chicago-based doctors' group denied a request by PRN officials for an additional loan of "several million dollars." In fact, according to AMA documents, the labor union presented a "revised business plan" in September 2000 that called for about $3.9 million in funding through 2004.
The AMA provided an initial subsidy of $1.2 million when the labor group debuted in November 1999, and a $1.8 million loan one month after PRN officials presented their costlier business plan. So funding from the AMA fell about $900,000 below the expectations of PRN's top officials.
Timothy Flaherty, M.D., chairman of the AMA's board of trustees, said PRN has not asked for more money in recent months.
Last summer, the AMA's House of Delegates, gathered in Chicago for its annual meeting, offered what appeared to be equivocal support for the group. Members voted to modify a resolution that called for the AMA to continue to provide "adequate funding for PRN, in accordance with applicable laws." That phrase was deleted and a substitute resolution said the AMA would "consider whatever is legally possible and fiscally responsible to support the continued viability of PRN."
AMA officials said the change in language was viewed as "positive" by PRN's president, Susan Adelman, M.D., a pediatric surgeon in Southfield, Mich., who also serves on the AMA's board of trustees.
The union group has suffered through a troubled existence since its difficult birth. It was created in 1999 by the House of Delegates despite opposition from the AMA's own board, which produced a 73-page report concluding that a national labor group would pose potential conflicts involving patient-care issues and prove very costly unless it was not quickly successful in attracting members. The report also pointed out that the AMA had little experience in collective bargaining.
The labor group's first full-time executive director, Robert Bernat, M.D., an internist who also holds a law degree, abruptly left the group without a public explanation in late June after just a year on the job. PRN officials said he left to pursue other opportunities. Bernat was reached last week but remained tight-lipped and terse about the reasons for his departure. "I can't say anything," he said.
Since Bernat's departure, the organization has operated without an executive director. A PRN official said last week there is no immediate plan to hire a replacement.
What's more, PRN halted efforts to organize privately employed doctors after an adverse Supreme Court ruling in May that greatly expanded the definition of supervisors, making it difficult or impossible to organize private-sector physicians. PRN's decision, questioned by officials from other unions, severely restricted PRN's ability to sign up new members and generate revenue.
Weinmann views the PRN decision as a surrender, saying union groups must be willing to aggressively challenge the Supreme Court ruling because it might not apply in every case involving privately employed physicians. "I think this showed the ambivalence of the AMA toward unions."
But PRN officials, who say they will fight the Supreme Court ruling, remain optimistic about the future of the labor union. For now, officials have said, they expect to target workers in the public sector, including those at state university teaching hospitals, and to persuade AMA members to help identify groups of physicians likely to join PRN.
Mark Fox, M.D., an otolaryngologist from Scarsdale, N.Y., who has been on PRN's board since the group's inception, believes the labor union is effective and will continue to get AMA support. "We're basically an organization in its infancy," he said. "We're very happy where we've come so far."
Despite predictions of a unionization boom by doctors who seek increased leverage in bargaining with powerful managed-care organizations, only about 45,000 of America's 650,000 active physicians are now union members.
In addition to representing the doctors in Detroit, PRN is now in the process of trying to organize two other groups-21 New Jersey physicians employed by Concentra Health Services at clinics throughout the state and 168 residents and fellows at Lutheran General Hospital in Park Ridge, Ill. It also formed an affiliation with a group of 18 emergency room physicians in Texas who already formed a stand-alone labor organization.
Eric Scherzer, associate director of the New York City-based Committee of Interns and Residents, which represents about 11,000 house staff, predicted that PRN's demise is a "foregone conclusion unless they organize more members."
"Our position is not to knock any group," he said, "but rather to say that CIR has a proven track record and has experience in dealing with all facets (of the collective bargaining process)."
The AMA created its labor group so that it would be well-positioned to represent independent, self-employed physicians should they become eligible for collective bargaining. Congressional action on that controversial issue-one of the AMA's principal lobbying efforts-appears unlikely in the near future.
The group faces another obstacle. As a compromise with doctors opposed to the labor group's formation in the first place, PRN vowed never to strike. Although AMA officials say a strike would amount to a violation of their ethical obligations to patients, leaders of other trade unions say the concession severely curtails PRN's effectiveness by depriving the group of a key bargaining tool.