The Union Cure

Unions were for the poor slob who couldn't make it on his own -- that was the thinking of many college-educated types. Unlike blue-collar workers who found that they had to band together to protect themselves from the excesses of their employers, professionals were proud of their ability to succeed in their jobs -- sorry, professions -- through individual effort. Their years of training gave them autonomy in their work and set them apart from the blue-collar stiffs who were just following orders all day.But as corporate behemoths gobble more and more sectors of the economy, even professionals are finding that their power over work conditions is dwindling. It's a lesson that's coming hard to some of the most powerful and wealthy employees in the marketplace: doctors. Gone are the days when your typical doctor owned his own practice. About 42 percent of doctors in the United States are salaried employees now, up from 24 percent in 1983. They work for the managed care companies that, with their emphasis on cost-cutting by any means necessary, have quickly come to dominate the medical market. The result? Doctors are signing union cards. "A doctor is not a small business owner anymore," says Dr. Ida Hellander, who is director of Physicians for a National Health Program in Chicago. "They're now more like a Walmart employee. This (unionizing) is an indication of how little power they have." But doctors say they aren't calling on Big Labor just to bargain another nickel in the pay envelope. Like the assembly line workers who sat down in the auto plants in the 1930's, these hired hands' beef is working conditions: they're steamed because the corporate takeover of medicine has eroded their autonomy. And that relates directly to one of their reasons for choosing medicine: the desire to heal the sick. Doctors who work for for-profit health care giants such as Aetna and Columbia/HCA say that management's push for profits is forcing doctors to do more with less -- and putting patients at risk in the process. That's exactly what happened at the Thomas-Davis Medical Centers in Tucson, where doctors have formed a union. Doctors' licenses make them legally responsible for decisions made about treatments, explains Jack Seddon, executive director of the Federation of Physicians and Dentists (FPD), and a key player in the organizing drive. When cost control mechanisms interfere with those decisions, "it finally gets to the point where if the physician is going to protect their license and the patient, they have to revolt."Seddon refers to overbearing use of "utilization review," which keeps doctors from referring patients to specialists both in-house and outside the HMO, and constraints on which procedures doctors may even mention to patients -- the infamous "gag rules." Another cost-cutter that threatens patients is restrictions on length of hospital stays, leading doctors' union leaders to complain about policies like "drive-through mastectomies."In the initial organizing stages in Tucson, Seddon says, the HMO's former management was "bleeding off two-thirds of every dollar of income, leaving very little to operate the clinic." The drain led to layoffs, making it harder for patients to schedule appointments or even get their x-rays read in a timely fashion. The bean-counters even cut back on rubber gloves.When a new company bought Thomas-Davis, according to Seddon, matters only got worse. Last December, doctors there became the first doctor-employees of a for-profit HMO to unionize, voting 93-32 to join the FPD. (The FPD is affiliated with an AFL-CIO union.) A few months later, the 458 other Thomas-Davis employees voted to unionize as well. The union's list of contract demands at Thomas-Davis includes not only the usual clauses regarding hours and salaries, but also addresses appropriate staffing and includes a patient protection program. "A lot of it deals with patient care and physicians' right to make medical judgment calls," says Seddon.In addition, he expects that 43 doctors who were terminated will be rehired with back pay.The Tucson organizing drive has inspired doctors in other cities to contact the FPD. Seddon says the union now has organizing drives under way in two western cities and has filed for a union representation election at the Las Vegas Medical center. A union that represents doctors in training, the 9,000-member Committee of Interns and Residents, likewise has grown by 50 percent in the last 18 months."We can't keep up with the demand," says Director John Ronches. "Doctors feel that their ability to take care of their patients is being influenced by clerks and other non-medical people that have no relationship with the patient, whose goal is to reduce the bottom line, not to reduce the patient's discomfort. For people who went into medicine thinking they were going to help people who are ill, it's a great shock."The growing interest in unions has now prompted CIR to affiliate with the huge Service Employees International Union (SEIU) after 40 years as an independent union of doctors only. The CIR hopes the affiliation will bring in more resources and engender unity with other health care workers.If you're worried that a unionized corps of physicians may leave you shivering on an examination table while they strike for even more pay, that doesn't seem to be in the cards. The Tucson group pledges not to use the threat of a strike as a weapon, and the American Medical Association (AMA) also adamantly opposes strikes, though the professional group does support doctors' right to unionize. An older union, however, the Doctors Council in New York, pulled the first attending physicians' walk-out in the country in 1991, at a Brooklyn hospital. After two days, they won a pay increase and restoration of funds for patient services. The larger question is how doctors' unions will impact the way medical services are delivered in this country. As doctors increasingly see themselves as proletarians, rubbing shoulders with orderlies and nurses' aides at union conventions, will they also become more liberal, breaking the stereotype of the golf-playing Republican? "Hope springs eternal," says Ronches. "We haven't seen that sort of sea change yet."Perhaps this is why some physician activists see unionization as not nearly enough to restore quality care. They believe the whole for-profit phenomenon will have to be taken on."The challenge is not just to preserve the prerogatives of certain licensed specialties," says SEIU's David Snapp, who organizes health care workers of all sorts. "The big challenge is dealing with powerful companies that are creating a market dynamic that is sweeping away things won over years."Along those lines, doctors in Massachusetts began a movement this spring against what they call the industrialization of medicine. They formed the Ad Hoc Committee to Defend Health Care and collected nearly 2,000 Massachusetts doctors' signatures on a "Call to Action." Tacitly recognizing past excesses, the petition condemns not only pursuit of corporate profit in health care but pursuit of personal fortune as well. It calls for access to health care as the right of all. The movement has spread to some 20 states, with nationwide conference calls and plans to publish the signatures in the Journal of the American Medical Association.Ida Hellander welcomes the development. Her group, Physicians for a National Health Program, wants the United States to adopt the Canadian "single-payer" model, where all citizens have the right to free care, paid for by taxes, and the profit motive is eliminated. She's for doctor's unions, but counsels that they're not enough. Unions, she says, may tend to focus solely on the issues in a particular workplace and care of the insured patients who come there -- leaving aside the millions of uninsured."Forming unions is an attempt to gain control within the current system," she says. "We're pushing for a whole new system." (To contact the Michigan chapter of the Ad Hoc Committee to Defend Health Care, which is organizing both nurses and doctors, call 313-531-2136.)

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