Doctors struggle to form union supported by AMA

  1. Doctors struggle to form union supported by AMA
    Supreme Court ruling (against nurses) makes process more difficult

    By THERESA AGOVINO
    Associated Press
    http://www.chron.com/cs/CDA/story.hts/business/973386
    Houstin Chronicle: July 20, 2001, 8:36PM

    GROSSE POINTE, Mich. -- Shobha Gehani had an image of union workers, and she didn't fit the bill.

    "I thought of unions as big men on picket lines," said the petite physician as she made avocado sandwiches for her guests. "I just didn't equate unions with doctors."

    Nonetheless, last year she and her doctor colleagues at the Wellness Plan, a Detroit-based health maintenance organization, voted to form a union with help from Physicians for Responsible Negotiation, or PRN, an arm of the American Medical Association.

    Wellness Plan physicians were tired of large patient loads and abrupt, unannounced changes. One day last year Gehani went to work to discover the medical lab had been closed. No explanation was offered.

    "It was like the doctors and the management were operating in parallel universes," Gehani said.

    PRN was formed in 1999 to respond to doctors considering unionization because they felt the focus on cutting health care costs was interfering with patient care and jeopardizing their professionalism. The organization's debut dovetailed with a National Labor Relations Board ruling that made it easier for medical interns and residents to unionize.

    PRN's membership includes two physician groups and an additional two are under review. The Committee for Interns and Residents, a separate organization that bargains for doctors in training, has added 1,500 members since 1999 to bring the total to 11,000.

    But in late May, the Supreme Court issued a ruling in a Kentucky case involving nurses that could make it more difficult for doctors to unionize.

    The case hinged on who is considered a supervisor. The court said white-collar employees who use "independent judgment" to direct other employees are supervisors and thus not eligible for collective bargaining. Labor experts say the ruling could have a chilling effect on union-minded doctors because instructing nurses and orderlies is part of their job.

    "Conditions for physicians are worsening. Hospitals are laying off nurses and other staff, and there is more pressure on doctors than ever," said Eric Scherzer, associate director of CIR. "The Supreme Court ruling still puts the pressure on employers to prove that people are supervisors."

    CIR will continue its activities, while PRN has suspended organizing for the time being.

    Labor law sets three criteria to be considered a supervisor -- in two of the three, the Supreme Court has already issued rulings that would define doctors as supervisors. The third criteria, not yet tested, focuses on whether someone can carry out managerial decisions such as hiring, firing or promoting.

    The issue could be further defined later this month when the National Labor Relations Board hears a dispute between PRN and Dallas-based Concentra Inc. Doctors in the New Jersey division of Concentra, an operator of occupational health centers, had voted to unionize, but the company is contesting the vote.

    Dr. Victor Salvo finds it ironic that the Supreme Court rulings could define doctors as supervisors because he and his colleagues want to unionize because they feel Concentra is micromanaging them.

    "Our independent judgment was compromised," Salvo said. "If the company thought that only 10 percent of patients should see specialists and you sent 12 percent, you would hear about it. Decisions about patients should be left to physicians."

    Since PRN has organized only two groups of doctors, it is difficult to assess whether it has improved conditions for those it represents.

    At CIR, which is more than 20 years old, recent contracts show signs of success. Doctors represented at Brookdale Hospital in New York recently received a raise and better benefits.

    "I think the union helped us achieve progress," said Gail McDonald, a resident at Brookdale. "Before, we didn't have a united front."

    Negotiations are continuing between Austin-based Third Coast Emergencies Physicians and some of its doctors, who unionized in 1999 and affiliated with PRN last year.

    Doctors felt they had little control over their schedules and emergency-room procedures, and they say Third Coast didn't supply them with copies of patient billing records that allow them to ensure excessive charges weren't attributed to their services. The company denies that billing records were withheld.

    "I have a hard time feeling sorry for those guys," said Dr. Bruce Moscow, an owner of Third Coast, which provides emergency-room doctors to Austin-area hospitals. "They get health, life and disability insurance and make between $250,000 and $300,000 a year."

    Dr. John Calomeni says the union isn't about the pay. "We want better control of our destiny and better control of patient care."

    Calomeni said he was disappointed by the Supreme Court ruling in May because it will make the already difficult task of pushing doctors to unionize even harder.

    Physicians have been reluctant to unionize for a variety of reasons, ranging from the novelty of the idea to the public image of unions.

    Indeed, PRN made the idea of unionizing more palatable because it was sanctioned by the AMA and would uphold the tenets of the profession. For example, PRN unions are barred from striking because of the ramifications on patient care.

    Doctors and the Wellness Plan had brief discussions with the United Auto Workers, but Gehani said she wouldn't join a union affiliated with the UAW.

    "The issues are just too different," she said.
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