Should Doctors Unionize?




Health and Healthcare CategoryIn this time of financial strain on physicians and the government reimbursement system we once again need to address the question — should doctors unionize?

Recently, a group of physician picketed Capitol Hill to denounce continue reimbursement cuts. This results in a temporary stay of a planned 20% cut for next year. As many doctors will agree, we are facing difficult times and many physicians are looking at other ways to create income to support their practice and their families.

UnionUnions have been around for a long time. They typically are based on industry, require a percentage of income to join, and have strong leadership to negotiate salaries and benefits. Businesses have never liked unions as they increase the cost of work and often lead to such cumbersome rules and restrictions that ultimately may limit productivity.

In the medical profession, unionization could have significant bargaining power among physicians or among specialists. For example, if we take the example of ophthalmologists who take care of cataracts and do eye surgery, the unionization and collective bargaining could single handedly dictate the terms and types of care that all people in this country receive for eye care. It could result in basically monopolization and anti-trust issues in the eye care industry.

Without such unionization, ophthalmologists (and all other physicians) are at the mercy of the government payer. If the government wants to decrease reimbursement then we must accept it. The alternative is for doctors to stop accepting Medicare and to fight back. For many physicians, this goes against the entire reason that we entered medicine — to take care of people. Some doctors are doing it, others are trying it out with mixed success. But one common theme emerges from these doctors — they are happier for doing so.

If doctors start doing this in mass, many patients will be left out on the street with nobody to take care of them. Are we as a country ready for this? Are physicians as a group ready to continue to accept lower payments? Should physicians unionize and collectively bargain for better reimbursements?

  • you know, I have been asking this question to many people, to understand just this very topic…. why docs dont unionize (I am just starting residency and am in a residents union and am thinking of my future in medicine)….

    I always thought there is power in numbers…. and if too many parties are controlling or influencing the delivery of medical care as its delivered by the physician, maybe docs have to take it back via unions?

    I am very curious about the costs and benefits of unionizing to docs and would love to read more on this topic.

  • Dazureus

    My wife is a general surgery resident, and I would love to see her stop getting worked to the bone. If a doctors union would help re-humanize health care, I would be all for it. However, I’m not sure what kind of power a union would have. The power of other labor unions come from organization and in extreme cases, strike. Striking just isn’t possible for doctors. The level of competition and the current hierarchical structure doesn’t allow for it, not to mention any personal oaths and morals. Nurses and physicians assistants have unionized and they’re reaping the benefits of guaranteed work hours with excellent pay. If you do the math, resident doctors don’t make much more those in the service sector, while non-chair post-resident doctors are compensated on par with most white color jobs. They’re demonized in the media when something goes wrong while only a handful of innovators are cherished for their daring. The U.S. litigious society has made it very very difficult for doctors and surgeons to enjoy their occupation. Instead of treating patients, they’re worried about how their patients will treat them. They’re besieged on both sides, hospital administrators trying to cut costs and vengeful litigation from those they try to serve.

  • I believe that the entire health care system has been taken over by big industry and has tainted medicine in its drive to make bigger and bigger profits. With that said I believe that most physicians are being used by the same corporate force that is using nurses. We are the providers and are complentary to one another. We along with the patient know what is best for them, yet the insurance industry and the corporations are the ones directing care and deciding what you get paid for that service. The relationship has become one sided and like any relationship that is dominated by one side it is doomed to fail. I don’t believe in a return to fee for service and do support regulation and caps in reimbursment but I believe that it should be fair and based on the reality of the cost associated with performing the procedure, includingthe skill it takes to perform it. I don’t believe that the insurance industry is the one that should decide that. Fairness is somewhere in the middle.

    Physicians have moved closer to the plight of the average worker in the sense that they have less and less control over their practice and how and where they deliver care. So fundamentaly I support any group of people using the avenue of organizing and collective barganing.

  • Should physicians unionize? It seems many doctors have already self-regulated into professional associations that function as mini-unions to increase leverage with both healthcare facilities and insurance providers. Case in point is the anesthesia group at my own facility, part of the Baylor system in Texas. Years ago each of our anesthesiologists were sole providers. All but one of them formed a group association. That one anesthesiologist, continued to work and managed to keep a decent caseload at the hospital.

    Today, I work with many of the same anesthesiologists that I have known from my early days at this facility. They now represent a large anesthesia group covering many of the hospitals in our area. The downside of their survival in an industry that has many economic indices and hurdles is that they are no longer able to settle in at one facility for the entire day. They may start their day with us and then travel down the road for 2-3 cases at the end of the day. As our own group covers several area facilities, both acute care with inhouse population demographics and free standing surgical and gastro facilities we observe the daily maneuverings of our group to determine who goes to what facility at any given moment should there be an emergency add on case.

    It seems that prudent physicians must seek to move to a demographic-based clientele that slices up the pie into percentages. Are they able to take a twenty percent Medicare/Medicaid demographic alongside an eighty percent standard insurance provider clientele? All of this will also depend on the facility in which they practice. Our own facility struggles with increasing numbers of self-pay clients and we are lucky to get a ten cent on the dollar reimbursement.

    I do not have the wisdom to adequately address this issue. It has the complexity of Ariadne’s thread. The legal and economic passageways are too convoluted and gone are the days when the R.N. was the most valuable asset for a physician. His most cherished employee is the one who can code the Medicare reimbursment or insurance reimbursement efficiently.

    Tammy Swofford

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  • Annie

    Unions may play a transformational role in representing physicians’ interests, but they can’t comprehensively address the professional judgment and autonomy needs of professionals, thus limiting their role.

    However, as more and more physicians practice as employees, they are discovering the nastiness in the guise of unreasonable patient case loads and unsafe work conditions, the oppressiveness and the contstraints that so doing has placed on registered nurses for decades.

    I think one alternative is to use the framework of professional practice organizations as busines entities to directly contract professional services and staff to patient care institutions. In fact, self-governed organizations could feasibly be populated with registered nurse and physcian members and for example, contract all inpatient nursing, diagnostic imaging, emergency medicine, hospitalist and anesthesia services to a hospital. They (the SGOs) would be able to recruit their own clinical leaders, thus making nursing and physician leaders accountable to their colleagues instead of to an employing organization, and the power of large numbers of nurses and physicians would influence their ability to retain reasonable measures of autonomy over their practice, work conditions and patient safety and advocacy.

    I blog about this at the link at my name, as well as at my dormant blog, Universal Health.

    What is clear is that physicians and nurses require collective representation in order to practice safely and to be able to bring the appropriate resources to bear to effect desired patient outcomes.

  • bhornet

    The way I see it. The days of putting up a shingle and seeing patients is over. Hospital own practices, and have monopolized entire markets, and can deny independant doctors admitting priviledges. They have hammered down salaries to below most nurses with 3 to 4 years of training after highschool. In Harvard affiliated hospital, fellowship trained physicians can be offered salaries below $90K to $120K. Yes, that is after 4 years of undergrad, 4 years of medical school, and 6 to 9 years of residency and fellowship training. This is all after accruing $100 to $250K of debt. The average nurse in Boston who has a bachelors degree makes $80 to $120K. Why is this true? Well simple. Nurses have unions that fight collectively on there behalf. Doctors don’t. This hostile environment for doctors will no doubt make it tougher to recruit well trained physicians to further there training into research/subspeciality care that will find new treatments for many of today’s disease processes.

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  • future of physician compensation

    An interesting discussion is worth comment. I do believe that you ought to write more about
    this issue, it may not be a taboo subject but typically people don’t talk about such topics. To the next! Cheers!!

JC, MD

Dr. JC is a medical doctor who has a passion for health promotion and education.
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