More HMOs cause some doctors to discuss unionizing
Some doctors argue that
hospital systems and
HMOs are dictating
medical decisions
The Associated Press
SOMERS POINT, N.J. — Mar
cus Welby with a union card?
It seems an unlikely proposi
tion. Yet with the rise of the HMO,
many doctors think unionizing is
their best weapon against Big
Medicine, and they are seeking the
same right as that afforded to
truckers or factory workers: to bar
gain collectively over pay and
working conditions.
Many group practices are now
owned by hospital systems and
managed care companies, so more
than 45 percent of doctors are now
employees. And many argue that
health maintenance organiza
tions, or HMOs, have become their
de facto employers, dictating how
they run their practices, how
much they are paid, even what
care patients receive.
“These doctors are employees,
no ifs, ands or huts. If you don’t
follow the rules, you are de-select
ed,” meaning fired, says Dr. Fred
erick Nahas.
Nahas, a vascular surgeon, ap
proached United Food and Com
mercial Workers Local 56, which
already represents nursing home
and other health care workers, for
help in organizing 500 family doc
tors and specialists in South Jersey
as “employees" of an HMO for
which they all do some work.
The National Labor Review
Board was scheduled to begin
hearing arguments on Monday, af
ter postponing an earlier session.
If successful, Local 56’s petition
would set a precedent for the na
tion by allowing doctors in private
practice to bargain collectively for
a contract.
But the HMO, AmeriHealth
Inc., a subsidiary of Independence
Blue Cross of Philadelphia, does
n't see doctors as employees. It in
sists in legal briefs to the National
Labor Review Board that they are
“independent medical practition
ers” who derive most of their in
come from other sources and pro
vide their own facilities,
equipment and support staff.
AmeriHealth says the physi
cians make independent medical
decisions, and any rules it impos
es are largely dictated by state
health regulations.
Up to now, federal antitrust law
has blocked moves to unionize,
categorizing doctors as indepen
dent contractors.
But Dr. John Hoeveler, an obstetri
cian-gynecologist in Somers Point,
says that independence is gone.
"HMOs dictate to us how to
write our chart notes... how much
time you will spend with the pa
tient, hours of coverage availabili
ty, who can cover your practice
when you’re gone, how much in
surance you’ll carry and in what
form, what specialists you will re
fer your patients to, what labs you
will send your lab tests to, what ra
diologists you must send your pa
tients to for X-rays, what drugs
you can and can’t use to treat a par
ticular patient’s disease, when pa
tients have to leave the hospital,
how much you will be paid,” he
says.
Hoeveler and other physicians
interviewed by The Associated
Press also claim red tape forces
them to employ extra staff just to
handle insurance company calls
and paperwork, increasing costs
and inconveniencing or harming
patients. Forms are different for
every company and change often,
complicating requests for pay
ment, doctors say.
Local 56 attorney Robert F.
O'Brien says most South Jersey
doctors get 95 percent of their in
come from insurance reimburse
ments, much of it from managed
care companies, so they limit their
complaints for fear of being cut
from networks. LInions, with their
lobbying power and war chests,
would give them a stronger voice.
Figures on unionized doctors
are scarce, but interviews, media
accounts and American Medical
Association reports indicate more
than 30,000 of America’s 700,000
plus physicians belong to unions
or guilds. Private doctors can’t join
unions, and guilds don’t have col
lective bargaining rights.
The entry of AFL-CIO affiliates
into the fray may change that.
Richard Bensinger, AFL-CIO or
ganizing director, expects doctor
unionization “to be a big, big effort
of local organizing in the next few
years.”
Dr. James B. Couch, a former in
ternist who analyzes health care
for consultants Coopers & Ly
brand, believes private physicians
will have a tough time getting
around the legal obstacles to
unionizing. He believes doctors
can achieve more by uniting into
very large group practices and
linking with local hospitals to
compete with managed care com
panies for health care contracts.
Doctors concede money is a mo
tive but insist their greatest con
cern is regaining control over
medical decisions.
Many doctors accuse HMOs of
ruining the doctor-patient rela
tionship by overruling them on
treatment, leaving patients with
less-than-optimum care. For ex
ample, physicians say people with
poor leg circulation sometimes
end up as amputees because they
can’t get expensive vascular
surgery and rehabilitation.
“The insurance companies al
ways deny high-tech treatments
like bone marrow transplants, or
they delay treatment like heart
surgery,” recommending medica
tion instead, says Dr. Anthony M.
Tonzola, a general surgeon in
Westfield. “Maybe the patient will
die if they delay it long enough."
HMOs insist doctors make all
medical decisions.
Susan Pisano, speaking for the
American Association of Health
Plans, the managed care trade group,
says the real culprit “is the old, failed
system,” which let costs escalate
without measuring quality of care.
Pisano says studies have shown
HMO patients receive care “at
least as good as those outside of
managed care.”
The association’s new policy re
quires members to have physi
cians involved in developing
guidelines for treatment and cov
erage determinations, and in mea
suring care quality.
Tonzola is helping organize col
leagues to join another union,
Clifton-based District 15, Interna
tional Association of Machinists
and Aerospace Workers. District
organizing director Kevin P.
Lynch says he has signed up more
than 500 doctors, primarily in
northeastern New Jersey, and is
aiming for 1,000.
Tonzola, and physicians and
their unions elsewhere, also plan
to lobby for laws giving doctors
and patients more clout — and for
ways to salvage Medicare other
than by slashing physicians’ reim
bursements.
The American Medical Associ
ation formed a division last July to
help doctors negotiate with HMOs
and push for legislation governing
managed care. It supports physi
cians' right to unionize but not to
strike. Doctors organizing in New
Jersey say they cannot envision
striking, although unions of hos
pital-employed physicians occa
sionally have threatened or en
gaged in strikes.
Couch of Coopers & Lyhrand
says physicians must convince the
public they are putting patients’
interests ahead of their own wal
lets. Local 56 is attempting that
with an ad campaign and says its
polling finds the majority backing
the doctors.
“I think this union thing is ...
excellent for finding a tialance” in
the health care system, says Patri
cia Downs, whose dissatisfaction
with HMOs led her to found a
grassroots patient advocacy group
in Morris County last summer.
“We want a voice with the
HMOs,” says Dr. Dennis Piccone,
a Margate family practitioner. “We
want to be able to sit down with
them and say, ‘Your regulations
are unreasonable. We can’t treat
the patients well with the restric
tions you’ve put on us, so here's
the compromise.’"
Deputies patrol ski resorts in response to ski safety concerns
Two Wyoming resorts
now have full-time cops
to enforce skiing rules
The Associated Press
JACKSON, Wyo. — As con
cerns over safe skiing grow after
two high-profile skiing deaths in
the last week, the Teton County
Sheriffs Department is putting
deputies on duty at two major ski
areas.
Deputies will patrol full-time at
both the Jackson Hole and Grand
Targhee ski areas to help enforce
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laws regarding skiing outside of
area boundaries, skiing recklessly
and skiing while intoxicated.
“I’m here to make sure every
body has a good time by safe ski
ing and to enforce Wyoming
statutes,” said Deputy Dave
Hodges, who helps patrol at Jack
son Hole.
Sheriff Roger Millward said the
decision to post deputies at both
ski areas stemmed in part from
complaints about the use of mari
juana and other controlled sub
stances at the ski areas.
“We’ve had incidents where we
thought we needed to have the sher
iffs presence,” said Jackson Hole
General Manager Jim Gill. "We feel
obligated to respond. There’s many
folks that want to enjoy this moun
tain without being around illegal or
unlawful activity. ”
Deputies at the areas are expect
ed to write tickets for skiing out of
bounds, skiing impaired, unsafe
and reckless skiing and hit-and
run skiing, all misdemeanors car
rying fines of up to $750. Howev
er, those citations can usually be
settled without a court appearance
for from $50 to $200.
Deputies can also cite skiers for
possession of a controlled sub
stance, also a misdemeanor that
carries a $170 fine.
Gill said problems with marijua
na use appear to have increased
since Jackson Hole installed its
new high-speed gondola, which
some valley residents have dubbed
the "Ganj-ola,” a reference to the
word "ganja," slang for marijuana.
But some skiers are not welcom
ing the presence of the deputies.
A message board at the ski area
earlier this week said the gondola
would be vandalized unless
deputies left the ski area.
One skier who asked not to be
identified blamed reckless mari
juana users for the decision to as
sign deputies to the slopes.
“I heard a lot of people blew it
by throwing down with people in
the gondola,” he said. “I think any
body that’s pushing the envelope
is bringing on their own troubles. ”
Millward said his deputies will
not aggressively pursue skiers.
"We’re not going to get into
chasing people down the hill,” he
said. “We don’t think everybody
out there is skiing impaired.”
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