AMA Union Leaders Aim To Recruit Residents.
In what union president Dr. Susan Hershberg Adelman described as "a fact-finding process," representatives of Physicians for Responsible Negotiation (PRN) have begun soliciting residents and employed physicians by mail and at medical society meetings. Collective bargaining units will not be formed until the union board decides that they are warranted based on membership interest and the seriousness of issues to be negotiated in specific locales, the union president told reporters at the AMA's interim House of Delegates meeting last month.
Dr. Adelman, a pediatric surgeon from Southfield, Mich., said the PRN expects resident recruitment to get a boost from a late November decision by the National Labor Relations Board (NLRB), which ruled that interns and residents at private teaching hospitals function more as employees than students and therefore should have the right to bargain collectively. The NLRB decision, in a 2-year-old case involving residents at Boston Medical Center, makes more than 90,000 residents and interns nationwide eligible to unionize.
But Dr. Paul Barach, an anesthesiology fellow at Massachusetts General Hospital in Boston, predicted that the AMA faces an uphill battle in terms of unionizing residents.
"I'm not sure people are going to flock to the AMA union," Dr. Barach told this newspaper. "A lot will depend on how the AMA positions itself, and it hasn't always done a good job of identifying trends." And it will be tough to compete with successful unions like the Committee of Interns and Residents, which has had a foothold in Boston for 30 years, he noted.
In fact, despite the AMA delegates' vote last June to create a national union for employed physicians and residents, most of those doctors have yet to ask the PRN for help in negotiating with heavy-handed HMOs. Just 40 physicians signed up with the PRN following a forum on the union at the delegates meeting.
And cost probably isn't an obstacle: Annual dues for joining the PRN are $25 for residents and fellows and $50 for employed physicians. Dues for physicians who request specific assistance from the PRN will be set at $50 per month.
An estimated 40,000 employed physicians already belong to traditional labor unions affiliated with the AFL-CIO, the Service Employees International Union, and other groups. For now, federal antitrust laws bar most of the nation's 740,000 physicians who are self-employed from joining the PRN or any other union.
But AMA officials are lobbying for changes in the laws to allow all physicians to unionize. During the meeting, the delegates got a pep talk from Rep. Tom Campbell (R-Calif.), who has sponsored federal legislation to give self-employed doctors antitrust protections that allow them to negotiate collectively.
"This bill will pass the U.S. House of Representatives," predicted Rep. Campbell, a former law professor at Stanford University in Palo Alto, Calif. The bill has 175 cosponsors and the support of 20 of 37 members of the House Judiciary Committee, who are scheduled to mark up the bill in early February. After a move to kill the bill last year. House Speaker Dennis Hastert (R-Ill.) has agreed to allow a floor vote in late February according to Rep. Campbell.
Nevertheless, the bill still faces major hurdles. In the past, U.S. Department of Justice and Federal Trade Commission officials have agreed with HMO and insurance industry lobbyists that giving physicians antitrust protections could allow them to fix prices and could lead to higher insurance rates. And Rep. Campbell hasn't yet been able to convince any of his Senate colleagues to cosponsor the bill.
The physicians who voted to create the union may face future frustrations with the PRN, which is a legally separate entity from the AMA even though its four-person staff is based in the AMA headquarters building in Chicago. The union is technically at arm's length from the association, although the PRN's budget is based on a $1.2 million loan from the AMA, which ended 1999 with a $10 million operating loss.
"The AMA House of Delegates can't pass resolutions telling the PRN what to do," noted Dr. Adelman, an AMA trustee. How that will play out remains to be seen, although several delegates mentioned the PRN as a vehicle for dealing with managed care during the meeting.
Meanwhile, the PRN's business plan calls for a projected membership of 1,750 employed physicians and 7,500 residents by 2005, according to Ross Rubin, the PRN's acting executive director.