A union of docs

The American Medical Association, the representative body for one-third of the nation’s 600,000 physicians, recently voted to create a union for its members for the first time in its 152-year history. The desire of at least some physicians for this sort of protection is more evidence that the cost of medicine continues to tear apart one of the revered institutions in this country, the doctor-patient relationship.

Only physician employees and medical residents are eligible for union membership. Self-employed physicians such as doctors who are in private practice are not legally eligible to belong to a union, although a proposal in front of this Congress would change that law. The AMA argues that a union is needed to give physicians greater bargaining power with managed-care organizations regarding various patient-care issues such as number and types of treatment, length of hospital stay, etc.

Critics suggest that the bargaining power physicians want has more to do with their salaries than patient care, especially as insurance companies have resorted to managing health-care providers to control rapidly rising costs during the last two decades. More likely, however, is that the union debate reflects a division between self-employed older doctors, who generally oppose the idea, and younger docs who work for hospitals or health-maintenance organizations and are tired of all the paperwork and lack of control in their patients’ care.

In one sense, the union issue for doctors is no different from union issues anywhere else: Doctors are concerned about quality-of-life questions and insurance companies, which have to pay the bills, are looking at the bottom line. As Andrew McLean of the Maine Medical Association puts it, Physicians are often married to physicians and they want to have more life with their families.

A union for docs continues the long slide away from the single doctor in private practice and toward the corporatization of medical care. A glance around the Bangor area reveals Eastern Maine Medical Center and St. Joseph Hospital buying numerous physician’s practices and employing these physicians within their community care systems.

Will our health care improve if physicians are less burdened by the multiple stress points of managing a private practice? Probably. But we will be less likely to have that long-term, continuous relationship with the same physician who comes to know us so well. For people who can actively participate and manage their own health, there is probably no cause for concern, and the efficiencies of corporate health care may yield benefits.

But for those who are chronically ill and need something more than a large medical chart to follow them, the gaps in the safety net just keep getting wider.