More doctors join unions to fight HMOs

December 25, 1997
Web posted at: 5:34 p.m. EST (2234 GMT)

From Correspondent Brian Jenkins

SUMMIT, New Jersey (CNN) -- Dr. Anthony Tonzola decided in the 1960s that he wanted to wear the blue scrubs of a surgeon. He never imagined himself as the blue-collar type, and, like most people, associated union membership with truck drivers, machinists and factory workers.

Thirty years later, the irony of his current position is not lost on him. With managed-care organizations controlling his salary and how he should handle patients, he often feels as if he works on an assembly line.

As a result, he is one of 500 physicians in northern New Jersey who have applied for membership in the Machinists Union.

CNN's Brian Jenkins reports

"Doctors want to regain control of the direction of medical care," Tonzola said. "The union will allow us to sit at the negotiating table, to talk about all aspects of patient care."

Doctors in private practice would violate antitrust laws if they tried, as a group, to negotiate fees with a managed-care plan.

But by affiliating with unions under the AFL-CIO, they can increase their bargaining power with health maintenance organizations (HMOs) by getting millions of workers on their side. Unions have a powerful tool: They can threaten to drop an HMO from their health plans, if it doesn't cooperate with unionized doctors.

"Organized labor, having a tremendous amount of political influence, can add to the equation and give them an extra tool in their bag they didn't have before," said Jay Porcaro, organizing director for the Office and Professional Employees International Union.

Strength in numbers

The number of doctors joining unions has jumped sharply over the past few years. As managed-care plans mushroomed to cover more than half of all Americans, the union movement among physicians has spread to at least a dozen states.

Groups of optometrists in Pennsylvania have unionized; so have neurosurgeons in Florida and specialists in Arizona. Podiatrists have formed a national guild.

San Francisco microsurgeon Greg Buncke belongs to the oldest independent labor group for doctors, the Union of American Physicians and Dentists. Three years ago, members banded together in California to negotiate contracts with HMOs.

"It's much easier for a large group, a community voice of physicians, to speak on our behalf," he said.

His father Henry, also a microsurgeon, was one of the union's founding members in the early 1970s.

"There was a lot of resistance, because physicians, as professionals, didn't think they should belong to a union," the elder Buncke said. "Now we realize we need all the support and representation we can get."

'There are many physicians who are adjusting well'

Managed-care executives stress that only a small percentage of the nation's 600,000 doctors have joined unions.

"There are many physicians who are adjusting well, and many physicians who are embracing managed care as a better way to deliver health care to their patients," said Susan Pissano, who works for the American Association of Health Plans.

But while those opposed to managed care may be in the minority, they are becoming more vocal. In Massachusetts this month, doctors and nurses representing 3,000 colleagues statewide staged a protest to dramatize their complaints.

That might be what they need to do to get more of their white-coated colleagues to sign up with historically blue-collar unions.

Related stories:

• The HMO backlash - November 5, 1997
• 3 HMOs move toward patient bill of rights - September 24, 1997
• Medicine coming to terms with managed care - September 8, 1997
• California voters to have their say on HMOs - May 18, 1996

Related sites:

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• Office and Professional Employees International Union (OPEIU)
• Union of American Physicians and Dentists
• American Association of Health Plans

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