Report From the States

Physician Unionization in Illinois and New Jersey

Miguel A. Faria, Jr., MD


Unionization Risks in Illinois

The Rockford Physicians Council formed in 1997 was founded to serve as an example of physician's ability to organize unions and make them efficient and influential. Writing in AMNews (Oct. 4, 1999), Sarah A. Klein reported that this group's unionization efforts "have gone from bad to worse."

"In order for something like this to be viable, it needs the support of a significant number of physicians. This did not seem to be the case," said William Sacksteder, M.D., a thoracic surgeon who served on the council's board. The dream of a union, he said, "sort of just gradually died away, sort of a quiet death."

Moreover, Ms. Klein wrote, "Some of the physicians who waited to see what would happen at the clinic weren't all that pleased with the results. While some physicians were given titles and leadership roles, salary cuts continued."

Even things that worked before weren't working now. "An attempt to install new dictation equipment went haywire and dictation couldn't be recovered, causing physicians great stress," said Dennis Norem, M.D. Let's just say we told you so...

New Jersey Physicians Suffer a Setback

The unionization effort in New Jersey has been watched closely around the country "as a growing number of doctors, frustrated by increasing control over their practices by HMOs, have attempted to unionize." The doctors in this case all treat patients of a managed care entity, AmeriHealth, and were not necessarily employed by a hospital authority.

The Associated Press quoted Dr. Frederick Nahas, a vascular surgeon of Somers Point, N.J, who helped organize his fellow physicians to join the union: "Unfortunately, patients are still going to be denied care in lieu of profiteering that's going on by the HMOs. That's really the bottom line: HMOs are trading patient lives and limbs for profits."

Be that as it may, the report goes on to say "U.S. antitrust law prohibits independent contractors from banding together to set prices and terms for their work, but the National Labor Relations Board (NLRB) has allowed unions for some whose work primarily is dictated

by others, including entertainers, athletes, cab drivers and, most recently, couriers. 'Even if the doctors are successful in unionizing, it may not be an answer to their problems, which revolve around stepped-up HMO control over their practices,' says Uwe Reinhardt, a Princeton University health economist. 'They think they can, as a union, sit there and shove a unionized fee scale down the throat of the insurer,' says Reinhardt. 'It would never be effective because insurance carriers in turn would band together to negotiate with the doctors,' he says. 'You just simply can't create a physician monopoly.' "

And thus, on May 24, 1999, the NLRB rejected a petition on behalf of the 650 New Jersey physicians denying they were employees of an HMO. This has been the second major setback for private doctors attempting to unionize. And thus the organizers say they will gear their efforts at federal legislation. It is estimated that 38,000 to 45,000 physicians or about 6 percent of the nation's doctors are unionized, up from about 25,000 two years ago.

Dr. Faria is Editor-in-Chief of the Medical Sentinel.

Originally published in the Medical Sentinel 2000;5(1);27. Copyright©2000 Association of American Physicians and Surgeons (AAPS)