A union for ED physicians is not the solution

By Todd Taylor, MD, FACEP

Department of Emergency Medicine

Good Samaritan Regional Medical Center

Phoenix

[Editor’s note: The Chicago-based American Medical Association has formed a union-like organization for employed physicians. (For details, see ED Management, October 1999, p. 117.) In this issue, ED Management presents opposing viewpoints on this controversial issue from two ED physicians.]

Traditionally, a major difference between "professionals" and "laborers" has been the professionals’ personal commitment to those they serve and their commitment to continuing their education beyond their formal training years. Professionals have traditionally looked to societies to support these organizational and educational commitments, while laborers have relied on unions to forward their goals. It has also been true that laborers traditionally have been employees, while professionals were independent contractors or self-employed.

Emergency medicine, more than any other medical specialty, has broken with those traditions. The number of emergency physicians who are employed has increased dramatically in recent years due in part to Internal Revenue Service and Medicare regulations. It would follow, then, that the recent American Medical Association formation of a physician union would have the most potential for emergency medicine. As we embark on this venture, it is imperative that we carefully consider the consequences of such a transition. Here are some potential consequences:

Loss of autonomy.

Much of the business of emergency medicine will be abdicated to business people and, in some circumstances, labor leaders who clearly have different objectives than physician professionals do. If you think managed care bean counters are bad, these guys have to be worse.

Public perception.

Positive public perception of physicians increased significantly from 1997 to 1999, according to recent polls (Harris Poll as reported in USA Today April 28, 1999). Medicine (increase of 28% in 1997 to 38% in 1999) is third from the top after the military (55% in 1999) and the Supreme Court (42% in 1999) in the minds of adults expressing a "great deal of confidence" in those in charge. Even more significant in the polls was that "union labor" (15% in 1999) ranked second to the bottom after Congress (12% in 1999) in the degree of confidence. Clearly, becoming a union will do little for public perception of physicians.

Dissension among physicians.

Union activity tends to promote single-mindedness and compliance among members. This is more easily done when union members are less competitive and less independent-thinking (more sheep-like). Organiz ing physicians is more like trying to herd cats. The principles necessary to form and be an effective union will likely run contrary to physicians’ basic mentality and values. Unions have much more potential to divide than unite physician members.

Discouragement of efficiency and productivity.

One of my more memorable impressions of unions is that union members who are more productive than the norm are encouraged to slow down so they won’t show up other union members. Increased productively is generally discouraged so you don’t work yourself out of a job.

Unions’ insistence on better work environments through shorter hours, more help, and fewer expectations may be contrary to many physicians’ fundamental principles. Despite promises to not negatively impact patient care, physicians will be required to follow the "union line" at work. It may mean they must leave patients unserved or underserved to justify the need for a better work environment.

Strike!

Anyone who believes a physicians union strike will never be an option clearly does not understand the basic principle of unions. Unions in other critical American services — for example, air traffic controllers, airline pilots/flight attendants, truckers, and rail line workers — still strike. Only an obscure federal law has allowed the president to intervene in those situations in the past.

Barry Liebowitz, MD, a New York pediatrician and president of the Oakland, CA-based Union of Ameri can Physicians and Dentists with approximately 5,000 members, said, "Strikes may be essential. Sometimes it is far better to strike than to allow a patient to go into a substandard facility. In other words, there are reasonable strikes" (American Medical News 1999; 42:1).

In my opinion, the current physician union movement is either grandstanding in an attempt to get the federal government to implement antitrust reform, or it is a desperate move by physicians frustrated with the current health care environment. Neither is a good enough reason to throw away centuries of tradition among physician professionals.

[Editor’s note: Taylor can be reached at 1323 E. El Parquet Drive, Tempe, AZ 85282-2649. Telephone: (480) 731-4665. Fax: (480) 731-4727. E-mail: tbt@compuserve.com.]