LaborTalk: Why Doctors Need a Union

By Harry Kelber, The Labor Educator, June 1999

The turbulent health-care industry received another shock when the American Medical Association, for decades a bastion of conservatism, voted to set up a union for salaried physicians and medical residents, who make up a third of the nation’s 620,000 practicing physicians.

The AMA was responding to the angry protests from thousands of physicians who work for health maintenance organizations (HMOs) and for-profit hospitals. These doctors feel powerless when they have to negotiate individually with HMO administrators, not only about their salaries and working conditions, but their professional role in delivering quality care to their patients.

The AMA’s 494-member House of Delegates, long hostile to unions, adopted this extraordinary policy change after its survey showed that 88 percent of doctors favored having unions that would enable them to negotiate with hospitals and HMOs on a level playing field.

The AMA is hoping that by setting up its own unions, it will head off the organizing campaigns of three AFL-CIO affiliates: Service Employees International Union, American Federation of Teachers and American Federation of State, County and Municipal Employees, each of which is devoting staff and resources to unionize doctors and dentists. More than 40,000 physicians have joined these unions and their number is growing.

The AMA expects to establish dozens of local unions across the nation in the next five years, but the kind of union it envisions will hardly satisfy the salaried physicians who seek remedies for their many grievances. Its unions will forego the right to strike, giving up a trump card which unions can play when an employer refuses to negotiate. The emphasis will be on quality care, not on economic factors or the working conditions of HMO and hospital professionals.

Over the years, the AMA has slowly and reluctantly abandoned its ultra-conservative, elitist attitudes. In the early 1960s, as the public affairs director of The Physicians Forum, I conducted a successful national campaign to win Social Security physicians over the fierce opposition of the AMA leadership, which argued that including doctors under the Social Security Act would be a major step toward socialized medicine and a loss of freedom for members of the medical profession. Since then, retired doctors have been happy to collect their social security checks, and whatever threat to the freedom of the medical profession has come not from government, but from cost-cutting, profit-oriented HMOs and private hospitals.

The debate within the AMA about sponsoring its own unions is far from over. The leadership is against it, and there will be heated arguments about how to implement the new policy. It should also be noted that a sizeable majority of AMA mermbers are self-employed physicians, who are forbidden from unionizing because they are not employees within the definition of the National Labor Relations Act.

But what the AMA has done is to legitimize the value of unions in the medical profession. It should add momentum to the organizing efforts of AFL-CIO unions.