So you may remember that I tweeted about a recent news item announcing the formation of a union by doctors in Oregon. Since then I’ve learned that unionizing by doctors is nothing new; the new thing about what happened in Oregon was that it was the hospitalists at Peacehealth’s Sacred Heart medical centers who unionized. I have been wondering since about whether or not a doctors’ union would help us influence the evolution of the burdensome Maintenance of Certification (MOC).
I’ve been ambivalent about it. The story in The Hospitalist online article gave me the bare bones of the story, but it was the article in The Register-Guard that really caught my interest, mainly because of the mostly intelligent comments following the story.
I had the bias against unions that probably many doctors have, given the images of picketing and striking and I’m uncomfortable with those images. It’s not how I see myself as a physician. I didn’t think doctors ever went on strike, but the University of California physicians have recently voted to do just that.
A a more recent review of the recurring question of whether or not doctors can form a union, despite the existence of the Union of American Physicians and Dentists (UAPD), clarifies that physicians can indeed form a union–as long as they’re employed and not in private practice which could trigger concerns about violations of antitrust laws if they tried to engage in collective bargaining over wages and fees, working conditions, or benefits. Of course, you’ll notice this issue doesn’t stop the UAPD from recruiting private practitioners for membership.
Again, in the Medical Justice Blog, the comments were interesting. A few of them came from someone who sort of hit the nail on the head for me about maybe why this issue of unionization by physicians keeps recurring over the years:
It would be nice if there were a national organization representing the welfare of physicians and patients. Something like what the AMA claims to be but is not. Ideally I might prefer lobbying from that sort of group over collective bargaining by physician employees. For now I would prefer that the physician employees change jobs when asked to work for too little money or when asked to do unethical things.
Actually a lot would improve if physicians just stopped communicating with and cooperating with Medicare, Medicaid, Champas and third-party interference generally. It seems rather silly to be going to all the trouble of unionizing in order to successfully consort with third party payers when the alternative is to just quit consorting with them entirely and be paid by patients in cash.
The only physician group I am aware of which is pro-physician and pro-patient is the Association of American Physicians and Surgeons and they do sue the government over its many sins and wickednesses in relation to doctors and patients. If anyone reading this is unaware of this group they should check it out at http://www.aapsonline.org. Their journal is very inspiring and so are their newsletters.
I think it’s ironic that the commenter mentions the Association of American Physicians and Surgeons (AAPS) because this organization filed a lawsuit in Federal Court in April of 2013 against the American Board of Medical Specialties (ABMS) for promoting MOC–based on violation of antitrust laws.
I don’t agree with much of what the AAPS does or says, but I agree with their opposition to MOC. And I tend to agree that forming a union would probably not advance the cause of MOC reform. That’s because it’s tucked into the Affordable Care Act in the form of the Centers of Medicare and Medicaid Services (CMS) PQRS MOC which will start levying financial penalties in 2015 to doctors who are not reporting.
We can thank the AMA for that (the same AMA that voted to approve a union for doctors), although recently that organization has announced a new policy about MOC which apparently opposes it being tied to hospital privileges, insurance reimbursement, or medical licensure.
It’s too little, too late in my opinion. I’m not renewing my AMA membership and neither am I renewing my American Psychiatric Association (APA) membership. They’re just too expensive and I don’t think either represents the interests of members on key issues which adversely affect doctors. I have to keep enough money around to pay all the cottage industries making MOC products that spring up around participation in MOC–so that I can keep my hospital privileges and keep my income so that I can make a living. And discussion about making the Focus Journal for Psychiatry a perk of APA membership not just for early career psychiatrists but for all members is not enough to sway me.
Hey, I just saw a CNN article about which professionals you should tip and how much. The list says you should not tip doctors, dentists, or cobblers. Does anyone even remember what cobblers are? They repair shoes and when was the last time you took your shoes to a cobbler to get them fixed?
I don’t expect a tip. But I would like a little more respect from the ABMS and member boards, the federal government, insurance companies, hospital employers and so on. If doctors could get that, we probably wouldn’t think so much about forming unions.
Here’s a tip: Don’t cross the street when the light is red–and nominate your physician as a Gold DOC for Christmas.