By Robert Mirsky, M.D.

President of the Bucks County Medical Society

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Drs. Sklaroff and Lodise favor a union or guild. Fewer and fewer physicians remain in the classic "Norman Rockwell" type of practice and rapidly the practice of medicine is entering the corporate world. If a medical system employs a group of physicians, setting their working conditions, determining their staffing and determining their salary based on a productivity totally out of control of the physicians, then are these physicians in a supervisory position. If the National Labor Relations Board determines that the physicians are in fact employed to act as supervisors for the remainder of the office staff, then all the excellent arguments given for unionization are for naught. Simply to lay the groundwork for unionization will require "significant" funds that will pass from the physicians to our favorite group of professionals, the lawyers. Allowing the AFL-CIO to fund the legal maneuvers, would certainly defray some of the initial costs, but dues can easily limit any monetary gain obtained.

As for the physicians in private, independent practice, the legality of them joining a union to collectively bargain with third party payers is even a trickier subject. What would happen if the payer refused to negotiate? The federal government has fined specialists using Anti-Trust statutes when multiple groups have gotten together to demand higher reimbursement. Would calling themselves a guild reduce the risk of federal censure? At this point in time the probability of a pro-guild decision by the federal regulators is certainly a long shot. Then there is the problem of getting physicians to agree. Does the expression, herding cats, remind us of medical meetings? Heck, we can’t even get the percentage of physicians in the state medical society over 50%. Whether unionization would or would not be good for physicians could certainly be argued, but the likelihood of getting a union past the multiple hurdles is very low.

Dr. Anthony Coletta wants to recapture the independence of physicians by forming physician driven enterprises that would be able to take on risk contracts and thus divert some of the monies going to executive salaries and shareholders back to physicians and patient care. To be successful in this type of system will we have to place the best interest of our corporate structure over the best interest of our patients. The malpractice lawyers will have a good time arguing that one if a decision does not turn out perfect.

Dr. Gary Brown reports on a new system in our state, the physician-owned insurance system. There are obvious concerns about this, similar to what I describe above and developing the product in the less intense environment of the center of this state was an excellent idea. I wish them luck, but competing with the large insurance players in this part of the state will not be easy. Especially if these insurance entities can keep lowering the reimbursement paid to hospitals and physicians, thus reducing their cost of doing business, beholden only to the shareholders.

Dr. Walter Tsou presented a short, yet excellent argument for a national health plan. His point that the "current direction of market-driven health care will ultimately destroy humane medical practice" is perfectly stated. Unfortunately, I just can’t forget what it was like working in a VA medical system during my residency. This is an area that will need further discussion, and one that increasing numbers of us will begin to favor as our current situation continues to disenfranchise more Americans, frustrate physicians and take medical care away from the reason we sacrificed years in study, that being the care of human beings in need. Who knows, could Hillary have been on to something? Boy, is that ever a bizarre way to look at the progression of medical care in this country.

In the meantime it is imperative that we increase our participation in organized medicine. The low participation impairs lobbying in our best interests as well as getting our voice out there to compete with organizations that want to reduce our strength in whatever system eventually triumphs. Individual specialty societies are important, but are to be additive to a large society that speaks for all of physicians in both the state and national levels. Quitting these organizations because you disagree with one policy is like shooting yourself in the foot because your tennis game has deteriorated. It certainly won’t help your tennis game and quitting the society won’t protect your interests in the changing health care environment.