By Jeffrey Barg

Published November 1999

• React to this article in the Discussion Forum.

PND: Why have you joined the Federation of Physicians and Dentists?

FD: The main reason is that there is a complete loss of autonomy in the practice of medicine today. Fifty percent of the obstetricians and gynecologists in the greater Pittsburgh area have either sold their practices or quit in the last few years. And only about fifty percent of us are still in private practices. The reason is that we do not have the power to negotiate contracts that are fair with the insurance companies and HMO’s. We have lost autonomy in dealing with patients and we cannot make medical decisions with our patients anymore. I’m afraid that there will be no future private physicians practicing any longer unless physicians can join together in a union. It’s the only way we can get bargaining power in dealing with the insurance companies.

PND: What services does the Federation supply to physicians?

FD: Number one is they give you help in contracting. Right now individual physicians don’t have any idea what’s in the contracts that they’ve signed. In fact sometimes they don’t even have copies of the complete contract. They sometimes don’t even have fee schedules. Once we joined the Federation of Physicians and Dentists we have the ability to send every contract in to the union to review it line by line. Experienced union attorneys will review that and let us know where the pitfalls are in the contract.

Lobbying is also very important. The Federation has lobbyists that are in Washington everyday lobbying for things that I think are important. I know the AMA has lobbying efforts going on and the Pennsylvania Medical Society lobbies. But the Federation of Physicians and Dentists seems as though they’re doing more to get their position heard.

There is a collective bargaining bill in the Congress that would allow physicians to collectively bargain with health plans. The Pennsylvania Medical Society authored a bill introduced in the Pennsylvania Senate that would allow physicians to collectively bargain with health plans in Pennsylvania. It’s already available to doctors in Texas. By joining the Federation of Physicians and Dentists, I’m already in a union that has a whole system set up and ready to go for collective bargaining should one of the bills pass.

PND: What has the FPD been able to accomplish elsewhere?

FD: I recently attended a meeting in Philadelphia where coordinators of the Federation of Physicians and Dentists from throughout the country met. I can tell you that in areas all around the country from Connecticut to Florida to New Mexico to Philadelphia have been making progress in dealing with unfair contracts with insurance companies. Doctors have been able to drop bad contracts with confidence and know that they have union support in looking over contracts that are unfair and dropping contracts that are unreasonable. Actually these physicians that are dropping bad contracts are ending up doing better by losing the bad contracts.

PND: For self employed physicians the Federation uses the third party messenger model. Could you explain that?

FD: Over and over physicians read that they can’t unionize. It’s true that we cannot collective bargaining right now. But we can use the third party messenger system. The third party messenger system allows independent private practice physicians all to decide to use a union negotiator. And we use the same negotiator to negotiate our contracts. The union reviews the contract. It sends it back to the individual private practice physicians. Each physician individually decides whether he wishes to accept or not accept that contract. Then that physician designates the union representative, if he desires, to become the negotiator with the HMO or insurance company. The union negotiator does not share information between doctors. And individual doctors do not share information between practice to practice. But it’s often the case that when physicians find out how bad a contract really is for their practice, they decide individually the same way to refuse a contract that’s unfair. This method of negotiation is legal and it has been used for the last ten years by the Federation of Physicians and Dentists throughout the country to help physicians get fairer contracts.

PND: When the Federation first came into Philadelphia in 1998, the leadership of the Pennsylvania Medical Society was making the point that the third party messenger model does not give you any effective leverage if utilized legally. They were predicting that the way that the Federation was using it was in violation of federal antitrust law. And a number of months afterward the Federation was hit with an antitrust complaint filed by the Justice Department in connection to their activities in Delaware. What’s the status of that lawsuit?

FD: I just attended a meeting in Philadelphia with the Federation’s antitrust attorneys. As I understand it, that suit is pretty much a stalemate between the federal government and the Federation of Physicians and Dentists. I believe that the Federation will never be found to be guilty because of the way the law was written. The third party messenger system is a legal way to negotiate. In fact, this method of negotiation was actually written by an attorney that’s in the Department of Justice now. The attorneys in the Department of Justice never thought that it would be utilized. And I believe the Federation of Physicians and Dentists looks at this as a way to force the issue to gain collective bargaining rights for physicians.

PND: How long has the Federation been in Pittsburgh and what are the extent of its activities?

FD: The first meeting was when Dr. Mike Connair spoke at the Allegheny County Medical Society in April of ‘99. Afterwards, myself and a couple of my partners decided to be the ones to try to spearhead the Federation of Physicians and Dentists locally. We’re the only group of physicians in this area right now trying to pursue this. Since that time we had an initial interest meeting for obstetricians in the area in June of 1999. Dr. Barry Rothman came from northern Virginia to speak. We had about forty physicians attend. Since that time we have had ten physicians sign-up. We will have five more probably signed on within a week or so. In fact one physician even signed up today. We are going around to local physician groups and there seems to be a lot of interest. However, it’s tough going because this is something new to Pittsburgh. Physicians still believe that joining a union is illegal and that something bad will happen. And there’s another whole group of physicians who are apathetic because they’re already employed or they’ve already resigned themselves to sell their practice and become an employed doctor. There’s another group of physicians who are older and ready to retire or don’t care anymore. So those physicians are hard to sign on.

PND: What do you think the Federation can realistically accomplish here in Pittsburgh? Does Highmark’s huge market-share present a special problem?

FD: I guess the answer to that is it remains to be seen since the Federation is just in its infancy here. But we hope to organize fifty percent of the obstetricians and gynecologists in this area and our goal is to have 100 doctors signed on within a year. If we can get the majority of the private practice obstetricians and gynecologists to sign on, we think we might be able to have some significant impact even with Blue Cross and Blue Shield. The reason is this. Pittsburgh’s a unique community where people don’t want to drive a long distance to get their health care. I know people who would change doctors in Pittsburgh when their doctor moves ten miles away. Women like to deliver in their local hospitals and if local pockets of ob/gyn physicians join the union, it still might have an impact despite Blue Cross’s monopoly in the area.

PND: I understand you had a meeting at the Allegheny County Medical Society on September 29th. How did that go and what’s the next step?

FD: I mentioned before we had a meeting in June of ‘99 with Barry Rothman, who’s an obstetrician in Virginia. Then we invited Jack Seddon, the executive director of the Federation of Physicians and Dentists, to speak at the Allegheny County Medical Society on September 29th. We had a smaller turn-out than hoped for. We only had about fifteen physicians come to that meeting. But those fifteen physicians represented practices that contain over thirty obstetricians. The thing that was good about that meeting as opposed to the meeting in June is that physicians there were highly interested and highly motivated. As a result of that meeting, we’re expecting within the next few months to have probably double the membership we have now. Probably thirty or more members signed on. After that meeting, myself and my partners have pretty much made a commitment to going out and individually speaking to practices about the Federation of Physicians and Dentists and what the union can do. We realize doctors are very busy and working long hours and not all doctors make every evening meeting we had. Most recently we went out and spoke to physicians at Forbes Regional Medical Center. We spoke to physicians at the Beaver County Medical Society. We have physicians at West Penn Hospital, at Allegheny General Hospital and many different major hospitals around the area that are highly interested and may sign on soon.

PND: What’s the Federation’s position on strikes? Do you think that unionization poses any sort of threat to professionalism?

FD: I think that’s the reason some of the old guard physicians are opposed to any affiliation with labor. Because the negative connotation labor has as far as strikes, work slow-downs, etc. The Federation of Physicians and Dentists has made it very clear that it has an absolute no-strike policy. Physicians take a Hippocratic oath to care for patients and the vast majority of physicians would never ever consent to a strike of any kind. We’re in the union movement to improve the quality of care for our patients, not take away from it.

PND: Do any of your patients know that you are involved with a union and if so what is their reaction?

FD: I’ve shown many patients my union card. It’s surprising. They seem to be behind me 100 percent. They see the declining quality of care they’re getting in hospitals. They see how doctors in the office have to rush through their patients. Sometimes, if I have a patient that is interested, I talk to her a little bit about why some of the changes are occurring in health care. In the Pittsburgh area, 25 percent of our patients are in unions and they understand that there’s no reason that a CEO of a health insurance company should be making $30 million a year. Why is it that a CEO of an insurance company can be paid at such obscene levels when their doctor’s paid 30 percent of his fee, they’re rushed out of the hospital, and their premiums are expanding? They ask: "What would be wrong with disbursing that money to improving the quality of their health care, paying their physicians, paying the nurses, paying the hospitals, paying the radiology techs, paying all the other employees of the hospital some of that $30 million salary?"

PND: Does the relatively high penetration of unions in Pittsburgh present any opportunities for a physician union?

FD: Yes. At the last union meeting we had on September 29th, Jack Shea, the president of the Allegheny County Labor Council, attended our meeting. And Jack Shea said that the unions in Allegheny County and labor in general in Allegheny County would be 100 percent behind locally organized physicians. He’s already made some contacts with Linda Odenkirk, our regional representative, and has started to see how he can help locally organizing physicians unions. The labor unions can decide to channel their contracts to physician-union-friendly insurance companies.