By Christopher Guadagnino, Ph.D.

Published September 1997

• React to this article in the Discussion Forum.

Julian Katz, M.D., is the newly installed president of the Philadelphia County Medical Society (PCMS). He is a Professor of Medicine at Allegheny University of the Health Sciences and an internist and gastroenterologist.

PND: Can you explain the process the Medical Society has gone through to chart its future course?

JK: We’ve had strategic planning retreats in June and July which have included discussions of the future environment and practice of medicine in Philadelphia, including significant threats to the future success of PCMS. We have considered as the society’s core purposes: ensuring the rights and interests of physicians, promoting the ethics and dignity of the medical profession, maintaining the highest standard of medical care and serving as the most visible medical resource for the community. We felt that the service niches for PCMS would be: recognizing PCMS as a significant organization affecting quality care, as patient advocate, and providing a forum for effective advocacy for the physician members of the society. We would try to answer the needs of the younger physician, including assistance, advice and help in negotiations, recognizing that the young physicians are mostly employed physicians. We would think about things like an ombudsman program for supporting physicians and patients. We would be a source of timely information for physicians and the public with increased use of technology such as e-mail, faxes and a web site within a few months. We also plan to offer education programs for the public and the physician so as to be the prime resource for the community on medically related issues. Ultimately, we would like to be an important factor in mediating conflicts between the insurance industry, the patient and doctor.

PND: What ideas and new directions are on the agenda?

JK: For my year of presidency, I’ve taken the theme of the Urban Medical Society, which would entail looking at medicine in Philadelphia, recognizing that this area has different problems from the other medical societies which are present in this most rural of states. I’ve met with the Health Department of the City of Philadelphia to integrate our programs. Our purpose is to make health care more available in this city which has so many medical resources and in which we have diseases, poverty and neglect occurring in the shadow of outstanding medical institutions. We feel we will need to restructure PCMS—form different committees for the board, try to liaison more closely with the Health Department and other agencies, have alliances with such groups as the College of Physicians of Philadelphia and medical specialty organizations and perhaps eliminate some of our standing committees and replace them with ad hoc committees.

PND: Can you give some examples of how the PCMS will act to fulfill the needs of younger physicians?

JK: This is a problem that we really must answer. The younger physician has not been as involved with organized medicine as we would like. The particular needs of the younger physician would include such things as help in negotiation and contracts, how to deal with insurance companies and other unique problems. We are trying to identify contacts at the various insurance companies and payers so that if there is a legitimate problem in which the physician is not allowed to provide a certain service which is justified, we’ll contact the insurance company and indicate what we feel is appropriate for quality care. We also feel we have to develop more resources for employed physicians. One of them might be to provide a guild for employed physicians under the aegis of organized medicine. It would carry out some of the purposes advocated by people who would like to have a union.

PND: Would that include collective bargaining?

JK: I don’t think so, but again we are exploring. We have a task force on guilds and unions which we created because we saw that there was a need to answer the concerns of the employed physician. We’re exploring collective bargaining. I think that might have some legal implications which we can’t get into, but certainly there are specific concerns which the employee physicians have talked about. We want to see if we can come up with a vehicle to answer these concerns.

PND: What sort of relationship would the guild have to the Medical Society?

JK: Again, I’m not specific on this because we are exploring this. We’re finding out what’s being done in other parts of the country, what the AMA’s view is on this and how we can utilize or modify it for our purposes. It would be perhaps an off-shoot of the County Medical Society. It may have its own independence. At this point we recognize the need, we are fact gathering, and the task force will give us a report based on the information about what other organizations have done and what is feasible. We’re going about this in a very deliberate fashion. We’re not forming a union. We’re not forming guild immediately. We’re just coming up with ways to see how we can match goals with the organization.

PND: Medical Societies have been losing membership, and therefore revenues from dues, making it even more difficult for them to accomplish their goals. How do you reverse this cycle?

JK: Philadelphia is rather unique in that we have so many physicians in academics and employed physicians in networks. We would like to make the Society indispensable to these people. The Academic Dean of Temple has joined the board of the Medical Society, and another new member is a young woman radiologist and attorney. We’re trying to appeal to the academic community and appeal to the employed physician. I’ll see if we can meet their needs better than we have been doing in the past. Specific programs include: the ombudsman, assistance in negotiation and capitation issues, dealing with personal finances and retirement plans, a computer information base for credentialing, appeals mechanisms for patients and physicians, being the primary resource for social activities, insuring the rights of the profession. We will deal with business acumen and management skills, peer counseling on malpractice and government challenges. We could have conferences, seminars, communication through a web page, faxes and publication in Philadelphia Medicine.

PND: One proposal to redress declining membership is to form a regional Medical Society. What’s your view of this approach?

JK: My personal view is that we should remain Philadelphia County Medical Society. We represent physicians practicing in the city of Philadelphia. We have interests that are identical to our surrounding societies, but I feel we should remain Philadelphia County Medical Society with regular meetings with leaders of the surrounding regional area. I personally am not for a regional Medical Society. We can have a caucus to represent the interests of this region. That is something our delegation to the state Medical Society is interested in and which we could further explore. I think our membership can be increased and will be increased. It’s really not dropping off as badly as some people have been crying. In fact, I would expect to see either a leveling off or an increase in membership.

PND: Could you tell me what PADV’s [Physician’s Association of the Delaware Valley] status is and what your future plans for moving it forward will be?

JK: PADV has not been active and has not achieved many successes yet. We’re going to explore further use of PADV, but at this time we haven’t achieved the membership to have an effective IPA. I have no intention of dissolving PADV, but if nothing happens over the next several months I may end up recommending that we put it on the shelf.

PND: How many members have joined PADV so far?

JK: It’s in the three hundreds. The goal was around a thousand.

PND: What is your view of a physician union?

JK: I have not seen the essential value of a physician’s union. I don’t know what it can do any different from organized medicine. When I spoke to the union people, basically their answer was, "we can do it better. You guys haven’t been very successful." Well, I certainly can agree with them that the apparent disempowerment of physicians has made the concept of unions very appealing to some people. I think their vision of the union is probably a mistake. I don’t think the advantages which are proposed for a union—joining a much larger organization having more clout—will be fulfilled. The appeal of unions is there. I think what we are seeing is an emotional response to the disempowerment and frustration of physicians, but I don’t think a union, per se, is the answer. We have not given up on the concept—and let’s change the word union to guild. We may have to make an ancillary organization under the aegis of organized medicine. The guild concept would share many of the goals of organized medicine.