Doctors of the World, Unite

At a recent AMA meeting, The Indiana delegation proposed that the AMA study and unionization in the U.S. The delegation noted that as more physicians become employees of large organizations, "Employed physicians often are 'on their own' as they deal with issues with their employer unless they use legal or mediation services ... The lack of the ability of physicians to join together as a group to address employment issues runs counter to the principles of democracy and freedom in the U.S."

This is not the first time, nor will it be the last, that physicians, dentists, nurses and surgeons have talked about unionization. In 1972, the Union of American Physicians and Dentists was formed. The National Federation of Nurses is a labor union for registered nurses and there have been several recent, high profile labor actions. Some argue that the AMA is a doctors union already and HR professionals are worried by rumbling in their ranks of employed physicians, be they academic or non-academic.

The movement is being driven by several things.

1. Primarily, employed physician ranks are growing and they feel they are losing control of not just their professional independence, but also their ability to represent their patients and place the patient interest first. Faced with increasingly annoying and time consuming rules, regulations and accreditation criteria, they are being drowned in administrivia that is distracting them from taking care of patients.

2. They are pushing back against healthcare information technology mandates that are interfering with the doctor patient relationship and bringing the high tech-high touch conundrum into full relief.

3. They feel they are being commoditized, marginalized and traumatized by hospital administrators more interested in the bottom line and their bonus than the welfare of patients.

4. Their salaries are dropping and their independence fading.

5. They feel powerless to make change without creating a unified voice. They feel abandoned by their professional medical societies who have been ineffective in advocating for their interests and are out of touch with the grunts in the trenches.

Unionization is but one way physicians have proposed to regain control of their professional destinies. Some are leaving employed positions to join groups in private practice. Others are demanding accountability from their local, state, national or specialty associations that they feel have failed to advocate for their interests. Lobbying Congress or electing medical professionals to state or national legislative bodies has been another successful strategy. There are a total of 20 physician members of the 113th Congress including three senators, 16 representatives and a delegate.

Unionization of employed physicians has many legal, social, public relations, healthcare and professional implications. For example, given the professed need to place interests of patients first, some see physician unions as just another ploy for doctors to feather their own nests and a smoke screen that will pass neither the smell test nor the NY TImes test. There are legal and regulatory barriers and significant differences among healthcare professionals with various political philosophies, particularly from those in various stages of their careers. Some have had enough and are manning the barriers with the pitchforks.

Doctors are angry and looking for answers. There is nothing more dangerous than a doctor with a wounded wallet and the result might be something that has unintended consequences.

One is that, pretty soon, we'll be hearing La Marseillaise playing over Musak in hospital elevators.