By Raymond J. Lodise, M.D.

President

Philadelphia County Medical Society

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Time has passed and now UNIONIZATION surfaces again. This time, in response to managed care, tort reform, and the CAT Fund. Physicians are having difficulty finding a level playing field. The legislators, legal profession, and the insurers have their rules with which to play. We, as physicians, dare not play by their rules. It suggests physicians are not part of the society they endeavor to keep alive. Physicians may not charge by the hour. We should work overtime. We may not charge mileage. We are not reimbursed for phone calls. We must have insurance to work. We must redundantly document our records. We must be available 24 hours a day. We must almost guarantee all our work. We should do free work. We must not discuss patients’ insurance plans and our and the patients limitations. Most of all, we should accept lower and lower net incomes and not complain. It should be no surprise the word UNIONIZATION arises. Consider if a teacher, plumber, dock worker, truck driver, or a lawyer was asked to follow these rules-you know the response that would occur.

Because physicians have attempted to maintain a professionalism, a morality, and be a servant of society, we have become the punching bag of insurers, legislators, and journalists. We are expected to keep taking the punches and not respond.

"Enough is enough" and a new philosophy is arising. Physicians must organize to exert a unified effort to level the playing field. We must have a voice, most assuredly the loudest, in health care. We are the licensed part of society to diagnose, treat, and protect the sick, not corporate America, the insurers, the plaintiff attorneys, or the judges.

Medicine has been limited by law from participating in unionization but organized medicine is not prohibited from advising, almost directing, physicians to associate with unions and use their methods to protect the basis of medicine until we can change the law. Unfortunately, we are now in a social environment which only seems to respond to work stoppages. I remind you of the miners, teachers, auto workers, dock workers, truck drivers, baseball players, and on, and on. These actions were not done to penalize society. They were done to get recognition and consideration of a problem and because of economic pressure and inconvenience produced a response not seen prior to the work stoppage. So it must be with medicine. This activity is done best through unionization, but can occur outside of a union. It is a bold step, but for those who do not agree, let them step forward and suggest a method whereby legislators, insurers, hospitals, and government would promptly acknowledge the problems cast upon us and more so our wards, the patients.

Already in California, Florida, Arizona, New York and Pennsylvania union-like organizations are forming. There really is no other choice. Do not let the word "professional" interfere with your thoughts. It has no meaning in today’s health care environment. It is used as an argument to suppress logical thinking and preserve organizations which have failed to thwart the socialization of medicine. Do not let the words "collective bargaining," "strikes," and "boycotts" cloud the issue with their negative connotations. Do not let "working through the legislative process" influence your desires since they only represent methods to slow the process.

The final rationale to form a union or a quasi-union is a simple one. Physicians need a podium from which to speak and be recognized by society and produce an awareness of "enough is enough." Along with a new organization we must educate the patients. We are those who recognize health care is being taken away, limited, rationed, and refused to patients who need it most. Insurers have produced a subtle attitude that we have a disposable part of society that is not productive and costs too much and should not burden the system.

The combination of an organization albeit a union representing physicians and patients cannot fail. Keep an open mind so you can preserve a reasonable health care system that is treating you now or certainly in the future.