By Robert L. Weinmann, M.D.

President, Union of American

Physicians and Dentists,

Oakland, California

• Union of American Physicians and Dentists web site

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AFRAID TO JOIN A UNION?

Traditional professional values professed by physicians make us think twice about collective bargaining. Somehow it seems unprofessional. Is standing independently and losing one fight after another more professional? There's no reason for collective bargaining if you enjoy losing. The Union of American Physicians and Dentists (UAPD) was formed for doctors who prefer winning.

One does not sacrifice an iota of professionalism by joining a union. Unions make sure that people get treated fairly. The real revolution is that gigantic corporations treat professional employees like chattel and that the nature of professional deportment precludes fighting back in a forceful and organized fashion. The emerging counterrevolution is that professional people are forming their own unions. The UAPD is part of this counterrevolution.

THE THREAT FROM THE LEFT IS MATCHED BY THE THREAT FROM THE RIGHT

Not so long ago physicians were worried about the threat from the left in the form of government controlled medicine. The big worry then was socialized medicine. In fact, the now defunct Soviet Union hammered physicians with this principle: the Hippocratic Oath was replaced by population-responsive medical care, care of the state, and minimal worry about the individual. This hammer, the threat from the left, made inroads in the United States but the principle of "first, do no harm" remained dominant in American medicine and remains dominant. Medical care to benefit the individual is still the driving force in our medical system.

But while we were busily warding off the threat from the left, a wily new threat arose from the right and poked its nose under the American medical tent. What this nose sniffed out was that the time was ripe for corporate medical enterprise. Managed care in the form of health maintenance organizations and other controlled access medical care plans began to emerge. The megamerger mentality of the 80s was in vogue, profit before all else was becoming increasingly glamorous, and new technology was ready.

FIRST, A LITTLE HISTORY, VERY LITTLE

After World War II, the insurance industry provided financing in a way that allowed America to expand business interests faster than was possible in other countries. In return for this largesse, legislation was passed that exempted insurance companies from antitrust, for instance, insurance companies would be allowed to share data, set prices, and so on. Individual contractors, so-called competitors, of course, would not be allowed to do so -- if they tried, they would run afoul of antitrust in the form of illegal collusion to fix prices.

For a while, the benefits were obvious. American insurance interests developed data for home loans, life insurance rates, and so on. Everybody was happy, and lots of people were getting rich. During these years, physicians practiced independently, set their own fees, and didn't worry much about insurance companies. All that changed radically during the 70s and 80s. The gross national product in terms of health care was growing. Financial institutions were now interested in what was heretofore essentially only a cottage industry. But unless the insurance industry could control the data, and share it, while their competitors would be restricted from controlling and sharing the data, they would just have to look wistfully at all that money.

What happened next was the emergence of rapid data processing such that an insurance company could with the flick of a toggle switch know what any physician's fees were anywhere, what contracts he had been bullied into accepting, and for what rates he was willing to grovel. Meanwhile, the physicians would not be allowed to penetrate the data bases of the insurance companies, they would not be allowed to bargain collectively, and they would be dissuaded by their own professional views of themselves as people of honor from pursuing a better pay scale.

Thus, the threat from the right in the form of insurance companies and big business supplanted the threat from the left. While physicians shored up the left flank, their right flank remained exposed. Now the trap has been shut in the form of a flanking maneuver from interests the physicians mistook as friendly.

WHAT TO DO? SHOULD WE WRING OUR HANDS, OR THEIR NECKS?

Join the professional union of your choice. The time has come for physicians to understand that there are other professions besides medicine, law, accounting, dentistry, military, clergy, and so on. The UAPD is an organization of educated and trained people, skilled in the art and craft of negotiation and confrontation, skilled in negotiating contracts, representing members in disputes with hospital administrations, medical boards, HMOs, insurance companies, and other adversaries. It's our metier, so to speak. It's our skill, and the skill of like professionals elsewhere, that will enable organized physicians to stand up to corporate interest so that they, medical professionals, can do the job they were trained for without fear of reprisal by your local unfriendly HMO.

The UAPD, founded in l972 with Dr. Sanford Marcus as the first president, is a non-profit mutual-benefit organization. We are an independent labor union representing physicians and dentists. Although over 90% of the 5,000 doctors we represent are in California, we are equipped to develop affiliates in other states and, in fact, are in the process of doing just that. In California we have developed an independent non-profit negotiating arm for 1,260 of our private practice doctors that provides access to 3.1 million modified-fee-for-service (PPO and industrial) lives.

HOW DO I LEARN MORE ABOUT THE UAPD?

You call us at (510) 839-0193, or fax us at (510) 763-8756, or write us at 1330 Broadway, Suite 730, Oakland, CA 94612-2506. Our e-mail address is uapd@uapd.com. Just say you want information about joining the UAPD.

If your bent is simply scholarly, read "When Doctors Join Unions" by Grace Budrys, published by Cornell University Press, c. 1997. This book discusses the history of doctors' unions and explains why the UAPD has been successful when so many counterparts have not. Doctors’ unions in other countries are also discussed.