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Re: Have we been used?From: Arthurfree@aol.comMon Oct 7 10:16:55 1996
In a message dated 96-10-07 10:31:34 EDT, you write:
> The AMA and ACOG are a professional/political organizations and cannot take part in any sort of collective bargaining on our behalf. To a certain extent, we are victims of our own (and historical) professional status. If you look at your third party payor/managed care contracts, you will find a clause in virtually all of them that says "this agreement does not create any relationship other than that of subcontractor to provide services" (or something similar). This clause does many things, but what is pertinent here is that it means, even if ALL of your income comes from a single plan, you have agreed not to be considered an employee. The significance of this is that if you are employed by a large clinic, you can organize within the business to negotiate with the management of that organization. Any organization that crosses lines (goes outside a single corporation) cannot negotiate fees or boycott a payor. This means that a solo physician (under anti-trust law) cannot discuss fees or payor issues with any other physician (at least if it results in those physicians taking an action) and is expected to be able to effectively "negotiate" with an insurer that controls the majority of his or her patients. The way the law is written, a "seller" of services (you and I) cannot control a commanding portion of a market (called a "monopoly"), but a "buyer" of services (in our case, third party payors) has no such limitation (such dominance being called a "monopsony"). I have long held that physicians will not have a true seat at the table until we are all employees of large medical conglomerates and can form the American Federation of Employed Physicians, pay dues and negotiate with the large provider organizations and strike if necessary. The problem is, that to do so we give up current autonomy and it is my feeling that the patient really loses us as primary advocate (just call the complaint department and listen to musak, dearie). Talk to your nurses and see how they have chafed with the majority of them being employees of hospitals and still trying to advocate for patients. Yes, physicians can unionize (many residents, who are employees of hospitals, already are; Kaiser employees in some places are), but you have to give up the independent profession of medicine to do so, barring very significant anti-trust reform. Arthur Freeland Warrensburg, Missouri
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