In radical turnabout, AMA votes to create national doctors union

Heated debate precedes decision to organize residents, salaried MDs


The American Medical Association, whose members viewed themselves for decades as elite professionals who did not need a union, voted yesterday to form a union for doctors in what it called an effort to level the playing field with powerful managed-care organizations.

At a delegates meeting in Chicago, the 290,000-member association jettisoned its anti-unionization stance because so many doctors complain of feeling powerless in their dealings with health maintenance organizations.

Several health industry experts said the decision by the AMA, long a pillar of conservatism, underlined how sweeping the changes have been in the health-care industry and how frustrated and angry thousands of doctors have become.

Declining representation

The 152-year-old medical association represents 34 percent of the nation's doctors, down from 45 percent a decade ago.

It felt pressure to act because several of the nation's most powerful unions were aggressively seeking to unionize doctors in moves that eroded the AMA's base and made it seem timid and behind the times in fighting for its members.

Specifically, the AMA voted to set up a branch that will work to unionize two groups of doctors -- salaried employees and medical residents -- which together represent about one-third of the nation's 620,000 practicing physicians.

The association also said it would work to unionize some of the nation's 325,000 self-employed doctors, but to do that it needs to persuade Congress to give these doctors the right to bargain collectively.

Eager to reassure patients that the AMA was not forsaking the Hippocratic oath, the association's leaders insisted yesterday that an AMA doctor's union would never strike if it were to jeopardize patient care.

AMA leaders said repeatedly that a major reason for favoring unionization was to pressure HMOs and hospitals to improve patient care.

"Our objective here is to give America's physicians the leverage they now lack to guarantee that patient care is not compromised or neglected for the sake of profits," said Dr. Randolph D. Smoak Jr., chairman of the association's board of trustees.

The AMA envisions trying to set up dozens of union locals for doctors around the country over the next five years.

Industry experts estimate that nearly 40,000 doctors belong to unions, and the AMA is expected to work to significantly increase the number.

"It's a major step for an organization that had been slipping," said Dr. Barry Liebowitz, president of the Doctor's Council, a New York-based union of 2,500 doctors that is the nation's oldest union of attending physicians. "The endorsement of a doctors union by the AMA gives an enormous psychological boost to the movement to unionize doctors."

Fierce debate, close vote

The association approved the unionization measure in a tense and close vote by a show of hands. Association officials said no formal count was conducted.

The debate was so fierce that while the association's board had recommended against forming a union affiliate, the association's 494-member House of Delegates rejected the board's advice in reaction to pro-union rumblings across the country.

An AMA survey found that 88 percent of doctors favored salaried physicians organizing to negotiate with hospitals and managed-care organizations.

Doctors in private practice are not allowed to unionize because federal labor law permits only people described as employees to unionize. Indeed, when self-employed doctors have sought to unionize, they faced the threat of antitrust charges of conspiring in restraint of trade.

In its resolution yesterday, the AMA vowed to lobby for a federal antitrust exemption that would enable self-employed doctors to engage in collective bargaining.

Pub Date: 6/24/99

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