Medicine for HMO ailment

Unions: Physicians union could shake managed care, but patients need to advocate, too.

July 02, 1999

THE VOTE by American Medical Association to form a labor union should induce health maintenance organizations to reconsider the way they do business with physicians and patients.

The AMA's move is a drastic one.

Not only do doctors have a median salary of about $164,000 a year, but by tradition they are entrepreneurs not laborers.

Yet many feel overly constrained by limitations on their ability to prescribe drugs, to refer patients to specialists and to keep patients hospitalized as long as they think necessary. One doctor complained of spending up to 20 hours a week haggling with insurers over approval of drugs and treatment for his patients.

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Patients, too, are frustrated by managed-care rules. The grumbling about HMO restrictions has even moved from hospital waiting rooms to Hollywood. The Academy Award winning film "As Good as it Gets" portrays HMOs as the villainous obstacle to decent health care.

Although the move to form a union is primarily to protect the interests of physicians who are on managed-care payrolls, the effort could ultimately mean better patient care if it returns a measure of flexibility that allows doctors to have the final say about the drugs and treatment they prescribe.

It is important to note, however, that unionization could become a negative for patients if HMOs simply pass on costs to patients. Frustrated consumers must not be led to believe that the move by doctors is automatically in their best interests.

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