Salaried Doctors Are Courted by Labor Union

Seeking to capitalize on doctors’ frustrations with the reduced fees and loss of control over treatment that come along with managed care, the nation’s fastest-growing labor union pledged Monday to spend $1 million a year to organize physicians.

The Service Employees International Union will target salaried doctors, about half of the nation’s 600,000 practicing physicians.

The timing could not be better.

From Seattle to Pittsburgh, a small but growing number of doctors have either joined unions or petitioned federal authorities for permission to organize. About 35,000 doctors, about 6%, are already unionized.

Desperate for representation, these typically independent and well-off physicians are signing up with an odd assortment of labor unions, ranging from the United Food and Commercial Workers to more established unions that have represented hospital residents and other salaried physicians for decades.

“I can see the time coming when we’re not simply independent business owners . . . but just workers,” said Dr. Lawrence Koning, a Corona obstetrician-gynecologist who is a member of the Union of American Physicians and Dentists. “Doctors are being fired, they’re being cut back, they’re being told what to do or how much to make. . . . We have no power.”

The Service Employees union, which is attempting to position itself as a national powerhouse among health-care workers, said Monday that it is forming a new organization, the National Doctors Alliance, out of three existing physicians unions. The alliance already represents about 15,000 doctors, residents and interns--members of the Union of Salaried Physicians and Dentists, the Doctors Council and the Committee of Interns and Residents.

Organizers said they would focus on California, Florida, Washington, D.C., and Washington state, where doctors unions are already relatively strong.

The group would not rule out the possibility of strikes, despite a strong admonition from the American Medical Assn. that such techniques are contrary to physicians’ ethical codes.

“Sometimes it is far better to strike than to allow a patient to go into a substandard facility,” said Dr. Barry Leibowitz, a pediatrician and president of the Doctors Council. That union, which represents about 3,000 New York doctors, is one of the groups joining the Doctors Alliance.

The move comes at a time when several labor unions are focusing attention on professional employees, people with salaries and advanced degrees whose sense of stability has been undermined by a decade of downsizing and layoffs among large employers.

Health workers--from doctors and nurses down to lab technicians--are among the first groups to be targeted. Many of these workers have seen their workloads increase and incomes stagnate as HMOs and other forms of managed care have attempted to control costs.

Just last week, the Teamsters union filed a petition with the National Labor Relations Board to represent about 900 dialysis workers in the Los Angeles area.

And the Union of American Physicians and Dentists is already deep in the midst of a campaign to organize about 800 doctors who work for the massive Los Angeles County Health Department. Salaries for the county’s doctors range from $85,000 to $115,000.

“The balance of power in the marketplace has tilted so far toward insurers and their shareholders and away from the interests of our patients that it has placed our patients and physicians in a very dangerous position,” said Dr. Randolph Smoak, chairman of the AMA board of trustees.

The AMA recently put together bargaining groups for doctors in Louisiana, Illinois and Maryland. Although not technically unions, these groups--which refuse to strike--negotiate pay and working conditions for affiliated doctors.

“Physicians in places where there is a high level of managed care are having a hard time keeping their offices open because of the low reimbursement levels,” Smoak said.

Compensation for physicians has actually risen over the last several years. In 1996, for example, family practitioners averaged $137,805 and non-surgical cardiologists made $239,943, up modestly from the year before, according to the consulting firm Deloitte & Touche.

But doctors’ representatives say income figures do not tell the whole story: The averages mask lower pay for some doctors; others have lost autonomy in treating patients; still more have lost their job security.

Dr. Janice Nelson, medical director of the blood bank at L.A. County-USC Medical Center, was one of the first doctors employed by Los Angeles County to join the union. She was surprised to find herself and fellow “effete, intellectual” physicians in a union “like you’re some sort of blue-collar worker. But we are.”

The 1995 county Health Department layoffs pushed her into membership. “We learned we were expendable,” Nelson said.

Physician membership in the American Federation of State, County and Municipal Employees, which is not affiliated with SEIU and was not part of the announcement on Monday, has increased fivefold to 10,000 to 12,000 physicians in the last four years, Vice President Dr. Dan Lawlor said.

Most of them are salaried employees working at clinics or hospitals.

Concerns about managed care, rather than salary, are the prime motivating force for doctor unionization, said Lawlor, whose organization serves as the umbrella group for the 5,000-member Union of American Physicians and Dentists.

Dr. Charles Goodman never thought he would need a union to do what he considers his job--seeing and treating patients.

When he began his pediatric practice in West Hills in 1989, Goodman says he simply “saw patients, which is what I went to medical school for.”

But, gradually, paperwork and fighting managed-care organizations took over his life.

He spent hours on the phone, calling to track down lost claims or challenge HMO decisions. “I found that national organizations I used to belong to, like the AMA, won’t go to bat for you or your patients,” Goodman said.

So last year he joined the Union of Physicians and Dentists.

Though he is in private practice and thus cannot be represented by the union in collective bargaining, he relies upon the union’s legal backing.

“Individual doctors and groups are powerless when they go up against large HMOs and [physician-management companies] and hospitals,” he said.

The unions, which have had modest success among pockets of doctors around the country, face an uphill fight. Doctors are a notoriously independent lot, most of whom see themselves as the owners of small businesses, not like factory workers or white-collar employees.

In addition, there are significant legal obstacles to efforts to organize physicians who do not work as salaried employees of HMOs, hospitals or other organizations. These doctors, some of whom have attempted to join unions in the past, are viewed by HMOs as independent contractors. And a private physician practice is considered by the Internal Revenue Service to be a business.

To win the right to unionize, such private physicians would have to prove that they are in reality employed by HMOs. One such effort was recently opposed by the Justice Department, which argued that the doctors are independent businesses attempting to engage in price-fixing.

To avoid those pitfalls, the SEIU drive will focus on salaried doctors, not independent practitioners.

SEIU, fresh from last week’s successful campaign to organize home health-care workers in Los Angeles County, said it will target four health-care organizations, but would not name them.

Since 1996, the Union of American Physicians and Dentists has been recruiting doctors in the public hospitals run by Los Angeles County, and an election to make that union their official representative is set for May.

“Doctors in the past used to consider themselves as part of management,” said Joe Bader, an official with the union local.

But cost-cutting administrators have taken over even public systems such as Los Angeles County’s, he said.

“The doctors are very demoralized,” he said. “And it can’t be good for the health of the system.”

Times staff writer Alissa J. Rubin contributed to this report.