A Doctors Union: Uniting or Dividing?

These are turbulent times for all providers. The winds of change are sweeping the country with gale-like strength to reform how health care is delivered. Incredible economic forces are colliding with a long heritage of professional integrity to create massive global agitation: witness the American Medical Association's (AMA) House of Delegates voting to establish a collective bargaining unit for employed physicians. Putting aside the fact that there are many hurdles to overcome, such as antitrust issues and employed doctors vs. the self-employed vs. the independent practitioner, the most important (and immeasurable) consequence of this unsettling action has yet to be determined.

The AMA's move may create an enormous negative backlash from the very people doctors profess to serve: their patients. No one has asked them what they think, but they will be the ultimate "union makers" or "union breakers." Time will tell if the AMA has dealt itself a fatal blow to the once invincible and almost omnipotent position it has enjoyed in Western society. The confusion and anger is fueled by the fact that health care reform has altered the power of the provider in the minds of patients and payers. No longer will society pay tribute to allopathic physicians simply because their image has been created by Madison Avenue and the AMA to indoctrinate the public that doctors are motivated by a higher calling and thus deserving of the "cultural authority" bestowed upon them by society. This position has been enjoyed by doctors for almost a century.

However, no matter how sugar-coated and positive the AMA spokespersons would like to spin this issue, it boils down to economic self-protection of the former coveted position enjoyed by allopathic physicians as independent free agents which the AMA, as the medical trade association, has failed to protect. If the doctors believe they can convince Americans that their motives are pure, and their objectives and goals to unionize are solely for patient protection and to provide better care for their patients, this transparent duplicity will only add fuel to the already mounting distrust of doctors which society already embraces.

Unionization in the health care industry is not new. Many hospital workers, from janitors to nurses, have been unionized by the Service Employees International Union. However, it is a newer phenomenon for doctors, who are the highest paid employees in the health sector, to consider unionizing. It seems almost ironic that at a time when union participation in general (e.g., UAW, Teamsters, Steelworkers) has been struggling with dwindling membership, the AMA would adopt a dinosaur of a model to present its grievances.

The union concept is the very antithesis of what caused many individuals to enter the healing arts. Physicians, for the most part, are fiercely independent lone wolves, self-directed and self-governing. Now they want to adopt a model which is based upon rejecting independent thought and relinquishing their individual will for the advancement of the group.

The AMA, like other trade associations, has been plagued with declining membership and questionable ethical decisions. This has caused a loss of confidence and division within its own house, all because of an inability to serve multiple interests during a crisis with respect to leadership.

This is hardly the profile of an organization that would engender confidence in its decision-making ability. Has the AMA leadership succumbed to the political pressures of a vocal minority and taken a politically expedient position, or have they lost their mission relative to why they are doctors? Decisions are often made for the wrong reasons rather than for the principles of taking an ethical stand; not only for the welfare of the patients, but because doing things right is not the same as doing the right thing.

In less than a decade, allopathic physicians have gone from being the kings of the roost to the poster boys for abused professionals. Why it happened is no secret: decades of economic abuse to the health care system, resulting in an erosion of confidence by the public, which resulted in a knee-jerk reaction by government to "fix the problem if the professionals cannot be trusted to fix it themselves."

Real or imagined, take any poll and you will find the words greedy, uncaring, rushed, arrogant, insensitive and indifferent used by the public to characterize the general feeling of the public toward medicine - perhaps not their own specific physician, but physicians in general.
Now the nation's largest trade association, the AMA, and perhaps even their "own" doctor, wants to join or form a union. Unions mean collective bargaining; negotiations over money and working conditions; and perhaps even intrusions into their judgments. But unions also mean strikes if the negotiations break down. The AMA president said the AMA would not strike, but without that final weapon, the union is a toothless tiger in a jungle full of predators. We won't discuss the "what if" doctors do decide to strike. Under such a scenario, there would be more government control imposed to protect patients' rights than any current imaginable practice restrictions. This situation has yet to be played out in the courts of law or the courts of public opinion.

The next issue the AMA will have to deal with is the question of its current dwindling membership lon with the possibility of labor unions vying for the very membership the AMA is trying to hold onto. Will this movement further weaken the AMA and shore up unions that will be enhanced by the infusion of doctor members? Can the leadership-challenged AMA convince its angry and frustrated members to have confidence that the AMA union will be more effective in resolving their problems than current AMA programs? What will the new union be called? Perhaps Doctor's Altruistic Medical Union, or DAM-U for short? There may be others, such as Guilds-R-Us, which may play better for those who do not like the word union.

The AMA is now using spin doctors to take the issue off the backs of the real facts that health care is changing and many doctors are refusing to change. The era of the doctor doing whatever he/she wants with impunity is gone forever. Their system of health care for the next century will demand accountability, responsibility, dependability, and most of all, believability. Care will be delivered in a fashion that will be part true art form, part science predicated upon disease management principles, and a significant amount of partnering with the patient. Outcomes will be measured, patient satisfaction will be monitored, cost will be stabilized, and quality will be more than a word.

What does all this have to do with chiropractic and our position in any or all of these discussions? The profession has an opportunity to step up to the plate and accept responsibility for delivering care in a manner consistent with the expectations now firmly established by the reforms in place. Chiropractic doctors have an opportunity to fill the void which will be created by the diminishing role of the allopathic physician. The stars in the galaxy are lined up. Allopathic prestige is being challenged and its methods are under scrutiny; its organizations are crippled by internal disharmony; and allopathic in-fighting has weakened the very fiber of medicine (reminiscent of why chiropractic has not made greater advancements).

Chiropractic can emerge as a viable alternative propelled by a trajectory of forces catapulting the complementary and alternative movement forward at a speed unthinkable a decade ago. Research has provided a sound basis for the profession. It feels less inhibited to pursue the direction our scholars, researchers and clinicians have advocated in the past, largely based upon empirical evidence rather than evidence-based investigation.

As we end the last year of the century, we have an opportunity to erase old prejudices, improve tarnished images, enhance clinical expertise, rebuild practice ethics and advance chiropractic by adopting the essence of what it means to be a professional. I predict the union of doctors will be the beginning of the demise of the AMA and the medical community as trusted professionals.

Chiropractic has usually been in the wrong place at the right time and made the wrong decisions at the wrong time. Perhaps this is one time we can look at someone else and learn from their mistakes. It will take more than the formation of a union to correct what is perceived by the public as the problems of health care. I hope that the chiropractic profession watches this drama unfold and is attentive to the positive and/or negative responses which will emerge from the current controversy. I don't know how this will ultimately play out.

Is there a union cry heard on the horizon for all other health disciplines, or is the emergence of self-regulation and restoring public confidence the wave of tomorrow? I, for one, would rather leave the union bug in the medicine bag.