Should Doctors Organize?

In recent decades, the healthcare industry has been largely consolidated under the management of fewer and larger entities [1]. The rapid rise of health-maintenance organizations (H.M.O.s)—with only three million patients enrolled in 1970 to eighty million represented by 1999—is attributed, by some, with aiding in the shift of control from doctors to health-management administrators [2, 3]. As regulatory and financial pressures have increased, doctors have seen a shift in their ability to make professional decisions [1, 2]. A 2016 New York Times feature unscored the central ethical dilemma doctors today confront: which is that “the imperative to increase efficiency in a high-cost health care system is often at odds with the deference traditionally accorded to doctors” [3]. A 2019 study found that among a subset of doctors, a mere 13% of their day was spent engaging in face-to-face patient care [4]. Another study noted that on average, over half of physicians’ workdays are spent maintaining electronic health records (EHR) [5]. Currently, rates of physician burnout stand at record high levels; Medscape’s 2018 National Physician Burnout and Depression Report revealed that 42% of doctors across specialties report burnout [1].

As it stands, no collective organization unites the approximately nine hundred thousand actively practicing U.S.-based physicians [2]. The largest entity, the American Medical Association (A.M.A.), which once enrolled three-fourths of American doctors, now represents only about two hundred and fifty thousand members [2, 3]. Thus, arises the impetus for the conception of a new kind of organization of doctors; one conceived and purposed to promote the interests of doctors and patients [1, 2, 3]. Although not common, the precedent for doctors to organize has been previously set. Perhaps the most well-known instance is that of San Mateo doctors’ response to a 1972 management change, which incited the formation of the Union of American Physicians and Dentists (UAPD) throughout Northern California [3]. In another instance, in 2014 at PeaceHealth Sacred Heart Medical Center in Springfield, OR, when hospitalists faced the challenge of outsourcing, they responded by organizing [3].

On the other hand, H.M.O.s and alternative managed care organizations provide financial and regulatory frameworks that may prove favorable to hospital employees, physicians, and patients [6]. Managed health care organizations provide a number of benefits to both its plan members and collaborating health care providers; to begin with, patients covered by managed health care plans enjoy reduced rates and assured access to medical services [6, 7]. Accordingly, doctors who are members of managed care organizations benefit from a reliable source and number of clients [6]. Additionally, physicians who are plan members reap the benefits of consolidated and streamlined billing services, which managed care organizations continuously strive to improve in efficiency [6, 8].  In addition to allowing families to stay together in accessing health care providers, managed care organizations provide a high degree of information-access and control to doctors through centralized diagnostic, prescription and patient history data-sharing across providers within shared networks [8, 9]. Plus, distinct types of managed care organization plans offer a number of useful options to providers and patients that allow greater access and choice of care coordination by primary care physicians and/or specialists [6, 8].

Another important set of considerations raised by the question of whether or not physicians should organize are the potential risks associated with unionization. First, the legality of such efforts is questionable, particularly in the case of independent practitioners as they would likely be in violation of anti-trust laws [11]. Furthermore, in the case of employed physicians, union representatives and negotiators often present demands that are simply unfeasible. This reality alone may severely jeopardize patient access to care, cheifly in the case that doctors respond by striking, a typical unionizing tactic [11].

While it is evident that doctors continue to face challenges throughout the medical field, the specific resolutions necessary to most effectively alleviate these obstacles remain unclear and may not be easily discerned. Without question, however, many agree that generating solutions to such complex healthcare challenges requires intensive collaboration and continued analysis [9].

[1] Hartz, Mandy Rae. “Physician Unionization: A Path Worth Considering.” The Independent Medical Business Journal. Minnesota Physician, December 2018.

[2] Topol, Eric. “Why Doctors Should Organize.” The New Yorker. The New Yorker, August 5, 2019. have a chance to,of all doctors is necessary. 

[3] Scheiber, Noam. “Doctors Unionize to Resist the Medical Machine.” The New York Times. The New York Times, January 9, 2016.

[4] Chaiyachati, Krisda H. “Allocation of Inpatient Time Among First-Year Internal Medicine Residents.” JAMA Internal Medicine. American Medical Association, June 1, 2019.

[5] Arndt, Brian G., John W. Beasley, Michelle D. Watkinson, Wen-Jan Tuan Jonathan L. Temte, and Christine A. Sinsky. “Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations.” The Annals of Family Medicine, October 2017.

[6] Araujo, Mila. “Managed Care Plans: HMO, PPO, POS, EPO.” The Balance. The Balance, April 1, 2019.

[7] “Managed Care.”, n.d.

[8] Ayres, Crystal. “12 Advantages and Disadvantages of Managed Care.”, n.d.

[9] Book, Robert. “Benefits and Challenges of Medicaid Managed Care.” Forbes. Forbes Magazine, October 19, 2012.

[10] “Can Doctors Form a Union: Medical Justice Services, Inc.” Medical Malpractice Insurance is Not Enough – Medical Justice, March 7, 2018.

[11] Masterfano, Michele. “Unions: The Good, the Bad, the Ugly.” HuffPost. HuffPost, November 17, 2013.

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