Ama Plans Union For Some Doctors

CHICAGO - Leaders of the American Medical Association say the national labor union they are forming for doctors will give them back the autonomy that managed-care companies are taking away.

"Physicians can't earn an honest return on an honest day of work," said Dr. Edmund Donoghue of Chicago. "Doctors are taking orders from all kinds of people who have no medical training."

The AMA's 494-member House of Delegates voted yesterday to form a labor union to bargain on behalf of doctors for better pay and working conditions - a dramatic attempt to give physicians more clout in an era of managed health care.

The decision signals the profound discontent of many of the 700,000 physicians in the United States over the direction of the nation's health-care system.

Some doctors said their field increasingly is dominated by bureaucratic bean counters instead of scientists.

The AMA's move also appears certain to inflame an already-smoldering debate over whether patients stand to gain or lose if their doctors can seize more leverage against health-maintenance organizations and other insurers. Such plans have acquired vast powers in the past decade to dictate most Americans' health care.

Insurance companies quickly predicted higher costs for consumers. The move could add 2 million people to the list of the uninsured and push premiums up by more than 10 percent, said Chip Kahn, president of the Health Insurance Association of America.

Doctors who work full time for health-maintenance organizations or hospitals already can unionize. The AMA vote essentially puts the organization's stamp of approval on the movement.

Nationwide, about 6 percent of practicing doctors - an estimated 38,000 to 45,000 - belong to unions, and experts predict the numbers will continue to grow. One of the largest unions is the Northwest Physicians Alliance, formed last year by doctors at Medalia HealthCare in Seattle.

Dr. Randolph Smoak Jr., chairman of the AMA's board, said the association will set up a national organization to help groups of doctors across the country establish themselves as bargaining units to negotiate contracts with hospitals and health plans.

Doctors' efforts to define themselves as employees reflect a remarkable shift. Since its founding a century and a half ago, the AMA has devoted much of its history to fighting to preserve physicians' autonomy.

Paul Starr, a Princeton University historian who is an authority on the history of American medicine, yesterday called the AMA's decision "a watershed," which "reflects a momentous change in the economic position of the medical position from the time when nearly all doctorss were independent businessmen. . .to a time when large numbers are either on salary or face very large buyers of their services."

Starr also interpreted the AMA's action as an attempt to create a counterforce to the recent consolidation of health plans across the country. "Each (side) is trying to represent a larger power in order to have more bargaining leverage," he said.

In an interview after yesterday's vote, Collette Willins, 35, a family physician in Cleveland, said she welcomed collective bargaining. "The problem is, little old me . . . going up against an insurance company," she said. "I have no negotiating power . . . (to) stand up and fight on behalf of my patients."

On the other hand, Lanny Copeland, who works in Albany, Ga., and is president of the American Academy of Family Physicians, said, "I think I'll be embarrassed when my first patient asks me if I'm a member of the union." Noting that the typical U.S. doctor's income is just below $200,000, he said, "The average connotation is, the biggest thing unions do is hold out for more money. . . . It smacks a little bit of greediness."

The AMA's top officials sought to distance themselves from other unions, saying that theirs would never go on strike, for example.