MARCH 4, 1997
Tom Bearden reports from Tucson, Arizona on the changing face of health care in the 1990's and doctors' unions.
JIM LEHRER: Now, another in our continuing series of reports on the changing face of health care in the 1990's. Tonight: doctors unions. Tom Bearden reports from Tucson, Arizona.
TOM BEARDEN: Tucson Dr. Keith Shelman says the idea of joining a labor union never crossed his mind when he was a medical student nearly 20 years ago. He's quick to add the concept of "managed care" never occurred to him either.
DR. KEITH SHELMAN, Union Organizer: I never realized that economic decision making would creep into what should be a clinical arena. I never realized that both doctors and patients would be commodities that would be bought and sold in the marketplace. So after dealing with that, the whole concept of joining a union was a very easy mental jump to make.
TOM BEARDEN: Managed care was designed in response to the demand for lower medical costs. And it succeeded by limiting a physician's ability to order tests and refer patients to specialists and by lowering doctors' fees. But managed care has angered a lot of doctors who feel too much control has been taken away from them and given to accountants. Now, some doctors are joining labor unions in hopes of regaining control. Two doctors unions, one based in California and another in Florida, have grown from just a handful of physicians to nearly ten thousand members nationwide. And in December a group of podiatrists formed a union that quickly attracted several thousand doctors from all over the country.
DR. KEITH SHELMAN: (on phone) It's Dr. Shelman calling for Esther.
TOM BEARDEN: In Tucson, Dr. Shelman and dozens of other physicians at the Thomas Davis Medical Center began talking about joining a union last fall when they learned the new owners of the center planned to make big changes.
DR. KEITH SHELMAN: Our access to specialists, internally and externally, was going to be severely constrained. The number of patients and the amount of time we could spend with patients was ready to be fundamentally changed. And this was a consequence of our being taken over by a new corporate entity and a new business model that they said was necessary to maintain a certain break-even point. Our problem is that we had a conflict. Our very fundamental duty was to the patients. Our owners had a fundamental obligation to their shareholders.
TOM BEARDEN: The new owners, FPA Medical Management, declined our request for an interview. They issued a written statement which said: "FPA empowers physicians by increasing their autonomy and responsibility. By minimizing the administrative burden on the physician, FPA enables physicians to focus exclusively on the delivery of high quality health care." Not all of the physicians at Thomas Davis think a union is a good idea. Dr. Neopito Robles, a surgeon who has worked at the medical center for nearly 30 years, defends the new management company.
DR. NEOPITO ROBLES, Union Opponent: I really take issue in some of the statements made by Dr. Shelman that the quality of care at Thomas Davis Clinic is deteriorating. I challenge him to show me that.
TOM BEARDEN: Robles says management made mistakes by not always communicating effectively with the physicians, but he says there was never any plan to curtail patient care. He says the real issue is that some doctors haven't adjusted to the realities of managed medicine.
DR. NEOPITO ROBLES: We used to be owners of Thomas Davis Clinic. We've become employees. And that's a lot of change. And some of the physicians have not been able to make that adjustment from an owner to an employee. I have because, like I said, I know what's happening out there. And this is what--we have to make adjustment to the times.
TOM BEARDEN: That question, whether physicians are employees, had to be resolved before the Tucson physicians could join a union in the first place. The owners of the clinic filed an objection with the National Labor Relations Board saying that physicians are managers and, therefore, prohibited from forming a union. Cornele Overstreet is the regional director of the NLRB. He said doctors are managers if they're actively involved in the operation of the hospital, itself. He said that wasn't the case at Thomas Davis.
CORNELE OVERSTREET, National Labor Relations Board: We decided that in this case the doctors were told how many patients they had to see; they were told hours in which they had to work. They were told many things that would take away the normal independent judgment that would be necessary, let's say, to consider a person to be managerial or supervisory.
TOM BEARDEN: After the NLRB ruling that doctors could unionize, Thomas Davis doctors voted 93 to 32 to join the AFL-CIO's Federation of Physicians & Dentists.
DR. KEITH SHELMAN: The movement is pro-patient to make certain patients get what they're entitled to.
TOM BEARDEN: Shelman, the newly elected union president, said the first demand they will likely make is for longer patient visits. That'll be good news for Margie Sampe, who has been a patient at Thomas Davis for over eight years. She says lately she's felt like she's been rushed in and out of appointments for herself and her 16-month-old son.
MARGIE SAMPE, Patient: I have noticed that they were taking less time with us than they could be--you know--because they have such back-to-back patients that they have to see on a schedule and stuff. So I think the utilizing will help them get back to where they're going to give us more time.
TOM BEARDEN: But Jean Faltin, who has been with Thomas Davis for 30 years, says care at the clinic has never been better. She says she's waiting to see what effect the union has on patients.
JEAN FALTIN, Patient: And I'm watching very carefully. I'm reading everything I can. I ask my doctor questions. I keep very involved in my own care, and if I notice any problem, I wouldn't hesitate to change.
TOM BEARDEN: The ultimate question nearly everyone is asking is: What happens if the doctors go on strike if their demands aren't met? Dr. Shelman says flatly that won't happen.
DR. KEITH SHELMAN: We are purposefully restricting ourselves from striking. We have committed to ourselves we're not going to ask for more money. What we are going to do is ask for the right and the privilege to be good doctors. All we want to do is give our patients the very best.
TOM BEARDEN: Dr. Robles is still skeptical. He thinks the real motivation behind forming a union is more money for doctors. He says he would have very strong words for his colleagues if they even think about striking.
DR. NEOPITO ROBLES: I said if you do this, and I said, I have lost my respect for you as a physician; although he might be my best friend, if he pickets, then he is not a physician.
TOM BEARDEN: Anesthesiologist Marc Leib is a spokesman for the Arizona Medical Association. That organization has not taken a position on the union, itself. Leib says he understands the frustration that led the doctors at Thomas Davis to join one. Nevertheless, he's not convinced that unions are the best solution to deal with the problems raised by managed care.
DR. MARC LEIB, Arizona Medical Association: Most of us went into medicine because we really want to help, and we really want to take care of patients, cure diseases, those kinds of things. And we really don't see that traditional union activity as part of that medical field.
TOM BEARDEN: Union doctors are still a minority; just over 2 percent of the nation's 680,000 physicians have joined one. Doctors who run private practices can't join unions without violating antitrust laws. But despite these barriers, membership is growing. Dr. Leib says the trend might be reversed if managed care companies would just make a few changes.
DR. MARC LEIB: If the companies and the physicians work together to improve the patient care, to give the physicians some autonomy in deciding how to take care of their patients, then maybe the physicians won't see a need to do this. I think this move was born more out of frustration in these early stages of dealings with these companies than it was from, gosh, this is the only thing we can do, and this is the wave of the future.
TOM BEARDEN: In Tucson, the initial round of negotiations between the doctors union and the management company is scheduled to begin this spring.