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Doctors are not entirely unlike basketball players, another group of rich and powerful professionals who've chosen to defend their rights with unions. "Their job is rough," says Jim Butler, president of Local 420, which represents many of the hospital staff who toil rungs below the exalted curers. To Butler, physicians' long hours and grueling responsibilities are in some ways comparable to "sliding across the floor of the Garden on your spine." More to the point, however, doctors and unskilled health workers are being pressured by the same cost-cutting new bosses: managed-care companies. "It's like with the ballplayers," says Butler. "They make money for the owners, so they should get a piece of the action."
As increasing numbers of docs band together and managed care irks more patients and health care workers Butler's view is enjoying growing support. But there is more than a little irony in a movement to protect professionals who still rake in far more dough than almost anyone else. Consider that the average worker in Butler's union makes $22,000 a year, for instance, while the average physician's income is almost 10 times that.
Physicians made about $200,000 on average in 1996, according to previously released data from the American Medical Association. (The professional organization no longer gives out such numbers, however, because some members worry they are inaccurate and provide fodder for poor-little-rich-doctor jokes. Nowadays the AMA will only say that in 1996 the bottom fourth of physicians had an income of $140,000 or less, while the top quarter made more than $240,000, and emphasize that physicians are typically about $75,000 in debt when they finish medical school.)
Whatever the exact number, the fact that doctors' earnings invariably hover well above those of other organized workers makes them seem odd union bedfellows. Take the rank and file of the International Association of Machinists, one of the unions now recruiting physicians in New Jersey. According to J. Stephen McLoughlin, administrative director for the physicians' local within IAM, doctors approached the union themselves after hearing that it had successfully negotiated on behalf of limousine drivers, whose ability to collectively bargain had been in question because of their semi-independent status. "Doctors looked at the limo drivers and said, 'We're in the same boat,' " says McLoughlin.
Well, sort of. Like the drivers, doctors may have a hard time making the case that they have the right to unionize (according to the National Labor Relations Board, in order to join a union, one has to be classified as an employee a term that is a questionable fit even for doctors who contract with HMOs). But driving for rich guys they're not. In fact, contrary to the recent cries of hardship, doctors' income has actually risen steadily in recent years, dipping only slightly around 1994.
Nevertheless, IAM, which represents low-paid airport workers as well as well-heeled engineers, became convinced that the doctors approaching them were in sufficiently bad financial shape to warrant a union. "We have members who have had to lay off their office staff and bring in wives to run their offices," says McLoughlin. "It's a crisis."
The crisis, such as it is, is as much about shoring up medical authority as it is about money. Doctors don't just happen to be among the most esteemed and well-compensated professionals in the country it takes doing. The AMA spent more money than any other organization lobbying Congress in '97. And the growing unions are also engaging in turf battles as well as fighting for higher pay. The Doctors Council, a union that represents 3400 New York City doctors, for instance, still boasts to potential members that it won doctors the exclusive legal right to sign off on death certificates (a move that even live patients are unlikely to care about).
Some of the battles unionized doctors are taking on will, on the other hand, be of great benefit to patients. One of the doctors' biggest struggles is to control their own schedules and have more leisurely appointments (i.e., longer than 7.5 minutes). And if the nascent movement ever does buck managed care, patients might once again be able to choose their own doctors, something many patients seem to prefer.
Some doctors' unions are even expressly public-oriented. The Committee of Interns and Residents, the nation's oldest doctors' union, is working to spare patients encounters with zomboid surgeons and ER docs by pushing for hospitals to abide by the law limiting medical interns and residents to 80-hour workweeks. And the Doctors Council lobbies for funding for local clinics and school health programs, which employ their members but also provide needed public services.
But both groups tread carefully when it comes to the matter of strikes, arguably the most powerful tool of labor. A doctors' strike is a much scarier prospect than a Saturday night with no ball game. Barry Liebowitz, president of the Doctors Council, dismisses strikes as extremely unlikely. But the doctor and labor leader stops short of assuring patients that strikes won't ever happen. "Why give away a very potent weapon unless you get guarantees in return?"