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Panelists Debate If Doctors Should Unionize

A crowd of curious and concerned medical students, residents, and physicians filled the MEC amphitheater on Nov. 18 to attend the Cabot Primary Care Series debate on whether or not physicians should unionize. Sea changes in the health care system over the last 10 years have shifted the organization of medicine from relatively small, private practices to managed-care systems run by large corporations, which directly employ some physicians. The transformation has left many doctors feeling powerless and ineffective, and it causes concern for medical students and residents who face an uncertain future.

union debate

Arnold Relman, Barry Liebowitz, and Thomas Reardon (l to r) showed agreement on the primacy of patient care in their debate on unionization of physicians, which drew thoughtful questions from the audience.

union debate

A No-Strike Union

Panelist Thomas Reardon, president of the American Medical Association and an active general practitioner from Oregon, defended the AMA's recent recommendation to form a negotiating organization for physicians. Stressing that the organization is not a traditional union because it will never strike or withhold care, Reardon said that the group acts as a collective voice for negotiation on behalf of physicians and their patients. He argued that a collective voice is a powerful and necessary tool for change, reminding the audience that the Patients' Bill of Rights would not have received the support it did in the House of Representatives without the organizational force of the AMA behind it.

Barry Liebowitz, president of the Doctors Council and National Doctors Alliance (NDA), which currently represents 15,000 unionized doctors nationwide, questioned the effectiveness of the AMA's union, given its no-strike stance. Although the NDA upholds the option to strike if absolutely necessary, Liebowitz, a practicing pediatrician in New York, said, "Our members are doctors first and union members second. Patient care will never, never be jeopardized [by the NDA]."

Liebowitz warned medical students in the audience that they "are being trained to treat patients, but are entering into a practice where profit is based on denying care." He argued that experienced, organized unions provide the tools to help physicians deliver medicine in today's for-profit health care industry.

Arnold Relman, editor in chief emeritus of The New England Journal of Medicine and HMS professor emeritus of medicine, fears that unionizing puts physicians in a combative position, which opposes the healing, service-oriented profession. He called for physicians to change the system in a more meaningful, radical way. Although he believes that managed care is here to stay, the current "marketplace" state of health care is not viable. In order for the system to work, it is going to have to be "not-for-profit, community-based, and run by doctors and local health care institutions with the support of community groups." Keeping the big picture in mind, Relman said, "Unions are unnecessary in a not-for-profit sector."

Despite their differences, the panelists agreed that they had more in common than not. Each panelist argued that the medical profession is in a critical condition. Whether or not unionizing is the best move for the profession, each agreed that current antitrust laws must change to allow physicians to organize. Furthermore, the speakers were primarily concerned with ensuring that patients receive the best care and that the ethical and moral integrity of the medical profession be maintained.

Summarizing a recent article in The New England Journal of Medicine, written by physicians who belong to the AMA, NDA president Liebowitz quoted, "We must make a moral commitment to the ethic of medical service, and we must be devoted to the work of providing health care, and we must negotiate and be a professional advocate for health care values."

—Catherine Chu