April 1997 Bulletin

Union helps orthopaedists in MCO pacts

AFL-CIO uses third-party messenger strategy

If the idea of unionizing offends orthopaedists' self-image as elite professionals, Michael Connair, MD, wants to set them straight.

The Connecticut orthopaedist says managed care organizations (MCOs) have already changed the status of orthopaedic surgeons. "Now, we're like carpenters, sitting in a union hall," says Dr. Connair. "The compensation is set; the benefits are established. We wait for an employer to hire us to frame a house."

A harsh image? Not for Dr. Connair whose experiences with MCOs in Connecticut led him to become a major force in bringing the power and skills of the AFL-CIO to the bargaining table with MCOs.

He is instrumental in having 28 of 30 orthopaedic surgeons in New Haven, plus others in nearby New Haven and Waterbury, join Federation of Physicians and Dentists (FPD) of the AFL-CIO.

Antitrust laws prevent physicians from collectively agreeing, for instance, to not sign a contract offered by an MCO, says Jack Seddon, FPD executive director. But it is legal for a third-party, such as FPD, to review the contracts sent to each of the physicians and to make recommendations to each physician whether he or she should sign or refuse the contract.

For union dues of $520 a year, FPD will provide services such as recommending changes in unacceptable contracts and even negotiating on behalf of individual physicians with an MCO. FPD also can perform services such as conducting surveys and publishing information needed by all physicians. The union published the mean customary charge and the median customary charge by every orthopaedist in New Haven for 46 orthopaedic/neurosurgery CPT codes. Physicians can use the information about the usual and customary fees charged if MCOs are underpaying for a procedure, Connair said.

Why use a labor union to negotiate physician contracts? Dr. Connair, guest speaker at a January meeting of the Council on Health Policy and Practice, said "labor unions protect employees from the unfair employment practices of employers. The relationship between physician and managed care company is now that of an employee and employer."

He is not optimistic that change can come about through legislative efforts. "There are not enough physicians to be vocal enough to influence legislators," he said. "There are not enough votes to vote people in and out of office. By attaching to a union, you have more clout." The FPD has 3,500 physician-members; the AFL-CIO, 14 million members.

Seddon added that MCOs are telling physicians that "for you to have the privilege of practicing medicine, you have to play on my court. It's a new ballgame, the ball is in your court."

Seddon assured the council that strikes were not one of the recommended strategies. "You can't abandoned patients," he said. "There are other ways to skin a cat, using the third-party messenger approach."

Seddon pointed out that physicians have belonged to unions for many years. FPD recently helped physicians employed by a clinic in Tucson, Ariz., hold an election to have FPD represent them in collective barganing. The clinic has asked for a National Labor Relations Board hearing to challenge the election results; FPD is considering filing unfair labor practices against the clinic. FPD also is working with physicians in Albuquerque, N.M.; Seattle; Philadelphia; and Ft. Lauderdale, Fla.

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