August 1999 Bulletin

Lots of work ahead to start AMA unionizing

NLRB must certify bargaining agent in each locality; process could take months to years

The American Medical Association's decision to form an affiliated national labor organization came after years of rancor in the ranks of physicians dealing with managed care organizations, but don't look for union activity anytime soon.

A majority of the AMA's 494-member House of Delegates meeting in June voted to form a labor organization-against the AMA Board of Trustees' recommendation. The union will represent employed physicians in negotiations with hospitals, health plans and universities in negotiations on contract terms and patient care.

The AMA estimates that although more than half of the physicians in the United States would be ineligible to join because they are self-employed, the union could represent up to 108,000 or 17 percent of the nation's physicians.

The amount of participation by physicians "will depend on how badly physicians are beaten up by the local people they are dealing with," says Randolph D. Smoak, Jr., MD, AMA president-elect.

The AMA has promised to begin work immediately to form the affiliated labor organization. Unlike a traditional union, "the national negotiating organization will not strike or endanger patient care," says Smoak. "We will follow the principles of medical ethics every step of the way."

After the national organization is formed, collective bargaining units will have to be certified as agents in each locality where physicians want to collectively negotiate a contract-a process that typically takes from months to years, says Les Heltzer, acting deputy executive secretary, National Labor Relations Board (NLRB), Washington, D.C. "Technically, a petition indicating who the employer is, the location and things like that, has to be filed to initiate a board-aproved election," Heltzer explains. "Then, after the petition is filed and supported by a 30 percent showing of interest, there can be an election." If a majority is achieved, the next step is to negotiate a contract with management.

To successfully launch this effort, Dr. Smoak says the AMA and physicians will have to provide financial support. The Board of Trustees' report to the House of Delegates included projections for an active model of an AMA-affiliated collective bargaining unit. In that scenario, the AMA anticipated there would be local bargaining units completed or in the development stage at 35 locations in the first five years. These would include 25 resident units and 10 units for employed physicians in hospitals and physician practice settings. After five years, more than 2.000 employed physicians and 7,500 resident physicians would be members. An additional 3,000 former residents who were members of collective bargaining units will have finished their programs during this time.

The total expense for the five-year active model would be $5.8 million, assuming a 50 percent success rate in forming the units. Revenue of $6.6 million is projected from dues of $720 a year from employed physicians and $300 a year from residents.

In a slow growth model in which there was successful development of only one resident bargaining unit a year and only one employed physician group a year, expenses would exceed dues until the fifth year when the effort would break even. The total financial liability until the break even point is estimated at $1.7 million.

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