Negotiators for striking physicians and the Group Health Association continued meeting with federal mediators yesterday in an effort to end the impasse that precipitated the doctors walkout last Saturday.
Officials of the Civil Service Commission said yesterday they are keeping in close touch with the situation to make sure that the 29,000 federal empployes who receive medical care from GHA are getting appropriate treatment.
A commission official said seven complaints had been received from federal employes since the strike began, a number she characterized as relatively small. GHA has 109,000 members, more than half of whom are federal employes and their families.
Emergency and non-routine care is being given by about 30 nonstriking physicians. Striking doctors are continuing to see hospitalized patients and to take regular turn on the emergency call schedule. Appointments for routine and elective procedures are being canceled by GHA.
Three basic issues have separated the physicians and the board of trustees, elected by GHA members to run the health plan:
Malpractice insurance - GHA pays about $875,000 a year for malpractice insurance premiums, according to GHA officials. Each physician has a $3 million policy for each occurrence, plus a $3 million "umbrella" policy to cover awards of more than $3 million. Awards made out of the umbrella policy, however, would diminish the amount available for subsequent judgments if another award of more than $3 million against the same doctor were made.
GHA has proposed to transfer coverage from commercial insurers to a self-assurance plan, putting about $1.4 million in this year and for the next three years to cover the liability of the health plan and its physicians. During negotiations, GHA has offered to purchase a supplementary $2 million policy, to put $1 million in escrow and to pledge its assets - currently estimated at $17.6 million - to insure physicians against a malpractice suit.
The physicians have asked that GHA purchase a $3 million supplementary policy. They say they have reduced their original demand, but that GHA's pledge of its assets is not sufficient since GHA had a financial crisis three years ago.
GHA has said that it cannot find an insurance plan that offers more than $2 million in malpractice insurance. The physicians say they have found a broker who believes he can get a $3 million policy.
Outside practice - Except for teaching responsibilities in conjunction with seeing patients at hospitals affiliated with local medical schools, GHA wishes to continue a ban on outside medical employment by physicians. GHA contends that its fulltime physicians are adequately paid and should devote their full professional attention to GHA members.
Physicians counter that few, if any, would establish an outside practice if they were permitted to do, that they should not be permitted to see GHA patients on a fee-for-service basis outside the plan, that they should be barred from working for another group health plan and that any practice should not be permitted to interfere with their GHA duties. They claim the right, however, to do research outside GHA and to see patients who do not belong to GHA - whether the patients pay or not.
Some physicians argue that limitations in GHA coverage prevent them from maintaining certain skills - for example, plastic surgeons performing cosmetic surgery - and that if they cannot do the procedures outside GHA, they will lose those skills.
Hours of work - according to GHA president harold Wool, GHA wants internists who have no hospital patients to work seven clinic hours, seeing 21 patients a day. When those physicians have patients who are hospitalized, Wool said, GHA is willing to be "flexible" and to allow physicians the current practice of two hours to make hospital rounds and six hours of seeing patients in GHA clinics.
The physicians say that they now work nine or 10 hours a day and that they want to maintain the current practice of two hours daily for hospital patients.
Tom Gagliardo, the physicians' attorney in the negotiations, said the physicians "always agreed that there ought to be productivity goals" for them.
Salaries are not in dispute. Physicians earn an average annual salary of $53,000, GHA says. The plan's offer would raise that average to $60,000 immediately and to $66,000 next year.
Internists and pediatricians in their first two years would go from $36,500 to 38,500 and to $40,810 in 1979. Physicians have said that raises close to these would have been given under the old contract, and that the loss of previously paidbonuses offsets some of the salary increases.