One hundred and ten thousand Washington area residents awoke on the morning of April 15 to discover that their family physicians were on strike. Given the image of doctors as rich, respected, professionals, it was quite a shock.
But what the members of the Group Health Association may not have considered was the fact that their physicians were, no matter how professional and how well paid, employes of a corporation. And like other employes, doctors can become embroiled in disputeds with their employers.
According to Louis J. Segadelli, executive director of GHA, the dispute that lead to the 11-day walkout by about 60 of GHA's 90 physicians, really began about nine years ago.
The distrust and suspicion built up over those years may explain, said Segadelli, why the first settlement of the strike fell through 24 hours after it was negotiated, leaving GHA with the prospect of a second strike May 7. That was finally avoided by the joint singing Tuesday night of a two-year contract.
While the other major figures in the GHA labor dispute all had a great deal to win or lose, depending upon the outcome, Segadelli had very little at stake, having long ago announced plans to leave the organization in June.
Segadelli sat back in his eighth-floor office in GHA's headquarters at 2121 Pennsylvania Ave.NW one day last week and considered the organization's past, present and future.
"I have seen a process here, and I don't think others have, which I think started in 1969 when the physicians changed from being individuals to a medical director, and first formed their organized; the medical group.
"At that time, based on legal advice that they would endanger their positions, the physicians voted . . . not to form an independent medical organization" that would contract with GHA fori ts services. And for three to five years things worked well.
"In 1974 we had a financial crisis," Segadelli said, "as a result of our not having a premium increase and the president taking controls off the health care industry on May 1, 1974. It was quite traumatic: In the first four months of the year, with controls on and no increase in premiums, things went accordning to plan; then those controls came off and in the last eight months of the year we lost $1.7 million. And it looked as though in 1975, if things continued like that we'd lose an additional $2.5 million!
"We took what for us were heroic steps, laid off 15 percent of our staff, including two assistant executive directors and a comptroller. And we cut back our staff by about eight physicians.
"This really forced the physicians to think about the organization, and what they felt was their lack of input into it. As a matter of act, that was one of the things that led to the physicians' interest in" forming a corporation that would sell health care to GHA "as a way of getting control of their destinies," Segadelli said.
The physicians' attempts to form a corporation were rejected resoundingly by the membership of GHA, led by the board. And those factors, Segadelli said, led to distrust of the board by physicians and the physicians by the members of the board.
A week ago Tuesday it looked as it the board and physicians had reached a contract settlement. One of the key issues keeping the two sides apart, the question of the sorts of medical activities the physicians would be allowed outside GHA, had been settled by allowing the physicians to teach, engage in research and in "pro bono" activities.
But then Tom Gagliardo, attorney and chief negotiator for the physicians, was quoted in The Washington Post as saying that "there's 'pro bono' and there's 'pro bobo,'" and the board refused to ratify that portion of the contract. In the contract agreed to Tuesday an arbiter will decide on the definition of 'pro bono" activity.
"The strike was a very dressing experience," said one physician-supervisor who did not strike." It polarized people into different camps, and some people still aren't talking to one another. There are still some people who (support staff) cry if I talk to them about the strike.
"It's like the Civil War," the physician said. "You're forced to take a side. Where do we go from here? I think one lesson to be learned is that the board should realize things are not well with the organization and should look in an objective fashion at why things ae not well. If things are handled right, we can make a silk purse out of a sow's ear" (the strike).
Segadelli, too, sees a need for some changes at GHA. "I think what is happening . . . is that in the history of the HMO field were a relatively limited number of people coming into it, both on the physicians side and the side of the people organizing it.
"Their views were kind of crusade-oriented, they were doing a soially useful thing. And that wasn't limited to the board members, there was a certain kind of physician who was attracted to this kind of practice, because in the early days this was not a popular thing to do.
"I think that now we're getting beyond that," Segadelli said, "because of the size and expansion of the HMO concept, into a different layer of physicians as well as a different layer of patient.Probably a lot of rethinking has to be done on a number of issues that were more or less sacred up to this point, on a number of positions that were the true faith. And I suspect that a number of collisions like this will force it.
"One of the things that's clear to me out of this experience is that there will probably be more and more physicians' unions out there across the country, and I think it's a function of instiutionalization," Segadelli continued.
Harold Wool, president of the GHA board, feels the "negotiation of a contract with the physicians' organization offers the prospect and expectation that we will have a way to work together constructively to offer better health care for our members and to plan for a better and still larger organization."
And Norman Lieberman, president of the physicians' union and the man who successfully led the first major physicians' strike in the nation, said he believes "GHA is healthy. I think the contract we signed is one both sides can easily lieve with."
"More and more physicians are going to be working for institutions whether it's an HMO or some other kind and they no longer have the feeling that they are in control of their own destinies as they were in private practice and collective action is probably going to appear more and more attractive to them," Segadelli said.
"I think," he said, "we're in a time of big change in the field and it's always hardest on the people who have to work it out."