Based on information supplied by the National Labor Relations Board, the Post reported yesterday that doctors employed by Group Health Associates had become the first all-physician group to petition the NLRB for recognition as a union. Representatives of the Physicians National Housestaff Association, which represents 12,000 hospital interns and residents, note that their organization previously has petitioned the NLRB for recognition as a union. Their petitions have been denied, however, on the grounds that their members are students rather than full-fledged employees. PNHA is fighting to change that status.
Doctors who work for a giant Washington-based pre-paid health care plan yesterday became the first all-physician group to ask the National Labor Relations Board (NLRB) for recognition as a union.
The doctors work as salaried employees for four clinics run here by Group Health Associaties, whose patient-members control its operations. Patients pay a set monthly fee that entitles them to virtually whatever medical care they need at no extra cost.
Acknowledging that some of their colleagues likely will brand them as "radicals," doctors in the pro-union group called their NLRB petition a "last gasp" effort to gain a greater voice in the organization's operations.
"We have no input in deciding how to run the show," said Dr. Norman Lieberman, one of 80 doctors employed by Group Health. "Our every attempt to improve (Group Health's) delivery of health care has been thwarted."
The petition was the latest stage in a struggle at Group Health between doctors wanting more autonomy and others in the organization, including some doctors, who want patient-members to retain control of the organization in keeping with what they see as its guiding principles.
The physicians tried earlier this year to incorporate themselves as independent practitioners and negotiate with the Group Health board, rather than continuing as employees. The membership of Group Health elected a board which rejected that idea.
According to Harold Wool, president of the Group Health board of trustees, the doctors do have a voice in medical decisions. "Everything we do that is connected with medical care is run by physicians. . . . We try to involve them in (other) aspects of our activities as well (such as budget matters)."
He said the board rejected the physicians' recent request for voluntary recognition of their union on the advice of attorneys, "in order to determine (through NLRB procedures) whether they actually represent a majority of the doctors."
Group Health serves more than 100,000 patient-members at four clinics in the area. Some 75 per cent of the patients are government employees or their families, according to a spokesman.
Founded as a consumer cooperative during the Depression. Group Health is set up on a prepayment basis that theoretically removes the incentive for a physician to provide unnecessary care in order to make more money.
"Patients pay a set fee that entitles them to a range of care as needed, including X-rays, lab work and some surgery.
The patients elect the policy making board. The doctors are paid salaries ranging from about $32,000 to $71,000 yearly, out of a budget set by the board.
"There is just no communication between the doctors and the board of trustees," according to Dr. Donald Mitchell, vice president of the union group and former medical director of Group Health. One of several doctors or administrators who have resigned administrative duties at Group Health because of the dispute, he is continuing his services as a dermatologist there.
One example of the doctors' specific cerns at Group Health is "quality" medicine versus quantity medicine," according to Dr. Lieberman. "The question, for instance, of how many patients a doctor should see in a day. That hasn't been worked our yet."
Currently, he said, there are "perhaps too many patients daily, and we are not well organized as to who should see who . . . I don't think a pulmonary specialist should be seeing kidney problems."
Supporters of the doctors' position have argued that other prepaid health care plans, such as the Kaiser clinics on the West Coast, have dealt successfully with their doctors as independent practitioners.
The doctors petitioned for union status under provisions of 1972 amendments to the National Labor Relations Act that apply especially to health care institutions.
According to spokesmen for the NLRB, the agency responsible for enforcing labor laws in the private sector, the prospects for the petition's being approved are good. Then, 30 per cent of the Group Health doctors must request an election and 50 per cent must vote in favor of the union, before it can be certified as the doctors' exclusive bargaining agent.
Doctors at some institutions have been included in unions along with other professionals; dentists and lawyers have also petitioned for their own unions, according to an NLRB spokesman, "but this is the first unit made up exclusively of doctors that we're aware of."
The doctors would have a limited right to strike under the law, according to their lawyer. Tom Gagliardo, "but we de-emphasize that."
In any case, the doctors would initially have to give their employer 30 days' notice of any strike "because of the critical nature of the health care industry."
Nurses, technical and clerical workers at Group Health already have a union there, Gagliardo added.