If the American Medical Assn. had moved more quickly, Charles Weatherby would be eligible to join the union it has announced plans to establish. But in two weeks, the 47-year-old family physician will be leaving his job at Multicare to start a private practice with three other doctors.
A Tacoma native, Weatherby is a graduate of Lincoln High School, where he played football and basketball and ran the quarter mile for the track team—and where he currently serves as team physician. He graduated from Washington State University, where he continued to run the quarter mile during his freshman year, and the University of Washington Medical School, but says that when it comes to sports, he has no divided loyalties—he’s a diehard Cougars fan.
He also is president elect of the Pierce County Medical Society, which has honored him in the past with its Community Service Award for his helping to initiate community health clinics and to help guide them as a member of their boards. In addition, he was a member of the Washington State Medical Assn. board of trustees for eight years.
In today’s Q&A, Weatherby discusses the reasons behind the AMA’s move toward unionization—and why he’s unlikely to be a card-carrying member anytime in the near future.
Q: Did the American Medical Assn.’s decision to form a union for doctors come as a shock to you or other area healthcare providers?
A: No. Five years ago, the AMA probably wouldn’t even have touched the issue, but nationwide, we’ve seen a movement among AMA members to form unions. The AMA doesn’t want to lose touch with its membership.
I think all physicians are feeling the need to exert influence over how they treat patients, particularly as it relates to the insurance industry.
Q: Why are doctors so angry?
A: They feel they are powerless to practice medicine on their own. The emerging power hospitals and insurance companies have wielded over doctors and how they practice medicine has left physicians almost impotent because of antitrust rules and regulations.
Not only have they been unable to organize, but they can’t even give the impression of being organized. Physicians are the ones providing healthcare, but it is insurance companies that control the market.
They can merge anytime they want to and they can get together with hospitals to set prices. Doctors cannot.
Public health depends on those in the medical profession, but we’re not even allowed to discuss with one another a proposed contract coming out from an insurance company or the hospitals.
As individuals, we can reject a contract, but it has to be on an individual basis. We can’t get together and reject it as a group.
Nor can the AMA or the Pierce County Medical Society recommend that a contract be rejected. They can only interpret what is says, what it means.
Q: What’s to stop doctors from simply rejecting bad contracts en masse?
A: Two things. If all of us voted to reject a contract, it could be interpreted as being in violation of antitrust regulations, we’d be hard pressed to prove we didn’t get together and agree to reject it.
Besides which, if we reject a contract—even a bad contract—we penalize patients who are covered by the policies included in the contract. And we penalize ourselves as well because we not only lose patients, we lose the revenue for treating them.
Q: If the anti-trust laws prohibit doctors from unionizing, how did the unionization movement get started ?
A: It prohibits doctors in private practice from unionizing, but doctors who are employees of a healthcare provider are eligible to bargain collectively. That’s a fairly recent interpretation, by the way.
In Tacoma, doctors in the Medalia Group wanted to form a union but had to go before the National Labor Relations Board to find out if they could even have a vote on the question. Franciscan Health, which owns Medalia, argued that they couldn’t on the grounds that they are supervisors—and supervisory staff isn’t permitted to organize.
The question went to the courts, and the courts determined that the doctors aren’t supervisors, they’re employees.
Q: Is this a dollars-and-cents question or one of sound medicine?
A: On the one hand, it’s financial and, on the other, it’s a matter of concern over patient health. But at the heart of both is the question of who controls healthcare.
People assume the healthcare market is controlled by physicians. We’re the ones who get blamed for healthcare rules and regulations that don’t make sense to our patients.
As physicians, we are at the mercy of the healthcare industry. Costs are beyond our control. It’s time to let the public know we also are as upset by the way things are going as they are.
Healthcare plans are making gatekeepers out of physicians. It’s not a role we’re asked to perform. It’s being forced on us by insurance companies.
I have to explain to my patients that I am their primary care giver and that if they want to see a specialist they have to get my permission first. If they don’t get my permission, then they have to pay for the treatment themselves.
The patients get upset with me. They think I’ve got a God complex, that I want to control every aspect of their healthcare. They don’t understand I’m required to limit who they see by the insurance plan they’ve signed up for.
It’s understandable that with the cost of healthcare rising, employers are looking for the best return on their investment they can find. So they select a plan for their employees that provides the most protection for the least cost. But many employees aren’t sure what these plans involve.
The plans are just as confusing to physicians as they are to the insured. Doctors have to hire extra staff to confer with the insurance companies to get answers to the questions that are raised by patients. As a result, the doctor’s costs go up.
In addition, the tools necessary to give patients the best care available also are becoming more and more high-tech—and more and more expensive.
And the cost of drugs is increasing because the Food and Drug Administration has strict and complex rules that pharmaceutical companies must play by in order to get a new product on the market. Those rules protect the public, but they also drive up the price of the drug when it finally does become available.
All those factors have been blamed for the movement among medical doctors to give up private practice and become employees of healthcare providers, but in the past year, that trend seems to be reversing itself—you’re a case in point.
Doctors are starting to go back to private practice in an effort to gain more autonomy—to gain control of both patient care and their finances. There comes a point where the advantages of being a hospital employee declines in magnitude.
Many of us are setting out to regain control of our own fate.
Q: How long before you open your private practice?
A: Two weeks. Four of us who now work for Multicare are going into private practice. It will be called Primary Care Northwest but will be located in the same place we’re now practicing, the Baker Building in Tacoma.
If you had remained at Multicare and become active in a union, who would be the target of collective bargaining?
Major insurance companies, but hospitals as well, though at hospitals the atmosphere is more collegial.
Our main concerns are with insurance companies—what they demand with regards to how we care for patients, the cost of doing business, the fact that we have to call them to get their OK for a treatment we’re prescribing or else we don’t get paid, then we have to get a case number and along the way we may get put on hold for 15 minutes while the decision at the other end of the line is being made, often by a nurse rather than a physician.
Q: Wouldn’t you want your case reviewed by someone who’s at least an expert in the illness being treated?
A: It’s not just the rules and regulations we resent, it’s the arrogance.
Q: How many doctors in this area would be affected by unionization?
A: The Pierce County Medical Society has 700 doctors in the organization. Of these, 200 to 300 are in employee positions.
Q: Would the union be open to anyone other than physicians?
A: Many healthcare professionals who aren’t physicians already have unions of their own, so I doubt it. But there is a group whose status is likely to create some serious questions.
I suspect the status of hospital-based physicians such as radiologists, anaesthesiologists and pathologists who aren’t necessarily hospital employees but whose operations are based in hospitals, would have to be decided by the courts.
As the law now stands, doctors in private practice are not allowed to unionize because federal law permits only people described as employees to unionize. The AMA says it plans to seek an exemption for doctors. Why would self-employed doctors unionize—who would they need to bargain collectively with?
The insurance companies. In Tacoma, with Regence being the big insurer, if you don’t sign a contract with Regence, you can lose half your patients.
With a union, you can negotiate to change this clause or that. Or you can collectively pull out. As it stands now, the insurance companies say, “Take it or leave it. What are you gonna do?”
One of the reasons cited for the AMA’s decision to sanction unionization was that several of the nation’s largest unions already are trying to organize physicians—that as many as 40,000 physicians already belong to unions. Are these established unions?
Medalia employees joined jonied the United Salaried Physicians and Dentists Union, which is affiliated with the AFL-CIO. I understand the Teamsters also are trying to get involved in the unionization of physicians.
Q: Why do you suppose non-medical unions would want to organize doctors? Don’t they have enough to occupy them already?
A: In some cases it’s to justify their own existence. Union membership in other fields has been declining and some jobs that used to be protected by unions have been eliminated altogether.
I think unions realize the tension that exists between doctors and insurance providers. They realize that physicians are angry, that they have been discouraged and in most cases prohibited from organizing. I think they see a need and an opportunity.
Q: The AMA and medical societies can exert a lot of pressure through their lobbyists, but when it come down to it, how much power do doctors have without unionization?
A: A good deal of concern has been raised in the past over the prospect of doctors going out on strike and the lives of patients being used as bargaining chips—which probably is behind the prohibitions that exist.
Perhaps, but I think such concerns are unwarranted. Physicians aren’t going to refuse to treat their patients.
The conflict isn’t between us and our patients. It’s between us and insurance companies and the hospitals.
Q: What is the difference between a union and an organization like the Pierce County Medical Society?
A: PCMS consists of all varieties of expertise under one umbrella. It enables us to come together and discuss common concerns. It employs people to lobby on behalf of these concerns. It also has delegates to the AMA to work on national issues.
A union can go a step beyond. It can protect members from being coerced into signing a bad contract. The ability to bargain collectively is the difference.
Q: You are president-elect of the PCMS, which means you’ll be president next year. Do you have an agenda you hope to accomplish during your tenure?
A: My main objective is to let physicians know we’re all in this together, to keep communications open between self-employed, hospital-based and employed physicians, as well as between primary care doctors and specialists. I want to keep reminding them that we can work together. PCMS can continue to be a forum for this. We can’t afford to let outside forces divide and conquer us.
Q: One of PCMS’s most fascinating ventures is one of its best-kept secrets—the annual mini-internship program. Tells us about it.
A: We want people to know what it’s like to be a doctor. We invite insurance representatives and representatives of other businesses, lawmakers, journalists, anyone who is sincerely interested, to spend two days with physicians, experiencing first-hand everything from an office visit to surgery. We want to let the community know what a typical day is like for a doctor.
Q: Some Business Examiner readers may not be familiar with the program. Is there somewhere they can get more information or perhaps volunteer to take part in the internship program?
A: They should contract Doug Jackman, who is PCMS’s executive director and can be reached at 572-3667.