This issue of the Bulletin discusses a topic of considerable interest to many neurosurgeons in today’s chaotic healthcare environment — physician unionization. We have made a special effort throughout the publication to bring you viewpoints and information that have bearing on this timely subject. While the potential leverage gained for physicians by unionization has appeal, the issues involved are complex and have ethical, financial, and professional implications for neurosurgeons.
The level of interest in unionization by neurosurgeons is related to several variables: one’s position as an “employed” or private practitioner, the local managed care environment and the available options for bargaining with third parties. In fact, federal law currently prohibits union representation for all neurosurgeons except those who are employees of an organization. This, coupled with many physicians’ natural aversion to unions and pressure by colleagues and professional societies against strikes and unionization, leads to a search for other solutions.
It is my personal perspective that while the current healthcare environment in many parts of the country may justify the debate about unions, the impetus to unionization is merely the response to a perceived threat — more of a retort than a solution. It is the responsibility of neurosurgeons who oppose the concept of unions and their professional societies to be innovative in identifying viable alter-natives to unionization.
The Messenger Model IPA
One alternative to physician unions is the messenger model IPA, or independent practice associations of self-employed physicians who use a “so-called” messenger to negotiate on behalf of the group. Messenger models allow physicians to address issues that are more patient-oriented rather than physician-oriented, thereby enabling doctors to remain committed to the vision and mission of the medical profession. Messenger model IPAs allow physicians to use some of the tools of collective bargaining in negotiating with managed care organizations without using more radical methods, like strikes, that are an anathema to physicians.
Broadening the Influence of Neurosurgery
With organized medicine actively developing advocacy strategies that support physician’s rights in the marketplace, doctors should expect support from their professional and educational organizations. In fact, one of the primary goals of the AANS is to enhance the competitiveness of its members via several strategies.
By maintaining liaisons with other groups in organized medicine, such as the Practice Expense Coalition, the American Medical Association and the American College of Surgeons, the AANS broadens the influence of neurosurgery in Washington. By collaborating with the Congress of Neurological Surgeons in the Council of State Neurosurgical Societies and the Washington Committee, the AANS analyzes and develops tactics pertaining to legislative, regulatory and socioeconomic issues facing our specialty. Through projects, such as the Outcomes Initiative, Practice Expense Survey, Cost Containment Initiative and the Getting SMART marketing communications project, the AANS assists neurosurgeons in building their practices, improving practice efficiency and negotiating with third-party payors. The success of such endeavors, however, often correlates with the neurosurgeons interest in actively participating in such programs.
Many neurosurgeons feel powerless and frustrated by the radical changes occurring in the health care environment and they need an effective means to counteract these pervasive influences. Even if legalized for self-employed physicians, unions that focus on salary, benefits and working hours, have serious limitations. While the programs cited above do not fully counteract all of the negative influences presently impacting health care, they are part of the strategy by the AANS tto empower neurosurgeons to re-establish their autonomy, rebuild their physician-patient relationships and regain control over their profession.
TALK TO THE EDITOR
The Editors of the AANS Bulletin are interested in hearing your comments or queries on this issue, as well as your ideas for future issues.
Write to Dr. Popp, care of the AANS, at 22 S. Washington St., Park Ridge, IL 60068; fax (847) 692-2589 or e-mail [email protected] We want to hear from you!
A. John Popp, MD, Editor of the AANS Bulletin, is the Henry and Sally Schaffer Chair of Surgery at Albany Medical College.