The Pros & Cons Of Union Affiliation For MFTs (March/April 2000) By: Mary Riemersma Executive Director

What was currently happening regarding union formation by health care professionals?
The American Medical Association voted in June of 1999 to unionize salaried physicians to gain leverage against managed care companies. They vowed that such a unionized body is not to strike, as that would seriously compromise medical ethics. However, instead the association is now moving toward an organization that will help physicians form bargaining units, rather than AMA serving as the bargaining unit. They are also considering other options, seeking the most reasonable and least costly means to solve perceived problems. They have created a governing committee to oversee this effort, “Physicians for responsible Negotiations” (PPN). PRN, as outlined in its constitution, will not be reflective of the traditional labor organization. Instead of striking, mandatory arbitration will be recommended as the means to resolve issues of patient care, rather than issues of money. Currently, aside from AMA’s membership, 42,000 of the nations 620,000 doctors are unionized. These 42,000 doctors are members of one of three unions affiliated with the AFL-CIO. These union affiliates are salaried doctors. However, this number could be growing due to the fact that approximately seventy percent of doctors in practice for five or fewer years are salaried.

Washington passed a law in 1997 allowing doctors to bargain collectively over everything except fees. Texas recently passed a law legalizing bargaining for independent physicians. The Texas bill was not really a union bill, however, it was an antitrust bill. It is believed by its sponsors to be a small step toward allowing physicians to advocate for patients. In Texas, sole practitioners may jointly negotiate with HMOs, however, they are prohibited from striking. Similar bills are also pending in Pennsylvania. New Jersey, Maryland, Michigan, Illinois and the District of Columbia. On Capitol Hill, Representative Tom Campbell (R-CA) has introduced a bill that would give health professionals bargaining power with managed care companies. However, it is unlikely that there will be any action on this bill in the near future.

Last May, the Philadelphia Office of the National Labor Relations Board (NLRB), the independent federal agency created in 1935 to enforce labor laws, turned down a bid by 500 New Jersey physicians working for an HMO to join the United Food and Commercial Workers Union. The reason the NLRB rejected the bid was the physicians were not employees of the HMO.

Psychologists in New York, upset over their treatment by managed care organizations, have affiliated with the American Federation of Teachers and its state chapter. They will not have collective bargaining rights, but they hope the alliance will increase their lobbying and negotiating power when it comes to managed care companies. They are seeking to take advantage of the union’s concentrated political power and ability to get things done in the legislature. Similarly, Pennsylvania psychologists studied this issue but never issued a final report after its study.

The Clinical Social Work Federation also affiliated with a union in 1998. In fact, they believe that they were the first mental health professional organization that chose to create such an affiliation. They have established a Guild Committee that is working with the Office and Professional Employees International Union (OPEIU) of the AFL-CIO. The Federation and eleven member states, including California, became the representatives of clinical social work in the National Guild structure. Guild membership is a personal choice, however, and not mandatory. The clinical Social Workers believe this relationship will strengthen them as a profession so that they have a larger voice in the transition from managed care, whatever that means. They also believe it will give them access to health and dental coverage, a credit union, legal services, group discount programs, travel services, life insurance, mortgage and real estate services, etc. Further, they believe affiliation will gain them access to 50 million union employees who use negotiated mental health services, access to a powerful lobbying force, and access to large employers who are exempt from state vendorship laws due to ERISA.

LA area home care workers have unionized; and the American Nurses Association has created a new entity to support collective bargaining efforts by state nurses associations.

Pros Of Union Formation For MFTs
MFTs who are employees of firms and members of a union would be permitted to strike against their employers. Of course, this may not attack the perceived culprit-managed care. Reminder: This ability to strike would be limited employees.

The psychologists in New York perceive this as an opportunity to build membership. The psychologists in New York believe affiliation with influences the union’s understanding about the mental health services that members receive and, ultimately, what they ask for.

Unionization provides an opportunity to guard against de-selection by managed care companies when practitioners complain. Once again, this ability would be limited to persons who are employed only.

Cons of Union Formation For MFTs
Unionization may be perceived as creating a group of greedy clinicians. Members would be viewed as protecting income. Professionals are perceived as affluent, even though they may not be. Strikes or labor actions would receive little public sympathy. Professionals are, by nature, independent and difficult to organize. Federal antitrust laws currently bar independent practitioners from striking. The Federal Trade Commission (FTC) believes that allowing independent contractors, like psychologists or MFTs, to have collective bargaining rights would hurt patients. The FTC is of the opinion that such collective bargaining (unionization) would mean that consumers would have to pay more in premiums.

Members’ views about unions, either pro or con, would get in the way of accomplishing worthwhile outcomes-the focus could easily get sidetracked about whether unions are inherently good or bad. Unionization would be perceived by many as a “kneejerk” or panic reaction to decrease professionals’ sense of helplessness in the face of major changes in status and autonomy brought on by managed care.

The profession needs to remain sharply focused on where its activities can have the greatest impact. Unionization could cause the profession to be diverted in too many directions, thereby decreasing the Association’s effectiveness.

Based upon an evaluation of the pros and cons of union formation, the CAMFT Board decided that the timing was not currently appropriate to pursue such an endeavor.