In recent years, there has been an unparalleled assault upon American medicine impelled by the desire to transfer control, power and money from physicians to government and, more recently, to managed care entities.
One of the attacks against this basic medical ingredient has been delivered by HMOs. Now, as a response to increasing intrusions by these corporations into the patient-doctor relationship, it is being suggested doctors join unions.
Physicians, nevertheless, are professionals who serve patients after arduous and advanced studies in college and medical school. Then, there is internship and residency and grueling hours. With service as his prime purpose, the physician continues to improve his state of knowledge and expects adequate financial reward for his services. Professionalism of this type cannot flourish in a unionized environment.
Health care corporations, staffed by physician members and designed to deliver medical care, have been established in several states. I was one of the early members of the Pennsylvania Health Care Corporation, which is now functioning in southern Pennsylvania. Unionization is another story.
Although (labor or trade) unionization has been proposed as a remedy for the attacks on medicine and physicians, it is not the answer. I have been associated with unionization both as a supporter and as an opponent. When the National Education Association (NEA) was being formed, I thought then and think now that unionization and professionalism cannot exist together.
The NEA has become an autocratic, antidemocratic group contributing greatly to the destruction of the education system in public schools. The NEA is a reactionary group that uses its resources without member approval to oppose necessary changes as school choice and improved scholastics. It has committed vast sums of its money to the political arena, without member approval. It has contributed to the creation of the massive bureaucracy and over-administration of public school system and the consequent decline in the quality of teaching. That, similarly, would be the effect of (labor) unionization on medicine and medical practice.
Unionization and professionalism are incompatible, and they cannot coexist. Physicians should not form (labor) unions, but instead be counted upon to stand for medicine and their patients.
Dr. Friedman is a radiologist in Philadelphia, Pennsylvania.
Originally published in the Medical Sentinel 2000;5(3):105. Copyright ©2000 Association of American Physicians and Surgeons.