|Volume XXVIII||October 5, 1999||Number 8 & 9|
SPECIAL EDITION - NATIONAL NEGOTIATING ORGANIZATION
Doctor John C. Nelson, who practices in Salt Lake City and serves on the AMA Board of Trustees, was in attendance at the NMA Fall Session, which took place on September 17th in Lincoln. A national negotiating organization is being established pursuant to Resolution 901 adopted at the June 1999 meeting of the AMA House of Delegates. Doctor Nelson is one of the five initial members appointed to the governing body of the national negotiating organization, which has been named Physicians for Responsible Negotiations (PRN). Doctor Nelson made several oral presentations on this issue during the NMA Fall Session and we are presenting one of the discussions in order that NMA members can be aware of the current status of this activity.
ďThanks very much for letting me be here. I am here basically to answer questions and to listen to you to see what you have to say. We have some unique times before us right now. As an organization who tends to represent physicians all around the country, every practice and every practice setting, every geography and every political circumstance, we find ourselves sometimes having a challenge to try to please everybody and in the process, sometimes donít please very many.
ďWe do a couple things, I think, fairly well at the American Medical Association: 1) We are representative; and 2) We are democratic. Sometimes those two very positive characteristics can get us into trouble. For example, when we tried to fit obstetrician / gynecologists by asserting that an obstetrician / gynecologist is a primary care physician, some primary care physicians did not feel too good about that. When we attempt to do things that might help our colleagues in surgery, some of our colleagues that donít do surgery feel disadvantaged and so on. What we try to do on balance is to do what we can that is right and especially, uphold the process. I would say to you that as your House is democratic, so too is the AMA House of Delegates democratic. In a very interesting, tedious, lengthy and at times, acrimonious debate, the American Medical Association has decided to do something. One of the things they have decided to do is to tell those people who have attempted to control physicians that they have had sufficientóWeíve had enough!
As one of the attempts to deal with that, the AMA House of Delegates instructed your Board to go forth and make a labor organization that has no affiliation with any current labor organization and we are in the process of carrying out that mandate. Now, I will answer the questions you want in any detail, let me give you a thumbnail sketch of what this organization is and what it is not. It is not a traditional labor organization. We do not have picks and shovels, placards, and we donít have strikes. We also will attempt to treat our patients and interact in an appropriate, fair and a professional manner. For example, any physician who chooses to be a member of this new group called ďPhysicians for Responsible NegotiationĒ or ďPRNĒ, does not have to be a member of the AMA but does have to subscribe to and adhere to the AMA Code of Medical Ethics. We think that is significant. We will not withhold care, we wonít slow down the process, we wonít do things just because weíre angry or upset with those who are trying to pay us. We wonít do anything that will do anything other than make good care for patients. Now, let me make it very clear, that this organization will be for those physicians who qualify to be in that group and who choose to be in that group. Roughly there are three groups of physicians ... First there are resident physicians. Resident physicians are, in some areas, undergoing some incredibly significant difficult times. In the state of New York, these doctors are working well over 100 hours per week, they are not paid very much money compared to other residents, and the prices they have to pay for a parking spot in the same time zone are so high that many canít afford that. Why are we concerned about that? Weíre concerned about that because some of the female residents are being assaulted as they try to get on the subway at 2:00 in the morning. We think that is something that needs to be dealt with. We are concerned about other, very unfair, practices about residents. Now these become particularly acute because right now, this month, the National Labor Relations Board is expected to make a decision officially as to what a resident is: is a resident a student or is a resident an employee? We believe that the NLRB will say that they are employees. You may know already there are physician unions - the American Physicians Union or whatever itís called, the Council on Interns and Residents, and the AFL-CIO, who through their Service Employees International Union, will also represent hospital workers and folks like that - who want to represent physicians. We believe that we are being responsive and we believe, responsible, for our resident physicians if, in fact, that ruling comes and they want to join us, we believe we can give a viable, professional alternative to what they have. Thatís the first group. The second group - employed physicians. Well, the question is whatís an employed physician? If you have a managed care contract, are you an employed physician? The answer is - um - it depends. Thatís the legal answer. In New Jersey, about six weeks ago, a group of physicians who did in fact have a contract with one of the managed care organizations said Hey, look, we want to organize and weíre employees and their Supreme Court of their state said, no youíre not. There were some very specific, detailed, circumstances on what is and what is not an employee. Secondly, an employee may not be in a supervisory capacity so a physician who is a medical director who supervises and/or hires and fires those physicians cannot be in this organization. Thatís not true, they can be in the organization but they canít be represented by the organization. There is a debate too, in the legal circles, as to the fact that any physician, by the nature of the work we do, is supervisory so there may be some challenges to any physician member of the Board of this group because that physician is indeed a supervisor. You can see how muddled this gets. But nonetheless, the second group of physicians is that group of physicians who are employed. Physicians who are employed in a variety of kinds of practices, for a variety of reasons around the country. For example, the dean of the medical school could be considered an employee if, in fact, that dean works for a state institution. A person who is a medical director of one of these health plans could be an employed physician. An employed physician might be a person who has a contract with Kaiser or, in our case, Rocky Mountain Health Care, or whatever your employed physician groups are called here. So indeed some of these physicians are there for a variety of reasons, some good, some perhaps challenging, nonetheless are there, sometimes under circumstances that are not the best. This labor organization could, in fact, if they chose, represent that group. The third, and right now the largest group of physicians, are the doctors in the room like me in solo, private practice or small groups. I happen to be a solo practitioner with five doctors in the office each with our own practice. I do have call coverage so I can be here to visit with you and others. The fact is that a variety of doctors like this may not be able to be represented by the group as it currently stands, as the law currently stands. Now thatís the labor union, labor organization, representational negotiating, whatever you want to call it, story.
There are two other very important things that weíre trying to accomplish that really apply to all of us, particularly the last group. We are committed to trying to get the Campbell bill passed (HR 1304). John Campbell, as you know, is trying to put together federal legislation that says it is okay and fair for physicians to negotiate. The example that just wonít go away for me is my tall and good friend Patrick Ewing who lost $253,000 every time he did not play an NBA game during the strike. Thatís a lot of money. Thatís a lot more money than I make in a year, even with my AMA stipend, a lot more. The fact is, thatís per game. The fact is, that because Iím not tall and donít have the skills Mr. Ewing has, I canít get together with you and talk about issues. I canít tell you when Iím going to do a pap smear, if Iím going to do a pap smear, and how much Iím going to charge if I do. There is something out of balance. Oh, by the way, Aetna and Prudential can merge for $10 billion, thatís okay, but we canít get together. John Campbell thinks that is wrong, I think thatís wrong, the AMA thinks itís wrong. Because of the AMA and the good help of the representative, we are now up to 165 co-sponsors of the bill. It takes 218 to have a majority in the House, we are not quite there. And thatís the good news. The bad news is we are no where near that in the Senate and the Senate is going to be a much tougher nut to crack. The Health Insurance Association of America is paying $30-40 million to oppose this with national advertisements. We believe the Campbell bill is the right thing to do and we are committed to seeing it passed and we will do what we can.
The final leg of the stand, the labor organization is one, the Campbell bill is another, the third one, I think, is very, very interesting. This is the issue called the State Action Doctrine. The State Action Doctrine is allowed by the federal Constitution which says that the state can take a group of citizens of that state, deem that group - say this group may do Ďxí provided that whatever Ďxí is, is under the aegis and watchful eye of an existing state organization or agency. George Bush signed into law in Texas the fact that physicians in Texas may indeed work together and negotiate together because theyíre going to do it under the aegis called the Department of Health in the state of Texas. They put some caveats on it, one of which is that only 10% of the group can get together in one group so with 3,000 doctors in this state, you have to have a minimum of ten groups of 300. Thatís still, in terms of balancing the scales, easier than one doctor at a time talking with a health plan.
So, those are the three stands, or the three legs of the stand: labor organization, Campbell bill, and the State Action Doctrine. Now realize again, we are trying to represent everyone. It may be that one of those or two of those or all of three of those might be exactly what you need, maybe you need only one, maybe you donít like the others, we are trying to represent all physicians. So thatís what weíve done. I repeat to you that this was done by the democratic process of the House of Delegates. I will tell you also, as a genetically-bred Republican who thinks that labor unions are found under the dís under ďdarned labor unionsĒ, that I have had a terribly difficult time finding where my heart is. I attempt to be an ethical individual and an ethical physician. I could not stand before you, nor could I stand before my patients or my family if I didnít believe that what we are doing is right. The reason I believe that it is right is Number one, my colleagues have told me itís right and I respect that process. Number two, and more important, we are going to negotiate on the issues that are important to us as professionals - The Code of Ethics of the American Medical Association and what is good medicine. And thatís the final comment. The test we should be giving to whatever we do is the test that you give to your patients every single day. You talk about doing a test, you talk about doing a procedure, you talk about not doing a test or procedure, what you do inherently is ask yourself a question - Is it good medicine? If itís good medicine you do it, if it isnít good medicine, you donít. And friends, I think this is good medicine. Iím here to answer your questions and thank you for the courtesy shown.
FALL SESSION REPORT
The Fall Session of the NMA House of Delegates and Board of Councilors took place on September 17th, in Lincoln.
The Board of Councilors reviewed the reports and resolutions in the Handbook, received an update on the status of complaints received from the public regarding NMA members, received membership information specific to each Councilor District and, when constituted as the Board of Directors of the Nebraska Medical Foundation, received and adopted changes to the Articles of Incorporation and the Bylaws of the Foundation which modernize the structure of the organization. The Board of Councilors also approved the list of 50 Year Practitioners to be recognized at the 2000 Annual Session.
The House of Delegates considered several reports and resolutions during its session. The House adopted a resolution which called on the NMA to provide full cooperation with the State Health Department in addressing the reported high infant mortality rate in the state of Nebraska.
The House referred a resolution to the NMA Commission on Association Affairs which asks that the Association review the Associate Member definition in order to draw physicians to this category of membership.
The House referred a resolution to the Board which asks that the Association work to clarify the reimbursement structure for medical payments for incarcerated individuals statewide.
The House adopted a resolution directing that the Association contact malpractice insurance companies in Nebraska to ascertain if their company automatically includes coverage for Y2K failure, and to address the matter further if companies did not offer the coverage automatically.
The House adopted a resolution which addressed the current federal rule regarding the use of seclusion and restraints, proposing that the NMA formally oppose this rule and its implementation as currently written, that the NMA work with the Nebraska Psychiatric Society on this issue, and that a resolution on this subject be sent to the AMA House of Delegates for action.
The House also accepted 18 reports and approved the following list of 50 Year Practitioners to be recognized at the 2000 Annual Session:
REQUESTS FOR 50-YEAR PRACTITIONERS
ANTELOPE-PIERCE COUNTY MEDICAL SOCIETY
Frank C. McClanahan, M.D., Neligh
DAWSON COUNTY MEDICAL SOCIETY
Rodney A. Sitorius, M.D., Cozad
HOLT & NORTHWEST NE COUNTY MEDICAL SOCIETY
Floyd H. Shiffermiller, M.D., Omaha
LANCASTER COUNTY MEDICAL SOCIETY
Roy F. Statton, M.D., Lincoln
Jon T. Williams, M.D., Austin, TX
MADISON COUNTY MEDICAL SOCIETY
James H. Dunlap, M.D., Norfolk
METRO OMAHA MEDICAL SOCIETY
Robert W. Gillespie, M.D., Omaha
The House approves the following requests for Life Membership and Associate Membership:
REQUESTS FOR LIFE MEMBERSHIP
METROPOLITAN OMAHA MEDICAL SOCIETY
Maurice T. Quinlan, M.D., Omaha
LANCASTER COUNTY MEDICAL SOCIETY
Logan A. Griffin, M.D., Lincoln
REQUESTS FOR ASSOCIATE MEMBERSHIP
HALL COUNTY MEDICAL SOCIETY
James Reiss, M.D., Grand Island
Bart Urbauer, M.D., Grand Island
LANCASTER COUNTY MEDICAL SOCIETY
James A. Bard, M.D., Lincoln
SHAPING STATE HEALTH POLICY
The NMA in cooperation with Glaxo Wellcome, Inc., will host a Legislative Advocacy Training Program on Friday, November 12 from 1:00 to 4:00 p.m. at the Nebraska Club in Lincoln. In addition to learning about the legislative process, attendees will hear from a state senator and be trained by professional lobbyists on how to effectively communicate with their elected officials. Included in the training will be discussion on presenting legislative testimony and effective grassroots networking.
NMA PRESIDENT DALE E. MICHELS, M.D., NAMED 1999 NEBRASKA FAMILY PHYSICIAN OF THE YEAR
The Nebraska Academy of Family Physicians has named Doctor Dale Michels the 1999 Nebraska Family Physician of the Year. Doctor Michels was honored by the Nebraska Academy at a luncheon October 6th, following a ceremony at the State Capitol where Governor Johanns presented Doctor Michels with an award.
Doctor Michels received nominations from patients and colleagues who described his caring and compassionate medical service and his leadership in the community.
As summarized by one of the nomination letters from a patient, ďDoctor Michels is devoted to Family PracticeÖhe is dedicated to community serviceÖ.a dedicated doctor trying to extend medical services to people who need them.Ē
DOCTOR LOSCHEN RECOGNIZED
Doctor Darroll J. Loschen was recently presented a Distinguished Service Award by the Nebraska Public Health Association. The Distinguished Service Award is awarded to an individual, agency, organization or business for the long-term enhancement of community health through public health activities.
AWARDS / RECOGNITION. . .
During the Fall Session, the NMA House of Delegates presented recognition awards to: