How do we get a stronger physician lobby?

[ceftazidime]

We all know that Medicare reimbursement rates keep dropping due to the strong insurance lobby in Washington, but what exactly can be done to build a stronger physician lobby to counter this? I know the AMA and AOA are consistently the ones who have, at the last minute, been able to prevent drastic cuts... but why isn't there a lobbying force at the top of the process to prevent the suggestion of reducing our reimbursement to even reach the floor? I'm really getting nervous with the whole economic recession going on, and feel like if we don't protect ourselves now we will forever be screwed. I am $200,000 in debt and plan on going into IM, but I did not give up my 20s to be on call every other day and barely make ends meet, while my predecessors got to enjoy the fruits of their labor worry-free.

---

Members don't see this ad.

 

[badasshairday]

I feel you. But I don't know what the answer is. Medicine is so fragmented with all the specialties.

 

[TMP-SMX]

Physicians tend to get a deaf ear in congress partly because the past generations of physicians have been politically averse in terms of donations to campaigns as individuals and lobbying as groups.

 

[carlosc1dbz]

Doctors need to come together. Is there any way they can unionize? Hey that would be so cool if there is a national movement to go on strike. I know peoples lives would be at stake, so there might be a problem there, but then whose fault is it? the doctors or the insurance companies who drove doctors to this? How long would it take for the government to fold? How long would it take for the insurance companies to fold, under the pressure of the government?

 

[themule]

Doctors need to come together. Is there any way they can unionize? Hey that would be so cool if there is a national movement to go on strike. I know peoples lives would be at stake, so there might be a problem there, but then whose fault is it? the doctors or the insurance companies who drove doctors to this? How long would it take for the government to fold? How long would it take for the insurance companies to fold, under the pressure of the government?

It is currently illegal for Doctors to organize into Unions. I don't know if that law went to the SCOTUS or not but it seems unconstitutional that other health care personnel can unionize but physicians are denied that right.

 

[DannMann99]

unionizing would be amazing. Doctors seem so fickle about things like that, and I really feel like its because most are very much overworked. Seems like we have so much on our plate from M1 onward, we don't really have time to fight back. I hope i'm wrong though

 

[montessori2md]

Run away from AMSA, AMA's little red headed step child, and create a stronger association for younger MDs, residents, and students.

MDs who have been practicing for 30 years sound silly when they complain about reimbursement. MDs who have been practicing for 3, and have 200k in debt, sound sane.

MDs also need to get off their high horses and play with others for lobbying purposes, like mid-levels and labs, who also have interests in reimbursement.

Private practice MDs have largely been in the corner of republicans, because of business tax, and other issues like tort reform. But republicans have no interest in increasing tax dollars for health care, with few exceptions. It's hard to effectively lobby when neither party is really meeting your needs. I think this partially explains AMAs interest in a single-payer system -that's a system that fits the small government, pro-business model, which fits with their historical ties to the republican party.

 

[DannMann99]

How about we all just stop taking the healthcare that the US gives to the elected officials.

 

[badasshairday]

How about we all just stop taking the healthcare that the US gives to the elected officials.

What is that healthcare? I really wonder who insures them. It definitely can't be medicare because they would be having a **** hard time trying to find a Family Practice doctor to see them. We should tell the Docs in DC to stop seeing them until they really reform healthcare with the AMA in charge of the ideas.

 

[DannMann99]

I'm DO; and between the AMA, AOA, SOMA, AMSA what are these guys doing to secure our futures? I mean I hear chatter back and forth from these groups every now and again, but this decrease isn't something that happened overnight its been gradual... which means these organizations have let slip quite alot over the years. Does anyone know any active initiatives these groups are partaking in?

 

[turkeyjerky]

It is currently illegal for Doctors to organize into Unions. I don't know if that law went to the SCOTUS or not but it seems unconstitutional that other health care personnel can unionize but physicians are denied that right.

Doctors can't unionize b/c they are not employees of a company. They are either business owners or classified as independant contractors. Thus, any attempt at "unionizing" would run afoul of anti-trust laws.

 

[chessknt]

Doctors can't unionize b/c they are not employees of a company. They are either business owners or classified as independant contractors. Thus, any attempt at "unionizing" would run afoul of anti-trust laws.

So how did nurses do it?

Any significant increase in lobbying power would require a lot of things to fall in plac that probably wont. Just off the top of my head, we would need politically-oriented individuals (that probably went into politics instead of medicine), funding for lobbying (which with decreasing pay wont be found easily), universally-agreed upon demands (which due to the fragmentation of specialties will be very short), and strong involvement from young MDs (which wont happen because they are extremely overworked as it is).

It will take a true MD hero(es) to solve the crisis the medical profession seems to have fallen into.

 

[badasshairday]

^^^ nurses are employees of the hospital.


If you are serious about reform and would like to see what we can do through the AMA please look at this. This is the AMA's proposal for reform.
http://voicefortheuninsured.com/amaproposal.html
Personally, I think it is a good idea. Definitely a better idea then any politician can make up. Obviously you may have some problems with it here and there, but lets be real, no proposal can be perfect. I definitly support this. At this momoent, the best way to get a stronger lobby would be to support the AMA and donate money to the Politcal Action Committee. 👍

And yes, it is the AMA that looks out for us, not AMSA.

 

[chessknt]

^^^ nurses are employees of the hospital.


If you are serious about reform and would like to see what we can do through the AMA please look at this. This is the AMA's proposal for reform.
http://voicefortheuninsured.com/amaproposal.html
Personally, I think it is a good idea. Definitely a better idea then any politician can make up. Obviously you may have some problems with it here and there, but lets be real, no proposal can be perfect. I definitly support this. At this momoent, the best way to get a stronger lobby would be to support the AMA and donate money to the Politcal Action Committee. 👍

And yes, it is the AMA that looks out for us, not AMSA.

All nurses everywhere are employees of a single universal hospital network? What? Are NPs employees of hospitals too? Are hospital-employed doctors just considered rogue units in hospitals or what?

 

[badasshairday]

If you get paid a salary by the hospital, you are the hospitals employee. Nurses tend to fall under this category. This is why nurses strike against the particular hospital they work for. Doctors are not paid by the hospital. They bill medicare and insurance companies for their services. Therefore, physicians are independent contractors.

I didn't make up the rules.

 

[chessknt]

Hmm sorry i guess i just didnt understand it. Do hospitals charge physicians to work in them then since physicians have to get their own pay?

 

[Substance]

I think that it would pay dividends if the AMA would lobby for physicians to have the right to unionize. It would be an expensive venture, but in my opinion it is a necessary one.

 

[djamel]

It's a good idea to unionize with fellow doctors. That will create a stronger physician lobby.

 

[badasshairday]

Who are they going to unionize against? They are not employees.

 

[psy]

what about hospitalists? Are they considered employees or contractors?

 

[turkeyjerky]

what about hospitalists? Are they considered employees or contractors?

Hospitalists are generally employees of the group that they work with/for, or of the hospital itself.

Look, the problem isn't strictly with being classified as an "employee" or "independant contractor" by either the group or hmo, or whatever that the doctor works for. Some doctors are classified as employees, some as independant contractors, of the group that they work for, which generally has a contract with the hospital to provide coverage. This stuff is beside the point for what we're talking about. The problem with unionizing or going on strike is that, functionally a physician acts as an independant contractor of a hospital/group in that they act according to their own discretion in how they provide the contracted service. In other words, because the group doesn't have the power to dictate how you practice, they don't "employ" you, they "contract" with you. Even if you are classified as an employee by the group, in the event of an attempt at organization, the law will side with them (and find you liable for any damages), b/c, functionally, you are not acting as an employee.

Most of this doesn't even apply to established physicians who are owners of their practice (ie partners).

You are, of course, free to end your relationship with the hmo/hospital/insurance plan, but if you try and get other doctors to do the same, you would be violating anti-trust legislation and you will quickly have your ass handed to you. Which is what happend to a few orthopods in texas a few years back when they all agreed to stop accepting a particular insurance plan.

Nurses don't have this issue, because, functionally, they are actually employees. Their bosses (the doctor who employs them in an office or the hospital they work at) can dictate what they do at work. Because of this (and the fact that they are blood-thirsty vultures who would bite off the head of a three-day old baby if it would further their agenda one iota) they can strike.

 

[Taurus]

Physicians need to recognize and respond to the threats to their profession, ie, the NP's and CRNA's who practice medicine but claim to be practicing "advanced nursing". If we don't unite, other groups are more than happy to erode our profession for their own gain.

 

[Dr Funk]

It is currently illegal for Doctors to organize into Unions. I don't know if that law went to the SCOTUS or not but it seems unconstitutional that other health care personnel can unionize but physicians are denied that right.

The Anti-trust and RICO laws block Doctors from unionizing or even talking to one another about what pay they have negotiated with other docs. That's right, the RICO laws. These are the racketeering laws put in place in an attempt to bring down mafia syndicates. That sounds fair, right?

 

[UTMBMD2012]

Would this work?

What physicians actually coming together as a union to petition for themselves despite the laws "preventing" it. The union would, in the current state of the law, be illegal and litigation would ensue. Now working the way up the judicial hierchy. If argued properly, I think trying to pigeon hole physcians into "racketeering" just because they want to try to earn what is their due, would seem preposterous. I think, if a test case came up, high end judges may see the racketeering laws as too broad and might change.

 

[NPEMTIV]

If you guys get this union thing going let me know. I'm in.

 

[troopa]

If you guys get this union thing going let me know. I'm in.

It's nice to know that residents can unionize so at least that part of our professional lives is covered.