Friday, June 25, 1999

Isle doctors join movement
to unionize

By Helen Altonn


Hawaii doctors are joining mainland colleagues in taking action to wrest patient care decisions from medical insurance companies.

The Hawaii Medical Association supports the development of a national negotiating organization for employed doctors that will help form local negotiating units, said Dr. Patricia Chinn, association president.

She said doctors just want "to try to even the playing field" because they have no impact now on health care plans or contracts with large managed-care companies.

"Doctors can't take care of patients if we don't get fair contracts," said Chinn, a general surgeon. "Contracts dictate terms under which we practice, and now we're at the mercy of managed-care plans.

"They dictate to us on a take-it-or-leave-it basis. They tell us what procedures we can do, what drugs we can order, what tests we can order or even whether we can take care of a particular patient. We need to restore balance."

Chinn and other HMA officials returned yesterday from an American Medical Association meeting in Chicago. The AMA House of Delegates voted to back formation of a union to give doctors who work for hospitals or agencies more autonomy in patient care.

"Our hope is, national will have that up and ready to go in a month or so," Chinn said.

The AMA also supports a bill pending in Congress to remove the threat of antitrust charges if self-employed doctors try to unionize.

Chinn said the delegates listened to more than four hours of heated discussion by physicians who feel they are helpless as individuals.

"Doctors in Hawaii are no less frustrated and, I guess, shackled."

Cliff Cisco, Hawaii Medical Service Association senior vice president, said, "The thing being expressed by the AMA may be reflective of needs elsewhere, but not in Hawaii."

He said HMSA meets continually with physician groups statewide and has advisory groups in every community. It meets with the Hawaii Coalition for Health, a consumer organization, and has continuing dialogue with all those groups, he said.

"We feel as much as possible that we have open communication here in Hawaii. ...

"Our position is that physicians make all patient care decisions, and we participate with physicians in providing benefits," Cisco said.

One result of collective bargaining, he said, could be to increase reimbursements to physicians, which would raise costs to communities and employers.

Dr. Philip Hellreich, HMA legislative chairman, said the movement isn't about doctors making more money.

"Salary does not come up in the discussion at all. This is about quality of care and preservation of traditional physician-patient relationship.

"A lot of physicians feel we're just widgets in the medical care industry, and as individuals we're powerless to negotiate with large managed-care organizations."

About 90 percent of physicians participate with the Hawaii Medical Service Association, he said. "We feel we have no choice."

As individuals, he said they can't challenge HMSA on many issues dealing with quality of care and the physician-patient relationship, including access of patients to their physicians of choice and the confidentiality of patient records.

Several years ago, HMSA changed some contract provisions opposed by doctors after HMA, the Hawaii Coalition for Health and the Federation of Physicians and Dentists banded together to demand changes.

Hellreich said HMA doesn't believe the ability to negotiate with managed-care providers over contracts will affect premiums.

"If we are able to deliver quality care and get our patients healthier and quicker, in the long term that will constrain costs more than other things (will)."

HMA recently polled its 1,600 members asking if it should get more aggressive in representing their interests, he said. The word "unionization" wasn't used but the response was "overwhelmingly yes," he said.

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