Psychologists and unions: time to pay our dues

By Joseph S. Bak, PhD

Big fish eat little fish. The health-care market is no exception.

Insurers merge and acquire each other at a frenetic pace while employers band together to form purchasing coalitions. Both groups are thereby increasing negotiating leverage with practitioners as fewer and fewer purchasing entities control more and more lives.

How can clinicians, whether as solo practitioners or as members of small groups, hope to negotiate effectively with these health-care giants? To defend our interests and preserve our professions, we must take advantage of the power of size and solidarity by forming large cross-disciplinary networks. I also suggest these networks become affiliated with unions for a variety of mutually beneficial reasons.

Industrialized health care has seriously eroded our control over the areas of practice that traditionally define an independent contractor. We are treated like 'deprofessionalized technicians,' barely more than tightly micromanaged de facto employees of insurance conglomerates. We are steadily losing control over the terms and conditions of our 'employment' as independent contractors and over our authority to define quality care. We dare not advocate loudly for our clients? interests without risking personal economic ruin. What can be done to resist the complete enslavement of our profession?

Strength in numbers

I propose both employed and independently practicing psychologists begin a serious discussion of the merits of union affiliation. Such a proposal, I realize, may violate some readers? sense of historical identification with ownership and management. Other genetically independent readers may find the challenges of solidarity overwhelming.

Professional unions, however, could provide us with a powerful tool to contain and counteract the managed destruction of our professions, until better methods of health-care financing and delivery replace the present system.

Podiatrists dared to pursue this option by recently forming the First National Guild for Health Care Providers of the Lower Extremities and then affiliating with the Office and Professional Employees International Union (OPEIU). The American Medical Association has also recently moved in the direction of forming an 'in-house union' by establishing the Division of Representation. This division was created to help state and county medical societies form unions and to help physicians cope with the daily hassles of working with managed-care organizations.

It is legal for independent practitioners to form networks and affiliate with unions as long as they do not attempt to collectively bargain or boycott. However, practitioners who are employees in either the private or public sector can make full use of traditional union collective bargaining tools. One example of this is the recently successful efforts of physicians at Thomas-Davis Medical Centers in Arizona to utilize union representation to defend their interests and the interests of their patients.

Mutually beneficial relationships

In a corporatized health-care system, psychologists are treated as labor and therefore have common cause with organized labor unions. Strategically speaking, if psychologists declare their pro-union stance and start paying dues, they can begin to cultivate an ongoing mutually beneficial relationship with labor. Psychologists may also gain direct access to the lobbying clout, political network, health-care contracts and sympathetic ear of organized labor.

Psychologists might be able to take advantage of a confluence of trends in the marketplace by joining their state chapters of the American Mental Health Alliance (AMHA). The state chapters or national AMHA could then become union-affiliated. The AMHA is a not-for-profit, practitioner-directed interdisciplinary network of mental health professionals that directly contracts for services. It seems to be positioned to capitalize on the desire of a number of employer, union and government purchasers of health-care services to eliminate the added expense of shareholder profit-driven middlemen.

The advantages for AMHA practitioners to become union members who are bidding to secure union contracts are readily apparent. Unions are the largest group of health-care purchasers and consumers in America. Unions support the notion that their members should be able to choose union health-care practitioners whenever possible. AMHA?s interest in providing clinically determined care, not bottom-line determined care, dovetails with the unions? interests in having the highest quality cost-effective care delivered to 43 million members and their families. Finally, both the AMHA and the AFL-CIO have declared the need to defend and promote the core principles of client choice, client protections and confidentiality.

The changing health-care landscape presents us with a challenge to respond with vision. Dare we imagine health-care practitioners as insiders educating representatives of labor unions how invisible rationing currently masquerades as quality care? Dare we stop our interdisciplinary skirmishes long enough to promote our common good in solidarity with labor and possibly regain control over our future?

Joseph S. Bak, PhD, is on APA?s Div 29/39/42 Task Force on Managed-care and is in private practice.