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From: B. Harris)
Subject: Re: Doctor-bashing
Date: 14 Mar 1999 11:18:39 GMT

In <> Kristopher Crawford <>

>So you see George, if you do away with the Medicare subsidy for GME
>positions, all residents then become just employee's (and the NLRB can
>forget about that case they are gnawing on) not students. Then the AMA
>could in fact form bargaining units for them (in that alternate reality
>George you could really then be right....the AMA would then be a union)
>and they could negotiate to be paid what they are worth to a hospital and
>then alternately pay the staff physicians directly for their teaching
>services. You do that and you'll double resident pay overnight.
>Please George call your congressman today get him to implement this plan
>I'm begging you.
>Kris Crawford

    I'd like to see this, also.  I have in mind my own internship,
where I calculated I was making below minimum wage-- certainly less
than the nurses and janitors were making.  The reason I was exempt from
various labor laws was that the money I got was for those purposes
considered a student "stipend."  "Aha," said I, "that will be great for
tax purposes."  "No, for tax purposes it's considered a salary."  It
didn't take a lot of intelligence to realize I was getting it coming
and going.

   There is nothing inherantly bad about unions-- unions are simply the
scars of bad management, and management will always manage no better
than it has to (which is horribly, if there is not feedback).  Doctors
have historically been self employed entrepreneurs and have not been
managed, and thus have had no union.  Now that we increasingly are
being managed as employees, we need one badly but are too proud to
admit it.  In countries where doctors really do work for the
government, they have a union.  But those countries do not permit such
unions the freedom and powers which unions have historically been
permitted in the U.S.   Socialists are loathe to regard doctors as
"workers" even as they plot to make them exactly that.  Well, you can't
have it both ways.  When we get it coming and going, we eventually
figure it out.

   People forget sometimes that a doctors union, when it eventually
does come to pass (and it's not here yet) will have certain advantages
that the AFL-CIO does not.  If the Auto Workers of America want too
much, the Suits can always threaten them with making cars in Mexico, or
buying them from Japan.  But if people threaten doctors with going to
Japan or Mexico for their medical care, the only response will be
"Sayonara."  Or perhaps more appropriately: "Via con Dios."

From: B. Harris)
Subject: Re: Resident Training Costs and Subsidies (was: The Patients' Bill of 
	Rights (was Backlash against HMOs: a declaration of war)
Date: 29 Apr 1999 03:15:42 GMT

In <> (Richard M. Poniarski, MD) writes:

>	Doctors are NOT free to organize as they wish. As far as I know,
>and I don't claim to be a legal expert, doctors are not allowed to form a
>union to negotiate with either their employers, ie hospitals, or with
>insurance companies. Organizations such as ASAM, AMA, etc, are
>professional organizations like the Bar Association. They are to help
>educate and promote the agenda of the physicians who are members.
>	Now I know there is a movement out there to organize doctors into
>a union, and with more and more physicians becoming employees may be
>will come to pass one day. But not today...

    It's worth noting that radiologists, who've longer than any group
been essentially employees of hospitals, have long organized into
bargaining groups which are local unions in all but name.  And by this
they've gotten themselves salaries second only to surgeons (and fairly
close to surgeons).  Despite far shorter hours and fewer years of
nasty, painful training.  Of course, I suspect that none of this raises
doctors' net take of the health care dollar, which remains pretty much
fixed at 15-20% (depending on how you count).   What radiologists take
away in extra comes out of the pockets of family practitioners and
pediatricians, etc. (& geriatricians...ouch).   Those medical
specialties most heavily populated by women, interestingly enough.   I
don't think, for once, that this is actually descrimination against
women.  Rather, it's that women are drawn to those parts of the medical
subspecialty world which involve social interaction, and the powers
that be in the U.S. have decreed that technology bills, and social
interaction can be on your own time, thank you very much.   You get the
bucks if you're down in the dark room in the basement next to the CT
scanner, not if you're up in the sunshiney clinic with the screaming
kids.  Radiologists, the Morlocks of Medicine.

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