Physicians for Responsible Negotiation: The right approach for doctors

The AMA-founded group allows physicians to collectively bargain -- with their values intact.

Editorial. Dec. 11, 2000.

Barely a year old, Physicians for Responsible Negotiation is having a significant effect on many facets of the heath care industry.

PRN was formed on the basis of instructions from the American Medical Association House of Delegates in June 1999. Although its directors were appointed by the AMA Board of Trustees, it is now self-governed. Its mission is to assist those physicians eligible for collective bargaining to recapture some control over patient care and medical practice issues.

But the House of Delegates included some stipulations that distinguish PRN from the traditional union. Most significant is PRN's refusal to authorize strikes or the withholding of necessary medical services to patients. Its commitment to the inclusion of a quality of care/patient's rights section in every bargaining package also sets it apart from other labor organizations.

As it enters its second year, PRN is actively involved in organizing or negotiating contracts for three groups of physicians -- in Illinois, Michigan and New Jersey. Consideration also is being given to conducting an organizing campaign at a major teaching institution, as well as programs involving a group of employed specialist physicians and the residents at a teaching hospital. Also being discussed are partnerships with subsidiaries of several state and county medical societies.

A major milestone occurs this month when residents of suburban Chicago's Lutheran General Hospital are scheduled to take part in a secret-ballot election in which the 170 physicians will decide whether they want PRN to represent them. The residents approached PRN earlier this year with concerns about the absence of a grievance process, the high cost of health insurance and numerous other workplace issues.

PRN's other major activity in its first year of existence has been an intensive education campaign, directed at all segments of the physician population but devoting considerable attention to residents and fellows. The focus is not on recruitment but rather on providing in-depth educational materials designed to give residents and fellows a broad understanding of what PRN has the potential to do -- and not to do -- for them.

The message also has been delivered in person. PRN has been active in addressing groups of residents and, in some instances, their administrators and program directors. These education programs, which provide information on resident representational options and background on the philosophical principles and operational strategies of PRN, already have been given at more than 15 institutions throughout the country, representing more than 7,000 residents and fellows.

PRN is not the only game in town for physicians seeking representation; an estimated 45,000 physicians belong to some form of union organization. But the unique features of PRN provide physicians with an ethical alternative to more traditional labor organizations -- an alternative that opposes striking and also opposes required union membership as a condition of employment.

In a more perfect world, of course, such an organization might not be necessary. But as long as health plans intrude into the way medicine is practiced, some groups of physicians will need a mechanism through which they can speak with a unified voice. Congressional passage of antitrust legislation that would allow collective bargaining by self-employed physicians would accelerate the trend.

Whatever occurs in the coming years, however, the role of PRN is a vital one for the foreseeable future. It is providing thousands of physicians -- including the profession's future leaders -- with valuable education and support as they grapple with an increasingly complex and often frustrating health care system.