The bargaining chip

Given the frustrations of managed care, have you ever felt the urge to go on strike? Of course, you’d have some big hurdles to overcome before uniting with the workers of the world.
First, the American Medical Association is against physician labor strikes given the potential for violations of medical ethics and the Hippocratic Oath, according to Charles D. Goodman, M.D., West Hills, Calif. Dr. Goodman still might be your first call since he advocated, in the November/December 1999 issue of the Western Journal of Medicine, that “unionizing is the best way to protect our patients and preserve our role as healers.”
Second, a striking physician would likely violate the National Labor Relations Act of 1935, which allows employees to unionize—not independent contractors or persons with supervisory or managerial responsibilities. Most physicians are not employees, and those who are usually have some supervisory role.
“Although physicians’ unions have existed since the 1970s, union members have always constituted an extremely small percentage of practicing physicians,” noted Troyen A. Brennan, M.D., J.D., M.P.H., Brigham and Women’s Hospital, Boston, in the October 2001 issue of The New England Journal of Medicine.
Fortunately, as an ophthalmologist, you won’t need an act of Congress to do some serious collective bargaining. You won’t even need to bargain yourself. All you have to do is join ProVision Network, a consortium of eye care professionals that negotiate favorable rates on everything from insurance to credit cards.
“Back in 1997, we were trying to save ourselves a little overhead expense in our local society,” recalls the founder and president of ProVision Network, John D. Sheppard, M.D., professor of ophthalmology, microbiology, and immunology, Eastern Virginia Medical School, Norfolk, Va.
What originally started out as a “ragtag group of 27 likeminded docs” in southeastern Virginia grew to become 700 strong today in 15 states, saving the average member $3,000 to $5,000 per year on office supplies, insurance, equipment, and other products and services, Dr. Sheppard said.
For example, an ophthalmologist can save between $1,500 and $3,000 per year with Ophthalmic Mutual Insurance Company (OMIC, San Francisco) for being a member of ProVision Network, Dr. Sheppard said. Better per-transaction fees on credit cards have also been negotiated, he said.
Dr. Sheppard finds that young ophthalmologists are especially benefitted by ProVision Network. There’s a big difference, for instance, between a 28-year-old ophthalmologist and a 38-year-old ophthalmologist who has had time to build a successful practice and can afford higher overhead costs, he said.
“If you get in on the ground floor and build cash value in your investments and policies, you can save money over the long term,” Dr. Sheppard said.
Older members benefit, too. Members speak for themselves with a 94% membership renewal rate, Dr. Sheppard said.
“Typically, a member doctor who utilizes everything under our umbrella can save even more—$5,000 to $7,000 per individual per year,” Dr. Sheppard said.
Moreover, you don’t have to do much as part of the ProVision Network. “Enthusiastically support your practice administrator and proceed with annual renewal,” Dr. Sheppard said. “It makes a lot of sense.”
Of course, the more members ProVision Network gains, the better its collective bargaining power will become. It also makes sense to join as an ophthalmologist because you deserve better rates, Dr. Sheppard said.
Ophthalmology has a much lower risk management profile than other medical professions, Dr. Sheppard said. “It generally turns out that ophthalmology is carrying the malpractice rates of everyone else,” he said.
Beyond the ProVision Network, physicians are finding ways to increase their bargaining power. “The American Medical Association (AMA), which opposed the idea of physicians’ unions for many years, has established a new organization, Physicians for Responsible Negotiation,” Dr. Brennan noted in his report. “It will serve as the bargaining agent, under federal collective-bargaining legislation, for employed physicians who decide to become members of the organization, including physicians who are not members of the AMA. Choosing a slightly different path, but with the same goals, the American College of Physicians and the American Society of Internal Medicine have endorsed efforts to permit collective negotiations by physicians through a waiver of federal antitrust laws.”
But why not save yourself a political headache and consider a simple bargaining solution instead: ProVision Network.
“We call ourselves The Doctor’s Buying Group,” Dr. Sheppard said.
That pretty much sums it up, except that it also buys at blue plate special prices.

Editors’ note: Drs. Brennan and Goodman have no financial interests related to their reports. Dr. Sheppard has financial interests with the ProVision Network.

Contact information

Brennan: tabrennan@partners.org
Goodman: UAPD@UAPD.com
Sheppard: 757-622-2200, docshep@hotmail.com