The medical director as educator: an interview with Elizabeth M. Gallup, MD, JD, MBA - The Evolving Role of the Physician Executive - Interview

Physician Executive, Sept-Oct, 1999 by Richard L. Reece

It's not advocating unions, but it is promoting acting together as a group such as an IPA if physicians want to stay independent, not become employed, and partner more with HMOs and hospitals versus being adversarial. Where employed physicians can form a union legally, independent physicians cannot. But independent physicians can form IPAs and act together as a group, avoiding some anti-trust issues. Unless physicians get together and act as a group, they are doomed to further and further erosion of their economic interests as well as their clinical autonomy.

Q. What do you read into the American Medical Association's decision to unionize? It can only affect about one third of employed physicians--400,000 of America's physicians are self-employed, independent contractors and are not candidates for a union. Is it a symbolic act? Does it have social significance?

Gallup: It has both. It's a symbolic act, in that it may be difficult for the AMA to accomplish. However, it's a symbolic message that the AMA does, in fact, realize the necessity of physicians somehow being able to negotiate as a group with their employers or otherwise act in a group fashion.

Unfortunately, the union concept has a negative connotation to the public, which is the societal impact. Unions equal strikes in the public's mind. Obviously, the public doesn't feet that doctors should strike, nor should they because it would be against their Hippocratic Oath.

The other thing is that patients almost universally think all physicians make a lot of money and don't work very hard. Of course we know that isn't true. Patients think why on earth do doctors need unions, just so they can drive bigger cars and have bigger houses? Unfortunately, there's not much that the AMA can do to change that general perception.

Q. The managed care backlash is now in full flower. It is probably number one on the congressional agenda. Will this patients' rights legislation, if enacted, curtail the managed care movement or affect the role of medical director?

Gallup: Yes. While it's well intentioned, the Patients' Bill of Rights may hurt the individual patient and the physicians more then help them. If you're trying to manage health care costs and promote efficiency, yet the patient can get everything he or she demands--without understanding that some of the tests or drugs or specialists aren't the appropriate ones--the physician will lose the ability to help guide the patient, albeit, under the regulations of the HMO.

That really isn't in the best interest of the patient, because one of the problems with fee-for-service medicine is that there are still a tremendous number of procedures that are unneeded and/or unnecessary. There are hospitalizations that are unneeded or too long; medications prescribed or doctor visits that are unneeded. By perpetuating this through legislation, It won't help reign in medical care costs. It actually can tie the hands of physicians more then they're even tied now.

Q. Last year, the physician practice management industry had a spectacular collapse. How do you read that collapse and how do you see the future of medical directors in such organizations?