Local doctors aren't sold on union
By Dan Nakaso
Advertiser Staff Writer
Dr. Robert Weinmann came to the Hawai'i Convention Center last week as a member of the American Academy of Neurology, but he was always looking for an opportunity to talk to Hawai'i doctors about joining a physicians' union.
Weinmann, the 66-year-old president of the Union of American Physicians & Dentists, has a neurology and pain management practice in San Jose, Calif., and also travels the country trying to get doctors to unionize.
Everywhere he goes, Weinmann hears the same objections: doctors are more comfortable making decisions independently. And many of them enjoy the feeling that their positions place them above the typical unionized hospital employees, he said.
"Snobbism plays an unfortunate role," Weinmann said.
But in Hawai'i, Weinmann has to con-front an additional argument against joining the Union of American Physicians & Dentists, one of a half dozen physician unions nation-wide.
Hawai'i doctors are particularly frustrated with the reimbursement plans they have with HMSA, Hawai'i's largest medical insurer, Weinmann said, but they don't think a union will make any difference.
"It is much more difficult in Hawai'i than, say, California," Weinmann said. "Doctors here are not convinced that we can produce. They don't feel they can take on HMSA and they worry that we're just another organization that wants their dues and won't be able to do anything."
Paula Arcena, executive director of the Hawai'i Medical Association that's in litigation with HMSA, said "that's probably a good assessment of the prevalent feelings in Hawai'i. Physicians feel very powerless in determining many aspects of their own practice. When physicians say to him, 'Why should I pay dues to one more organization that will be powerless to make fundamental changes?' that really speaks to the need for fundamental changes."
Cliff Cisco, senior vice president of HMSA, has heard of the union's recruiting efforts over the years in Hawai'i but believes that federal law prohibits doctors from unionizing.
"We understand the motivation and we're trying our best to respond to the physicians' needs," Cisco said. "We work very closely with the physician community. We engage physicians at all levels. We meet with them on a continuing basis."
But court and labor board rulings nationwide have allowed doctors to join unions.
In many instances, doctors who work for county or state hospitals and agencies can join unions and have won the right to collectively bargain. Others, who are considered independent contractors, can join a union but cannot negotiate as a group.
In other instances, large companies in situations similar to HMSA have been ruled by the courts to be de facto employers — and thus doctors can negotiate through collective bargaining, Weinmann said.
"If someone holds the ability for you to make a living in the palm of their hand through, say, setting fees, then that is equal to the power that an employer has to cut off your salary," Weinmann said.
The Union of American Physicians & Dentists is the only physicians union in the Islands, Weinmann said, and represents only about 50 of the estimated 5,000 doctors licensed to practice in Hawai'i.
But each year, Weinmann said the union successfully represents about a half-dozen doctors in disputes with hospitals, HMSA or other agencies.
"Their lawyers had been counting on the fact that doctors wouldn't spend $300 an hour for their own lawyer with no guarantee of victory," Weinmann said.
Instead, for annual dues of $440, a handful of Hawai'i doctors have received unlimited legal advice in dealing with their hospitals or insurers, he said.
Last year Dr. Barry Blum, an orthopedic surgeon in private practice in Kealakekua on the Big Island who is also on staff at Kona Community Hospital, tried to organize the hospital's doctors and get them to join the union.
"We're not in opposition to our administration," Blum said. "We have good relations with our hospital administration. The administration is not our enemy. Our enemies, if you want to call them that, are HMSA and Medicare. I'd like us to be able to present a united front when we talk to them."
Blum didn't hear many philosophical objections to Hawai'i doctors joining a union, he said. It was more a case of doctors resigned to their fate.
The union gave Blum legal advice and enlisted the help of U.S. Sens. Daniel Akaka and Daniel Inouye in Blum's dealings with the Veterans Administration. But Blum's inability to get more Kona doctors to join the union even has him sounding a little dejected.
"Maybe my colleagues are right," he said. "Maybe it's hopeless. Maybe this isn't the point that's going to get us organized. I certainly don't want to join any more organizations. I already belong to too many organizations. Maybe the enemy is just so overpoweringly strong."
