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Podiatrists Plan Unionizing Vote as Managed-Care Debate Escalates

Health: Foot specialists seek to boost their bargaining power with HMOs, which they accuse of putting profit ahead of patients.


Complaining that the managed-care industry is stepping on their toes, California podiatrists plan to vote next week on whether to join a union.

The effort by the 1,000-member California Podiatric Medical Assn. is one of the latest efforts by doctors across the country to unionize in an attempt to boost their bargaining power with managed-care companies, which they accuse of putting profits ahead of patients.

The foot doctors will vote next Wednesday on joining a national podiatrists union affiliated with the AFL-CIO and created in October. Called the National Guild for Health Care Providers for the Lower Extremities, it already has thousands of podiatrist members in 13 states, said Jack Bois, president of the California podiatrist group.

"Five years ago, if you would have suggested a union, you would not have gotten far," Bois said. "But the frustration level has really grown the last few years."

Podiatrists are among a number of medical specialists whose incomes have been hit hard by HMO industry practices that tightly control access to specialists in an effort to limit unnecessary care and reduce costs. Podiatrists generally make $65,000 to $110,000 a year, Bois said.

Podiatrists are not medical doctors but are trained and licensed to diagnose and treat a broad range of foot diseases and disorders. HMOs have been asking primary-care doctors to treat foot disorders themselves or refer patients to specialists who are medical doctors, Bois said.

"The dependence on primary-care physicians has put the squeeze on" podiatrists, Bois says, with the result that "many patients aren't getting the specialized treatment they need."

Bois said the podiatrists group does not expect to engage in strikes. But he said unionization would give them greater negotiating power with health plans over pay and patient care and help them win contracts with health plans for union members.

As managed-care enrollment has swelled in recent years, many physicians have strongly resisted what they view as efforts by HMOs to exercise excessive control over their profession.

While many doctors have adapted to the changes and say they actually prefer practicing under managed care, others have adopted a more militant stance.

In December, more than 100 doctors at Tucson's most prestigious medical clinic voted to join a union, the Federation of Physicians and Dentists, an affiliate of the American Federation of State, County and Municipal Employees.

They were protesting cost-cutting efforts by the clinic's owner, Foundation Health, a California-based HMO. The efficiency moves came as Foundation prepared to sell the clinic to FPA Medical Management, a San Diego-based physician management company.

Until the Tucson vote, nearly all the doctors who belonged to unions were government or university employees. For example, the Union of American Physicians and Dentists, a 5,000-member independent union founded in 1972, primarily represents California doctors who work for government-owned hospitals and clinics. About 1,200 of the union's doctors are private physicians who have formed their own medical group.

"I think health-care providers, including nurses, podiatrists and physicians, are looking at ways they can have more of a voice and impact in decisions," said Art Pulaski, head of the California Labor Federation.

Leaders of the state's largest medical society, the California Medical Assn., rejected the idea of unionization last year, said Dr. Rolland Lowe, the CMA's president.

Doctors voted the idea down "because they want to appear as a profession and not just a union advocating for its self-interest," he said. "We feel we can carry the message of patient advocacy better as a professional organization."

Added Dr. Robert Weinmann, president of the Oakland-based UAPD: "Doctors are afraid their images will be tarnished because they'll be part of a union like everyone else. People who don't know much about unions think, 'Ugh, Jimmy Hoffa.' "

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