White Collar Unions for Healthcare Providers

June 9, 2013

opeiu_logoI attended the tri-annual Office and Professional Employees International Union – OPEIU – conference in San Diego last week. The event is as much a gathering of the tribes as it is a working convention of the 50-plus OPEIU member unions and guilds. I took pages and pages of notes as I sat through presentations in the main hall, and met in small groups with the OPEIU leaders, as well as leaders of member unions or guilds. Here is what I came away with.

White collar professionals will comprise the new members of unions and guilds. They will join because they need protection that can only come with numbers.

As John Mattiacci, President of OPEIU Guild 45/The First National Guild for Healthcare Providers of the Lower Extremity, said “The issue is not political. It is economic. We are fighting big business. I joined the OPEIU for its influence.”

Unlike unions a guild does not collectively bargain and it does not strike. Mattiacci had organized his own independent podiatric guild with a thousand members when he approached the OPEIU in the mid 1990s. He wanted a law passed that would expand podiatrists’ scope of practice so they could reconstruct ankles for which they had been trained.

“40 years we couldn’t get this law passed. Once I was in the OPEIU the law was passed in 30 days.”

Mike Goodwin President OPEIU

Mike Goodwin President OPEIU

I have been working with acupuncturists since 2008 trying to figure out how to organize them under the National Guild of Acupuncture and Oriental Medicine (NGAOM). Our guild has grown from 6 members in 2008 to 25 one year ago to 100 today. The Podiatric guild has 6500 members of 16,000 DPMs in the nation. There are approximately 25,000 licensed acupuncturists (LAcs) in the country. California has a plurality with about 10,000.

The hurdles that must be cleared have gotten lower since this meeting. They include the following.

1. Work within mainstream medicine if we want to earn a living wage. This has been a contentious issue within acupuncture but it is no longer. The national professional organization of acupuncture understands this is the only path to survival and success.
2. LAcs must market themselves as healthcare providers which means LAcs must learn to work within medicine, “speak medicine,” refer back and forth with mainstream providers, act and look like they are a part of mainstream medicine.
3. Join the NGAOM so we have strength in numbers. The NGAOM is small. But the OPEIU with 103,000 members across all the member unions and guilds is big. The AFL-CIO of which OPEIU is a member is huge. With all our brothers and sisters we are 4 million strong.

Every speaker from the dais began their presentation with the words “brothers and sisters.” It was not corny. It was heartfelt. The diversity among OPEIU groups was astounding. Here is partial list: Allstate agents (the “good hands” company tried to fire all the employees then hire them back as independent contractors without benefits of course), real estate appraisers, actuaries, street vendors, tax drivers, civil service employees in a group of South Florida towns and cities, and 10,000 nurses across the nation.

Acu Guild President Steve Paine chats up Richard Trumka AFL-CIO President

Acu Guild President Steve Paine chats up Richard Trumka AFL-CIO President

Mattiacci has begun to organize a profession that has to be the least likely to ever be organized under a guild or union: physicians. He explained why he believes this will happen by confirming something I have observed in my hometown. Private hospitals are buying up private physician groups as doctors have come to understand they will never be able to realize their traditional exit strategy: selling their office files to a younger version of themselves seeking to start his or her own private practice. Those days are gone. Doctors are selling to private hospitals so they can continue to work without the burdens of malpractice insurance, overhead, staff salaries, diminishing reimbursements, and less autonomy.

Mattiacci points out “this has created an unexpected consequence. All those doctors are now employees. And employees can be organized as a group.” If you do not think doctors are feeling burned and left out of decisions about how they work, then you do not know many doctors.

Acupuncturists have never been organized. In fact, many profess to be content to exist outside the realm of medicine with its insurance, pharma and governmental nuisances. This view is not less simplistic than Mattiacci’s view with one major difference. Being isolated leaves you alone. Being organized gives you a say in your destiny.

NGAOM member Mario Mancici, OMD, joined us for a day at the OPEIU conference. We visited his clinic which is decidedly mainstream. He is a graduate of a California program and has a thriving acupuncture practice in San Diego. He has 14 individual treatment rooms and is opening his version of a community acupuncture treatment room where he will treat up to 10 patients at a time in a group setting filled with negative ions. He does not use a sliding fee scale but he does accept health insurance, works with the only group in the nation that feeds referrals to LAcs – American Specialty Health or ASH, and he is enrolled in Medicare. Each of these choices remains controversial among many acupuncturists.

Acu Guild meets with Podiatry Guild

Acu Guild meets with Podiatry Guild

Here are a few excerpts from his brochure which, in my mind, offer a guideline for how to market oneself as an LAc who wants to work with and be seen as a partner for other healthcare providers.

His Center for Integrative Care is focused on optimal health and personalized patient-centered care.

His purpose is to help patients achieve optimal health and to educate them about the benefits of nutrition and Oriental medicine.

He educates patients to focus on a lifestyle of optimal function for health and wellness instead living by disease maintenance.

Mario lists a range of diagnostic tests none of which exceeds his scope of practice and common conditions he helps none of which are fantastic or outside an evidence base.

Here is how he explains acupuncture. “Acupuncture or needling therapy stimulates the nervous system to increase the flow of blood bringing oxygen, nutrients, hormones and immune cells to targeted areas of the body. Acupuncture points are junctures on the body where blood vessels and a dense collection of nerves intersect.”

Mancini believes acupuncture belongs in functional medicine which is something integrative physicians have told me. The way Marion sees it “functional medicine is the biomedicalization of acupuncture.” The path is clear. Those who choose to follow it will find strength in numbers and a new community of brothers and sisters.

One Response to “White Collar Unions for Healthcare Providers”

  1. A union for healthcare professionals to join is a wonderful idea. Most podiatrists are in private practice, usually solo practice, and have little leverage to negotiate fair reimbursements with insurance companies.

    Collective bargaining is not available for us as “private contractors” with the insurance companies but that needs to change. The big insurance companies have major control over how we practice, what we are paid and what procedures we can do. It is a control relationship. The “private contractor” legal status should not be a tool by corporations to allow abusive practices including interference with the doctor patient relationship and use of dictated fee schedules which effectively determine which services and procedures can be provided to patients.

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