L.A. County Doctors Vote Decisively to Unionize

In a historic victory for organized labor, officials announced Friday that Los Angeles County’s doctors have become the largest U.S. group of physicians in nearly two decades to vote to unionize.

The nationally watched election culminated a three-year campaign to organize the county’s 800 physicians--those who are not medical residents--in the wake of the county government’s massive effort to restructure its Department of Health Services.

Ballots were mailed May 3 and were accepted through Wednesday. More than 500 physicians cast their votes, and the final tally to join the Union of American Physicians and Dentists was 341-182.

Union leaders, who had predicted an extremely close election, were ebullient over their margin of victory.

“This is a great day for patients and physicians alike,” said Dr. Dan Lawlor, the union official who led the effort. “Financial markets and Wall Street are taking over [health care] . . . and it’s not just the private sector managed care that is affected. It’s the public hospitals as well.”

Union leaders stressed that their commitment to patient care meant that although they could not rule out striking as a bargaining tool, they doubted that such an action would ever occur.

“We’ve got so many other ways to settle labor disputes,” Lawlor said, adding that the union has never struck in its 27 years. “I can’t see it happening.”

Dr. Donald Thomas, assistant director of the health department, said the vote should not threaten those served by the vast health care system, which treats the county’s nearly 3 million uninsured patients and runs the county’s largest trauma centers.

“We deal with unions all the time,” he said.

In fact, he was skeptical of the union’s ability to effect large-scale change.

“It is much easier for the union to claim they’re going to change health care than to do it,” he said. “It’s not like there are a group of us who are sitting around and not trying to change anything. There are certain constraints, like the budget.”

Lawlor and others said the county’s focus on the bottom line and its recent cost-cutting drives are what spurred the vote to unionize. The same motivation has prompted a growing number of physicians to organize nationwide as a backlash against managed care.

Coming a few months after the county’s low-paid home care workers voted to unionize in another groundbreaking election, Friday’s vote demonstrates a deep discontent among employees of the county’s health care system.

“This is about decent workers’ rights,” said Miguel Contreras of the County Federation of Labor. “It cuts across the board. . . . We’ve gone from the bottom to the top.”

Friday’s vote also mirrors a nationwide jump in physicians’ enrollment in unions, which many attribute to the dwindling fees and loss of control over patient care resulting from the managed care revolution. About 6% of the nation’s 600,000 practicing physicians are unionized.

The physician membership of the American Federation of State, County and Municipal Employees, the umbrella labor group that includes the Union of American Physicians and Dentists, has quintupled in the last four years. Another labor group, the Service Employees International Union, kicked off a $1-million nationwide organizing drive this spring.

As a result of the high-profile Los Angeles effort, leaders of the physicians union--which, with the local group, now represents 6,000 doctors--say they have been contacted by physicians and are organizing nationwide. They predicted rapid expansion of their ranks.

“Trends start in Los Angeles,” said Dr. Louis Simpson of Martin Luther King Jr./Drew Medical Center in Willowbrook. “This is a revolution that is going to spread like wildfire across the country.”

A brush with bankruptcy in 1995 forced Los Angeles County to lay off doctors for the first time, and ever since, the county has been trying to cut the health department. The layoffs and cost-reduction efforts sparked the union drive, which picked up momentum from recent plans to reconfigure laboratories and change county law governing the employment of physicians.

“Doctors are very hard to get together,” but the changes finally made them angry enough, said one county physician.

Union leaders vowed to slow down the health department’s restructuring efforts to focus more on patient care and to try to replace lost emergency room and support staff.

“Today’s a great day not just for doctors but for patients,” said Dr. Robert Weinmann, president of the physicians union, at a news conference in front of County-USC Medical Center. “With a union representing doctors so they can concentrate on health care and what’s best for patients, patients can rest easy.”

Dr. Janice Nelson, who runs the blood bank at County-USC, added: “Today is the day we physicians begin the process to take back the practice of health care in Los Angeles County.”

But Thomas noted that although the majority of voting doctors opted for the union, those votes represent a minority of county physicians.

He also complained that the union “misrepresented” his proposal to change county law on how doctors are employed by casting it as an effort to contract out their work to the private sector. He said he believes that many doctors threw away their ballots rather than voting.

For the measure to succeed, at least 60% of the 800 doctors had to cast ballots, and a simple majority of those voters had to favor unionization.

The union will represent all 800 doctors, though the physicians are not required to be dues-paying members. Another election that could establish such a requirement is planned for later.

The county’s Assn. of County Physicians, a professional group of publicly employed doctors, opposed the union drive, and some physicians posted letters on the group’s Web site expressing fear that doctors would not turn out to vote.

Raising the threat of a possible strike if the union won, Dr. Ronald Koretz wrote: “Say no to the [union]. Instead of feeding that power base and its agenda, we should use our own power to remove the fat from our system.”

However, nonresident physicians were the only significant part of the health department not represented by a union before Friday. Some doctors complained that other unions, such as those representing nurses and medical residents, had more of a say in health policy than did individual doctors.

Notoriously independent-minded, physicians have historically looked askance at unions, and organizing doctors is considered to be one of the tougher tasks in labor circles. The job got tougher this month when, in a New Jersey case, the National Labor Relations Board upheld its policy that fee-for-service physicians are not eligible to organize.

Still, salaried doctors such as those employed by public health systems or private hospitals are up for grabs, and labor leaders say it is important to enroll those people in unions. The push is part of a drive to unionize more white collar workers in an era of downsizing.