The advantages of these limitations overwhelmingly favor the MCO, health care purchaser, offering contracts to a network of doctors. The policy statement has a blunt example of the benefits to the health plans. A managed care organization already enrolling a number of employees of a large industry in its region, wanted to expand into small-town from which a number of these enrollees commuted. They found that it was too costly to try to contract with individual doctors, or to administer a program in the smaller area. They encouraged a group of doctors to form an IPA to take care of their enrolled patients, choosing this simply because it was cheaper.
Every union knows that in numbers there is clout.
These size and composition restrictions limit the ability of the physician network to bargain productively with MCOs. A union, however, could certainly try to sign up as many doctors as possible in order to achieve strength. There are examples given in the policy statement of circumstances in which the numerical and specialty ceilings could be breached. It would appear that competition is maintained even when size quotas are set aside if replacement workers are available. Medical organizations may be trying to have this requirement lifted, but it should not be a goal of unionization.