Health plan limitations on patient referrals to specialists, limits on hospital lengths of stay, drug formularies and determinations of medical necessity are also priority concerns. To distinguish the physician union from more conventional labor organizations, guiding principles establish that it will never affiliate with the latter nor engage in strikes. Public reaction has been mixed. The insurance industry obviously does not support the development of physician unions. If physicians are permitted to set prices for their services, the inevitable result will be higher premiums.
Some physicians continue to believe that unionization is incompatible with professionalism.
Of equal interest is the Texas legislation signed into law by Governor George W. Bush on June 23. The new law will allow physicians in independent practices to negotiate collectively through third-party administrators on contract and reimbursement matters without fear of the antitrust enforcement authorities. The process thus takes on the mantle of state action and is immune to federal antitrust prosecution. The statute also limits the size of a bargaining group to no more than 10 percent of the licensed physicians in a given area. The managed care industry and business interests lobbied as heavily against the legislation as physicians lobbied in its favor, with strong AMA support.