"American physicians are angry, frustrated, and exhausted over the intrusions of third-party payers into the day-to-day practice of medicine," said Dr. William G. Gamel, a delegate from Austin, Tex., and director of that state's Medicaid program.
"They are looking to us, their representatives at the local, state, specialty and national levels, to help them find a way to practice their profession as they've been trained," he added.
Gamel spoke Sunday, the opening day of the AMA's convention, where hundreds of doctors debated the merits and risks of forming a labor union.
New Jersey doctors testified that young physicians in their state often can't even begin practices because managed-care companies set unreasonable fee restrictions. Older doctors are retiring early or moving, they said.
The 494 delegates representing about 290,000 doctors -- about one-third of U.S. physicians -- were meeting through Thursday to debate issues.
At their winter meeting in December, the delegates asked AMA trustees to investigate collective bargaining, and the trustees responded with a 70-page report that served as a starting point for debate about what the AMA can do without violating antitrust laws.
"The House of Delegates resolution was 'to level the playing field.' ...There is no vehicle that will do that totally," said AMA board president Dr. Randolph D. Smoak Jr., in an interview last week.
"Whether it's a traditional labor union or what we call a union without striking...you have to have an employer-employee relationship under the National Labor Relations Act. Otherwise you are subject to huge antitrust problems," he said, adding that only one of every seven U.S. physicians is an employee under the federal law's definition.
Some doctors who spoke Sunday said the AMA must take an activist role.
"More testosterone is needed by the AMA," said Dr. Michael Connair, an orthopedic surgeon in New Haven, Conn. "I am not asking that the AMA establish how a collective bargaining unit should be formed; it doesn't have the expertise or wisdom to do so...But it does have the moral authority to establish the guidelines," he said.
"There are now 25 states with private labor unions for physicians, and if the AMA does not involve itself now, with those that exist and those that will exist...then the AMA will lose its credibility," Connair said.
The delegates on Sunday elected Smoak, a surgeon from South Carolina, to be their new president-elect. He ran unopposed and will take over the largely speech-making position next summer, after the term of incoming president Dr. Thomas R. Reardon.