Grace Budrys, DePaul University sociology professor, analyzes the formation of a San Francisco-based union for doctors in her new book "When Doctors Join Unions," as a harbinger of what could happen in the rest of the country.

Released this month, this book focuses on the 1972 formation of the Union of American Physicians and Dentists (UAPD) in San Francisco. UAPD was organized by Dr. Sanford Marcus, who was angered when the administrator of his hospital did not consult with staff doctors before establishing an HMO and announced that the doctors would be expected to provide services to it.

Marcus sent a letter to 500 doctors throughout the area and was gratified to find that they shared his sense of outrage, said Budrys. Many sent the $25 fee that Marcus requested in order to launch a doctors' union. In retrospect, she said, Marcus acknowledged that part of his outrage came from being "pushed off the pedestal."

However his anger was not simply ego-based, she said.

"Doctors are now taking orders from all kinds of people who have no medical training," she said. "They must get pretreatment approval from an insurance company's clerical employee, located in some other city. Health care decisions are made by third parties, and doctors no longer have personal responsibility for their patients."

Budrys, who has worked in various health care settings including hospitals, said that doctors' treatment plans are increasingly being ignored, which is one reason for the renewed interest in doctors' unions.

In fact, she said, doctors' unions are being formed in Florida, Pennsylvania and Arizona. The Doctors Council in New York, which has been in existence as long as the UAPD, is expanding, Budrys said.

Budrys compares the movement to the industrial revolution of the 19th Century, where small cottage industries folded as huge corporations run by managers gained control of manufacturing.

She uses the experiences of UAPD organizing as a model for doctors across the country.

"Physicians are being welcomed to the factory floor," she said of the trend. Budrys compared the doctors' organization and tactics to teachers' and pilots' unions rather than the traditional blue-collar unions.

Health care statistics already reflect a major change, Budrys said. Nearly 70 percent of all physicians are salaried, 77 percent of the population is in managed care organizations, 93 percent of which are owned by for-profit firms.

"The motivating force in medical care comes from insurance companies," she said. Doctors' treatment plans are increasingly ignored, she observed.

In the future, Budrys said, doctors will have no alternative but to organize collectively to gain control over their work.

"Whether unions or union-like organizations emerge is what is difficult to predict," she writes. "That will depend on the number of physicians in an area, the extent of managed care market penetration, the political and social environment, and whether the courts change their interpretation of labor law."

Budrys received her bachelor's degree from the University of Illinois in psychology; her master's degree in industrial relations from Loyola University of Chicago, and her doctorate in sociology from the University of Chicago.

"When Doctors Join Unions," published by Cornell University Press, is available at local bookstores.

For more information contact Budrys at 773/325-7000, Ext. 1814.

(To obtain press copies contact Andrea Clardy, Cornell University Press, at 607/277-2338, Ext. 230.)