The abysmal state of health care in the United States has created a wave of worker militancy that threatens to bring down entire systems. Yet the issues driving this militancy cannot be resolved system-by-system, facility-by-facility, or negotiation-by-negotiation. Rather, they require a national effort that extends worker voice across the industry and workforce. Doctors must organize to create a counterweight to the growing power of for-profit entities that control their own practice of medicine.
But it’s not easy to organize doctors. In a profession that was once dominated by individual physicians, the number of practicing doctors has dropped sharply. Many have gone into group practices that are then purchased by for-profit healthcare corporations and private equity. The rest are employed by hospitals, insurance companies, and government agencies. They often feel smothered by the management-labor hierarchy that suffocates workers everywhere else in the economy. The result is that doctors do not have the same collective power as other workers. With private sector union density at only 5%, it is unlikely that traditional forms of organizing will succeed in giving doctors a meaningful voice in the workplace.
The problem is compounded by a lack of coordination among local medical councils. For example, doctors in different regions may use logos, email accounts, domain names, and websites that are completely different from those used by their national councils. This impoverishes the image of their national organizations and leads to a decline in their sense of unity.
To address this, it is important to understand how and why doctors’ associations are organized. The goal of this article is to provide a critical review of the organizational structure of medical professional associations worldwide and to identify some of the problems these associations are facing. It focuses on three dimensions of the organization of these associations: legal form (public law corporations or independent professional association), centralization-decentralization of the registry, and compulsory/voluntary membership.
We find that the type of organization and its level of autonomy are associated with the degree of identification of doctors with their organizations. The stronger this identification, the greater is the willingness of doctors to fight for their organizations’ policies and objectives. This is particularly evident in countries with central registries and public law corporations as opposed to those where the registration is decentralized and done through medical associations or individual doctors. Moreover, the results indicate that medical associations can promote this identity through strategies such as fostering a sense of professionalism in their members and by promoting cooperation between local councils to create an integrated map of health professionals in a country.