Antitrust Laws Unfair to M.D.s

The January 2 issue of Psychiatric News contains two articles that are worthy of comment. The first is the “From the President” column, titled “APA Stands Strong in the House of Medicine,” and the second is the article on page 12 titled “Beware Non-Negotiable ‘Hold Harmless Clauses.’ ” Taken together, the two articles point up the fact that a change in federal antitrust law is essential for practicing psychiatrists, and that this crucial issue is not getting the attention it deserves from the psychiatric and medical leadership.

In her column, Dr. Marcia Goin, our president, celebrates the influence that psychiatry enjoys in the “House of Medicine” and mentions the support we are receiving from the AMA for our positions on psychologist prescribing, parity, privacy, and the recognition of the importance of psychiatric treatment to the workplace. This stands in sharp contrast to the article on page 12 that reports Magellan insists on “hold harmless clauses” in the contracts that they force psychiatric practitioners to sign as a condition of having access to patients in the Magellan networks.

If we were carpenters, bricklayers, plumbers, electrical workers, or other independent tradespeople, companies like Magellan would not be able to get away with this. That is because those other trades are allowed to unionize and negotiate collectively with large corporate contractors. This right is denied to us by the way the federal government interprets antitrust law; any attempt to negotiate collectively by physicians triggers federal prosecution. Each individual psychiatrist, indeed any medical practitioner, is at a severe disadvantage when contract-signing time comes with these huge managed care monopolies.

In fact, seeking a corrective change in antitrust law is official AMA policy. While I do not know where APA stands on this, it certainly should also be APA policy. What worries me about Dr. Goin’s column is the absence even of cursory mention of the unfairness of the conditions created by current antitrust law and the absence of any acknowledgment that a plan to correct this is part of the APA agenda. Psychiatrists in practice are affected by this unfairness every day.

I think that APA leadership should give more urgency to this drastically needed change. It will be an uphill struggle against political opposition, but it will never happen unless the leadership of the “House of Psychiatry” leads the effort.