Letter to the Editor
Antitrust Laws Unfair to M.D.s
Psychiatric News
Volume 39 Number 7 page 66-66

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.

Dr. Goin responds:

As active as APA is in the realm of public policy, it is difficult for any one column or article to mention all of our efforts to advance psychiatry and the care of our patients. I am grateful to Dr. Abramson for the opportunity to reiterate APA’s role in supporting necessary changes to our nation’s antitrust laws.

For several years now, APA has worked in collaboration with the American Medical Association and other medical societies for passage of specific legislation to enable physicians to deal effectively with insurers—and without fear of violating antitrust laws. Our most recent lobbying effort is on behalf of HR 1120, the Health Care Antitrust Improvements Act of 2003, which would give physicians greater power in negotiating with insurance companies.

As Dr. Abramson says, correcting the law is an uphill battle, but APA is firm in its commitment to this bill, which now has 15 cosponsors in the House of Representatives. I will update you as APA secures more cosponsors and takes every step necessary to achieve a level playing field.

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