The plaque on Dr. Sanford Marcus’ office wall proclaims: “A gadfly on the rump of American medicine.” The words were said about him—and not admiringly—by the president of the American Medical Association, but Marcus is proud of the epithet. The San Francisco surgeon says that for years he devoted himself to being “A law-abiding, tax-paying surgeon, tending my patients and improving my skills.” Then one day in 1971, an administrator at the San Francisco hospital where Marcus practices announced that doctors there must participate in a group practice rather than having individual patients. “The administration assumed we would go along with it,” Marcus recalls. “But suddenly I was on my feet screaming, ‘Why wasn’t I consulted?’ ” He decided that doctors simply had to protect their own interests. That year he founded the Union of American Physicians.
Today it has 10,000 members (out of 375,000 doctors in the U.S.). It is the nation’s largest medical union—and Marcus, 54, has become a cross between Dr. Welby and George Meany. While he still works 75 hours a week taking out gallstones and treating ulcers, he spends another 30 hours in his duties as UAP president.
In the beginning Marcus conducted union business from his home, where he and his wife, Hannah, mimeographed and mailed out recruiting letters, starting with 5,000 Bay Area doctors. Now headquarters is a small suite in a San Francisco office building. Last spring the union took part in its first strike, a 28-day walkout by anesthesiologists in California to protest a spectacular rise in malpractice insurance premiums.
Hardly from a radical background, Marcus is the son of a San Francisco G.P. and he remembers his father being paid with sacks of potatoes and enchiladas during the Depression. After medical school at the University of Pennsylvania, Marcus went home for his internship and residency, inheriting many of his father’s patients when he began practicing in 1944. His own son, Richard, 23, is now a premed student at the University of California and his daughter, Susan, 22, is studying nursing, both at Berkeley.
“My children aren’t going into the medical profession with any illusions,” says Marcus. “Whether they will be able to develop warm doctor-patient relationships is problematic, since doctors and patients may be matched by computer in the future.”
Political control of medical care will become inevitable, Marcus believes, as government insurance programs pay the bills of more patients. “My concern is that we don’t get forced into accepting deterioration of health care as some countries with nationalized medicine have done,” he says. He cites other problems doctors face, such as authoritarian hospital administrators, who treat them as “inefficient bumblers,” and health insurance companies. (Marcus’ own malpractice premiums, which were $15 a year when he graduated in 1944, had gone up to $4,290 by 1974. This year they soared to $22,140.)
Marcus is strongly critical of the American Medical Association. The AMA, says Marcus, is “retreating ignominiously before those who are openly committed to the subjugation of doctors.” An AMA spokesman counters that the union “breaks up the unity of the profession.”
Marcus says he would like to give up his labor activities, but that his job isn’t done yet. “People say I’ve been building an ark on a dry hill for years,” he says. “Well, now it’s beginning to rain.”