Collective bargaining by physicians—labor law, antitrust law, and organized medicine. Choudhry S, Brennan TA. N Engl J Med 2001;345:1141–1144.

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Although physicians’ unions have existed since the 1970s, union members have always constituted an extremely small percentage of practicing physicians. However, physicians are turning to unions to increase their bargaining power with managed care organizations. They are also seeing unions as a way to help reclaim their clinical autonomy and to preserve and enhance the quality of care. Leading medical organizations are now supporting these efforts to reclaim clinical autonomy and increase reimbursement through collective bargaining. The American Medical Association, which opposed the idea of physicians’ unions for many years, has established a new organization, Physicians for Responsible Negotiation. It will serve as the bargaining agent, under federal collective-bargaining legislation, for employed physicians who decide to become members of the organization, including physicians who are not members of the American Medical Association. Similarly, the American College of Physicians and the American Society of Internal Medicine have endorsed efforts to permit collective negotiations by physicians through a waiver of federal antitrust laws. Struggles over reimbursement and physicians’ clinical prerogatives are likely to increase during the next decade as health care costs rise. The authors examine the relations and tensions between federal labor law and antitrust law in the context of collective bargaining between physicians and managed-care organizations.—Nancy J. Newman