Rrr-ing! Rrr-ing! 'Union Hall, er, Doctor's Office'

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In what may turn out to be a watershed moment for the American Medical Association, the nation’s largest doctor’s group voted on Wednesday to help form a national doctor’s union. The purpose: to help physicians negotiate with managed care companies. The proposal faces a host of legal hurdles before it can become a reality, not the least of which is the head of the Federal Trade Commission, who believes collective bargaining agreements by physicians could lead to price fixing.

While the incomes of many doctors have been cut by cost-slashing HMOs -- and the AMA won’t find much sympathy from Mercedes-less consumers on that score -- many patients will find themselves allied with doctors on what they say is the main reason for their desire to band together: the exercise of their best medical judgment. "Wednesday’s vote puts the AMA on record as recognizing that physicians need to increase their contractual leverage against managed care companies to regain their role of practicing medicine," says TIME senior economic reporter Bernard Baumohl. "Too often doctors have found their medical opinions subordinated to the judgment of managed care bureaucrats whose only concern is the bottom line." The AMA vote is in some sense a "belated decision," says Baumohl. Doctors’ groups in about half the states have already moved to unionize. The AMA’s action now assures a national stage for the movement and means that many of the quality-of-care issues surrounding HMOs -- not to mention the even bigger question of universal health care -- will soon again be debated in Congress.