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addressing legal concerns. Last Update: August 2016 PHYSICIAN COLLECTIVE ACTION As most physicians are aware, today's negotiations between individual physicians and huge managed care organizations are not conducted on a level playing field. Rather, the managed care organization which controls a substantial portion of the health care market possesses the economic leverage to force physicians to accept unfavorable terms in their contracts. In an effort to level the playing field, physicians have been struggling to organize themselves into groups to bargain more effectively with insurance giants by combining the economic power of otherwise competing providers. Although the unionization of physicians may appear to be a viable method of achieving this goal, physicians should be aware that federal law prohibits any collective activity on the part of most physicians unless certain strict criteria are met.Under current federal law, only physicians who are employees fall within the labor exemption to the antitrust laws and may engage in collective bargaining. Self-employed physicians are not in an employment relationship, and, therefore, do not qualify for the labor exemption to the antitrust laws. Under the antitrust laws, physicians who are not economically integrated by sharing substantial financial risk may not collectively bargain, a principal tenet of any union activity. Unfortunately, the penalties for participating in any such collective activity in violation of federal antitrust laws can be substantial. Not only may the collective organization be subject to fines and penalties, but the individual physicians comprising the organization also would be subject to penalties ranging from fines and jail sentences, to prohibition against any future partnerships. It is therefore crucial that physicians ensure that any organization which attempts to negotiate on their behalf is either sufficiently economically integrated, or does not assume the authority to negotiate on behalf of an unintegrated group of physicians.Despite the dangers associated with unionization, many of the goals enunciated by current physician unions are ones shared by the Florida Medical Association and the American Medical Association. It is for this reason that the FMA House of Delegates, at the 1998 Annual Meeting, adopted Resolution 98-13 which directed the FMA to support legislation proposed in the U.S. Congress by Representative Tom Campbell (R-California), entitled “The Health-Care Coalition Act,” which stipulates that: “Any group of health care professionals, negotiating with a health maintenance organization, insurer, or other payer, shall, in connection with such negotiations, be entitled to the same treatment under the antitrust laws accorded to members of a bargaining unit recognized under the National Labor Relations Act. Similarly, as a result of a resolution submitted by the FMA in 1997, the AMA, at its June 1997 Annual Meeting, adopted Resolution 240 calling for the removal of restrictions for physicians to form collective bargaining units “in order to negotiate reasonable payments for medical services and to compete in the current managed care environment including the drafting of appropriate legislation.”In this changing health care environment physicians recognize the need to work together. However, until the current antitrust laws are changed to allow full collective negotiations on the part of independent self-employed physicians, physicians should be wary of joining any organization which may subject the physician to an FTC investigation.This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last Update: October 2005 PHYSICIAN TREATMENT OF RELATIVES A delicate issue among physicians is whether it is morally, ethically, and legally acceptable to treat one’s relatives. While some states have statutes regulating a physician’s treatment of relatives, friends, and self, Florida is silent on the issue. The American Medical Association (AMA) advises against the treatment of relatives except for in emergency situations, isolated settings, or for routine care for minor problems. Opinion 8.19, AMA Council on Ethical and Judicial Affairs.There are some inherent dilemmas with the treatment of immediate family members. Close relatives may withhold crucial information on sensitive issues, a physician’s confidence may be compromised by emotions that result from treatment of a loved one, there are higher risks for privacy violations, and strained relationships may develop in both the physician-patient relationship and in the family relationship.Despite these risks, the reality is a vast majority of doctors in some way diagnose, treat, or prescribe medication for a family member. Since this is the case, it is important for physicians to take certain steps in order to protect themselves from liability. This can be done by creating a proper written record for all diagnoses, treatments, procedures, etc. Encourage relatives to establish a general practitioner and recognize that relative-patients have the same rights as nonrelated patients concerning informed consent and alternative treatments. Also keep in mind that it is legal in Florida for physicians to prescribe medications to family members, but physicians can never self-prescribe controlled substances. This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last Update: April 2013 POLITICAL INVOLVEMENT BY PHYSICIANS Physicians often refuse to sign letters of endorsement, distribute candidate literature in their offices, or otherwise publicly participate in the political process. Unfortunately, many physicians, despite the efforts of the FMA, still have the mistaken notion that involvement in political matters is unethical and/or illegal. In reality, physicians not only have a right to participate in the political process, they have a duty to do so as well.Principle VII of the American Medical Association Principle of Medical Ethics requires physicians to "recognize the responsibility to participate in activities contributing to an improved community." Principle III requires that physicians "recognize the responsibility to seek changes in those requirements [of the law] which are contrary to the best interest of the patient." Rather than insulating a physician from the political process, these principles require a physician to keep well informed about current political questions and to exercise the full scope of their political rights as citizens.In addition to the rights and privileges of free political speech shared by all Americans, physicians have an enhanced duty to work for the reform and enactment of laws that affect access to medical care, quality of medical services, and public health. It is natural that in fulfilling this duty, physicians will express their positions on political issues and attempt to solicit the support of their patients and their families. These conversations are a fundamental part of political freedom. However, political activism must be undertaken with great care in order to not interfere with the physician-patient relationship or exploit the medical authority of the physician by imposing upon vulnerable patients or family members. Physicians should appropriately exercise their discretion when deciding on the time and place to exercise their political rights.The AMA's Council on Ethical and Judicial Affairs has recognized that it is without doubt that physicians have the right to engage in political activity,