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Local physicians react to AMA's approval to unionize by Cindy Abole Public Relations  The American Medical Association's (AMA) decision to form a collective bargaining agreement has made medical news on a national front, but its effects in South Carolina may be minuscule as it concerns MUSC physicians.   “The AMA's decision is a direct response to the problems patients and physicians have in dealing with America's giant managed-care industry,” said Robert M. Sade, M.D., professor, Department of Surgery and speaker of the house, South Carolina Medical Association (SCMA). “The sentiment here in South Carolina is against unionization.” As a subject that has been long discussed within AMA circles, medical organizations and state medical chapters, the formation of a physician's union was developed to give America's physicians the leverage they lack in negotiating good patient care with powerful managed-care organizations.  Others feel that a doctor's union adds another layer of bureaucracy for physicians and patients to work through when it comes to providing medical care. “There is definitely a growing frustration shared among many physicians across the country,” said J. Chris Hawk III, M.D., an MUSC clinical faculty member and AMA delegate who attended the June meeting in Chicago. “The lost ability to make good medical decisions regarding tests, medications and treatment compromises the physician/patient relationship and the ability to provide the best medical care.” In South Carolina, the formation of a national union for salaried physicians and residents is expected to have little effect, according to Sade. Since South Carolina is a right-to-work state, the presence of labor unions is not as strong as in the northeast and far western states. Of the 5,475 SCMA-registered physicians, more than 1,800 practice within the Lowcountry area. It is not likely that the AMA decision will inspire South Carolina physicians to join a union, Sade said. Among state medical associations, the SCMA boasts the highest percentages in physician participation through membership. About 70 percent of all South Carolina physicians are SCMA members. That's roughly 30 percent more than the average 30 to 40 percent of members affiliated within other state programs. “The vote reflects a sign of change,” said Layton McCurdy, dean of the College of Medicine and vice president for Medical Affairs. “Not only does it show increasing power of HMOs, it interrupts the doctor-patient relationship and the freedom to make decisions.” “The formation of a union among physicians implies that medicine is a trade,” McCurdy said. “Medicine is not a trade, it is a profession. Trades have unions, professions do not.” According to Hawk, June's AMA vote has taken issues past the agenda towards important legislation like U.S. Representative Tom Campbell's sponsorship of the Quality Health Care Coalition Act of 1999. Passage of the bill would allow physicians and other health care professionals the opportunity to negotiate collectively with health plans regarding terms that affect patient care.  “At the same time, physicians need to be mindful of costs,” McCurdy said. “There should be better practice of cost-effectiveness within the profession.” And what's next in the AMA union saga? The AMA is expected to present more detailed plans about the physician union by early fall 1999.