(MONEY Magazine) – Imagine pulling up to an emergency room with a wailing child only to find the doctors outside, marching on a picket line. That's the image managed-care officials want you to focus on as they fight efforts aimed at making it easier for doctors to unionize.

Right now, only employees of medical institutions like hospitals and HMOs are allowed to bargain collectively over contract terms. Few doctors fall into this category, and those who do have been slow to align themselves with unions: Only about 35,000 to 45,000 doctors are covered by collective bargaining agreements, estimates Mark Levy, executive director of the National Doctors Alliance.

But the advent of managed care--which is turning more doctors into employees rather than independent professionals--is changing all that. The Service Employees International Union just announced a $1 million drive to unionize nearly 300,000 doctors on staff at hospitals and HMOs. And the proposed federal Quality Health Care Coalition Act of 1999 would take this effort even further, allowing any medical professional--even those in private practice--to bargain collectively with insurance companies.

Managed-care officials contend that if doctors have greater leverage, they'll use it to raise fees--and if they don't get what they want, they'll strike. "If doctors were as concerned about the quality of care as they claim they are," snipes Richard Coorsh, spokesman for the Health Insurance Association of America, "they'd be focusing on limiting medical errors." But physicians respond that they are fed up with increased workloads and tightened restrictions on patient care.

--GALINA ESPINOZA