This position paper of the American College of Physicians-American Society of Internal Medicine addresses public policy issues related to physicians' joining to negotiate issues affecting patient care and the working environment in which patient services are provided. It seeks to identify an appropriate way for physicians to negotiate jointly with health care plans while maintaining professionalism and keeping the interests of patients paramount. It proposes that physicians in nonintegrated private practices should be able to meet and communicate among themselves for the purpose of negotiating primarily with health care plans about specific issues that affect quality and access. However, the College opposes strikes or any joint action by physicians that would deny or limit services to patients or result in price-fixing or other anticompetitive behavior. The College states that employed physicians should continue to have negotiating rights. It maintains, despite a recent decision by the National Labor Relations Board, that physicians in residency training are protected by accreditation requirements for programs of graduate medical education, and education content should not be subject to negotiations [corrected]. Physicians in residency training are protected by accreditation requirements for programs of graduate medical education, and educational content should not be subject to negotiations. The College also calls for determination of negotiating units for physicians but recommends that nonphysician providers not be included in the same units as physicians. Membership in an organization that negotiates for physicians should be voluntary, and conflict-resolution mechanisms must be available for resolving impasses.