Texas recently passed a law to give self-employed doctors more bargaining leverage.

Even self-employed doctors may have difficulty donating free care if it can only be given in a hospital.

In some regions, especially rural areas, even established self-employed doctors say they are no longer able to make ends meet.

Federal antitrust law prevents the A.M.A. union from representing self-employed doctors.

Medical leaders believe that it is easiest for self-employed doctors to provide free care in their own offices because the decision is solely theirs to make.

Self-employed doctors.

The American Medical Association estimates that self-employed doctors had an average of $182,200 in expenses in 1993, the latest year for which figures are available.

Indeed, when self-employed doctors have sought to unionize in the past, they faced the threat of antitrust charges of conspiring in restraint of trade.

Among sport utility vehicles alone, many exceed 6,000 pounds, enabling business owners and self-employed doctors, lawyers, sales representatives, consultants and others to use the speedier depreciation schedule.

In its resolution, the A.M.A. vowed to lobby for a Federal antitrust exemption that would enable self-employed doctors to form unions and engage in collective bargaining.

At a House Judiciary Committee hearing on Tuesday, officials with the Justice Department and Federal Trade Commission testified against granting an antitrust exemption to self-employed doctors.

So H.M.O. advocates came up with a new approach: Dozens of self-employed doctors banded together in loosely structured independent-practice associations that offered discounted fees for medical services to employer groups.

For a couple of years, many of the nation's once-independent, self-employed doctors have been agitating against the proliferating managed care organizations that they see as jeopardizing their authority, jobs, income and patient care.

The association also said it would work to unionize some of the nation's 325,000 self-employed doctors, but to do that it first needs to succeed in its push to persuade Congress to give these doctors the right to bargain collectively.

ASSOCIATIONS AND FEDERATIONS - Cannot bargain collectively under Federal antitrust laws, but give facts and figures to self-employed doctors and group practices to help them negotiate with managed-care companies.

The system was built upon Blue Cross and Blue Shield, then and still the area's leading insurer, as well as self-employed doctors and 24 hospitals, most of them affiliated with a religion, like Baptist, Menorah, Bethany, Trinity Lutheran and St. Luke's.