Will Physician Unionization Overrun the Previous Decades of Physician Independence?

By Stephen F. Hightower MD FACP

“The Labor Movement was the principal force that transformed misery and despair into hope and progress” Martin Luther King

fixingushealthcare.com

Saturday, January 11, 2025

Dear Mr. President, Honorable Members of Congress and Distinguished Staff and Fine Citizens,

The process of becoming a physician remains a distinct effort in grueling hours, months, and years, of cognitive and physical exertion in the study and care of humans of all shapes sizes, intellects, and often languages.  During hospital rounds as a first-year medical student, your knowledge base is tested multiple times daily. All of these challenges can promote a sense of inadequacy.  Similarly, the ability to borrow or identify monetary resources to maintain yourself for currently a minimum of 4 years for room, food, heat, gas, and transportation, can be an additively  stressful scenario.

The 3- 4 years after medical school are spent within your chosen residency and focused on your specific specialty. This provides more detailed education about the specific type of medicine you will pursue as your life’s goal, and will likely find you at times overworked, mildly depressed and perhaps somewhat disillusioned about your career choice. Sleep hours will be more highly strained due to overnight shifts, and related to the volume of patients you need to supervise overnight, along with the inclusion of all the new admissions over that time span. Likely you will survive, but the question is why does it have to be like this? Do we do it this way simply because that is the way it has always been done?  Why can’t we make this a more functional experience for those who are willing to devote their career to the very worthy cause of health care?

It is these questions of why that has promoted a fairly aggressive movement to consider unionization in medical care.  Recent information about that process has provided significant data which includes:

• Eight percent or about 72,000 physicians are currently unionized and the number of official union drives among private-sector physicians has increased in the past two years.

• From 2000 to 2022, 44 union petitions were filed. In 2023, 21 union drives occurred and there were also 12 union drives in the first five months of 2024. Suggested reasons were declining morale and increased corporate employment of physicians instead of physicians opening independent practices. If the drives for unionization for the past two years succeed, unions would represent 3,523 new physicians.

• Of 66 actual Unionization efforts between 2020 and 2024,  62% were certified.  These occurred most commonly at hospitals (49%), community health centers (38%) and nonhospital corporate owners (13%).

Information about the reasons for the success of unions included: strong motivation to improve working conditions (85%), a sense of lack of voice within management (81%) and  patient care concerns (54%).  Interestingly, pay concerns were at only( 4%).

Unionization is likely not an absolute silver bullet, as it was noted in a 2024 study, where unionized residents at several general surgery programs, when surveyed, did not have improved well-being or benefits.

One of the benefits of considering unionization is the requirement to specifically sit down and outline: your and the groups specific concerns; identify broadly your needs; and then put in the effort to organize your fellow workers who feel similarly.  The negatives to unionization can be possible membership dues, perhaps initially less flexibility of assignments or rotations, potential conflicts with your fellow residents if they are not all supportive of the change, and the potential to create controversy and changes to the company culture.

Be assured teaching hospitals, like businesses, exude a culture of expertise or care as prominent as it is in corporate America. Medical power houses such as: The Mayo Clinic in Rochester Minn; The Cleveland Clinic;  Massachusetts General Hospital; Johns Hopkins; and Duke; are all very proud of their reputations which rely on the excellent work done at their facilities by staff and physicians. None of these hospital systems have specific unionized physicians in their main hospitals at this time. 

However, of significant note is an article in the Journal of Surgical Education from July 2024, noting that unionized membership among surgical residents and fellows was at an all-time high with seven surgical residency programs voting to unionize in the past 2 years.  Also, the trend for surgical physician practices to shift from private practices to corporate health system-based employment provides more opportunities for unionization to arise. The benefits to or the conflicts of unionization with other medical specialist groups will take time to determine. Which path will remain the best for patients and their physicians who are Family Practice or Internal Medicine specialists also remains in consideration.  Each specialty group will likely evaluate their best opportunities for care and what they feel is appropriate compensation, and then, we hope, balance by providing the best care available to every patient they encounter.     

Respectfully submitted,

Stephen F Hightower MD FACP

fixingushealthcare.com

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