Organized labor is having a moment, and doctors and support staff in the nation's hospitals want in on it.
While those groups of workers have historically been less engaged in union activity than their nurse colleagues, they are expressing an unprecedented level of interest in organizing.
Related: Healthcare unions see increased interest, contract wins
In the most recent win for the movement, more than 550 Allina Health doctors, physician assistants and nurse practitioners will join the Doctors Council, an affiliate of Service Employees International Union, after a vote earlier this month to unionize. The individuals work at more than 50 clinics in Minnesota and Wisconsin and may represent the largest group of unionized private-sector physicians in the U.S.
Union interest within hospitals was on the upswing during the COVID-19 pandemic as many healthcare employees said they felt increasingly overworked and underpaid. Staffing shortages have added to employees' frustration and concerns about patient safety, with more than 300,000 physicians, nurses and other clinicians leaving the workforce in 2021 alone, according to a Definitive Healthcare report.
More physicians working as employees of an organization and experiencing tension in their relationships with employers has spurred the interest in organizing.
Allina Health physicians who voted to unionize cited chronic understaffing and a lack of administrative communication as problems compromising quality patient care, a complaint shared by many of those the Doctors Council has helped organize, said Dr. Frances Quee, president of the union.
In a statement issued after the vote, the health system said it was "disappointed" in its providers' decision to unionize, but it pledged to continue working to "create a culture where all employees feel supported and valued."
Doctors Council has more than 4,500 members, and the number of requests to join increases annually, said Quee, who works as a pediatrician at NYC Health + Hospitals/Gotham Health, Belvis in the Bronx.
“With all the labor movement in the country, this is the right time, because the point is not just monetary,” she said. “Patients are our responsibility, and doctors just want to have a say in how these patients are being taken care of.”
Organizing efforts are underway at a number of other facilities ranging in size and workforce type.
At Unity Health Care in Washington, D.C., 50 physicians and residents recently filed a petition with the National Labor Relations Board to unionize. Another petition, at Resilience Healthcare in Oak Park, Illinois, would be for a bargaining unit of 27 employees.
For the Committee of Interns and Residents/SEIU, the past two years have brought the largest increase in membership in the union’s nearly 70-year history. It has added 10,000 members, bringing its total to 30,000 members, and is organizing four to seven groups a year, compared with just one or two annually before the pandemic.
“We're in a bit of a renaissance moment when it comes to resident physician unionizing,” said Sunyata Altenor, communications director for the union.
After recent wins, several thousand resident physicians, interns and fellows represented by the committee at Stanford Health Care, George Washington University and Penn Medicine are bargaining for first contracts at the health systems. Better healthcare benefits, housing stipends and higher pay are among their demands.
At some health systems, union members are taking more direct action in the form of protests and strikes.
Earlier this month, a group of unionized resident physicians and fellows at the University of New Mexico Hospital in Albuquerque rallied to advocate for more comprehensive benefits and higher pay to offset student debt and other living expenses.
“The real issue is that residency has not really changed in 100 years,” Altenor said. “What COVID-19 and the mass exodus of healthcare workers did was exacerbate the very exploitative nature of residency.”
Unionization had been considered somewhat taboo among physicians, who were often their own employers and enjoyed higher rates of pay and independence in their practice, said Dr. Robert Wachter, professor and chair of the Department of Medicine at the University of California, San Francisco.
"Physicians had a lot of agency," Wachter said. "Even if you did work for a hospital, the hospital was very beholden to you. The general feeling was that we didn't need [unionization due to] the nature of the system and how it was organized and the importance of physicians in the system, as both clinical and economic drivers."
That has changed, a result of high rates of burnout and the administrative burdens faced by physicians, many of whom no longer work for themselves but for a hospital.
Around 74% of physicians were employed by hospitals, health systems or corporate entities in January 2022, compared with 62.2% in January 2019, according to data from Avalere, a healthcare consulting firm, which was published in a Physicians Advocacy Institute study.
While it is unlikely that physicians will ever be represented by organized labor as much as nurses are, more are acclimating to the idea as they see working conditions and pay improve for the unionized members of their health systems, Wachter said.
“If the residents are unionized, it becomes natural for [physicians] to begin asking the question, ‘Would this be useful for us or not,’” he said. “What you saw with Allina Health [is that] you're going to see more groups answer that question affirmatively.”
