Exploding physician union membership signals a significant labor market shift

As of 2022, about 70,000 medical doctors in the United States, or about 8% of the physician workforce, belonged to a union—a notable increase of 26.8% since 2014.

This shift reflects significant changes in the employment landscape for doctors, with nearly half of all physicians now working for health systems or large medical groups.

The rise in union membership comes amidst broader labor movements in healthcare, highlighted by the 2023 Kaiser Permanente strike, recognized as the largest healthcare worker strike in U.S. history.

While nurses have typically led these efforts, physicians and residents are increasingly exploring unionization as a means to advocate for improved pay, benefits, and working conditions.

The American Medical Association (AMA), endorses the right of physicians to engage in collective bargaining, but it does not maintain statistics on union membership, which complicates efforts to understand the scope of participation within the profession.

The Union of American Physicians and Dentists (UAPD), an AFSCME local affiliated with the AFL-CIO, represents more than 7,000 licensed doctors and advanced practice clinicians, most in California and Washington, but the group is helping to organize physician unions in other states as well.

A recent survey by MDLinx involving 50 practicing physicians revealed that while only 2% of respondents currently belong to a union, a significant 73% expressed interest in unionizing.

The majority of the surveyed physicians were over the age of 55, with nearly half working in private practice. Notably, 80% reported that their workplace did not have a union.

Despite the growing interest in unionization, physicians express a range of concerns regarding the implications of joining a union.

Common apprehensions include perceptions of increased political involvement, potential disruption to productivity, and concerns about how union membership may alter public perceptions of the medical profession.

Dr. Calvin Lambert, an OB/GYN at The Mount Sinai Hospital, articulated a prevalent sentiment among physicians, questioning who will “take care of the caretaker.”

Lambert noted that societal narratives have long emphasized self-care as the solution to physician burnout, neglecting systemic issues such as staffing shortages and overwhelming administrative demands.

Conversely, advocates for unionization argue that collective bargaining provides essential protections and a unified voice for physicians.

Unionization could enhance negotiation power regarding compensation, working conditions, and patient care standards. As healthcare increasingly becomes corporatized, physicians see unions as a necessary means of safeguarding their interests against larger health systems and insurance companies.

The landscape of healthcare has been transformed by various factors, including the COVID-19 pandemic and recent labor strikes. Events like the Kaiser Permanente strike, which resulted in significant wage increases and commitments to address staffing crises, exemplify the potential impact of organized labor movements in the healthcare sector.

With a growing number of physicians employed by hospitals and health systems—73.9% as of January 2022—there is an increasing urgency for collective action. Many physicians feel disempowered in negotiations with large entities, leading to calls for greater representation through unions.

Physicians face unique ethical dilemmas regarding unionization, particularly concerning the potential for strikes.

The National Labor Relations Act mandates that physicians give prior notice before a strike and ensure continued emergency care, complicating their ability to take collective action without risking patient care.

A majority of MDLinx survey respondents (54%) believe that striking can be ethical if it ultimately benefits patient care, though many expressed concerns about the impact on their patients. This sentiment highlights the tension between professional obligations and the need for systemic change within the healthcare industry.

The increase in union membership among physicians signals a significant shift in the medical profession’s approach to labor relations.

As doctors navigate the complexities of corporate healthcare structures and challenges of work-life balance, unionization offers a path for advocacy and reform that remains fraught with ethical considerations, personal reservations, and a need for alignment with the core values of the profession.