Congress of Delegates: 2024 Resolutions

Res 308 (Colorado A) - Study of Physician Unionization

Substitute:

RESOLVED, That the American Academy of Family Physicians (AAFP) study the issue of family physician unions and the current extent of physician unionization in the U.S., with such a study including, but not limited to: 1.) the history of physician unionization in the U.S. and elsewhere, and the current state of physician unionization in the U.S.; 2.) differing types of unions, and their risks/benefits to union members; 3.) the similarities and differences between unions and professional guild organizations such as the AAFP; 4.) best practices for family physician unionization, to include an examination of differences in the benefits (if any) offered by unions and the AAFP, and an examination where the AAFP might incorporate new benefits traditionally offered by unions; and 5.) legal and practical barriers to increased physician unionization in the U.S., and be it further

RESOLVED, That the American Academy of Family Physicians (AAFP) make available the results of a study concerning physician unions to AAFP members at least two months prior to the resolution deadline for the 2026 AAFP Congress of Delegates.

Referred to the Reference Committee on Practice Enhancement

Introduced by the Colorado Chapter

Report as of 8/2025:

Pending Board action.
During the July 2025 Board meeting, the Board of Directors received insights from two recognized experts regarding physician unions. The Board will continue to evaluate this matter to assess whether a formal study should be initiated.

WHEREAS, Many family physicians in the current market find themselves working for large corporations as employees (as opposed to serving as practice owners), and

WHEREAS, such large corporations, both for-profit and not-for-profit, are increasingly subject to further corporatization through mergers, acquisitions by private equity groups, and other market dynamics, and

WHEREAS, such intense corporatization threatens to increase the corporate practice of medicine, putting the viability of the profession of family medicine, and thus the wellbeing of our patients, at risk, and

WHEREAS, unions are a traditional structure in which many employed members of society have sought to secure routes for advocacy, mutual aid/welfare, and (as necessary) the power of collective bargaining to protect their professional interests in the presence of increasing corporatization of their industries, and

WHEREAS, family physicians have the unique and particular benefit of the American Academy of Family Physicians (AAFP) as their chief advocate in the U.S., tirelessly representing our interests in many forums, in ways that are particular to a professional guild (and distinctly different from unions), and

WHEREAS, the benefits of family physician unionization have the potential to spread beyond family physicians to the patients we serve, leading family physicians to increase their individual and collective advocacy for patient care, outcomes, and patient safety, and

WHEREAS, some large physician groups in the U.S. have already sought to form unions, and

WHEREAS, any such efforts at unionization ideally would work in collaboration with, rather than competition with, the AAFP, now, therefore, be it

RESOLVED, That the American Academy of Family Physicians (AAFP) study the issue of family physician unions and the current extent of physician unionization in the U.S., with such a study including, but not limited to: 1.) the history of physician unionization in the U.S. and elsewhere, and the current state of physician unionization in the U.S.; 2.) differing types of unions, and their risks/benefits to union members; 3.) the similarities and differences between unions and professional guild organizations such as the AAFP; 4.) best practices for family physician unionization, to include an examination of differences in the benefits (if any) offered by unions and the AAFP, and an examination where the AAFP might incorporate new benefits traditionally offered by unions; and 5.) legal and practical barriers to increased physician unionization in the U.S., and be it further

RESOLVED, That the American Academy of Family Physicians (AAFP) make available the results of a study concerning physician unions to AAFP members at least two months prior to the resolution deadline for the 2025 AAFP Congress of Delegates.

(Received 7/30/24)

Fiscal Note: $122,500

Political Risk Assessment: Low

Background

The first resolved asked the AAFP to study the issue of family physician unions and the current extent of physician unionization in the U.S and specifically address the following topics

• History and current state of physician unionization in the U.S. and elsewhere
• Types of unions and the risks/benefits of each to union members
• Similarities and differences between unions and professional guild organizations such as the AAFP
• Best practices for family physician unionization
• Examine whether AAFP could incorporate new benefits traditionally offered by unions
• Legal and practical barriers to increased physician unionization in the U.S

The AAFP does not have any current resources, education, or policy on unionization of physicians. The most recent coverage of the topic was in the FPM journal in 1999. FPM staff are currently researching an article covering the topic.

The AAFP does have a policy on collective bargaining, which states that AAFP unequivocally supports the rights of physicians to organize and bargain collectively.

In 2019, the American Medical Association (AMA) House of Delegates adopted a resolution requesting a study of the risks and benefits of collective bargaining for physicians and physicians in training in today’s health care environment. The 2023 issue brief, “Collective Bargaining for Physicians and Physicians in Training,” includes information on the history of physician unionization; benefits of collective bargaining; advantages and disadvantages of physician unions; issues to consider about union formation by medical societies. In early 2024, AMA published the article, “What Employed Physicians Should Know About Collective Bargaining.” This article addresses the similarities and differences between unions and professional guild organizations.

Given that AAFP staff does not currently have expertise on this topic, the AAFP will need to engage external experts in physician unionization and labor law to conduct the requested study.

The second resolved clause asks the AAFP to provide the results of this study to AAFP members at least two months prior to the deadline for resolutions for the 2025 Congress of Delegates.

If this resolution is adopted, it would be implemented in fiscal year 2025-2026 and we would not be able to begin work until June 1, 2025. Given those parameters, the timeline provided in the second resolved clause is not feasible. AAFP would have less than one month to complete this project and make a report available to members.

Current Policy

Collective Bargaining