The Pros and Cons of Physician Unions

Labor unions gained momentum in 2023 as high-profile strikes by auto workers, Hollywood writers, and Kaiser Permanente health care workers garnered headlines.¹ That momentum also extended to physicians, with Allina Health employees in Minnesota and Wisconsin forming what's believed to be the largest group of unionized private-sector physicians in the U.S.²

More physicians than ever are now employees rather than independent operators,³ which means more physicians than ever are now eligible to join unions. With burnout levels high,⁴ many of those employed physicians may consider unionizing in the years to come if they believe it will improve their working conditions. Here's what family physicians should know if they're considering joining a union.

While unions have traditionally been more the domain of factory workers and government employees, physician unions are not entirely new. For example, there was a burst of physician unionization in the 1990s, in response to the expansion of managed care and health system mergers that created larger physician employers.⁵ Now, with health care organizations becoming still larger, doctors chafing under administrative demands and decreased autonomy, and ongoing disruptions related to COVID-19, there is again renewed interest in unionizing among the more than 70% of physicians who are employed.³ (Antitrust law largely bars self-employed physicians from unionizing to collectively bargain with payers. There are some exceptions, but this article focuses on employed physicians forming unions to collectively bargain with their employers.)

According to the American Medical Association (AMA), union membership among physicians has more than tripled since 1998, but unionized doctors still make up only about 7% of the total physician workforce.⁶

James Vandermeer, MD, is a recently retired family physician who helped form the Northwest Physicians Alliance (NWPA) union in Washington in the late 1990s. He said he thinks more primary care doctors should explore unionization as a way to improve their working conditions and patient care. But he cautioned that it's not an easy process.