The majority of physicians (56%) say that physician unionization would significantly improve patient care, according to a Doximity poll.
In recent years, unionization has received renewed attention for its pivotal role in labor disputes across a wide range of industries, from Boeing machinists and Hollywood writers to physicians in Minnesota. Indeed, roughly two-thirds of health care professionals reported that they are willing to join a union. Yet questions remain about the impact of unionization on patient care.
The Doximity poll, which includes the responses of 1,602 physicians in September 2024, suggests that unionization is more likely than not to benefit patient care. Whereas 86% of physicians believe unions would either improve care or not have much impact on patients, only 14% believe it would cause more harm than good.
“I’m a big believer that the quality of patient care is strongly influenced by the quality of working conditions of the physicians,” Robert Wachter, MD, professor and chair of the department of medicine at the University of California, San Francisco (UCSF), told Doximity.
Dr. Wachter, who has worked alongside unionized residents at UCSF for years, has seen both the positive aspects and downsides of unions in medicine. On the one hand, there are those who might simply push for higher wages, overlooking the broader effect of unionization on patient welfare. But by and large, he has found that when physicians advocate for their own needs, they’re advocating on behalf of patients as well.
“When I see physicians think about unionization, it’s not all about salary and benefits,” he said. “It has a lot to do with support structures and resources for patients that allow physicians to be their best selves and do their best for their patients.”
‘An Enormous Change'
Overall, the physicians who are most likely to believe unionization would improve patient care are those who tend to spend the most time interacting with them.
Among primary care physicians, 63% say that physician unions would significantly improve patient care, compared with 56% for nonsurgical specialists and 50% for surgeons. As they generally dedicate more of their work day to communicating with patients, primary care physicians may have more opportunities to consider how they might be able to advocate for patient needs.
A similar trend emerges by gender: 64% of women — who on average spend more time with patients than men — say that unionization would improve patient care, compared with 52% of men. And physicians in their 30s (at least 68% of them) are more likely to say unionization would improve care than those in their 40s (57%) and 50s (46%).
Younger physicians may find the idea of unions more favorable due to increased access and exposure to it during residency. The percentage of residents represented by the Committee of Interns and Residents, for example, has doubled from 10% of residents in 2019 to 20% in 2024.
But this movement is not unique to medical residents. Interest in physician unions has been increasing across many medical professions.
In the case of physicians, Dr. Wachter has observed this interest in unions emerge largely in response to changes in their work environment. Where 30 years ago most doctors used to work for themselves — dictating the terms of their practice — about 78% of physicians are now employees of hospitals or other corporate entities.
“It really is an enormous change in the way we think about ourselves and our world,” Dr. Wachter said. “Physicians look around and see that they’re no longer working for themselves but for some entity.”
What’s more, working in a health system allows physicians to see how unions have helped some nurse groups and other clinicians receive substantial improvements to their pay and work conditions. In contrast, “physicians have either gotten nothing or much less in their negotiations with health systems,” he said. “If you’re all working for a single corporate entity and everyone around you got a 7% raise and you got a 2% raise, it’s only natural for people to see that and consider what that means for them.”
Physician Unions: Pros and Cons
Still, unionization has its skeptics — and not without cause.
“I was a union member when I worked at the VA but it was useless; it basically had no teeth to do anything,” a psychiatrist told Doximity under conditions of anonymity. The union was unable to help the psychiatrist secure a day off, which the hospital had initially promised the physician could take before it changed course.
“Admin is going to be admin, whether you have a union or not,” the psychiatrist said. “And the union — even a large one like the federal employees union — can’t do anything about it.”
Opponents of physician unions have also argued that a strike or holdout could create terrible optics for the medical community. How would the public react, they ask, if physicians walked out of the workplace when they already earn four or more times the salary of the average American?
But advocates for physician unions, including Sergio Bartakian, MD, an interventional cardiologist and former member of the American Medical Association’s RVS Update Committee, have emphasized that “it’s not about going on strike; it’s about having a voice to negotiate … and bringing sound ethical care back to medicine.”
Whether physician unionization can improve conditions for physicians and, in turn, help them better care for patients depends heavily on who ends up leading the unions, according to sports physician Charles Lascano, MD. “In order for the union to work the leaders must be physicians proven to give priority to general benefits over their own, and with proven integrity … who truly care about the common interest,” he said.
A major concern that Dr. Wachter has had with early discussions about physician unions is their potential to create this “us” versus “them” dynamic — or physicians versus the administration — which could disrupt the provision of care and create friction in an already overworked environment.
In his experience so far, however, this kind of tense, adversarial relationship hasn’t been the case when working with unionized residents.
“I have been pleasantly surprised that that hasn’t played out in a way that I feared,” Dr. Wachter said. “Physicians are professionals, and the tradition is that we roll up our sleeves. If a sick patient is in front of us, that trumps all other contractual relationships.”
Ultimately, he added, the impact of physician unions and their capacity to improve patient care rests on how both sides of the table come together: “If they are going to be successful, the relationships between both sides of a union have to feel like things are leading to great care.”
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