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Doctors Are Reluctant to Unionize. Why?

Op-Med is a collection of original articles contributed by Doximity members.

Health care workers from nurses to custodial staff have been organizing for years, achieving important gains in wages and working conditions. But doctors? We’re still waiting. Why?

Not only have nurses’ unions been around for years, but they sometimes even go on strike. In the past year, nurses have struck in many parts of the country. In New York more than 7,000 nurses at two New York hospitals struck in January, and in my home state of Connecticut, there was a strike at Windham Hospital the same month. The nurses were not just fighting for better wages. Staffing levels and working conditions were the issue. Hospital systems are limiting staffing levels to manage costs, which is more of a concern to nurses than their salaries.

Yet many doctors, especially those employed by large health care organizations, now face similarly demoralizing employment conditions. While the immediate concerns differ from the stresses that burden nurses, many of them stem from the same root causes. In both cases, there is one fundamental that stands out: the consolidation of health care delivery in the past two decades into ever-larger systems that now dominate in many regions. One result has been a rise in the number of physicians who work as employees and are beholden to these systems.

The conditions that should be encouraging us as doctors who are employed by these systems to unionize are obvious. Patients, as well as doctors, are keenly attuned to the increasing regimentation and shrinking duration of their encounters, all the while documenting the interaction on a computer. The patient visit, the most fundamental element in the physician-patient relationship, is no longer what it was. The result is that doctors are losing morale, suffering from depression, and burning out. Medical journals are replete with studies that document this.

One recent study found the incidence of burnout among physicians in the New York City area was found to be much greater among employed physicians than the national average. Meanwhile, the same health care corporations responsible for worsening the problem are all creating programs to “prevent burnout” rather than changing the fundamentals that lead to it.

While the problem is obvious, as Mark Twain apocryphally observed about the weather, everyone complains about it but no one does anything about it. I believe that for doctors, our best chance to reverse this downward trajectory in our quality of life and loss of autonomy is to organize into unions, just as the workers in much of the rest of health care have done. We need to represent our interests, and ultimately the interests of our patients, in the forceful way that nurses’ unions have done.

A powerful physicians’ union need not be a self-interested organization narrowly focused on doctors’ wages. A focus on working conditions should be primary, and it would also be a tremendous benefit for patients. Just as nurses have demanded a greater number of nurses per patient, doctors might demand a greater amount of time per patient visit.

Doctors’ unions are not a new idea. One known as The Committee of Interns and Residents formed in the 1990s in New York, due to dangerous working conditions such as 36-hour shifts. Its creation followed a highly publicized medical error blamed on physician fatigue that resulted in a patient death. An ensuing lawsuit led to a change in work rules, and the union has tried to keep up the pressure to prevent unsafe working conditions from producing another such tragedy. It has grown since its inception, and in 2021, it added five chapters.

Until now, doctors had been prevented from unionizing by a ruling of the National Labor Relations Board (NLRB) 30 years ago that held doctors ineligible to unionize because of their "supervisory role." But, in fact, employed physicians supervise no one. They have no say in selecting their office staff or the APRN and PA whom they direct. The NLRB recognized this change in a ruling in April 2022 against Piedmont Health Services, Inc. in North Carolina. Making note of changed circumstances, it found that employed physicians and other clinicians including APRNs and PAs should be allowed to hold an election on unionizing.

Despite the benefits to be gained from unionization, doctors are still reluctant to unionize. The explanation for this seeming passivity is unclear. In a few places, there seems to be some movement in this direction. Recently unionized resident physicians at Mount Sinai Morningside and West rallied for pay parity with non-unionized residents, who got a 6% pay raise.

Yet in most of the U.S., doctors are still just complaining. Perhaps we doctors are like the woodsman in the tale who is working extra hours due to a dull saw, groaning about his work, but is unwilling to take an hour to sharpen it, saying he has no time to spare due to his overwhelming workload.

But regardless of the reason, it is long past time for the leaders of the medical profession to look up from their computer screens and march.

Dr. David Sack is a gastroenterologist living in Cheshire, CT and is is now on the emeritus staff of MidState Medical Center after practicing there for 36 years. Since leaving his last position at Connecticut GI, PC, he has been working as a locum tenens physician and pursuing medical writing. He received his medical degree from Johns Hopkins University School of Medicine and did his GI training at Boston's Beth Israel-Deaconess Medical Center. He is experienced in general gastroenterology, esophagitis, esophageal motility disorder, colon cancer, and colonic disease. He has three publications and over 50 citings. He also enjoys playing music on several instruments and talking to amateur radio operators around the world.

Image by Alphavector / Shutterstock

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