Why Doctors Join Unions The Importance of Organization

Why Doctors Join Unions The Importance of Organization

The Rise of Unionization Among Doctors: A Shift in Healthcare Dynamics

Emotional exhaustion among doctors soared during the COVID-19 pandemic, with a record 62.8% reporting signs of burnout in a 2021 study. Now, there appears to be a ripple effect: A growing number of physicians are joining labor unions.

Amidst the backdrop of the COVID-19 pandemic, doctors across the nation are experiencing an unprecedented surge in emotional exhaustion. According to a recent study, a staggering 62.8% of doctors reported signs of burnout. As a result, a growing number of physicians are now turning to labor unions to address the challenges they face in their profession. While only about 10% of doctors and dentists currently belong to labor unions, the trend is picking up steam. Earlier this year, 82% of residents and fellows at Montefiore Medical Center in Bronx, NY voted to unionize. This was followed by doctors at Allina Health Mercy Hospital in Minneapolis and Providence St. Vincent Medical Center in Portland, OR. The Committee of Interns and Residents (CIR) alone represents approximately 30,000 residents and fellows, reflecting a 76% increase in membership in the past year alone.

The surge in unionization among doctors can be attributed to various factors, with the COVID-19 pandemic acting as a clear catalyst. However, this trend predates the global health crisis. A key contributing factor is the shift away from private medical practices, with 75% of physicians now being employees rather than owners. Consequently, they have limited control over their working conditions and minimal autonomy in clinical decision-making. The appeal of organized labor is particularly pronounced among residents and fellows – licensed physicians who have completed medical school and are undergoing additional training. Residency programs, known for their grueling nature, can last anywhere from 3 to 8 years, depending on the specialty. Fellowships, which involve further subspecialty training, often require additional years of training. These early-career doctors work up to 80 hours a week, frequently enduring 28-hour shifts, with virtually no say over any aspect of their jobs. It is this lack of agency that has increasingly attracted young doctors to unions.

“We have little to no agency over our working conditions,” says Kendall Major, MD, a third-year resident in internal medicine at the University of Pennsylvania’s Penn Medicine. Major highlights the limited ability of individual residents to negotiate for better pay or benefits and the difficulty of transferring to another residency program if one’s current experience is unsatisfactory. As a result, young doctors like Major are joining unions.

The roots of this “resident revolution” can be traced back to the establishment of the first union for resident doctors in New York in 1957. During that time, public hospitals were notoriously underfunded, but residents faced fewer hardships compared to the present. The majority of young doctors were white men who had some level of financial support, and their student debt was incomparable to the burdens faced by doctors today. However, with women now accounting for nearly half of American hospital residents, issues such as family planning and fertility benefits have become increasingly important. As a result, a seismic shift in the perception and organization of resident doctors is underway, marking the beginning of a “resident revolution.”

Among employed doctors, the crux of the issue lies in restrictive contracts that often allow for termination without due process. Many doctors are compelled to sign non-compete agreements, preventing them from starting their practices or working for other healthcare organizations within a specified geographical area if they leave their current positions. Emily Onello, MD, associate professor of medicine at the University of Minnesota, explains that these contracts are a motivating factor for doctors to join or form unions.

While the primary goal is to improve the working conditions and benefits for doctors, physicians who unionize also have the welfare of their patients in mind. A union in North Carolina, for example, negotiated for a greater say in clinical decision-making. This demand stemmed from the pressure doctors face to see a high number of patients per day and make decisions influenced by profit margins—a common grievance among doctors employed by corporate healthcare companies. Improved working conditions not only benefit doctors but also have a positive impact on patient care. Alejandra Vélez, MD, a union member and fourth-year family medicine resident at the Greater Lawrence Family Health Center in Lawrence, MA, highlights union efforts to establish a fund that covers expenses for patients in need, such as walkers or transportation vouchers for appointments.

However, there are doctors who oppose unionization, perceiving it as a threat to the educational aspects of their profession. For instance, Jennifer Bauer, MD, chief of spine surgery at Seattle Children’s Hospital, believes that unions shift the focus away from education and place it on job-related matters. Bauer and others argue that medicine is a calling, and medical training should maintain its traditional apprenticeship structure without the interference of unions.

Onello, on the other hand, suggests that resistance to unionization stems from doctors holding onto a business owner’s mindset, despite no longer owning their practices. She explains that doctors used to enjoy substantial wealth, thus unknowingly resisting the idea that they are no longer part of the top 1%.

Patients also express concern about potential strikes by doctor unions. The fear of being left without healthcare during a health crisis or while requiring routine care for chronic illnesses is valid. Pro-union doctors, however, dismiss this worry, asserting that the ethical obligations of medicine are unwavering. Doctors take an oath to provide the best care and to “cause no harm” to their patients. Strikes are viewed as a last resort, to be employed only when good-faith negotiations have broken down. Pro-union doctors emphasize that striking is a rare occurrence, and ample notice is given to hospitals to ensure patient care continuity. Ultimately, the goal of these unions is to avoid strikes and negotiate fair contracts with hospitals.

The rise of unionization among doctors marks a paradigm shift in the healthcare landscape. As doctors increasingly face challenges regarding their working conditions, patient care, and autonomy, they are seeking collective solutions through labor unions. While the debate surrounding unionization will likely continue, the shared goal of both doctors and unions remains clear: providing the best care possible for patients.