Abstract
This cohort study examines trends in attending physician unionization efforts.
Declining morale and increased corporate employment have led many physicians to consider unionization.1,2 This study examined trends in unionization among attending physicians (not trainees3,4) and the characteristics and motivations for these unions.
Methods
We gathered data from the National Labor Relations Board (NLRB) on all petitions to form a union that included physicians from 2000 through May 2024.5 We collected information on the number of individuals in the petitions, certification (approved by a majority of the eligible members in an election), membership (physicians and nonphysicians) of the bargaining unit, location, and employer.6
Because filings appeared to increase in 2023, we compared petitions filed between 2000 and 2022 with those filed from 2023 through May 2024. We calculated descriptive statistics on petition data and annual rates (with 95% CIs calculated using the Poisson exact method) of filings for these periods using R version 4.2.1. We identified statistical significance as the lack of overlap of the 95% CIs for annual filing rates for the 2 periods. This study was nonhuman subjects research obviating the need for institutional review board approval.
We also qualitatively assessed motivations for unionization by surveying press reports for the unionization drives in 2023-2024 using Google searches including the location where the union drive was occurring, the hospital name, and the terms physician and union.
Results
There were 77 union petitions filed with physician members (44 in 2000-2022 and 33 in 2023-2024), representing 7064 individuals (3541 in 2000-2022 and 3523 in 2023-2024; Figure). The annual rate of union petition filings was 3.2 (95% CI, 2.5-3.9). It was 2.1 (95% CI, 1.5-2.8) in 2000-2022 and 23.3 (95% CI, 16.0-32.7) in 2023-2024. Overall, excluding petitions that had yet to have a disposition, 41 of 66 (62%) were certified: 24 of 44 (54%) in 2000-2022 and 17 of 22 (77%) in 2023-2024.
Figure. Number of Physician Bargaining Unit Filings to the National Labor Relations Board and Bargaining Unit Members.
Data for 2024 are included through May.
The size of the bargaining unit ranged from 4 to 560 (mean, 93 [SD, 116]; median, 45 [IQR, 23.5-140]) employees; 34% of the unions were exclusively physicians and doctors of osteopathy, 40% were composed of physicians and advanced practice clinicians (eg, nurse practitioners and physician assistants), and 26% represented a broader coalition, including physicians, nurses, and administrative personnel. Petitions were concentrated in western states, with 43 of the 77 in California, Oregon, and Washington.
Petitions were filed against a diversity of employers: 49% were filed against hospitals, 38% against community health centers, and 13% against nonhospital corporate owners, such as Optum and private-equity-backed companies.
Of the 33 petitions in 2023-2024, we found press reports documenting the motivations for the union campaigns for 26 (79%). Union campaigns were primarily motivated by noncompensation concerns: 85% cited working conditions, 81% lack of voice in management, 54% patient care concerns, whereas only 1 (4%) cited financial compensation.
Discussion
Compared with 2000-2022, the number of union petitions with physicians in the bargaining units filed and certified increased in 2023 through May 2024. Organizing efforts were motivated by concerns about working conditions, physicians’ autonomy, and voice in management, and the quality of patient care.
Limitations include that public-sector physician unions governed by state law and unions voluntarily recognized by the employer were not included. For bargaining units with a diverse range of employees, physicians may only comprise a subset of the individuals in the unit. For the assessment of motivations, statements made to news outlets may reflect public relations determinations. Although duplicates of the same bargaining unit were screened out, individual petitions against the same employer from different bargaining units were counted as unique filings.
Collective bargaining agreements from recent unionization efforts will provide early indications of whether collective bargaining achieved the unionization objectives.
Section Editors: Kristin Walter, MD, and Jody W. Zylke, MD, Deputy Editors; Karen Lasser, MD, MPH, Senior Editor.
Data Sharing Statement
References
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Associated Data
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Supplementary Materials
Data Sharing Statement
