The practice of medicine has changed dramatically in the past decade. One of the most significant trends is the migration of physicians from privately owned practices to hospitals owned and managed by corporate entities, in some cases, private equity (PE) and venture capital (VC) firms with a fiduciary obligation to their investors. The potential for conflict between this obligation and the ethical requirements to physicians for patient welfare is obvious. The tension of these forces has only increased as physicians have become employees in hospital systems rather than managers or supervisors, and thus are eligible to unionize under US labor law.
In this issue of the Journal of Hospital Medicine, Burden et al. conduct a broad review of these trends and how physician unionization attempts have increased dramatically. 1 The authors, consistent with most of the literature on the topic, posit that the growth in unionization is associated with the loss of autonomy by physicians. The thinking of many physicians is that by forming a union, they can regain some control over patient care through collective bargaining. 2 Analysis of the growth of unionization and theories behind it is not new, and the article is well‐sourced. What is most helpful is that the authors surveyed actual persons in the field using an exploratory mixed methods study involving hospitalists’ perceptions of the growing influence of corporate ownership in healthcare—particularly PE and VC—and the rise of physician unionization.
The study involved a 15‐question survey with semistructured virtual focus groups. Eleven focus groups were held in May and July 2024, involving 33 participants from 26 organizations. Twenty‐eight participants completed the survey (85% response rate). Most respondents were physicians (93%), with 36% holding leadership roles, primarily in nonprofit or academic institutions.
Several themes emerged from the study. The first is the misalignment of values in modern healthcare. Participants recognized the tension between clinicians’ values and health system priorities. Their concerns were not limited to investment firms. Nonprofit hospitals were described as behaving similarly to for‐profits, emphasizing margins over mission. Corporate ownership mimicked private industry with streamlining and often replacing highly trained physicians with lower cost providers and reducing access.
Another regards the perception that unions are a tool to fight back against these trends and recapture lost autonomy. However, the study showed a lack of knowledge among most participants over what unions do and don't do, or even how they are created. Most respondents’ knowledge of unions was by interaction with unionized residents and nurses. For those with more familiarity with unions, it was recognized as a mechanism for a collective voice, enabling negotiations over salaries, benefits, and working conditions. However, 57% of survey respondents expressed opposition, citing bureaucracy, slower decision‐making, and tensions between unionized and nonunionized staff. Views varied widely, influenced by generational differences and political and regional context. Some worried that striking—a last resort mechanism of resolving differences with management—conflict with professional responsibilities. 3 Others saw unions as another level of nonphysician oversight, eroding autonomy ever further. The inevitability of universal physician unions is overstated at best and most likely wrong.
This is an important addition to the literature on physician unions, highlighting a perceived misalignment between healthcare organizations’ financial priorities and clinicians’ professional values. Unionization has emerged as a tool to protect those values.
Considerations for future research are the study scope and applicability. The study is limited in its ability to generalize across diverse hospital systems. The sample size for qualitative interviews is small, and geographic variation is underexplored. Most union attempts are in so‐called “blue” states where unions are more entrenched.
The authors acknowledge that further research on these topics and others is necessary. We agree and encourage others to continue in this effort.
CONFLICT OF INTEREST STATEMENT
The author declares no conflicts of interest.
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.
REFERENCES
- 1. Burden M, Kenisten A, Astik G, et al. A perspective: increasing corporate ownership and unionization in hospital medicine – an exploratory mixed methods study. J Hops Med. 2026;21(8):898‐910. [DOI] [PMC free article] [PubMed] [Google Scholar]
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Associated Data
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Data Availability Statement
Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.