Union Petitions Involving Physicians Spiked in the Last 2 Years

The number of union petitions with physicians in the bargaining units increased in 2023-2024 compared with 2000-2022, according to data from the National Labor Relations Board.

There were a total of 77 union petitions filed with physician members — 44 in 2000-2022 and 33 in 2023-2024 — with annual rates of union petition filings of 2.1 and 23.3, respectively, during those time periods, reported Kevin Schulman, MD, of Stanford University in California, and colleagues.

Overall, excluding petitions that had yet to have a disposition, 41 of 66 were certified: 24 of 44 in 2000-2022 and 17 of 22 in 2023-2024, they wrote in a research letter in JAMA.

Notably, based on press reports documenting motivations for 26 of the 33 petitions in 2023-2024, union campaigns were motivated by working conditions (85%), lack of voice in management (81%), and patient care concerns (54%). Only one campaign cited financial compensation.

“As consolidation of the healthcare market continues, we have seen increasing concerns about physicians’ roles in governance of the clinical enterprise, and workflow and staffing issues,” Schulman told MedPage Today. “With 52% of physicians now employees of hospitals, we have seen the turn to unionization as one approach to addressing these challenges. Unions offer an opportunity for physicians to bargain collectively with management over these issues.”

“While there have been anecdotal reports of physician unionization, there was not real documentation of where and how these unionization activities have been occurring,” he added. “By exploring union filings over a 20-year period, we were able to document a significant uptick in union petitions, and success in certification drives.”

Interestingly, a recent historical look at house staff unionization showed that efforts date back to the 1930s.

The authors noted that “collective bargaining agreements from recent unionization efforts will provide early indications of whether collective bargaining achieved the unionization objectives.”

Schulman added that he believes “we are still at the beginning of this effort to address the governance issues of healthcare delivery.”

“Unions are one approach to these governance challenges,” he added, “but have limits in their effectiveness if every specialty develops their own collective bargaining unit.”

For their study, Schulman and colleagues utilized data from the National Labor Relations Board. “Because filings appeared to increase in 2023, we compared petitions filed between 2000 and 2022 with those filed from 2023 through May 2024,” they wrote.

The 77 union petitions represented 7,064 individuals (3,541 in 2000-2022 and 3,523 in 2023-2024). The size of the bargaining units ranged from four employees to 560, with a mean of 93. About a third of the units were exclusively physicians, while 40% included physicians and advanced practice clinicians, such as nurse practitioners and physician assistants, and 26% consisted of broader populations, including physicians, nurses, and administrative personnel.

Union petitions were concentrated in western states, with 43 of 77 in California, Oregon, and Washington, and petitions were filed “against a diversity of employers,” Schulman and team noted, with 49% filed against hospitals, 38% against community health centers, and 13% against non-hospital corporate owners, such as private equity-backed companies.

To inform motivation for union petitions, the researchers used press reports in 2023 and 2024 found in Google searches.

Public-sector physician unions governed by state law and unions voluntarily recognized by the employer were not included in the analysis, which was a limitation, as was the fact that statements made to media outlets “may reflect public relations determinations,” Schulman and colleagues said.