The physician-unionization trend: 2023's major moments

By Naveed Saleh, MD, MS | Fact-checked by Barbara Bekiesz
Published December 29, 2023

Key Takeaways

  • Unionization efforts by physicians are on the rise—California and New York especially have seen a recent increase in strikes by physicians.

  • This ongoing trend can be primarily attributed to more and more physicians choosing employment over private practice. 

  • The AMA offers union-related guidance, saying that physicians should refrain from using strikes or walkouts as a bargaining chip; to what extent clinicians will heed that advice remains to be seen.

The right to unionize is as American as apple pie, and the National Labor Relations Act extends this right to physicians. Unions can benefit HCPs by improving working conditions, offering protection from legal actions, improving advocacy efforts for patient care, and returning some of the autonomy employers have taken away, according to authors of an article published in the AMA Journal of Ethics.[]

Related: A collective stand: The rising trend of physician unionization

The current healthcare milieu is primed for unions like never before. Following an explosion in the acquisition of physician practices in the wake of the pandemic, 52.1% of docs are employed by health systems and 21.8% by other corporate structures. In total, 74% of practicing physicians are employed by consolidated systems.[]

In case you missed them, here are some of the most significant strikes and unionization efforts to take place throughout 2023. 

The largest healthcare worker strike in history

In October 2023, 75,000 HCPs employed by Kaiser Permanente walked off the job, making history as part of the largest strike involving healthcare workers (including nurses, medical technicians, and support staff at hundreds of Kaiser hospitals and clinics) on record.[]

The walkout put pressure on an already short-staffed healthcare industry, with some considering it a bellwether for future union activities, given the win. As a result of the walkout, Kaiser workers won across the board wage increases totaling 21% over 4 years, improved performance rewards, and an outline for methods to effectively address staffing crises. 

Prison physicians in California

In August 2023, 91% of the members of the union representing physicians and psychiatrists in California correctional facilities voted in favor of a strike.[]

They claimed stressful working conditions, noncompetitive salaries, and an overreliance on higher paid scabs as reasons. These conditions historically make it difficult to hire staff physicians in prisons, and nearly half of the staff jobs for these physicians go unfilled. 

UAPD takes on UC

In another example from the Golden State, between April 9 and April 14, 2023, University of California docs protested unfair labor practices that transpired during the year-long bargaining effort for a first contract.[] They not only picketed at student health centers in Berkeley and Los Angeles but also at events for new students.

Residents decry pay in NYC

New York City’s Elmhurst Hospital Center, which is located in Queens, gained notoriety as ground zero for the coronavirus pandemic, and as of May 2023, it became the first NYC hospital where doctors engaged in a strike since the year 1990.[] 

At the crux of the conflict is pay, with the residents at the hospital, who are employed by Icahn School of Medicine at Mount Sinai Hospital in Manhattan, claiming that their counterparts at the flagship center are remunerated $7,000 more per year.

”It feels, fundamentally, like Mount Sinai is saying that this community does not matter. Like we as Elmhurst residents do not matter, as largely immigrant, union doctors,” said a 2nd-year internal medicine resident to the Associated Press.

To boot, an additional 500 residents from Mount Sinai Morningside/West in Manhattan also went on strike for reasons related to compensation.

More residents unionize

In March 2023, residents at the Hospital of the University of Pennsylvania and Pennsylvania Hospital made the decision to form a union, part of a growing trend. 

Most recently, medical residents at Montefiore Hospital in New York and George Washington University in Washington, DC have also formed unions. Issues at hand include pay, parking, childcare, and dirty call rooms.[]

Benefits of unionization

The AMA notes three primary benefits of joining a union, including opportunities for collective bargaining, member assistance/welfare, and political advocacy.[]

In large healthcare organizations, unions give physicians a greater voice—especially in an environment where layers of management obfuscate physician interests. Unions can also help establish a system of checks and balances. Importantly, the right of physicians to collectively bargain via unions is supported by the AMA. However, the AMA cautions against physicians using strikes or walkouts as a bargaining tactic, given the risks to patient care.

What this means for you

There is a growing trend of unionization efforts among physicians in the US, primarily due to more and more physicians choosing employment over private practice. The year 2023 was notable for strikes and walkouts that contribute to this trend—the most significant being the Kaiser Permanente strike that included 75,000 healthcare workers nationwide. Among other benefits, unions give physicians a greater voice in addressing issues like staffing shortages and unfair pay, while allowing them to take back some of the autonomy taken away by growing corporate structures.

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