Opinion: Health system consolidation will fuel growth of physician unions

The pursuit of physician unions is likely to continue amid the consolidation of health systems and medical practices, two attorneys and a physician argue in an article published July 28 in the JAMA Network online.

In the article, titled "The Rise and Potential of Physician Unions," Daniel Bowling III, Barak Richman, PhD, and Kevin Schulman, MD, examine the rise and potential of physician unions, while providing their perspective on the issue. Mr. Bowling teaches courses in labor and employment law at Duke University in Durham, N.C., and Drs. Richman and Schulman are from Stanford (Calif.) University.

They begin by citing data from Avalere in a study sponsored by the Physicians Advocacy Institute, showing that the percentage of U.S. physicians employed by hospitals, health systems or corporate entities grew from 62.2 percent in January 2019 to 73.9 percent as of January 2022. The experts contend this has transformed control of medical care and the role of physicians at organizations.

"Strategic conflicts between hospitals and physicians are not new, but physicians have traditionally negotiated with hospital interests and managed conflict by striving to maintain their independence," Mr. Bowling and Drs. Richman and Schulman wrote. "The large healthcare systems currently gaining traction can lack avenues for physician advocacy and meaningful participation in organizational governance. As a result, a new trend is likely to emerge: the pursuit of physician unions." 

While labor actions during the pandemic have more often involved nurses and other healthcare professionals, physicians are increasingly involved in union activities, including votes to unionize. Residents and fellows at the University of Southern California's Keck School of Medicine in Los Angeles voted last spring to unionize with the Committee of Interns and Residents.  

The three experts provided several considerations for physicians considering unionization, such as the benefits of collective bargaining for pay.

They ultimately conclude: "While unions offer benefits compared with individually negotiated employment agreements, they may be limited in their ability to address the higher governance concerns of the profession."

Read the full article here

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