Preparing for Residency

What medical students need to know about unions

Brendan Murphy , Senior News Writer

Physicians, particularly those involved in organized medicine, understand the importance of power in numbers. That has been demonstrated in a number of arenas, including union membership.

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As more physicians work in employed arrangements, membership in physician unions has grown. A recent webinar, co-hosted by the AMA Medical Student Section and AMA Academic Physicians Section, looked at the basics of physician unions and how they serve their membership. For medical students who may choose to work in an institution that has a union, here’s a look at some of the questions the webinar covered.

Unions serve three basic functions: collective bargaining, political advocacy and mutual aid (health insurance and pensions for membership). For physicians, the right to collectively bargain—loosely defined as the act of negotiating contract terms with an employer on behalf of its employees—tends to be the driver of union membership.

Diomedes Tsitouras is executive director of the American Association of University Professors–Biomedical and Health Sciences of New Jersey, a nonprofit organization that represents 1,400 faculty at Rutgers/Rowan Universities.

“The idea with collective bargaining is that, unlike individual bargaining, employees of a workplace can come together to combine their power,” Tsitouras said. “By combining their power, they can level the playing field with their employer who usually has more economic power, and by that produce better workplace conditions for everybody.”

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The importance of collective bargaining has grown as many markets have developed in which hospitals have market power and physicians have few hospital employment alternatives and often suffer burnout, Tsitouras said.

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A relatively small number of physicians are union members, but the demand is growing. As of 2019, about 68,000 physicians were in unions. The figure represents about 7% of the physician population nationwide, but it also grew 25% from the five years prior.

Some examples of larger unions that represent physicians include the:

  • Service Employees International Union—Doctors Council, Committee of Interns and Residents.
  • American Federation of State, County, and Municipal Employees—Union of American Physicians and Dentists.
  • American Federation of Teachers.
  • American Association of University Professors.

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In citing key changes his union has created, Tsitouras said the group has improved minimum pay standards based on Association of American Medical Colleges’ benchmarks, created mechanisms to reduce gender-based and arbitrary pay inequity, and enhanced access to child care, parental leave and other policies that support better work-life balance.

“Sometimes people at the top don't always get a sense of what's going on at the ground level, and we can kind of bridge that gap and point out issues and be a voice to hopefully solve problems,” Tsitouras said. In recent years, the need for union intervention in health care was evident. One case of a group of residents unionizing took place at Stanford, where resident physicians were unable to access COVID-19 vaccines ahead of nonessential hospital employees. This past May, Stanford residents voted overwhelmingly to unionize.

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“It is interesting that, you know—what might be perceived as sort of well-resourced, probably better paid than a lot of places, kind of a sweet gig—in some ways those workers were still really motivated to organize to get improvements,” said Rebecca Givan, PhD, co-director of the Rutgers Center for Work and Health. “Realizing that that was the only way to get the voice on the job that they really needed.”

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Striking is very uncommon among all unions, particularly physician unions.

“In general, there are lots of ways of gaining power and striking is only one of those ways,” Givan said. “There’s lots of other methods, things like button campaigns, social media campaigns …

to show collective unity and urgency of the particular demand of interest.”Physician strikes are illegal in some states and even in those states which do not forbid strikes, the union would need to vote overwhelmingly—likely more than 90% of union members voting in favor—to go on strike.

The AMA has policy noting that unions should adhere to the AMA Principles of Medical Ethics, and not engage “in any strike by the withholding of essential medical services from patients.”

Editor’s note: The AMA has released an issue brief (PDF) on collective bargaining that outlines risks and benefits for physicians and doctors-in-training. Meanwhile, an AMA Organized Medical Staff Section webinar held in September offers further expert perspectives. Watch it now.