What employed physicians should know about collective bargaining

With ever more physicians choosing employment over private practice—the most recent AMA survey data (PDF) shows that about half of physicians were employees in 2022—the notion of unionizing is gaining traction in employed settings. One of the main reasons: Unions are the only associations that do collective bargaining.

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A webinar, “Understanding Collective Bargaining for Physicians: An Expert Perspective,” hosted by the AMA Organized Medical Staff Section (AMA-OMSS), examines the risks and benefits of collective bargaining for physicians in today's health care environment.

AMA-OMSS is the member group that gives voice to, and advocates for, issues that affect physicians affiliated with medical staffs, whether employed or in private practice.

It’s what makes unions unique

Unions serve three main functions for their members: political advocacy, mutual aid and welfare, and collective bargaining.

“Political advocacy is something that lots of kinds of associations do,” said Rebecca Givan, PhD, associate professor of labor studies and employment relations in the School of Management and Labor Relations at Rutgers, the State University of New Jersey. “So, the Audubon Society would do political advocacy around birds and environmental issues, and the AMA would do political advocacy around health care and physician issues.”

Meanwhile, mutual aid and welfare can be anything from providing traditional insurance benefits to more informal activities.

“Collective bargaining is the thing that only unions do,” Givan said. “Other kinds of associations and advocacy groups don't do collective bargaining.”

How employed physicians might benefit

So what do physicians specifically stand to gain from collective bargaining?

“It gives doctors a stronger voice,” said Diomedes Tsitouras, executive director of the American Association of University Professors Biomedical and Health Sciences of New Jersey.

Big health systems are often managed by far-flung executives with several layers of management between themselves and the physicians delivering the care.

“Often, a human can actually bridge that gap—can actually highlight problems that maybe management didn't even know existed before,” Tsitouras said. “That alone sometimes can be powerful, because it creates a check on how entities are managed.”

An AMA issue brief (PDF) explores collective bargaining for physicians and physicians in training.

“The AMA supports the right of physicians to engage in collective bargaining, and it is AMA policy to work for expansion of the numbers of physicians eligible for that right under federal law,” says the brief. “For example, the AMA supports efforts to narrow the definition of supervisors such that more employed physicians are protected under the National Labor Relations Act.”

Several AMA union-related policies contain several caveats, the brief notes. For example, physicians should:

Form workplace alliances only with those who share their ethical priorities.
Refrain from the use of the strike as a bargaining tactic, although in rare circumstances, individual or grassroots actions, such as brief limitations of personal availability, may be appropriate as a means of calling attention to needed changes in patient care.
Be aware that some actions may put them or their organizations at risk of violating antitrust laws.

Among other topics, the AMA issue brief covers:

AMA policy and experience with physician unions.
The status of physician unions.
The employment status of physicians.
The basic rights of employed physicians to engage in protected collective bargaining.
The advantages and disadvantages of physician unions.

During the AMA-OMSS webinar, Tsitouras outlined these other potential benefits of physician unionization.

Shifting power back to doctors. “Physicians have gone through essentially being the boss or owning their own practices to working for the boss,” Tsitouras said. “Physicians have lost the traditional economic and political power that they've been accustomed to having over the decades.”

Focusing on needs of physicians as employees. This is important because physicians haven’t always developed the mutual aid that other groups have.

Counteracting system-level harms. “By reclaiming some of the voice or reclaiming some of the power,” he said, “we can be an antidote to some of the burnout and the turnover in the profession.”

Givan noted that some physicians might hesitate to embrace unionization because they associate them with auto workers, miners and other heavy industrial workers. But lots of white-collar professionals are unionized.

“I like the example of the Boeing engineers,” she said. “Their unofficial slogan is ‘No nerds, no birds,’ because the plane is kept in the air by their great nerd expertise.”

The webinar also looked at trends in physician union membership, summarized which national unions represent doctors and provided case studies in physician unionization.

Learn more with the AMA about understanding physician employment contracts.