Tired of pleasing ‘corporate masters,’ physician union membership rises

Union membership among health care professionals in the United States, including physicians, is on the rise, which could have seismic implications in work patterns and patient care in an increasingly corporatized medical system.

“The trend toward physician unionization can be seen as part of changes in the U.S. health care system over the past 3 decades, which has been marked by consolidation of hospitals and health systems, consolidation of insurers, and private equity investment,” Allan Gibofsky, MD, JD, MACR, FACP, FCLM, professor of medicine at Weill Cornell Medicine, and attending rheumatologist and co-director of the Clinic for Inflammatory Arthritis and Biologic Therapy at the Hospital for Special Surgery, told Healio. “This has resulted in a loss of physician independence and burnout, factors that were exacerbated by and during the COVID epidemic.”

Robert M. Doroghazi, MD, a retired cardiologist and editor of The Physician Investor Newsletter, was more forceful in his assessment of these recent trends in medicine.

“I have come to appreciate that increasing corporatization is a very significant negative trend,” he said in an interview. “If physicians do not please their corporate masters, they are out of a job.”

That said, Doroghazi does not view unionization as the appropriate response.

“To the contrary, it will be an immense negative,” he told Healio. “Physicians are — or used to be — held in the highest respect in our society because they were taught to do what is best for the patient. If physicians unionize, they will imme-diately lose this well-earned mantle of respect.”

However, this is not a universally held opinion. Nor is union membership among medical professionals a strictly recent phenomenon. Gibofsky noted that the first organization of trainees, the Intern Council of New York, was established in 1934.

“It is notable that one of the largest physician unions in the United States today is the Committee of Interns and Residents (CIR), a union of house staff/trainees, with over 33,000 members in 10 states and the District of Columbia,” he said.

More recently, the CIR, now part of the Service Employees International Union (SEIU), reported representing 32,000 trainees — or 20% of the resident workforce — as of May 2024, up from 10% in 2019, according to a commentary from Adam E. Mikolajczyk, MD, and Colin Goodman, MD, published in JAMA Network Open. Their numbers include resident physicians and fellows at Stanford, who voted 81% in favor of unionization in 2022, and resident physicians at Mass General Brigham, 75% of whom voted to join CIR-SEIU in 2023.

In a study published in April 2025, also in JAMA Network Open, Barger and colleagues surveyed 1,235 resident physicians from 2020 to 2023, and found that 20% belonged to a union at their institution. Notably, among the 986 nonunionized resident physicians, 63% stated they would vote to unionize, while less than 10% said they would not. Pay and work hours were the most commonly cited factors in considering unionization, according to the researchers.

Another study published in JAMA Network Open, by Ahmed and colleagues in 2022, found that approximately 13% of 14,298 respondents — including physicians, dentists, advanced practitioners, nurses, therapists, technicians and support staff — were members of a union.

However, despite the increase in union participation, organizing membership remains a challenge.

“Health care professionals are quite diverse and a single union may not successfully advocate for all subgroups,” Jeffrey Sparks, MD, MMSc, director of immuno-oncology and autoimmunity in the division of rheumatology, inflammation and immunity at Brigham and Women’s Hospital, and associate professor of medicine at Harvard Medical School, told Healio. “Conversely, many small unions may not be able to organize efficiently to make change.”

Meanwhile, underscoring all of this is the specter of strikes.

In the short term, medical professionals walking out on the job might lead to adverse health consequences for individual patients. However, whether the potential long-term benefits of a strike — improved wages, less burnout, a generally happier workforce — could ultimately improve patient care is a matter of opinion.

What is not a matter of opinion, though, is that medicine has become more corporatized. How that plays into trends in union membership is worth examining.

Best interests of ‘the suits’

In a 2022 paper published in JAMA, Bowling and colleagues tracked the consolidation and corporatization of health systems and physician practices. Their results showed that in 2012, 60% of practices in the United States were owned by physicians, while 23.4% of practices were owned in part by a hospital, while just 5.6% of physicians were directly employed by hospitals.

However, by 2022, 52.1% of physicians were employed by hospitals or health systems. Moreover, 21.8% of physicians were employed by other corporate entities at that point. Overall, 74% of practicing physicians in 2022 were employed by some larger entity.

“Increasing unionization among medical professionals may be attributed to a larger role on the commercialization of health care,” Sparks said.

The acquisition of private practices by corporations and health systems has had a dramatic impact on the daily practice of medicine, according to Gibofsky.

“This trend fundamentally changed the status of the practitioner from independent owner to contracted employee, with all of the associated challenges inherent in any employment relationship,” he said.

These challenges have created a unique situation for physicians in the clinic, according to Kyle A. McCoy, JD, a founding member of the Milwaukee-based law firm Soldon McCoy, LLC, which represents organized labor exclusively and provides seminars on labor and employment laws.

“Once you become an employee, every day you go to work, you are broken down into your most efficient numbers and digitized, and you have lost some control,” he said.

Doroghazi drew a straight line between this phenomenon and patient care.

“Corporatization puts tremendous pressure on physicians to put money on the bottom line,” he said. “This can lead to less time for individual patient visits than may be required.”

The time that doctors are actually able to spend with patients has changed with corporatization, as well, according to McCoy.

“The relationship between doctor and patient is now being dictated by MyChart, because you get told how to be more efficient, you get told how you are supposed to put things into the chart, and the primary goal is maximizing revenue,” he said.

Too much time spent on the laptop or tablet is not the only way the doctor-patient relationship can be impacted by cor-poratization.

“As a patient, I would always have a lingering doubt about the physician’s recommendation,” Doroghazi said. “Is this in my best interest, or in the best interests of their employers, the suits?”

Meanwhile, the frustration at the lack of control can feel personal to overworked employees, he added.

“It is impossible not to appreciate that the close-in, preferred parking spots saved for ‘the suits’ are vacant on Friday night, Saturday night, Sundays and holidays,” Doroghazi said.

The rise in unions is a response to all of these trends, according to McCoy.

“A union is way to get some control back,” he said.

On the other hand, Doroghazi remains unconvinced that unions are the answer.

“I rate corporatization and unionization equally as negative trends in medicine,” he said.

Although the overall picture is unclear on this count, many health care professionals currently see unionization as a benefit.

Collective bargaining

“Unlike individual physicians, unions can legally engage in collective bargaining,” Gibofsky said. “This can result in physicians gaining stronger leverage in communicating with their employers — usually hospitals or hospital systems — and focus attention on issues such as addressing the increase in physician burnout, improving work conditions, improving patient care, and reducing administrative burdens.”

Improved housing stipends and sexual harassment policies may also be attractive benefits.

According to McCoy, shifting demographics of the medical workforce — including the rise of two-physician families — may be another factor as well.

“Due to the increasing numbers of two-physician families, they want time off for maternity and paternity leave and medical leave for family members and spouses,” he said.

“The union also can serve as an HR department,” McCoy added. “If you are being subject to a disciplinary process, you can go through the union. They will help with unmeritorious complaints that an individual employee may not be able to dispute. Disputes with leave, benefits and insurance coverage all can go through the union. Of course, it helps the employee, but it also streamlines communications for the employer.”

However, it is important to understand that unionizing does not necessarily mean that every demand is met.

“For example, you see a lot of these Starbucks locations organizing and unionizing,” McCoy said. “Not a single one of them has a contract. If the employer has a lot of money, they find ways to work around many unions.”

When employers work around the union, or when union employees feel as though they have reached the end of traditional negotiations, strikes can occur. What that looks like in a health care setting is subject to multiple factors.

The growing ‘threat of strikes’

The American College of Physicians Ethics Manual states: “Physicians should not engage in strikes, work stoppages, slowdowns, boycotts, or other organized actions that are designed, implicitly or explicitly, to limit or deny services to patients that would otherwise be available.”

Despite this, strikes do occur.

“The threat of strikes and actual job actions has grown considerably over the last several years,” Gibofsky said. “In 2023, resident physicians went on strike for higher pay at New York City’s Elmhurst Hospital Center. They were the first doctors to go on strike in NYC since 1990.”

In a 2024 paper published in the Journal of Surgical Education, Zeitouni and colleagues provided an overview of physician unionization at the current moment, including strike activity. Their findings showed that employees at six U.S. hospitals threatened to strike in 2024.

In January 2025, nearly 1,000 physicians across four New York City municipal hospitals threatened a strike over contact negotiations, demanding better pay and working conditions. However, the parties reach a tentative deal to avoid a strike.

“In the introduction to his major work, ‘On War,’ Carl von Clausewitz wrote his most quoted dictum: ‘War is nothing but the continuation of policy with other means,’” Gibofsky said. “Similarly, strikes by physicians can also be seen as the continuation of policy by other means. The major difference is that strikes by physicians can affect patient care and thus are undesirable.”

Gibofsky is far from the only expert with this concern.

“I cannot imagine it would have a positive impact on patient care,” Doroghazi said.

McCoy said he also recognizes the point at which strikes could become problematic for the medical community.

“If something bad happens to a patient when health care professionals are striking, the false narrative will be that the union has blood on their hands, that they should have been at the bedside,” he said. “No doctor wants that. No health system wants that.”

However, McCoy added that he not convinced that a worst-case scenario event would necessarily impact the medical community overall.

“I am not sure if it would take physicians down a notch in terms of social status,” he said.

The next question is whether a physician strike could lead to a negative impact on patient care in the long-term. Essex and colleagues conducted a meta-analysis of 14 studies investigating in-hospital mortality and three studies investigating population mortality in the setting of strikes. The findings, which were published in 2022 in Health Services Research, showed that none of the data sets reported a significant increase in mortality associated with strikes.

“The conundrum is that the rationale for a strike is often the result of a failure to address those factors that are already directly impacting patient care, such as staffing, resource allocation, physician hours,” Gibofsky said. “That said, strikes are very rare among physicians, who are concerned about their identification as professionals.”

Although it remains possible that strikes could “stress” patient care in the short-term, the long-term impacts could improve experiences for physicians and patients alike, according to Sparks.

“Strikes are certainly a traditional way to negotiate so this is definitely a possibility,” he said. “Certainly, strikes would provide a short-term stress to patient care. However, ensuring working conditions could have long-term benefits related to the pipeline, retention, and satisfaction of the workforce.”

The reality is that strikes among medical professionals are both rare and unlikely. However, with union membership on the rise, understanding the legal implications surrounding negotiations between management and labor may contextualize the current moment within the health care industry.

Laws and ‘good faith’

The legal issues surrounding union membership among medical professionals are complicated and vary from state to state — and health system to health system — depending on the applicable statutes and protocols in place, according to McCoy. The laws can then impact how employers approach negotiations and attempts at unionization.

For example, employees at the University of Michigan — which has had a robust union for more than 50 years — are subject to state law because it is a state school. The law is different in Wisconsin, where only a base wage can be negotiated.

“There are many different laws in the public sphere — for example if you work in the Veterans Administration, you are covered by the U.S. Federal Labor Relations Authority,” McCoy said. “In the private sector, most are controlled by the National Labor Relations Act.”

Health system employees who are contracted out also are subject to different unionization rules, according to McCoy.

“Independent contractors, insofar as that designation is accurately applied, cannot unionize,” he said. “The National Labor Relations Board has repeatedly tried to expand the definition of an employee, but that has been met with roadblocks.”

There are other ways that employers can prevent employees, including physicians, from unionizing.

“If you serve in an advisory or supervisory role — for example, if you are chair of a division — you are probably unable to be in a union,” McCoy said. “Employers can use this to prevent some physicians from unionizing.”

To that point, some systems have argued that all doctors are essentially supervisors of nurses and other staff.

“There has been pushback on that,” McCoy said.

Meanwhile, current organizing strategies have seen workers lean into the natural differences between the professions that fall under the medical umbrella, by establishing separate unions for nurses, doctors, technicians, administrative staff and other support employees in health systems.

This division is necessary because each of these groups has different needs and demands when it comes to collective bargaining. However, health systems can use this division, often required by law in the private sector, to their advantage, according to McCoy.

“Most health systems will not welcome the Teamsters in to set up a wall-to-wall union,” he said.

The specter of strikes also allows for the different groups to be essentially pitted against one another, even if they are all working toward the same goal of better workplace conditions.

“If nurses go on strike, guess what? Doctors are going to work longer hours,” McCoy said.

All of that said, employment parameters are generally worked out amicably — for the most part — between management and labor in the health care space.

“When negotiations are conducted in good faith with transparency on both sides, strikes or other ‘job actions’ become unlikely,” Gibofsky said.

McCoy stressed that health system employers have long negotiated in good faith with their physician, nursing, administrative and support staff. Whether that will change as the U.S. health care system becomes even more corporatized remains to be seen. If so, union membership may increase further.

What is certain, for now, is that individuals who go into medical professions still want what they have always wanted.

“Even for young trainees at the start of their careers, it is not all about the money,” McCoy said. “They just want to be treated fairly.”

References:

ACP Ethics Manual.

https://www.acponline.org/clinical-information/medical-ethics-and-professionalism/acp-ethics-manual-seventh-edition-a-comprehensive-medical-ethics-resource/acp-ethics-manual-seventh-edition

Ahmed AM, et al. JAMA Netw Open. 2022;doi:10.1001/jama.2022.22790.

Barger LK, et al. JAMA Netw Open. 2025;doi:10.1001/jamanetworkopen.2025.3106.

Bowling D, et al. JAMA. 2022;doi:10.1001/jama.2022.12835.

Essex R, et al. Health Serv Res. 2022;doi:10.1111/1475-6773.14022.

Mikolajczyk AE, Goodman C. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.21634.

Zeitouni F, et al. J Surg Educ. 2024;doi:10.1016/j.jsurg.2024.04.002.

For more information:

Robert M. Doroghazi, MD, can be reached 339 East Legend Ct., #B, Highland Heights, OH 44143; email: rdoroghazi@yahoo.com.

Allan Gibofsky, MD, JD, can be reached at 535 East 70th Street, New York, New York 10021; email: gibofskya@hss.edu.

Kyle A. McCoy, JD, can be reached at 3 934 North Harcourt Place, Shorewood, WI 53211; email: kyle@soldonmccoy.com.

Jeffrey A. Sparks, MD, MMSc, can be reached at 450 Brookline Ave, Boston, MA 02215; email: jsparks@bwh.harvard.edu.