The New England Journal of MedicineHospital Consolidation and Physician Unionization

Emerging Trends in Physician Unionization: A Response to Health Care Consolidation and Corporate Control

As the US health care system undergoes significant restructuring due to hospital consolidation and the corporatization of health care delivery, physicians are increasingly turning to unionization as a strategic response. This shift is largely driven by the need to address deteriorating working conditions, reduced autonomy, and a lack of involvement in governance, which are direct consequences of these broader industry changes.

Key Points:

• Hospital consolidation has been a dominant trend since the 1990s, leading to health systems with significant market power and the aggressive acquisition of physician practices.
• The proportion of hospital-employed physicians in the US increased from 5.6% in 2012 to 52% by January 2022, reflecting a major shift in physician employment structures.
• The growth of physician unions, from a low base, increased by 26% between 2014 and 2019, with significant organizing activities noted in 2023 and early 2024 at various health institutions.
• Physician unionization is seen not as a reactionary measure but as a necessary response to the impacts of health system behaviors that treat physician services as financial liabilities and physicians as interchangeable units.
• The National Labor Relations Act supports collective bargaining, which is crucial as more physicians become employees and lose individual negotiating power.
• Unions offer physicians the opportunity to negotiate better wages and influence organizational governance, areas heavily affected by the monopolistic tendencies of hospital employers.
• Key motivations for unionization include concerns over staffing, burnout, and the quality of patient care, with physicians advocating for substantial improvements in these areas.
• The long-term implications of physician unionization on the health care system remain uncertain, highlighting the need for continuous monitoring and evaluation by both the medical community and policymakers.

According to a 2022 study by the Economic Policy Institute, unionized workers in all sectors earn on average 11.2% more in wages than their non-unionized peers, underscoring the potential financial benefits of unionization for physicians facing subcompetitive wages under monopolistic employers.

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