Physician Unions? What About Physician Leadership Instead?

Union activity has gained attention in medicine, with 2 recent JAMA articles presenting viewpoints on physician unions. JBJS Deputy Editor for Social Media Dr. Matt Schmitz ponders this multifaceted topic. 

JAMA recently published 2 perspective pieces on the potential benefits of physicians forming unions. There is no doubt that the landscape of medicine has changed. As Bowling et al. discuss in their article “The Rise and Potential of Physician Unions,” it is estimated that nearly three-quarters of practicing physicians are employed by hospital systems or corporate entities in 2022, compared to less than 30% in 2012. They note that the pursuit of physician unions is likely to emerge as a new trend given that large health-care systems can lack pathways for physician advocacy and meaningful participation in the shaping of hospital policies.  

In their opinion piece, “Resident and Fellow Unions: Collective Activism to Promote Well-Being for Physicians in Training,” Lin et al. advocate for the formation of unions by physicians in training to help combat burnout and poor work environments. They note that, since March 2021, eight physician training centers have unionized. They also state that “some outdated concepts of professionalism and physician autonomy have created controversary surrounding house staff union activity.” 

I think all of us would agree that physician burnout is a problem. It is a problem not only for trainees but staff physicians as well. We as a physician community must come up with solutions to combat it. That is not debatable. But I find myself pondering how that is best achieved.  

Medicine is a learned profession. It is not a trade providing a service. It is not an industry. Many of us who enter medicine chose our field out of a true calling. Is this an outdated concept for medicine? I don’t believe it is. In addition, there are criteria that define our professional status, such as autonomy, membership in organizations, specialized training, codes of ethics, etc. If we as physicians form unions to negotiate salaries or shape hospital policies, how might that change our status as a profession?  

I don’t presume to have all of the answers. As we consider the topic, I would ask that we look at the argument from a different perspective. Rather than form unions, I personally advocate that physicians go back to taking on leadership positions to help us enlist the changes we’d like to see. In my opinion, we have all too frequently given up our seat at the table in decision-making around medicine. Physicians need to aspire to be leaders and help reshape policies that we might now complain about. To me, it is a vital part of the profession, and one that I hope many others agree with. We should strive toward taking back autonomy. Physician leaders charged with training our future generations in residency should lead from the front and address resident concerns that some feel may be solved with unions and collective action. That is at the heart of taking back autonomy.   

Our primary focus remains the care of our patients. Nonetheless, we can attempt to reserve a portion of our time for extra duties, including committees and leadership activities, that may be required at this time. As the old adage goes, “If you don’t have a seat at the table, you are on the menu.” It is time for physicians to work toward getting back a seat at the table. Otherwise, I fear even unions can’t save us from being on the menu. 

Matthew R. Schmitz, MD 

JBJS Deputy Editor for Social Media