In the latest sign of growing frustration among professionals, doctors employed by a large nonprofit health system in Minnesota and Wisconsin have voted to unionize.
The doctors, about 400 primary and emergency care providers at more than 50 clinics operated by Allina Health System, appear to be the largest group of unionized private sector physicians in the United States. More than 150 nurses and physician assistants at the clinics were also eligible to vote and will be members of the union, which is represented by a local from the Service Employees International Union.
The vote was 325 to 200, with 24 other ballots challenged, according to a count by the National Labor Relations Board, which conducted the vote.
In a statement, Allina said: “While we are disappointed by the decision of some of our providers to be represented by a union, we remain committed to our ongoing work to create a culture where all employees feel supported and valued.”
The doctors complained that chronic staff shortages lead to burnout and endanger patient safety.
“Between patients, your doctor handles prescription refills, phone calls and messages from patients, and lab results,” Dr. Cora Walsh, a family doctor who was involved in the organizing campaign.
“In a clinic with enough staff, you have enough support to handle some of that workload,” Dr. Walsh added. “If staffing levels go down, this work won’t go away.”
Dr. Walsh estimated that she and her colleagues often spend an hour or two each night dealing with the “inbox load” and worried that the bottlenecks were leading to increased backlogs and the risk of errors.
The union vote follows recent strikes by pharmacists in the Kansas City area and elsewhere over similar concerns.
A variety of professionals, including architects and engineers, have attempted to form unions in recent years, while others, such as nurses and teachers, have waged strikes and aggressive collective bargaining campaigns.
Some argue that employers have taken advantage of their sense of mission to pay them less than their skills warrant or to keep them on 24/7. Others claim that new business models or budget pressures are threatening their independence and impairing their professional judgment.
Doctors increasingly seem to be raising both concerns.
“We feel like we can’t advocate for our patients,” said Dr. Matt Hoffman, another doctor who helped organize at Allina. Dr. Hoffman added of managers that “we can’t tell them what we need on a daily basis.”
Consolidation in the healthcare industry over the past two decades appears to be a major source of frustration among physicians, many of whom now work for large healthcare systems.
“When a doctor ran his own practice, he made the decisions about the people and technology he surrounded himself with,” said Dr. Robert Wachter, chair of the medical school at the University of California, San Francisco, in an email. “Now those decisions are being made by administrators.”
Allina doctors say staffing levels were a problem before the pandemic, that Covid-19 pushed them to the brink and that staffing levels never fully returned to pre-pandemic levels.
The relatively low pay of clinical assistants and laboratory staff appears to have contributed to the staffing problems as these workers moved to other fields in a tight labor market. In some cases, doctors and other clinicians within the Allina system have resigned or had their hours reduced because of what is known as moral injury – a feeling that they could not do their work in accordance with their values.
“We were promised that staffing levels would improve once we got through the acute phase of the pandemic,” said Dr. Walsh. “But staffing never improved.”
Allina, which has billions of dollars in revenue but is under financial pressure and recently cut hundreds of jobs, did not respond to questions about doctors’ concerns.
Joe Crane, national organizing director for SEIU’s Doctors Council, which represents attending physicians, said that before the pandemic, he received about 50 inquiries a year from doctors interested in learning more about forming a union. He said he received more than 150 inquiries in the first month of the pandemic. (Mr. Crane was with another doctors’ union at the time.)
Mr. Crane noted the insular nature of the medical profession and said that while unionization among attending physicians had been slow, the Allina victory could provide momentum.
In March, more than 100 doctors voted to unionize at another Allina facility, a two-site hospital. Dr. Alia Sharif, a doctor involved in the union campaign, said doctors there are under pressure not to exceed patient length-of-stay guidelines, even though many have complex medical conditions that require more sustained care.
Allina is appealing the result of this vote to the National Labor Relations Board in Washington; A board official declined an earlier appeal.
Although unionization among attending physicians has declined, it has increased significantly among residents. A sister union within the SEIU, the Committee of Interns and Residents, has gained thousands of members in recent years.
Dr. Wachter said this could be a sign of increased unionization of doctors outside of training programs. “As these physicians complete their training and enter practice, they will be more comfortable in a world where unionization does not automatically conflict with their ideas about practicing the profession,” he wrote.