Why doctors in stressful health care systems are joining unions to improve working conditions – Milwaukee Independent

Report on Physician Unionization and its Alignment with Sustainable Development Goals

Introduction

A significant trend is emerging within the United States healthcare sector: a rapid increase in physician unionization. This development occurs in contrast to declining union membership across other professions. This report analyzes the historical context, driving factors, and implications of this trend, with a specific focus on its alignment with the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 8 (Decent Work and Economic Growth).

Trends in Physician Union Membership

Historical Context

Labor organization in the U.S. healthcare sector is not a new phenomenon. Nurses first formed unions in 1896, with approximately 20% of registered nurses being union members today. The first union for physicians was established in 1934 by hospital residents seeking to improve pay and working hours. For decades, the growth of physician unions remained slow.

Recent Growth Trajectory

The pace of unionization among physicians has accelerated significantly in the last decade. This growth is particularly notable when contrasted with the overall decline in union membership in the American workforce, which fell from 20.1% in 1983 to 9.9% in 2024.

• Physician union membership increased from 5.7% in 2014 to an estimated 8% by 2024.
• Membership in the Committee of Interns and Residents (CIR), a chapter of the Service Employees International Union (SEIU), grew by nearly 14% to 37,000 between late 2024 and early 2025, reaching over 40,000 by September 2025.
• Other prominent unions include Doctors Council (SEIU) and the Union of American Physicians and Dentists (AFSCME).

Causal Factors Driving Unionization

Shift in Employment Structure

A fundamental driver of this trend is the structural shift in physicians’ employment status. In 1983, over 75% of physicians owned their clinical practice. By the 2020s, this figure has inverted, with nearly 80% of physicians now employed by large health systems or corporations. As employees, physicians are eligible to unionize and engage in collective bargaining to negotiate compensation and working conditions, a key component of SDG 8: Decent Work and Economic Growth.

Economic and Workplace Conditions

While physician salaries are high relative to the average worker, several factors contribute to a demand for collective bargaining to ensure decent work.

1. Financial Pressures: Significant student debt and compensation models that do not account for extensive uncompensated administrative work reduce effective earnings and create financial strain. This relates to targets within SDG 8 concerning fair and equal pay.
2. Physician Burnout: A 2022 survey indicated burnout rates exceeding 50% in several key specialties. This directly threatens SDG 3: Good Health and Well-being, as the well-being of healthcare providers is essential for a functioning and resilient health system.
3. Administrative Burden: Physicians report spending nearly two hours on administrative tasks, such as updating electronic health records, for every one hour of direct patient contact. This administrative load is a primary source of workplace stress and detracts from the core mission of patient care central to SDG 3.
4. Job Security: Concerns exist regarding the expanded roles of nurse practitioners and physician assistants, as well as the potential for artificial intelligence to automate tasks, prompting a desire for job security through union contracts.

Implications for Sustainable Development Goals (SDGs)

SDG 3: Good Health and Well-being

The movement towards unionization is intrinsically linked to SDG 3. By addressing the root causes of physician burnout—such as excessive hours, administrative overload, and feeling undervalued—collective bargaining seeks to create a more sustainable work environment. A healthy, supported, and stable healthcare workforce is a prerequisite for delivering high-quality patient care and achieving universal health coverage.

SDG 8: Decent Work and Economic Growth

Physician unionization is a direct expression of the principles outlined in SDG 8. It represents an effort by a highly skilled workforce to:

• Protect labor rights and promote a safe and secure working environment.
• Advocate for fair compensation that reflects all hours worked, including administrative duties.
• Negotiate for reasonable working conditions that prevent burnout and promote long-term, productive employment.

Ethical Considerations and Recent Labor Actions

Impact on Patient Care

A primary concern surrounding physician unionization is the potential for labor actions, such as strikes, to disrupt patient care. In response, organizations like the American College of Physicians have issued guidance for responsible collective bargaining. However, a 2022 meta-analysis of 17 studies found no significant impact on patient mortality rates during healthcare worker strikes. Nonetheless, recent actions have demonstrated the potential for disruptions.

Case Examples of Labor Actions

• January 2025, Providence Health (Oregon): A 27-day strike involving 70 doctors resulted in an agreement that improved pay, expanded sick leave, and committed to revised staffing models, though it caused delays in elective procedures and increased emergency room wait times.
• June 2025, Allina Health (Minnesota): Members of the Doctors Council SEIU union held protests following 18 months of failed contract negotiations, seeking higher compensation, reduced workloads, and increased support staff.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article on the rise of physician unionization connects to several Sustainable Development Goals (SDGs) by focusing on the well-being of the healthcare workforce, their labor rights, and the overall quality of the healthcare system.

• SDG 3: Good Health and Well-being

  This goal is central to the article as the working conditions of doctors directly impact their ability to provide quality patient care. The article discusses physician burnout, stress, and long hours, which are critical factors affecting the health and well-being of the medical workforce and, by extension, the health outcomes of the population they serve.

• SDG 8: Decent Work and Economic Growth

  This is the most prominent SDG in the article. The discussion revolves around doctors seeking better working conditions, fair compensation, and the right to collective bargaining. Issues like uncompensated administrative work, long hours, financial stress despite high salaries, and the shift from practice ownership to employment highlight the struggle for “decent work” within the medical profession.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, specific targets within SDG 3 and SDG 8 are particularly relevant.

• Target 3.c: Substantially increase health financing and the recruitment, development, training and retention of the health workforce.

  The article directly addresses the retention of the health workforce. It highlights that “rates of burnout exceeding 50% in several key specialties” and that “more than half of those responding said they felt undervalued by their employer.” These factors are significant threats to the retention of skilled physicians. Union efforts to improve working conditions and reduce burnout are aimed at making the profession more sustainable, thus supporting this target.

• Target 8.5: By 2030, achieve full and productive employment and decent work for all… and equal pay for work of equal value.

  The concept of “decent work” is the primary driver for doctors joining unions. The article notes that unions seek “better working conditions, higher pay and better benefits.” It points out that many hours spent on administrative tasks are “often uncompensated, significantly reducing physicians’ effective hourly earnings.” The push for fair compensation for all hours worked and manageable workloads aligns directly with achieving decent work.

• Target 8.8: Protect labour rights and promote safe and secure working environments for all workers.

  The entire movement of physician unionization is an exercise in protecting labor rights. The article explains that as physicians become employees rather than practice owners, they “are now eligible to unionize and may have an interest in doing so to bargain with employers.” The reasons for unionizing, such as addressing administrative burdens that are a “significant source of workplace stress,” are efforts to create a safer and more secure working environment, particularly concerning mental and emotional well-being.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article contains several quantitative and qualitative data points that can serve as indicators to measure progress.

• Indicators for Target 3.c (Health workforce retention):

  • Physician Burnout Rate: The article explicitly states that a 2022 survey “reflected rates of burnout exceeding 50% in several key specialties.” Tracking this percentage over time would be a direct indicator of the well-being and potential retention of the health workforce.
  • Feeling of Being Valued: The survey finding that “More than half of those responding said they felt undervalued by their employer” is a qualitative indicator of workplace morale, which is crucial for retention.

• Indicators for Target 8.5 (Decent work):

  • Physician Financial Stress: The article mentions that “as many as 15% of physicians said they had cut back on their personal expenses, and 40% expected to delay retirement for financial reasons.” These figures serve as indicators of whether compensation constitutes a decent living, even for a high-earning profession.
  • Ratio of Compensated to Uncompensated Work Hours: The article implies this indicator by stating, “Doctors spend nearly two additional hours updating electronic health records or doing related administrative tasks for every hour they spend with patients,” and noting that this extra work is “often uncompensated.” Measuring this ratio would track progress toward fair pay for all work performed.

• Indicators for Target 8.8 (Protecting labour rights):

  • Union Membership Rate (Union Density): The article provides precise data for this indicator: “The share of doctors who belong to unions rose from 5.7% in 2014 to 7.2% in 2019. By 2024, an estimated 8% of physicians were union members.” This directly measures the extent to which physicians are exercising their right to organize.
  • Number of Labor Strikes and Collective Bargaining Actions: The article mentions specific instances, such as the “27-day” strike in Portland and protests by the Doctors Council SEIU in Minnesota. The frequency and outcomes of such actions are indicators of the active protection and exercise of labor rights.

4. Table of SDGs, Targets, and Indicators

Source: milwaukeeindependent.com