In an unexpected turn of events, health care professionals, including doctors, nurses, and pharmacists, are increasingly turning to labor organizing and unions to address concerns about their working conditions. The trend is particularly pronounced among those employed by large health care corporations, where consolidation of companies and a rise in performance metrics have left workers feeling powerless and overburdened.
Dr. John Wust, a longtime obstetrician-gynecologist from Louisiana, initially saw himself as outside the realm of labor agitation. However, after joining Allina Health, a large nonprofit health care system in Minnesota, he and his group of over 100 doctors at an Allina hospital voted to unionize in response to an unsustainable workload and a lack of input in hospital decisions. This move marked one of the largest groups of private-sector doctors to unionize at the time.
The wave of health care worker unions continued, with approximately 400 primary-care physicians employed by Allina, unionizing shortly after. Nurses, pharmacists, and other health care workers have also joined the trend, with eight major work stoppages in the past year – the most in a decade.
The motivations behind these labor actions are multifaceted. Health care professionals, including doctors and nurses, express concerns about being asked to do more with dwindling staffing levels, leading to exhaustion and anxiety about patient care. Many feel stretched to the limit, especially after the challenges brought on by the COVID-19 pandemic.
However, the root cause of this surge in unionization goes beyond immediate working conditions. A longer-term trend of consolidation in the health care industry has left workers feeling powerless within large bureaucratic structures. The consolidation, combined with increased reliance on performance metrics, has diminished the autonomy of health care professionals and limited their ability to exercise their professional judgment.
For doctors, the transition from independent practices to larger health systems occurred as a response to the changing landscape of reimbursement rates with insurers. The passing of the Affordable Care Act in 2010 further incentivized bigness, tying reimbursement to specific health outcomes. Administrators began evaluating medical staff based on metrics tied to patients’ health, introducing incentives and mandates that often clashed with the professional judgment of doctors.
Similarly, pharmacists experienced a shift in the work environment as pharmacy benefit managers and retail giants like Walgreens and CVS engaged in consolidation. This consolidation led to reduced staffing levels, increased pressure to meet performance metrics, and strict limitations on scheduled work hours.
The pandemic exacerbated these existing strains, with overworked pharmacists, doctors, and nurses reporting increased stress and concerns about patient safety. Despite promises of additional staffing from health systems, deficits and a shortage of professionals persisted, prompting health care workers to organize.
The response to the consolidation and increased reliance on metrics has been a growing worker consciousness. Health care professionals who once enjoyed a certain level of autonomy in their roles now feel like subordinates constantly at odds with their overseers. The dissatisfaction has led to a surge in unionization efforts as workers seek collective bargaining power to address their concerns.
While health care corporations like Allina argue that they are making progress in addressing workload issues and collaborating with health care workers, the push for unionization suggests that workers feel their voices are not adequately heard within these large organizations.
The trend reflects a broader movement seen in other fields where workers, including schoolteachers, college instructors, and journalists, have sought to unionize amid declining budgets and increased reliance on performance metrics. The growing wave of healthcare worker unions is a response to the challenges posed by industry consolidation and the imposition of performance metrics.
The shift from independent practices to large health systems, coupled with the changing landscape of reimbursement and evaluation based on metrics, has left health care professionals feeling disempowered. The pandemic intensified these challenges, leading to a surge in unionization efforts as workers demand a seat at the decision-making table and the ability to uphold their professional standards.
New York Times, Why Doctors and Pharmacists Are in Revolt,