Opinion | How I Became a Union Doctor

I recently added my name to a small but growing number of union doctors, as a founding member of the first-ever U.S. union composed exclusively of emergency medicine physicians, nurse practitioners, and physician assistants.

By voting unanimously to form the Southern Oregon Providers Association (SOPA), we hope to show other physicians how we can use our union power to advocate effectively for patient care and safety.

What Led Us to Form a Union?

My colleagues and I had been peripherally aware of other physician unions, but until recently, we hadn’t seriously considered unionizing. However, emerging from the pandemic we found ourselves mired in the ever-growing challenges facing healthcare providers nationwide.

The mass exodus of healthcare providers leaves those of us who remain trying to maintain the same standard of care with diminishing resources. Day after day, we feel we are being asked to do more with less, and we increasingly find ourselves having to support services and patients outside the emergency department (ED).

We, along with ED providers nationwide, have felt the impact of the public health emergency of ED inpatient boarding. We fear that this known patient safety risk puts the well-being of patients in danger of complications and poor outcomes.

Finally, we have watched as the increasing corporatization of medicine around the country has reduced physicians’ autonomy to provide the care they felt was in the best interest of their patients. We saw long-standing physician groups at other institutions replaced in the blink of an eye by physicians from large contract management groups. We knew we were not immune to these possibilities, and needed a new strategy to stand against them.

Despite these and other challenges, we wanted to ensure that we continued providing our patients with safe, high quality care. However, we felt that by ourselves we lacked the power or influence to make meaningful changes to the status quo. We knew we could not stand by and be complicit as we watched these seismic shits shake the practice of emergency medicine, and healthcare in general, to its core. Given our deep commitment, not only to our profession, but to our patients, we decided to pull together and explore the possibility of unionizing to ensure our voices were heard.

What Allowed Us to Unionize?

Resident physicians first unionized in 1957, attending physicians in 1972. However, union membership remains low, accounting for only about 5.9% of doctors. Because we are directly employed by our hospital, are not independent contractors, and do not hold supervisory positions such as medical director, we were eligible to form a union under the criteria set forth by the National Labor Relations Board (NLRB), the federal agency charged to protect “the rights of private sector employees to join together, with or without a union, to improve their wages and working conditions.”

After recognizing that unionizing was an option, several of my colleagues and I decided to evaluate how a union could help us tackle our mounting patient safety concerns.

How Will a Union Help Us?

While unions are not a panacea, unions ensure employers negotiate in good faith on both issues of compensation and conditions of employment. We know that a union contract cannot directly compel staffing changes in other departments, but we hope it will help us contractually define the scope of our practice to align with national guidelines. Namely, we hope to codify that the role of ED providers is to evaluate, stabilize, and treat ED patients, a position supported by the American College of Emergency Physicians and the American Academy of Emergency Medicine. We must be available at all times, day or night, to care for any patient with an emergency that presents at our doorstep. A union contract may allow for us to lobby for staffing ratios that give us the support and resources we need to provide safe care in the face of challenges like boarding.

Just this year we saw the power of unions, as New York State nurses bargained for enforceable patient ratios. Notably, a union also provides an outlet for systemic issues to be made public, hopefully inducing institutional change. Finally, while a union cannot explicitly prevent our replacement by a contract management group, it can ensure that we are given the opportunity to negotiate before significant changes to our contract and receive ample notice and/or severance benefits in the event of the termination of our contract.

Looking to the Future

With overwhelming group support, we contacted the Oregon Nurses Association and the American Federation of Teachers, who have represented other physician groups in Oregon for nearly a decade. In February we petitioned the NLRB for a union election and, on April 25, we voted unanimously to unionize and form SOPA.

I hope that with a unified voice in the ED, we can ensure we have a seat at the bargaining table to advocate not only for ourselves, but more importantly, for our patients. The safety of our ED patients is our highest priority, and we now have a powerful tool to ensure that our voices, united as one, will be heard speaking up for patient safety.

Bryce Pulliam, MD, is an emergency physician in southern Oregon and is a founding member of the Southern Oregon Provider Association, the first emergency medicine provider union in the U.S.