With roughly three-quarters of U.S. physicians now employed rather than independent, a growing number are turning to unions to reclaim decision-making power eroded by employer policies and regulatory constraints, according to a viewpoint published in The DO.
About 8% of physicians — roughly 70,000 — were unionized as of 2025, up from prior years, while about 20% of residents belong to a union, according to data from the American Society for Health Care Human Resources Administration. Unions can negotiate for better hours, safer staffing ratios, higher pay, and stronger job protections through collective bargaining under the National Labor Relations Act.
But the benefits aren’t clear-cut. A JAMA Network Open survey of roughly 5,700 surgical residents found unionized programs offered more vacation time and housing stipends, but showed no measurable difference in work-hour violations, educational environment, or burnout compared with non-unionized programs.
The viewpoint’s author, a former resident union chair, cautions that union membership carries tradeoffs beyond the bargaining table: “Joining a union is much more than seeking adequate representation to reclaim control of a local practice setting or addressing some individual employment issue; it is also joining a much larger universe that may not represent your interests fully and may publicly take stances that you disagree with.”
Dues typically run 1% to 3% of gross salary, and strikes — which require at least 10 days’ written notice under federal law for healthcare workers — carry risk of public backlash and strained patient trust.
The commentary stops short of endorsing or rejecting unionization outright, instead urging physicians to weigh the decision case by case — and calling on health system leaders to treat physician executives as essential partners rather than interchangeable staff, regardless of whether a union is in the picture.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
