Collective Goals, Collective Bargaining, and Collective Action: The Viability and Urgency of Physician Unions in Corporate Healthcare

U.S. Physicians have been unable to develop politically viable and sustainable frameworks to protect their own and their patients' interests in a healthcare system increasingly dominated by corporate interests. The dominant voice in U.S. medicine, the American Medical Association, represents a shrinking minority of physicians and is financially beholden to the interests of its corporate sponsors. Consequently, physicians are marginalized both politically (by the pharmaceutical and insurance corporations, among others) and institutionally (by health management organizations and hospital corporations). This may account for the discontent, disillusionment, and apathy experienced by U.S. Physicians. A fixture of medicine in many developed and developing nations, physician unions have never established a strong presence in the U.S., despite decades of successful advocacy for physicians and patients. Historically, the right to unionize for physicians has been tenuous, favoring physicians-in-training over self-employed physicians. However, as more U.S. physicians practice as employees of healthcare corporations, unions may offer opportunities for personal, professional and community advocacy that have thus far been elusive. Challenges to unionization are many: they include rigidly held associations between unions and both class and partisan politics, concern about the professionalism and ethics of industrial action, public sentiment and political action against unions, and limits on the available time of busy physicians. The authors propose an agenda for physician unionization that will enable more sustained and successful advocacy for healthcare reform with an aim towards promoting healthy communities of both physicians and patients.