'Our autonomy is gone': Why more physicians are unionizing

Physicians are increasingly moving to unionize and seeking representation in decision-making. 

Matt Mazurek, MD, assistant clinical professor of anesthesiology at St. Raphael's Campus of Yale New Haven (Conn.) Hospital, joined Becker's to discuss the factors leading more physicians to unionize. 

Editor's note: This interview was edited lightly for brevity and clarity. 

Question: What are the factors that have led to a more recent increase in efforts to unionize by physicians?

Dr. Matt Mazurek: There are two major factors. First of all, I think that the work environment has deteriorated with regards to workload, administrative burden and resources to take care of patients. So I think that's one of the drivers. The other driver, too, is this downward drift in reimbursements from Medicare and the continued fight for private groups to renegotiate their contract rates with the commercial payers. Unionizing as private groups, of course, doesn't really make much sense, but now that physicians are part of larger systems, I think that's a key driver. Now that we're employees, our autonomy is gone, our ability to self direct is gone. So there's so much power and autonomy and independence that we once enjoyed, that is no longer there. So I think that that overall sentiment of feeling a little bit powerless has given rise to the idea that unionization is the only way for a voice to be heard.

Q: What issues do you think could be addressed through unions or that perhaps could not be addressed without that sort of collective bargaining power?

MM: I think productivity and work expectations, unions could assist with that. I think that's one of the reasons why residents have been pushing more for unions than attending physicians. The other thing, too, is that we used to be able to be patient advocates when we were in charge. If we lacked the resources to take care of a patient when we were in private practice, we could say if we don't get this equipment, we can't take care of the patients. If you're a surgeon or a specialist, you can just take your business elsewhere. If they didn't feel like they could provide the standard of care with the resources being provided, then they could move on.

Now, they can't do that. Now, they're stuck with things like noncompete clauses, which really have physicians with their backs against the wall. I also think that with the union, some of these noncompete clauses may even flat disappear. I think that there's a drive for us to regain some of the control that we once enjoyed, and I think a union is the best vehicle to do that. It's the only vehicle really left. I think unionization is also one of those last resorts, there are obviously bad aspects of being unionized, and they're well known and documented, but the benefits often far outweigh some of the risks and some of the negative attributes of being unionized.

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