Dr. Haddock: I think unionization is an option emergency physicians need to know more about and be able to consider, depending on their employment situation. We know that partnership groups can’t have unionized members. If you’re a partner, you can’t be in a union, so seeing the growth of those groups in order to restore autonomy is wonderful. But if you’re not in a position to be a partner, unionization can be a way for individual emergency physicians to gain leverage with their employers to secure better compensation and benefits.

I was excited to see that the group in Oregon, which finalized its contract, negotiated not just substantial raises but also improvements in the working environment. One of the key items negotiated was about limiting how much emergency physicians are pulled from the emergency department (ED) to provide care elsewhere in the hospital. It’s not just about pay. It’s about whether you can focus on your job, which is predominantly taking care of patients in the ED, and only responding to calls outside the ED for truly emergent situations. That kind of negotiation can help reduce burnout and the feeling of lost autonomy. The union also negotiated increased shift differentials for night shifts. Previously, nocturnists weren’t paid enough extra for those hours, and now that’s been addressed. That’s a win.

Dr. Dark: Alright, let’s talk about private equity. Everybody’s talking about it these days. Just this week I saw that a beloved, local Houston doughnut shop, Shipley’s, was acquired by a California private equity firm. It went from one private equity firm to another.¹ The doughnut shop cited “transformational growth” as a benefit of the private equity partnership. My question to you is, “Why aren’t doughnuts and doctors the same kind of commodity?”

Dr. Haddock: I love that question. We’ve seen many challenges with treating health care like a commodity. Emergency physicians choose this specialty because we believe in the mission to care for anyone, anytime, for any problem. The private equity model is focused on short-term profits, which doesn’t align well with that mission.

Many emergency physicians working for private equity-owned companies feel their work is undervalued. This year, I’ve been giving a talk across the country titled “Financialization and Emergency Medicine.” It’s about the corporatization and market forces that have transformed our field over the last 20 years. Evidence on how private equity affects quality and cost of care is mixed, especially in emergency medicine. We need more data and research.