When Sean P. Codier, DO, became a leader in the effort to unionize physicians at Salem Hospital in Salem, Massachusetts, he said he knew it was likely a “career-ender.” That is because decisions to unionize have been known to create adversarial relationships between organized physicians and their employers.¹

“We tried a variety of things before unionizing,” said Dr. Codier, an emergency physician at Salem Hospital, which is part of the Mass General Brigham hospital system. Dr. Codier and colleagues wanted to address some of the systemic issues related to the increasing corporatization of the health care industry. Many of these issues started prior to the COVID-19 pandemic but only got worse during and after the pandemic. “Unionization was a last-ditch effort,” he said.

Through his and others’ efforts, the Salem Physicians Union was formed in March 2024 to ensure that “members have a unified and impactful role in the decisions that affect the safety and quality of care of our patients.”²

Although the number of physicians who are union members is still relatively small, there is growing interest. Data from the National Labor Relations Board showed that 44 union petitions were filed with physician members between 2000 and 2022; however, there were 33 petitions filed in 2023-2024, increasing the annual rate more than tenfold from 2.1 per year to 23.3 per year.³

As interest in unionization grows among physicians, it is important to be well-informed about unions and the viability of physician unionization in emergency medicine.

What are Unions?

“In the United States, a union is a group of employees who work for a particular employer who use their collective strength to try to advance their own interests and stop the employer from doing things the union members don’t want them to do,” explained John August, director of healthcare and partner programs at the Scheinman Institute on Conflict Resolution at Cornell University. Members often pay dues to support the union.

The history of unions in the U.S. dates back more than 150 years to the formation of the National Labor Union in August 1866, which called on Congress to mandate an eight-hour workday.⁴ Today, millions of Americans are union members. Gallup polling from August 2024 estimated that seven in 10 Americans (70 percent) currently approve of labor unions, up from a historic low of 48 percent in August 2009.⁵

The right to seek better working conditions and designate representation without fear of retaliation is enshrined in the National Labor Relations Act (NLRA), passed in 1935.⁶ The NLRA applies to most private sector employers, including manufacturers, retail workers, private universities, and health care facilities. It does not apply to government workers or independent contractors, and it does not apply to physician supervisors — although the definition of a supervisor has been subject to legal scrutiny.⁷