It isn’t a stretch to think that doctors who were part of a union as a resident or fellow may be more interested in forming a union later in their careers, Shulman said. “As more people graduate out of those programs and into attending jobs, I think we will slowly see more interest among attendings.”

What Can Be Bargained For?

Unions can use collective bargaining (see sidebar) to negotiate contracts that include terms of employment such as pay, benefits, hours, leave, job safety, and more.

The Salem Physicians Union crosses specialties — emergency medicine, critical care, hospital medicine, psychiatry, pain medicine, pediatric emergency medicine, infectious disease, and palliative medicine — and plans to negotiate for things specific to certain specialties. A common complaint across all specialties is understaffing. At one point, Dr. Codier said the emergency department (ED) had five open spots on its roster, leaving a lot of open shifts. The requirement to maintain staff levels could be included in collective bargaining. Salem Physicians Union is currently in the middle of negotiations related to a new observation unit in the ED; they are in discussions around the type of patients that would be placed in the unit and the qualification criteria for exclusion or inclusion.

“That is the beautiful thing about being in a union … you can negotiate the things that affect your workplace environment,” Dr. Codier said. “We want to be back in on the decision-making process for how care is provided in our community.”

Although pay may not have been the first item, Dr. Codier’s colleagues mentioned in discussions, it was an issue.

“Prior to my arrival it was normal for the organization to negotiate with an individual or a group regarding pay and benefits,’” Dr. Codier said, but this changed with time. Eventually physicians were being told what they would be paid, how much time off they would have, and how many hours they would work, with little or no input at all, he said.

Published data has shown that unionized health care workers earned better pay and received better non-cash benefits compared with non-unionized workers.¹²

Has collective bargaining worked? Dr. Codier said that he and his colleagues started to see changes even before the vote to unionize.