The horse was out of the barn though. He is quick to add that the process of unionization is not without struggles. The partnership with AFSCME provided Dr. Codier and other union leadership with protection and an advocate for their legal rights, both of which were a vital part of the process, he said.

Where are EM Docs Unionizing?

Salem Physicians Union was not the first in this wave to unionize, and likely will not be the last.

A group of physicians, advanced practice nurses, and physician assistants in the ED at Providence Medford in Medford, Oregon, unionized in 2023,¹³ and were recently able to negotiate a 20.7 percent hourly wage increase in their contract with Pacific Northwest Hospital Medicine Association.

A group of contract emergency physicians, physician assistants, nurse practitioners and lead advanced practice clinicians — contracted through TeamHealth — unionized in 2023 and spent months negotiating with Ascension St. John Emergency Department in Detroit, Michigan, before going on a 24-hour strike in August 2024. The Greater Detroit Association of Emergency Physicians saw some changes because of the strike, but it appears as if Ascension St. John did not renew its contract with TeamHealth.¹⁴ Doctors there were forced to reapply for their own jobs when a new contract management group was hired.¹⁵

More than 400 physicians at Delaware’s Christiana Care formed a union in 2024, joining Doctor’s Council. The group includes physicians from Christana Hospital, Wilmington Hospital, and Middletown Freestanding Emergency Department. They formed the union to address many of the needs outlined by Dr. Codier: patient safety, professional autonomy, and corporate influence on decision-making, among other things.¹⁶

August said he believes the formation of physicians’ unions is somewhat inevitable, and that a union at one of the nation’s leading medical institutions would create an explosion of unionization.

The NLRA mandates union membership if a workplace is unionized. Physicians considering joining a workplace where a union already exists should be fully informed about the local union.

“You have to be in the union if your group of physicians is already unionized,” Dr. Codier said of the Salem Physicians Union. “If someone had a strong moral stance against unions, they would still get all the benefits of being represented by the union but would have to pay the equivalent in union dues to a charity of some kind.” He also pointed out that, generally speaking,  most unions, including AFSCME, do not charge dues until the first contract is ratified.