Physician Unionization: A Primer and Prescription

In 1975, anesthesiologists in San Francisco protested high malpractice premiums by refusing to assist in elective surgeries for four weeks. This led to half of the hospital beds in the city emptying and significant financial losses for hospitals. This resulted in legislation capping damage awards to medical malpractice plaintiffs in California.

After the introduction of managed care in 1996, physician incomes decreased by 44 percent. This led to a resurgence in interest in physician “unionization” to preserve the quality of care and professional incomes. This movement is governed by the National Labor Relations Act, which gives employees the right to form unions for collective bargaining. In the late 1700s, efforts began to turn the “healing arts” into a formal profession. By 1830, five states had set standards for physicians. In 1847, the American Medical Association set academic standards for medical education. The “corporate practice doctrine” was established to prevent corporations from employing licensed physicians. This doctrine still exists in over 30 states today. In states where physicians can be employed, there are exceptions to their ability to unionize. One exception is that physicians who have authority over other employees cannot unionize. The National Labor Relations Board has a controversial interpretation of the “supervisory” duty for health care professionals like doctors. The Supreme Court is reviewing this interpretation. The NLRB also excludes managers from the coverage of the NLRA, and a physician may be considered a manager if they make important corporate decisions independent of their medical expertise.

Source: https://www.floridabar.org/the-florida-bar-journal/physician-unionization-a-primer-and-prescription/