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This Week in Primary Care
The Surge in Physician Unionization
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In healthcare across America, something unusual is happening. Attending physicians, a profession historically reluctant to unionize, are organizing at the fastest rate in modern history. They are organizing, not for higher salaries, but because they believe the current structure of healthcare is making it harder to care for patients safely and ethically. Perhaps most significant is the loss of the physician's voice to manage the care of their patients.
A new study of National Labor Relations Board filings reveals that physician unionization efforts have surged more than tenfold in 2023–2024 compared with the prior two decades. From 2000 to 2022, an average of 2.1 physician-involved union petitions were filed per year. In 2023 through May 2024, that annualized rate jumped to 23.3. In addition, these efforts are increasingly successful: 54% of union petitions were certified in 2000-2022, versus 77% in 2023-2024. (See feature below.) The authors analyzed media reports for clinicians’ motivations to unionize, and found 85% cited working conditions, 81% cited lack of voice in management, 54% cited patient care concerns, and only 4% cited compensation.
The bargaining units ranged from small specialty groups to large multisite cohorts, with a median of 45 physicians per unit. A majority of unions included advanced practice clinicians, and more than one-quarter involved broader interdisciplinary coalitions that included nurses and administrative staff. This reflects a growing recognition that workplace conditions and patient care concerns extend across the healthcare team.
The employers targeted tell an important story about the corporatization of medicine. Nearly half of the petitions were filed against hospitals, followed by community health centers and corporate- or private-equity-owned medical groups, including large national firms. Physicians are organizing not in small independent practices, but in consolidated health systems and investor-backed organizations. This reflects the rapid corporatization of medicine, the same trend that drives productivity quotas, incentivizes procedural revenue over prevention, and undervalues relationship-based care.
We are living through a pivotal moment in American health care. As consolidation and corporatization accelerate, more physicians are recognizing that the system is drifting further from its core purpose: caring for people. Physician unions have emerged as one response, but they are not the end goal. Physicians and healthcare workers cannot fix the system alone but they are sending a signal for structural change.
Primary Care for All Americans (PC4AA) offers that structural vision.
PC4AA calls for rebuilding the health system on a foundation of universal primary care access, increased and protected investment in primary care, and real accountability to patients and communities. It is about bringing communities into the equation, helping towns and cities take shared responsibility for their own healthcare infrastructure, starting with primary care.
The investment required is not radical; it is responsible. Comprehensive primary care for an entire community costs no more than what municipalities already spend on police and fire protection. And like police and fire services, primary care functions best when it is universally available. When provided to everyone, it improves population health, stabilizes families, reduces preventable emergency use, and helps employers control the cost of health insurance for their workforce. It is not simply a healthcare intervention; it is civic infrastructure.
Physicians are organizing because they feel the misalignment every day. Administrative directives override clinical judgment. Financial incentives reward volume over prevention. Unionization, while extremely important, is not a replacement for reform. It is one of the few tools available to demand it.
In full transparency, PC4AA newsletter co-editor Valerie Fouts-Fowler is a co-founder of ConcernedUHPhysicians.org, an effort to unionize attending physicians at University Hospitals of Cleveland. She did not begin this journey intending to organize a union. She began by searching for solutions to the systemic problems that were harming patients and burning out clinicians. During this process she learned of Primary Care for All Americans. PC4AA articulated what many were struggling to name: the problem is structural, and so must be the solution.
Now is the moment to move from reaction to reform. The surge in physician unionization tells us something important: the people inside the system are ready for change. PC4AA provides the roadmap. We have started planning for our first national convening, tentatively scheduled on May 20th, 2026 in Cambridge, Massachusetts and tentatively called "How Communities Can Take Control of Their Health." Mark your calendars, and volunteer to participate as part of the planning workgroup by emailing admin@primarycareforallamericans.org!
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