ChristianaCare doctors are riding the medicine unionization wave a year after Penn residents

Dozens of doctors working at ChristianaCare dialed into a Zoom call last week to learn more about union organizing from their peers in Minnesota and Oregon.

There’s no precedent in the Philadelphia region for the effort underway at ChristianaCare, Delaware’s largest health system, where attending physicians will decide over the coming days whether to form a union. If approved, it would be the first of its kind locally for hospital-employed physicians who have completed their training.

Ahead of the weeklong voting period — which will start Thursday — some of the roughly 70 ChristianaCare doctors on the Zoom call still had questions. The vast majority of physicians in the U.S. are not part of unions, and many are unfamiliar with the mechanics of collective bargaining.

» READ MORE: ChristianaCare physicians will vote on whether to unionize. Here is how each side is making its case.

“What did you have to give up to get more teams, better patient census limits, more money?” one attendee asked, according to a recording of the event obtained by The Inquirer. “It seems too good to be true.”

Physicians gave up little when they unionized at PeaceHealth in Oregon, said David Schwartz, who specializes in care for hospitalized patients at the West Coast health system. He explained that their first contract negotiations took 18 months and were contentious, but subsequent contracts have gone smoothly.

“[Administrators] realized that when they were speaking to us, they were speaking to all of us,” Schwartz said.

» READ MORE: ChristianaCare attending physicians are taking the first step toward forming a union

That privately employed doctors would want a union signals a shift in the medical landscape. American physicians traditionally were not part of organized labor. Three out of every four physicians in the U.S. owned the medical practices where they worked in the early-1980s, according to the American Medical Association.

But that has been changing amid a broader restructuring of health-care employment. Hospitals are consolidating under large health systems, and often acquiring private practices to directly employ the physicians responsible for their patients’ care. Systems claim that by getting bigger, they can better control costs and improve the way health care is delivered.

In 2022, an estimated 74% of practicing physicians in the U.S. were employed by hospitals, health systems, and other corporate entities — a complete reversal from the rate of physicians who were self-employed just four decades ago.

Physicians are also reporting high rates of burnout since the COVID-19 pandemic, and many say they’re frustrated with the load of administrative tasks they are required to carry out, eroding the time they can spend with patients.

In response, a growing number of physicians are turning to unions. Newly graduated doctors completing their medical training as residents and fellows at Penn Medicine’s Philadelphia hospitals in May 2023 formed the largest new union in Philadelphia in half a century.

Now, ChristianaCare’s more than 400 attending physicians are poised to extend the trend to physicians who are no longer in training. If the attending physicians unionize, they would also be the first ChristianaCare employees to do so in the health system’s 136-year history.

The growing number of physicians working as employed staffers for hospitals opened the gate to unionization. The National Labor Relations Act guarantees a right to unionize for workers who are not owners or managers of their workplace.

Last fall, more than 400 attending physicians at Allina Health in Minnesota and Wisconsin formed a union, making them the largest group of unionized doctors in a privately owned hospital.

“For the past couple of years, we’ve been having a lot of doctors inquire about how to join a union,” said Frances Quee, president of Doctors Council, a national group that’s part of Service Employees International Union, and helped Allina physicians in their unionization.

The ChristianaCare physicians are also unionizing with Doctors Council.

Another SEIU group has been even more active. The Committee of Interns and Residents has been unionizing physicians in training during their residency and fellowship years throughout the country.

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Penn’s Philadelphia residents and fellows unionized last spring and have been negotiating a contract since. Outside the Philadelphia area, residents and fellows unionized over the last couple years at Mass General Brigham in Boston, George Washington University in D.C., Montefiore Medical Center in New York City, and Kaiser Permanente hospitals in Northern California, among other hospitals and health systems.

Rutgers University medical residents reached their first contract last summer, getting a pay increase, a $25 meal stipend per shift, and $1,300 annual education stipend.

The attending physicians working at hospitals have been paying attention to the organizing by trainees in their hospitals.

“They’re also interested, especially since the residents were able to unionize,” Quee said.

Michael Noonan, a ChristianaCare physician who provides end-of-life care, completed his residency training at Boston Medical Center, where trainees have been part of a union represented by the Committee of Interns and Residents since the 1990s.

Now, he answers his peers’ questions about what it’s like to work in a unionized environment.

One concern: The union will lead to a one-size-fits-all contract. Noonan has been telling his peers that a union contract can accommodate each department’s needs while securing sweeping protections for working doctors.

“What is changing right now is our voice,” Noonan said.