ChristianaCare attending physicians are taking the first step toward forming a union

Physicians at ChristianaCare, Delaware’s largest health system, are petitioning to form the first union in the Philadelphia region for hospital-employed attending doctors.

Doctors increasingly are looking to unions to advance their workplace concerns and negotiate their benefits, as a growing number of physicians work as hospital staffers.

ChristianaCare doctors say they are being forced to work in unacceptable conditions, including taking care of a large number of patients without adequate time or support. They also say the number of administrative tasks they are required to do has increased in recent years, but the health system has not accounted for the time the tasks require.

Their organizing push follows last year’s creation of a union for physicians-in-training at Penn Medicine’s Philadelphia hospitals, also the first of its kind in the region.

Now, more than two-thirds of roughly 450 attending physicians who staff Christiana Hospital in Newark, Wilmington Hospital, and the Middletown Free-Standing Emergency Department have signed a petition saying they’d want to be represented by the Doctors Council, which is part of Service Employees International Union (SEIU).

The organizers informed ChristianaCare administrators this week that they were seeking recognition for their union from the nonprofit health system.

The drive reflects frustration among physicians over the long hours they have been working since the beginning of the COVID-19 pandemic in 2020. During the health emergency, they focused on the work. But they say the working conditions did not improve as the pandemic waned, and hospitals received fewer patients. Physicians stay after hours to call patients and finish writing medical notes in charts — time that otherwise they’d spend with family.

“It’s really an unsustainable practice,” said Bryan Haimes, who works at ChristianaCare as both a pediatrician and an internal medicine physician.

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ChristianaCare recognizes the rights of the physicians to vote on whether they want to be represented by a union, a spokesperson for the system said in a statement.

“We believe that continuing to have a direct relationship with physicians is an essential component of our continued shared success,” the statement said.

The next step in the process is a National Labor Relations Board-administered union election in the coming weeks.

Recent unionization efforts by physicians reflect changes in how doctors are employed, experts say.

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 in the decades since, as health-care providers consolidated under large systems, the number of physicians working in private practices has dwindled. Health systems and large hospitals increasingly employ doctors directly. In 2018, for the first time, the number of physicians working as staff exceeded those who were self-employed.

But physicians’ unions remain rare. Fewer than one in 10 physicians were in a union in 2019, according to AMA data that includes nonprofit organizations, government employees, and physicians-in-training.

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The changing employment model, accompanied by pressure to treat larger numbers of patients, have made physicians feel like “workers on an assembly line,” said Gennadiy Ryklin, a physician who splits his time between the Wilmington and Christiana hospitals.

“It all boils down to how much time I can spare with a patient,” Ryklin, who takes care of patients during their hospitalization, said. “Now I feel that my job is about checking checkboxes.”

At ChristianaCare, the union would represent attending doctors — those who have fully completed their medical training. Although unions are more common among health-care professionals such as nurses, technical specialists (like X-ray techs), and administrative hospital workers, the physicians’ unions would be the first of any kind in ChristianaCare’s 136-year history.

Because physicians’ unions are still unusual among their peers, the doctors involved say they had to educate themselves about their rights. For instance, Ryklin wanted his peers to know that the physicians themselves will have a seat at the bargaining table.

Organizers say a recent dispute with the health system’s management showed the strength that workers gain from banding together.

In December, ChristianaCare announced changes in the paid time-off policy for physicians caring for hospitalized patients. When physicians complained individually, management didn’t respond. A group of attendings signed a letter to management expressing their discontent. Administrators then met with the physicians, and changed parts of the new time-off policy.

“When we bound together and sent them collectively a letter from 100 physicians, then they sat with us and listened,” Haimes said.