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In a changing medical workplace, Salem Hospital physicians form union through AFSCME

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In a changing medical workplace, Salem Hospital physicians form union through AFSCME
By Pablo Ros ·

Attending physicians at Salem Hospital in Massachusetts voted overwhelmingly last month to form a union through AFSCME Council 93. In doing so, they gained a voice in the decisions that affect patient care and safety at a time of rapid change in the medical workplace.

Just a little more than decade ago, according to the American Medical Association (AMA), most physicians worked in private practice. They made the most important decisions surrounding patient care.

But today, due in part to the COVID-19 pandemic, the doctor’s office — run by a small group of physicians at most — is increasingly rare. The nonprofit Physicians Advocacy Institute estimates that between 2019 and 2022, hospitals and other corporate entities acquired 36,200 physician practices, resulting in a 38% increase in corporate-owned practices and accelerating a trend towards consolidation of the health care marketplace.

One of the consequences of such consolidation is that decisions concerning patient care and safety are being made in corporate offices rather than by doctors.

“The big thing that brought us all together wasn’t compensation, though that needs to be addressed because physician pay has not kept up with inflation over the past several decades,” says Dr. Sean Codier, an emergency room physician at Salem Hospital. “The big thing that brought us together were changes in our health care system, down to the local workplace environment, that we feel have changed the way we provide care to patients, and the changes have been mostly negative.”

Codier is one of 145 physicians at Salem Hospital, part of the Mass General Brigham (MGB) system, who formed the Council 93-affiliated Salem Physicians Union.

“We seek to collect our voices to reassert our rightful place within the house of medicine, to impact positively our hospital, our patients, and ultimately, our health care system,” the Salem union’s mission reads.

Many of the concerns that Codier and his fellow union members have about their workplace began before the pandemic, but things have gotten significantly worse in the last few years.

“We went through this period of the COVID pandemic, this national crisis, that was an all-hands-on-deck type of situation,” says Codier, who began working at MGB in 2018. “But coming out of COVID, we faced a medical system that was understaffed and under-resourced, and we ended up with a situation where we didn’t have a voice or the power to influence how things were conducted in our own hospitals.”

MGB hires 80,000 providers who work in hospitals, labs, outpatient centers and more, and they spend $2 billion in research activities, according to their website. In an organization this big, says Codier, “the voice of a single physician is really small. Only together are we going to be able to address some of the problems we have in common in our health care system.”

Just 7% of practicing physicians in the United States were unionized in 2019, according to the AMA

To Codier, the novelty of organizing physicians is both a challenge and an opportunity.

“Trying to forge new ground and trailblaze a new path was definitely the biggest challenge to us,” he says.

But physicians are a group of professionals accustomed to engaging and helping each other, he adds, and thus unionization “is something that seems to come quite naturally, in the sense that we’re used to collaborating and working in a team environment, so it’s not a huge step to engage in the organizing process.”

Codier hopes that the victory he and his co-workers achieved is just the beginning of a trend of physicians coming together in unions. Since news of their success spread, Codier has heard from several groups of doctors who are also seeking a voice in the workplace.

“It is a very encouraging thing to see physicians across the country taking a proactive approach and starting to talk to each other and taking risks to really address these problems and speak up for each other and themselves,” he says. “The only way physicians in this country are going to be heard is if we’re heard together.”

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