Trends in Labor Unionization Among US Health Care Workers, 2009-2021

Abstract

ImportanceLabor unionization efforts have resurged in the US, and union membership has been shown to improve worker conditions in some industries. However, little is known about labor unionization membership and its economic effects across the health care workforce.ObjectivesTo examine the prevalence of labor unionization among health care workers and its associations with pay, noncash benefits, and work hours.Design, Setting, and ParticipantsThis cross-sectional study was conducted using data from the Current Population Survey and Annual Social and Economic Supplement from 2009 through 2021. The US nationally representative, population-based household survey allowed for a sample of 14 298 self-identified health care workers (physicians and dentists, advanced practitioners, nurses, therapists, and technicians and support staff).ExposuresSelf-reported membership status or coverage in a labor union.Main Outcomes and MeasuresPrevalence and trend in labor unionization. Further comparisons included mean weekly pay, noncash benefits (pension or other retirement benefits; employer-sponsored, full premium–covered health insurance; and employer’s contribution to the worker’s health insurance plan), and work hours.ResultsThe 14 298 respondents (81.5% women; 7.1% Asian, 12.0% Black, 8.5% Hispanic, 70.4% White individuals; mean [SD] age, 41.6 [13.4] years) included 1072 physicians and dentists, 981 advanced practitioners, 4931 nurses, 964 therapists, and 6350 technicians and support staff. After weighting, 13.2% (95% CI, 12.5% to 13.8%) of respondents reported union membership or coverage, with no significant trend from 2009 through 2021 (P = .75). Among health care workers, those who were members of a racial or ethnic minority group (Asian, Black, or Hispanic individuals compared with White individuals) and those living in metropolitan areas were more likely to report being labor unionized. Reported unionization was associated with significantly higher reported weekly earnings ($1165 vs $1042; mean difference, $123 [95% CI, $88 to $157]; P < .001) and higher likelihood of having a pension or other retirement benefits at work (57.9% vs 43.4%; risk ratio [RR], 1.33 [95% CI, 1.26 to 1.41]; P < .001) and having employer-sponsored, full premium–covered health insurance (22.2% vs 16.5%; RR, 1.35 [95% CI, 1.17 to 1.53]; P < .001). Union members reported more work hours (37.4 vs 36.3; mean differences, 1.11 [95% CI, 0.46 to 1.75]; P < .001) per week. White workers reported mean weekly earnings that were significantly more than members of racial and ethnic minority groups among nonunionized workers ($1066 vs $1001; mean difference, $65 [95% CI, $40 to $91]; P < .001), but there was no significant difference between the 2 groups among unionized workers ($1157 vs $1170; mean difference, −$13 [95% CI, −$78 to $52]; P = .70).Conclusions and RelevanceFrom 2009 through 2021, labor unionization among US health care workers remained low. Reported union membership or coverage was significantly associated with higher weekly earnings and better noncash benefits but greater number of weekly work hours.

Strikes, patient outcomes, and the cost of failing to act

“…For example, a cross sectional study of around 14 000 healthcare workers in the US found that, although labour union membership remains low overall (13.2%), unionised healthcare workers had significantly higher reported weekly earnings ($1165 v $1042; mean difference, $123, 95% confidence interval $88 to $157, P<0.001) and better non-cash benefits than non-unionised workers. Furthermore, union membership protected against race based wage disparities in this sample 34…”

Challenges to Forming Physician Unions

“…I believe that my experience is not unique and may explain why only 9.8% of the employed physician workforce is unionized . It is clear to me that unionization of physicians will not succeed as a grassroots effort, and must come from outside the health care organization.…”

Labor Unionization Among Physicians in Training

“…Physicians in training (interns, residents, and fellows) with government employers have always had the right to unionize, whereas those with private employers regained it in 1999 . Given recent concerns about work conditions, burnout, and patient safety, physicians in training appear increasingly interested in collective activism, but little is known about their unionization efforts . We assessed the number of unique unions and characteristics of unionization elections among physicians in training.…”

“…1 Given recent concerns about work conditions, burnout, and patient safety, physicians in training appear increasingly interested in collective activism, 2 but little is known about their unionization efforts. 3 We assessed the number of unique unions and characteristics of unionization elections among physicians in training.Methods | Labor unions represent a bargaining unit-employees with common interests and work responsibilities-against a specific employer, which may include more than 1 hospital or health care system and physicians in training from multiple…”