Should physicians unionize?

Sofia Ramirez

Alright, it's time to dive into a topic that's been buzzing recently—physicians organizing and forming unions. It feels like the conversations around this are getting louder, and today we're tackling it head-on.

David Caldwell

Yeah, and honestly, I've gotta say, I never thought of physicians as the "unionizing" type. I mean, isn’t medicine traditionally all about individual autonomy?

Sofia Ramirez

Well, it is, and that’s part of what makes this so interesting. But before we get too deep, quick disclaimer for our listeners—we're your AI hosts, remember? This episode is prepared and edited by Dr. Swanson, who's an ER physician. All credit to him for digging into these topics. We're just here to deliver the goods... with flair, of course.

David Caldwell

Flair? Oh, sure. So, think of this as Dr. Swanson's informal conversation with the world, assisted by AI. Who better to bring the flair than artificially intelligent podcasters?

Sofia Ramirez

Exactly. Anyway, Dr. Swanson’s been busy. Here’s a quick rundown of the stuff he’s been reading and listening to these past few days. First up, Robert Bowman of Basic Health Access chimed in on a LinkedIn post Dr. Swanson made about Cityblock.

David Caldwell

Cityblock. That’s the model focused on value-based, integrated primary care, right?

Sofia Ramirez

Exactly. What’s cool is, Bowman brought up two other models that are doing something similar—Southcentral Foundation and ChenMed. Southcentral Foundation is based in Alaska and practices what’s called the Nuka approach. It’s a relationship-based system tailored to the indigenous population. It focuses on culturally aligned, person-centered care. ChenMed, on the other hand, caters more to seniors in underserved areas. They emphasize preventative care and operate under a fully capitated model—which basically means they take on all the financial risk for their patients' care.

David Caldwell

Huh. Two very different models, but both trying to break away from, you know, the traditional one-size-fits-all approach. Love that. Okay, what else did Dr. Swanson dig into?

Sofia Ramirez

He watched Dr. Vinay Prasad’s video on YouTube—“Why the NIH is a Broken Funding System.” If you haven’t heard of him, Prasad’s a hematologist-oncologist and researcher. He’s provocative, critical—not afraid to challenge the status quo—and honestly, I think he comes off a bit irreverent.

David Caldwell

Irreverent? Ha, sounds like my kinda guy. What’s his main gripe with the NIH?

Sofia Ramirez

It’s complicated, but here’s the gist. He argues that NIH funding is stagnant and overly conservative. He feels it doesn’t prioritize innovation or younger researchers, who are often stuck waiting years for their first major grant. There’s also a heavy reliance on grants for maintaining academic careers, which, according to him, creates inefficiencies and even stifles creativity.

David Caldwell

Wow. So, he’s saying the whole system isn’t just outdated, it's actively slowing down progress?

Sofia Ramirez

That’s basically his point, yes. Speaking of NIH, Dr. Swanson also came across Dr. Jay Bhattacharya. He’s been floated as a candidate for NIH Director. There’s a lot to unpack there, but Bhattacharya seems to focus on counterpoints to pandemic policies, especially around lockdowns. His message revolves around the broader impact on public health—not just the virus but also mental health, delayed care for chronic conditions, and economic disparities.

David Caldwell

So a massive systems thinker. Definitely a shift from what most people associate with NIH leadership. What about the last resource Dr. Swanson checked out?

Sofia Ramirez

That was a video by Dr. Erik Bricker. Bricker talked about healthcare cost transparency—or, well, the lack of it. He made a case for why patients need clearer pricing and providers need better incentives to curb spending. It’s a pretty familiar tune if you’ve been following healthcare reform, but his way of breaking it down was practical and easy to follow.

David Caldwell

So, we’ve got value-based care models, a broken funding system, economic ripple effects, and transparency—whew. That's quite a mix.

Sofia Ramirez

It definitely is. And that's just the grounding for today’s conversation on physician unions.

Sofia Ramirez

Alright, diving in, let’s explore what physicians organizing actually means. You might not think of doctors as the "unionizing" type, but there have been efforts over the years. It’s faced pushback though, largely because of the profession’s culture of autonomy and prestige—that’s a tricky balance to navigate.

David Caldwell

Right, I mean, medicine has always been seen as this individualistic career… like the independent genius saving lives, not someone marching with a sign, you know?

Sofia Ramirez

Exactly. Medicine is steeped in this sense of individuality. But here’s the kicker: the healthcare landscape has changed so drastically in the last couple of decades. Doctors today are increasingly employed by large health systems or corporations rather than working in private practice. That shift is eroding some of that independence.

David Caldwell

Huh, so they’re more like employees now—with bosses and everything. That’s gotta be a big adjustment for people who spent their whole lives training to call the shots.

Sofia Ramirez

Absolutely. And with that shift comes the same challenges employees face anywhere else: excessive workloads, limited decision-making power, and burnout. Many physicians feel like they’re being forced to prioritize metrics and quotas over patient care.

David Caldwell

Okay, so let me see if I’ve got this straight. They’re caught in these high-stakes environments, trying to navigate systems that don’t always have their—or their patients’—best interests in mind?

Sofia Ramirez

That’s exactly it. For example, there was this article in The New Yorker—Dr. Swanson flagged it for us—about why physicians should organize. The author, Eric Topol, dives into how unionization could give physicians more collective power to resist harmful policies, like patient quotas that risk compromising care.

David Caldwell

But unionizing is a drastic step, right? Are we seeing doctors really willing to do this, or is it still just hypothetical talk?

Sofia Ramirez

There’ve been real moves. Resident physicians at hospitals like UCSF have unionized successfully, and they’ve seen concrete changes—higher wages, better benefits, and more reasonable working hours. It’s proof that collective action can make a tangible difference for doctors and their patients.

David Caldwell

Okay, but what about the flip side? I mean, doesn’t unionizing bring challenges, too? Like, would these massive health systems fight back?

Sofia Ramirez

Definitely, and we can’t ignore that there’s a potential for friction. After all, these systems often prioritize financial goals, and a union’s demands could cut into profits. But that tension is exactly why these conversations are happening more often now—especially with burnout levels hitting crisis points.

David Caldwell

Burnout as a rallying cry. That’s, uh, pretty powerful. And also, kind of heartbreaking when you think about how much time and passion actually goes into becoming a doctor in the first place.

Sofia Ramirez

It is. It’s a profession built on healing and trust, and when physicians feel that their working conditions prevent them from doing their best, it’s a problem we all need to care about. But this isn’t just about individual well-being—it’s about the larger systemic impact, too.

David Caldwell

So, by organizing, they’re not just protecting themselves, they’re also trying to reclaim the focus on the patient. That’s fascinating.

Sofia Ramirez

It really is, and it sets the stage for some important questions about what collective bargaining could look like for a profession that’s traditionally resisted it.

Sofia Ramirez

To bring this all together, let’s consider a real-world example. Dr. Bryan Haimes, a hospitalist at ChristianaCare, has become a prominent advocate for unionizing physicians. He highlights how collective bargaining isn’t just theoretical—it’s a practical approach to tackling burnout, reducing excessive workloads, and improving work-life balance for doctors.

David Caldwell

Okay, excessive workloads. I mean, I know things can get, like, super demanding in healthcare, but how bad are we talking here?

Sofia Ramirez

Pretty bad. Doctors are often working 60 to 80 hours a week, and that’s not sustainable—mentally or physically. Burnout isn’t just some buzzword here; it’s a legitimate epidemic in the profession. And beyond the personal toll, it directly affects patient care.

David Caldwell

Yikes. So you're saying doctors are basically at their breaking point, and the system just… expects them to keep going?

Sofia Ramirez

Exactly. And that’s where something like unionizing becomes appealing. It’s like a way for physicians to say, "Enough is enough." Last year, over 500 physicians at ChristianaCare in Delaware and Maryland decided to do just that. They voted to join the Doctors Council SEIU, which is one of the largest organizations working to represent doctors.

David Caldwell

Wait, they actually unionized? Like, this isn’t just people talking—it’s happening?

Sofia Ramirez

Oh, it’s definitely happening. And they’re already using their collective power to negotiate for better working conditions—things like more manageable workloads, additional support systems, and policies that allow for a healthier balance between their professional and personal lives.

David Caldwell

Okay, but when you say “support systems,” what does that mean exactly? Like hiring more staff or…?

Sofia Ramirez

That’s part of it. It can mean more nurses, better access to mental health resources for the doctors themselves, or having proper administrative support so physicians aren’t bogged down by non-clinical tasks like endless paperwork. It’s about making the system work for them, instead of just squeezing every ounce of energy they’ve got.

David Caldwell

Got it. So, it sounds like the union is kind of like their lifeline—giving them a way to push back against this pressure cooker environment.

Sofia Ramirez

Absolutely, and it also normalizes the idea of collective power in a field that’s traditionally been so focused on individuality. It’s a clear signal to health systems that doctors can—and will—stand up for what they need to take care of their patients and themselves.

Sofia Ramirez

Building on that, let’s dive into how this collective action enhances physicians' bargaining power. For instance, the Doctors Council SEIU has been pivotal in helping physicians secure tangible improvements—like better pay, expanded benefits, and significantly improved working conditions.

David Caldwell

Okay, but can they really change those things on a big scale? Like, do you have an example where it’s worked?

Sofia Ramirez

Absolutely. Just last year, in October 2023, over 500 clinicians—doctors, nurse practitioners, physician assistants—at Allina Health in Minnesota voted to unionize. It’s one of the largest private-sector clinician unions formed in the U.S.

David Caldwell

Whoa, 500 clinicians? That’s—that’s huge. So, what pushed them to unionize?

Sofia Ramirez

It was a mix of things. They were looking for better compensation, yes, but also greater input into workplace policies. You know, they wanted to shift the balance of power so it’s not just the administrators calling all the shots.

David Caldwell

Right, like, they needed a seat at the table instead of just getting handed decisions that affect their daily lives.

Sofia Ramirez

Exactly. And by banding together, they’ve created a structure for negotiating policies that actually work for them, rather than being stuck reacting to decisions made without their input. It’s a powerful shift.

David Caldwell

So instead of just fighting individual battles behind closed doors, they have this... collective voice. That’s gotta feel like a game changer for them, right?

Sofia Ramirez

Absolutely. And it’s not just about money or benefits—it’s also about protecting their ability to advocate for patients without fear of retaliation from management.

Sofia Ramirez

And that shift doesn’t just amplify their collective voice—it also provides immediate protections that matter. For example, one major benefit of unionizing is safeguarding physicians when they raise concerns about patient care or workplace policies that might otherwise put them at risk.

David Caldwell

Risk? You mean, like, getting fired for rocking the boat?

Sofia Ramirez

Exactly. That, or being sidelined. It’s unfortunately not uncommon for clinicians to face retaliation—subtle or otherwise—when they raise concerns. Dr. Geneva B. Tatem, she’s a pulmonologist in Detroit, has been very outspoken about this. She’s highlighted how unions can shield physicians from these kinds of consequences.

David Caldwell

Hmm. I never really thought about that. Doctors are usually the ones we see as the authority figures, but it sounds like even they, uh, need backup sometimes.

Sofia Ramirez

They do, and unions offer exactly that. One recent example comes from the Salem Hospital in Massachusetts. Back in March 2024, the hospital’s physicians came together to form the Salem Physicians Union.

David Caldwell

And what was the tipping point for them? Like, why now?

Sofia Ramirez

It came down to protections against unfair labor practices and having a formal way to address grievances. They wanted to ensure they could advocate for both themselves and their patients without fear of repercussions. Creating a union gave them that platform.

David Caldwell

Wow. It's wild that they had to go to these lengths just to feel safe calling out problems. But I guess it makes sense if the stakes are high enough.

Sofia Ramirez

Exactly. And for physicians, it’s not just about their individual working conditions—it affects patient care, too. When a doctor feels they can’t speak openly about unsafe practices or policies, it ripples into the quality of care patients receive.

Sofia Ramirez

Building on that, let’s talk about how unionizing doesn’t just shield physicians—it empowers them to advocate more effectively for patient care standards. The American College of Emergency Physicians—ACEP for short—has been discussing this very topic. They emphasize that a united voice enables doctors to push for critical improvements that not only address their working conditions but also significantly enhance the care patients receive.

David Caldwell

Wait, so what does that look like in practice? Are we talking about, like, doctors actually going on strikes or something?

Sofia Ramirez

Well, yes, in some cases. Take the emergency medicine physicians at Ascension St. John Hospital in Detroit. Just this past April, in 2024, they organized a one-day strike. Their main issue? Staffing shortages that were compromising patient care. They wanted better conditions—not just for themselves, but for the people they’re treating.

David Caldwell

Huh, a strike. That’s a bold move. I mean, doctors are, you know, usually the ones running into emergencies, not stepping away from them.

Sofia Ramirez

Exactly. And that’s why this particular strike stood out. It wasn’t about walking away from patient care, but, honestly, about ensuring they could provide the level of care their patients deserve. They were fighting for safer staffing levels. When you’ve got too few physicians covering an ER, it’s not just exhausting—it’s dangerous.

David Caldwell

Yeah, I mean, if you’re one of the few doctors on call and the place is flooded with patients, there’s no way you can give everyone the attention they need.

Sofia Ramirez

Exactly. And that’s at the heart of why unionization is becoming more appealing to a lot of physicians. It’s about advocating for patients when the system isn’t set up to do that on its own. Case in point, the Detroit physicians used their union to make their voices heard and demand better conditions for everyone involved.

David Caldwell

It kinda makes you wonder why hospitals don’t address these issues before it gets to the point of a strike, you know?

Sofia Ramirez

Right? But it comes down to priorities. For most hospitals, financial concerns often take the lead, leaving things like staffing to, well, lag behind. Unions force these issues to the forefront—it’s harder to ignore a collective demand.

David Caldwell

So, instead of just complaining, they’re saying, “Hey, let’s actually fix this—for the patients and for us.”

Sofia Ramirez

Exactly. And it’s not just symbolic. These actions can lead to real changes, like better nurse-to-patient ratios or policies that ensure more sustainable workloads. These aren’t just “nice to have” things—they’re essential for effective care.

Sofia Ramirez

Now, on the flip side, let’s explore one of the big criticisms of physician unionization—strikes. While actions like the one we discussed in Detroit highlight the push for better care, opponents argue there are significant risks involved. They worry that delaying or disrupting care during a strike could harm patients, especially in critical, time-sensitive situations.

David Caldwell

Okay, but physicians striking… isn’t that, like, really rare? I mean, most doctors probably see it as a last resort, right?

Sofia Ramirez

Oh, definitely. Strikes in medicine are rare. No one goes into healthcare thinking, "Someday, I might walk off the job." But even when strikes are rare or short, they can have serious implications—for both patients and the physicians themselves.

David Caldwell

Like what? What kind of impact are we talking about?

Sofia Ramirez

Well, think about any delay in critical care settings—like emergency departments or ICUs. One case worth noting is the strike this past April at Ascension St. John Hospital in Detroit. Emergency physicians struck for just one day, but it caused enough concern that officials had to bring in temporary, out-of-state doctors to cover shifts. That’s not ideal, especially when seconds can matter for a patient’s outcome.

David Caldwell

Right, makes sense. I mean, if you’re a patient with a serious issue, you’re not exactly, uh, gonna wait around hoping the staffing crisis sorts itself out.

Sofia Ramirez

Exactly. Even if the strike is about improving long-term patient care, the immediate impact can feel counterproductive. Critics point out it's a tough balance—advocating for broader change versus protecting patients in the short term.

David Caldwell

But what’s the argument doctors make for pushing through with a strike? Like, why take that risk?

Sofia Ramirez

Good question. Most physicians who join strikes argue they’re trying to address systemic issues that would otherwise compromise patient care in the long run—things like chronic understaffing or unsafe workloads. But even with the best intentions, the optics of stepping away from patient bedsides can be… dicey, to say the least.

David Caldwell

Yeah, I can see how that would put them in a tough spot. It’s like, do nothing and risk burnout—or take action and risk those optics and delays. No win-win scenario there, huh?

Sofia Ramirez

It’s a lose-lose in some ways, and that’s why strikes are so controversial. Even when they’re framed as a “last resort,” the disruption opens up a whole debate about ethics.

Sofia Ramirez

And that brings us to one of the biggest hurdles physicians face when discussing unionization or even considering strikes—the question of ethics. It’s hard to ignore the weight of the Hippocratic Oath, this commitment to “do no harm” that forms the foundation of medical practice.

David Caldwell

Right. So if the Oath says “do no harm,” a strike could be seen as, well, going against that commitment, right?

Sofia Ramirez

Exactly. Dr. Jeremy Lewin wrote about this last December, and he framed it as a real ethical dilemma. He argued that stepping away from patient care for any reason, even to address systemic issues, feels inherently at odds with the principles of the profession.

David Caldwell

Hmm, that’s a tricky spot to be in. I mean, I get it—on one hand, you’ve got these larger problems to tackle, but on the other, people need care right now.

Sofia Ramirez

And it’s not just hypothetical. When physicians at the University of California system went on strike back in 2015, it was a two-day work stoppage. Even though emergency services remained staffed, outpatient procedures were delayed, and that sparked debates about whether the benefits of the action outweighed the immediate risks to patient care.

David Caldwell

So even if they kept emergency services running, people still felt the effects of the strike.

Sofia Ramirez

They did. And critics were quick to point out how it created a ripple effect—essentially questioning how doctors could reconcile their responsibility to patients with collective action that inherently disrupts care, even temporarily.

David Caldwell

Okay, but to be fair, doesn’t this boil down to intent? Like, they’re not stopping care to, you know, take a day off. They’re pushing back because they believe the system itself is harming patients in the long run.

Sofia Ramirez

Oh, absolutely. And that’s the argument many physicians make—what good is patient care today if the system collapses tomorrow? But it’s a nuanced balance. Striking or organizing is always going to raise tough questions about where to draw the line between immediate duty and long-term advocacy.

Sofia Ramirez

Building on that delicate balance between obligations and advocacy, another concern many physicians raise about unionization is the potential loss of individual autonomy. Some doctors worry that being part of a union could mean giving up their ability to negotiate contracts that fit their unique needs or practice in a way that aligns with their personal philosophy of care.

David Caldwell

Wait, you’re saying that by joining a union, they can’t just, like, hash out their own deals anymore? It’s all standardized?

Sofia Ramirez

Not necessarily, but that’s the concern. With collective bargaining, you do gain a unified voice, but you’re also agreeing to shared terms that might not suit every individual’s preferences. For example, let’s say a physician values flexibility in patient scheduling, but a union contract prioritizes reducing overall hours—that could create tension.

David Caldwell

Huh, I can see how that’d be a tough pill for some physicians. I mean, autonomy is what draws a lot of people to medicine in the first place, right?

Sofia Ramirez

Exactly. Autonomy has always been a cornerstone of the profession. And historically, physicians have been seen as independent practitioners—masters of their own craft, so to speak. But that image is shifting as more doctors find themselves employed by large healthcare systems, where policies are often dictated from the top down.

David Caldwell

Right, like they’re already giving up some autonomy by working under massive organizations, and now unionizing could feel like even more restrictions.

Sofia Ramirez

That’s the fear for some. A recent example would be the Salem Physicians Union, which formed earlier this year. It triggered debates among doctors in that community. On one hand, joining the union gave them more leverage in negotiating workload limits and compensation. But on the other hand, there were concerns from some members about losing the ability to negotiate individual terms that reflected their specific circumstances.

David Caldwell

Interesting. So, it sounds like a trade-off—get collective power but lose a bit of personal freedom. Do you think that’s why some doctors are hesitant to organize?

Sofia Ramirez

Absolutely, and it’s a valid hesitation. Medicine attracts people who value independence and control over how they practice. Forcing everyone into the same framework can feel, well, limiting—to use a mild word. But the flip side is that autonomy might already be eroding, especially if you’re stuck in a system where you don’t have any bargaining power at all.

David Caldwell

Oh, wow. So doctors end up choosing between two kinds of control—individual freedom versus a collective voice. That’s… not an easy decision, is it?

Sofia Ramirez

That trade-off between individual freedom and collective power doesn’t just raise personal concerns for physicians—it’s further complicated by legal hurdles. For example, anti-trust laws, which were originally intended to prevent monopolistic practices, can unintentionally make collective action efforts for doctors much harder to navigate.

David Caldwell

Wait, anti-trust laws? Aren’t those the ones aimed at, like, giant corporations from gobbling up all the competition? How does that affect physicians trying to organize?

Sofia Ramirez

Great question. So, technically, independent contractors—like many physicians in private practice—can be classified as running their own businesses. That puts them in a position where, under anti-trust rules, collective bargaining could be seen as price-fixing, since they’re negotiating as competitors rather than employees.

David Caldwell

Whoa, wait a second. You’re saying that by joining a union, they could actually be breaking laws meant for corporate monopolies?

Sofia Ramirez

In some cases, yes. It’s a tricky legal gray area. And for employed physicians, who are technically staff, the barriers are different but no less significant. This is where supervisory roles come into play. Under U.S. labor law, employees who are considered supervisors or managerial staff aren’t typically allowed to unionize.

David Caldwell

Okay, I gotta pause you there. What exactly makes someone a supervisor in this context? Like, if a doctor leads a team of nurses, does that count?

Sofia Ramirez

It could. The definition of a supervisor can be surprisingly broad. If a physician has authority over things like hiring, firing, or setting work schedules, they might qualify as a supervisor under the National Labor Relations Act. And that classification can disqualify them from unionizing, even though they personally face many of the same workplace pressures as non-supervisory employees.

David Caldwell

Wow. So even just having some say over schedules could bar them from unionizing? That feels, I don’t know, kinda unfair.

Sofia Ramirez

It does seem unfair, and it’s a point that’s often debated. For example, last year at Allina Health in Minnesota, their clinicians attempted to unionize. But Allina initially pushed back, arguing that many of those clinicians were supervisors or managerial employees, thus exempting them from union protection under the law.

David Caldwell

Wait, hold up. Allina Health actually used that argument to block the union? What happened?

Sofia Ramirez

It’s a classic example of the legal hurdles physicians face. Allina eventually backed down, and the union went forward, but it highlights how these structural definitions can become a battleground. Employers often use these laws to challenge union efforts, especially in industries where professional roles blur the lines between employee and management.

David Caldwell

Huh. So even when doctors are ready to organize, they’re up against not just their employers but the legal system itself. That’s intense.

Sofia Ramirez

It is. It’s a multi-layered problem, and each layer—the anti-trust concerns, the supervisory classifications—makes collective action uniquely difficult for physicians. But at the same time, overcoming these challenges could be a game-changer for the profession.

Sofia Ramirez

And yet, despite these challenges, we're seeing some significant momentum. Let’s take a look at the big players stepping up in this space. For example, Doctors Council SEIU stands out as one of the largest and most notable physician unions in the country.

David Caldwell

Okay, so when you say “largest,” what are we talking about here? Like thousands of doctors or what?

Sofia Ramirez

Exactly. They represent employed doctors across hospitals and health systems nationwide. So if you’re a physician in a big health system, chances are you’ve at least heard of them. They focus on bread-and-butter issues—pay, working conditions, and advocating for patient care standards.

David Caldwell

Got it. So, kind of the starting point for someone looking to join forces, I guess.

Sofia Ramirez

Exactly. But they’re not the only option. There’s also the Union of American Physicians and Dentists—or UAPD for short. They’re a bit broader because they represent both government-employed doctors and those in private hospitals. So they’ve got a unique mix.

David Caldwell

Wait, government-employed doctors?

Sofia Ramirez

Exactly. UAPD is heavily involved in advocating for those folks. Think of environments like prisons or public healthcare clinics—the stakes for patient care there are different but no less critical. They’re tackling things like staffing ratios and even safety concerns for doctors in those settings.

David Caldwell

Huh. So they’re kinda focused on those specific niches where the challenges are a little… unique?

Sofia Ramirez

Right. And then there’s the Committee of Interns and Residents, or CIR-SEIU. This one’s especially interesting because it focuses on resident doctors and fellows—basically physicians still in training.

David Caldwell

Okay, but why would residents need their own group? Aren’t they already kind of, like, just learning the ropes anyway?

Sofia Ramirez

Good question. Residents are often overworked and underpaid. They might be working 80-hour weeks while juggling complex patient cases under intense supervision. For them, unionizing isn’t just nice—it’s critical for protecting their rights during this training period.

David Caldwell

Whoa, 80-hour weeks? That sounds… I mean, I don’t even know how you’d function at that point.

Sofia Ramirez

You function on caffeine and adrenaline. But seriously, CIR-SEIU gives them a collective voice to demand fair treatment. Things like better wages, safer working conditions, or even just—get this—meal breaks. You’d be shocked how often that becomes a rallying point.

David Caldwell

Not gonna lie, I was not expecting “meal breaks” to be part of the revolution, but hey, makes sense. So those are the heavy hitters in this space. Do the goals of these groups overlap much, or is each one running its own play?

Sofia Ramirez

There’s definitely overlap, especially when it comes to improving conditions for physicians and, by extension, for patients. But the focus shifts depending on the group. For example, Doctors Council SEIU might fight for hospital-level policy changes, while CIR-SEIU hones in on issues specific to trainees. It’s a spectrum, but they all connect through the goal of empowering doctors to advocate for themselves and their patients.

David Caldwell

Got it. So, joining one of these isn’t just about getting better paychecks—it’s about fixing the bigger issues, too.

Sofia Ramirez

Exactly. And what’s emerging is this idea that organized physicians aren’t just protecting their own interests—they’re redefining how healthcare works at its core.

Sofia Ramirez

So, David, now that we’ve talked about the major players redefining how healthcare works through unionizing, it brings us to an essential question—if physicians successfully gain more power through these collective efforts, what are they going to do with that power?

David Caldwell

Huh. That’s a good question. I mean, people might assume it’s all about making positive changes, but history doesn’t always paint such a rosy picture, right?

Sofia Ramirez

Exactly. Take the history of the American Medical Association, or the AMA. It’s a good example. For years, they held a near-monopoly over the medical profession, and while they did fight for things like better educational standards, a lot of their actions were pretty self-serving. They actively suppressed alternative medical practices and used their influence to maintain that monopoly.

David Caldwell

Ah, so not exactly shining examples of altruism all the time. What did that mean for patients back then?

Sofia Ramirez

It wasn’t great, to be honest. Yes, there were advances, but restricting competition meant patients had fewer options—both in terms of treatments and affordability. And it wasn’t just the AMA, by the way. Physicians, as a collective, have often prioritized their own professional interests, sometimes at the expense of the greater public good.

David Caldwell

Wait, so you’re saying that, historically, doctors—who people look up to, right?—have leaned into self-interest when they’ve had the power?

Sofia Ramirez

I wouldn’t say it’s universal, but there are definite patterns of it happening. You know, focusing on maintaining high salaries, restricting entry into the profession, controlling the healthcare market—stuff that raises costs without necessarily improving care. And here’s the thing: if the goal of modern unionization is to stand up to corporations and advocate for patients, we have to ask, will it actually achieve that? Or could it risk becoming just another power structure focused inward?

David Caldwell

Oof, yeah. That’s kind of a sobering thought. It’s like, unionizing could be this big step forward, but if they’re not careful, they could fall into the same traps as before.

Sofia Ramirez

That’s why oversight and accountability are so important. Physician unions have to constantly check themselves: are they advocating for policies that truly improve care and access for patients, or are they just reinforcing systems that protect their own interests?

David Caldwell

Right, because at the end of the day, it’s not just about the doctors—it’s about the whole system, and the millions of people who rely on it.

Sofia Ramirez

Exactly. It all loops back into this broader question: if physicians gain collective power, how do they wield it responsibly? And how do we make sure it doesn’t repeat the missteps of the past?

Sofia Ramirez

It all really circles back to this idea of accountability. When we think about how physicians might wield collective power, we can’t ignore the healthcare system’s complexity. It’s not just a bunch of individual parts working independently—it’s this massive, adaptive system, constantly evolving, with a million moving pieces.

David Caldwell

Right, and honestly, it’s a little intimidating to think about. Just hearing you describe all this—systems theory, self-organization, and even high leverage points—it’s like, where do you even begin?

Sofia Ramirez

That’s where it gets interesting. Physicians organizing? That’s a perfect example of what we call emergence in these systems. It’s about recognizing these underlying forces—burnout, inequities, administrative bloat—and then self-organizing to push back, to create change. But it has to be deliberate. You can’t lose sight of the bigger picture.

David Caldwell

The bigger picture being… health for everybody?

Sofia Ramirez

Exactly, health for all, and at the lowest possible cost. That’s the vision, and I feel like it’s a vision physicians can champion—but only if they understand the dynamics of the system they operate in. If they see themselves as system stewards, they can focus their energy on the high leverage points that actually shift the needle.

David Caldwell

High leverage points… like collective bargaining power, addressing burnout, those sorts of things, right?

Sofia Ramirez

Yes, and systemic ones, too—like questioning the status quo of payment models or advocating for policy reforms that prioritize public health. But, David, the real challenge is staying relentlessly focused on that vision and not getting trapped in smaller power struggles along the way.

David Caldwell

Hmm. So it’s not just about fixing one thing—it’s the whole system we’re talking about.

Sofia Ramirez

Exactly. And if you think about it, that’s where we all come in, not just doctors. As patients, families, policymakers, we all have some role in shaping this system. At the end of the day, health systems should serve communities, not corporations, and that’s impossible without collective effort.

David Caldwell

Wow, that’s… a lot to chew on. But I’ll say, for a complex, adaptive system, it seems like there’s at least some hope. I mean, people organizing, stepping up as system stewards… that’s inspiring, you know?

Sofia Ramirez

It is. As overwhelming as it can feel, every change starts somewhere. And with the right focus, I genuinely believe transformative change is possible. Health systems can adapt—but only if we push them to.

David Caldwell

Well, on that note, Sofia, this has been an incredible conversation. And to our listeners, thank you for joining us today. We hope this sparked some ideas, maybe even a little hope, about what’s possible when we think big and act decisively.

Sofia Ramirez

Absolutely. And that’s all for now. Until next time, take care—and let’s keep working toward a healthier, more just future.