Why primary care doctors in RI are turning to unions

Dr. Yul D. Ejnes

Guest columnist

Could your primary care physician become a card-carrying union member? It’s more possible than it’s ever been.

For decades, medical trainees have joined labor unions to address pay and work conditions. A recent guest column by Dr. Tori Riccelli ('Brown Health residents struggle with low pay, paid leave,' Commentary, Sept. 20) explained why residents and fellows at Brown University Health (BUH) unionized last year.

While 15% of residents and fellows are members of unions, fewer physicians in practice, about 8%, are represented by unions. Unlike doctors in training, those in practice have for the most part avoided unionization. That is, until recently.

A research letter in the Journal of the American Medical Association that reviewed unionization of practicing physicians (not trainees) found that from 2023 to 2024, there were almost as many union petitions as there were in the preceding 22 years.

In May 2025, almost 300 primary care physicians at Mass General Brigham voted to unionize. Currently, over 10,000 practicing physicians in the University of California system are in the middle of a union drive.

Will Rhode Island’s primary care physicians be next?

The practice of medicine has changed, with over 80% of physicians now employed, most of them by hospitals and health systems. With the corporatization that brings, more decisions are now in the hands of managers, not front-line physicians. While employers are not telling physicians what drugs to prescribe or tests to order, they are making decisions about scheduling, staffing and work hours – all of which affect patient care – with little or no physician participation.

We see this in the leading reasons for union campaigns: working conditions, lack of input in managerial decisions, and concerns about patient care, with compensation a much less cited issue.

If it’s not about the money, then what is pushing primary care physicians to unionize? Here’s an example: In one practice, management observed that the practice was losing money because of patients who didn’t show up for their appointments, so it started overbooking the physicians.

That approach may look familiar – it’s what airlines do. When airlines overbook, if everyone shows up, they ask for volunteers and hand out vouchers. They don’t squeeze eight passengers into a six-seat row. A medical office can't bump anyone. Every patient gets seen, visits get rushed, the doctor runs late, and everyone is unhappy, except the finance department.

And if that’s not enough, a few days later, the physician might get a 'friendly' email from the patient relations department asking for a response to a negative patient review due to the overbooking.

Other themes in the unionization efforts include adequate staffing of patient care teams and acknowledgement of the hours spent every day responding to patients’ portal messages and phone calls.

How might unionization affect patients? Primary care physicians who have a greater say in how their practices are run can give each patient the time that they need. They are less likely to burn out and quit. That matters in Rhode Island, where many patients already struggle to find a primary care doctor. What about strikes? Doctors' strikes remain rare, and the few so far kept hospitals open. Medical ethics codes require that patients never be abandoned during work stoppages.

Employers can address their physicians' grievances without a union. Management can give physicians a meaningful role in decision-making, put physicians with real managerial authority in leadership instead of executives who happen to have a medical degree, and look beyond this year's bottom line when measuring the value of primary care. Steps like these could make unionization unnecessary.

Will Rhode Island’s primary care doctors unionize? It’s up to their employers.

Dr. Yul D. Ejnes is a clinical professor emeritus of medicine, Alpert Medical School of Brown University.

Resident doctors from the British Medical Association picket outside St. Thomas’ Hospital in London during the union’s strike in November 2025.

Hiba Kola/REUTERS