**The Progression and Significance of Physician Unions: An In-Depth Examination**
The narrative of physician unions in the United States encapsulates a story of progression and adaptation, propelled by the evolving landscape of the medical profession and priorities in patient care. Central to this evolution are two pivotal threads: enhancing working conditions for resident physicians and empowering practicing doctors through collective efforts.
**Residency and Union Formation: A Historical Overview**
The journey commenced with the creation of residencies in hospitals located in major urban centers like Boston and New York City. In 1987, the Housestaff Association at Boston City Hospital represented early attempts at unionization. At that juncture, resident unions sought to minimize “scut work” – trivial tasks that detracted from essential learning opportunities – and tackle strenuous duty hours often surpassing 80 hours per week.
The pivotal occurrence in the pursuit of humane working conditions arose from the unfortunate Libby Zion incident in New York City. This case highlighted the repercussions of overburdened residents and prompted the Accreditation Council for Graduate Medical Education (ACGME) to impose regulations on duty hours, ensure resident oversight, and create ombudsperson roles for reporting concerns. These measures profoundly transformed residency programs, prioritizing educational quality, resident welfare, and patient care.
**Growth and Importance of Physician Unions Today**
The dawn of the 21st century has witnessed a rise in resident union formations at leading institutions such as Harvard’s Massachusetts General Hospital and the University of Pennsylvania. These unions tackle modern challenges including reasonable salaries, childcare assistance, and proper medical equipment, mirroring broader economic and professional trends. Concurrently, even employed physicians have initiated unionization, a trend that was once uncommon, now gaining momentum due to escalating administrative pressures and waning autonomy in clinical environments.
**Enabling Physicians for Improved Patient Care**
The American College of Physicians (ACP) underscores the significance of physician unions in its policy document, “Empowering Physicians through Collective Action.” The paper discusses the diminishing quality of the patient-physician relationship and advocates for collective efforts to enable doctors to deliver quality care, reclaim professional authority, and improve their overall well-being. Despite historical reservations regarding strikes based on patient needs, numerous physicians acknowledge that collective action could enhance patient welfare when regular avenues fall short of ensuring quality care and working conditions.
Essential recommendations stress the necessity for safe, affordable, high-quality care through collective empowerment initiatives. Proposed measures include securing governing board roles for practicing physicians to influence decisions within hospitals or health systems.
**Final Thoughts**
As physician unions continue to progress, there is a unified belief that patient care remains the highest priority. Through organized advocacy, unions strive to maintain the integrity and effectiveness of healthcare services, thereby honoring the physician’s commitment and ensuring that patients are always at the forefront of all endeavors.
**About the Author: Janet A. Jokela, MD, MPH**
Dr. Janet A. Jokela served as ACP Treasurer at IM 2025 and is presently a professor and senior associate dean of engagement at the Carle Illinois College of Medicine, Urbana, IL. Connect with her on BlueSky at @drjanetj.bsky.social.
**About the American College of Physicians (ACP)**
The ACP is the largest medical specialty organization in the U.S., with members across more than 145 countries. Its members consist of internal medicine physicians, subspecialists, and students committed to comprehensive adult care. Engage with ACP on X @ACPIMPhysicians, Facebook, LinkedIn, and Instagram @acpimphysicians.