We’ve all seen the commercials – “stop taking Fantasima and call your doctor immediately if you notice any of these symptoms . . . .”  If health care regulations came with such warnings, physician unionization should be a listed symptom.

Increasing oversight, declining payment rates and administrative burdens imposed by public and private insurers have for years been driving self-employed physicians into hospital employment. Physician groups, bar associations and the Wall Street Journal have recognized the trend, which pre-dates the ACA but has been accelerated by its effects, along with EHR, ICD-10 and other recent government mandates.   Advocates of such policies hope for related cost control and care management improvements. But neither the policy makers nor the hiring hospitals seem to be concerned for the foreseeable labor law consequence of turning disgruntled entrepreneurs into disgruntled employees.

In popular culture, the union-represented employee looks like a miner or manufacturing worker – someone doing hard, manual labor under close supervision.  But federal labor law requires only non-supervisory employee status with a non-governmental employer.  So, a doctor employed by a private sector hospital (even if non-profit) is union-eligible unless he or she hires, fires or independently directs the work of subordinates.

How commonly do health care workers unionize?  We looked at National Labor Relations Board representation case decisions from January 1, 2013 through April 30, 2014.  Five of the nine Board decisions issued during those sixteen months involved health care employers.  Of the 272 representation case decisions issued by NLRB Regional Directors during the same period, 55 involved health care employers.  Most hospital union organizing drives focus on lower-paid workers – housekeepers, clerks, medical techs, CNAs, LPNs and RNs.  But there are many unionized physicians and unions are hungry for more.  Imagine the staff-wide impact of physician organizing by the Teamsters or the SEIU.  If you’re hiring physicians as hospital employees without giving them true management control of subordinates, then you should plan for this prospect.