Why US doctors are unionising

“They somehow found a way to upset every single physician in the hospital,” says Bryan Haimes, explaining why he and several hundred of his colleagues at the Christiana Care hospital network voted to unionise last year. The decision was precipitated by the imposition of a new contract which included the removal of all paid time off. But Haimes emphasises that this was the final insult after a gruelling few years dominated by the covid-19 pandemic.

“There were huge surges of patients, and people were stretched as thin as they could possibly be stretched,” he says, describing the moral injury caused by the early waves of the pandemic. “Terrible nursing ratios, terrible doctor to patient ratios, and everybody felt like they were not necessarily practising the best medicine they could at the time.”

Physicians felt increasingly excluded from decision making, too—both about their own contracts and about patient care. Haimes says that the rapidly evolving nature of the pandemic demanded quick decisions from hospital managers, without input from physicians. But once the pandemic had receded this approach to management didn’t go away. “They implemented a completely siloed, top down management model, where a lot of the decisions for changes in our working conditions came from above and they were communicated to us by middle management, usually poorly.”

It was in this context that Christiana Care imposed the new contract. “Four days before Christmas, they dropped it on us,” says Haimes. “It was such a large unilateral change that we started to research what we could do about it.”

Within six months they had voted to unionise.

The group is part of a growing movement …