Leon Adelman, MD, MBA, FACEP
Co-Founder & CEP Ivy Clinicians
Author, Emergency Medicine
Workforce Newsletter
Clinical Emergency Physician, Wyoming
Only about one-quarter of attending emergency physicians are practice-owners. For many employed emergency physicians, working condition improvement is desperately needed. Emergency medicine has become the specialty with the highest burnout rate and lowest levels of job satisfaction.
Improving working conditions is generally more difficult for employees than for practice owners. Some would say, just kick out the non-physician-owned groups and bring in a better EM practice. The problem with that solution is that emergency physicians don’t determine who staffs a hospital’s emergency department. The hospital CEO makes that decision.
Employed emergency physicians who are dissatisfied with their working conditions and do not want to change jobs have the legal right to bargain collectively with their employer. In other words, EPs have the right to unionize.
Source: Author’s analysis of AMA 2020 Physician Practice Bench
For community EDs, what are the most likely outcomes from emergency physicians bargaining
collectively with their employer and the hospital?
- The hospital CEO would get mad. Unionized employees have legal protections to publicize poor working conditions. No hospital CEO wants their emergency physicians to talk with the press about boarding, staffing, or quality concerns.
- The hospital would terminate the staffing company’s contract. Emergency physicians unionizing against a subcontractor would mean the end of that contract.
- The hospital would choose a physician-owned group to staff the ED. Legitimate practice owners cannot unionize. If the physicians remain employees rather than becoming owners, the union can also remain.
Bottom line: collective bargaining through unionization is the most effective method for employed community emergency physicians to change their contract-holder from a CMG to a physician-owned group.
For recent examples, check out Ascension St. John and the Greater Detroit Association of Emergency Physicians: