Over the last three decades, the job market for physicians has shifted significantly from a private practice opportunity to a full-time position offered by academic centers, teaching hospitals and corporate America. In some instances, the type of employment chosen depends on factors beyond the control of the applicant. This is exemplified by young physicians who view full-time positions as the sole viable option due to the potentially burdensome costs associated with starting a private practice. Alternatively, some may opt to work within an academic or teaching environment.

Yet, all types of medical employment may be associated with issues and grievances related to working conditions, staffing, workplace safety, patient care standards, fair reimbursement, operational inefficiencies, policy conflicts (ageism for example), violation of rights and other important issues.

When a full-time employee raises issues and grievances that are not satisfactorily addressed by institutional leadership as expected, one could consider that a collective bargaining approach, such as a union, may be more successful in achieving the intended goals.

The National Labor Relations Act (NLRA), also known as the Wagner Act was enacted in 1935 and it allows full-time employee workers to form a Union. Accordingly, it appears that full-time physicians who are employees of a hospital, clinic, medical group or any other healthcare facility can unionize. The NLRA requires physician members of a union to give employers 10 days’ notice before engaging in a concerted refusal to work. Important to note that emergency care for patients must always be available and hospitalized patients continue to always receive medical care. This mandate weakens the union’s power to negotiate but it does not nullify it. It is interesting to mention that the NLRB received a 57% increase in Union election petition across all types of labor in 2022. To our knowledge, no study has investigated the effects of an independent Union for practicing physicians.

To evaluate the strengths, weaknesses, opportunities and threats associated with the creation of a physician Union one needs to carefully and thoroughly evaluate all options. Since laws vary among different States, reaching out to local labor lawyers is highly recommended.

Some of the advantages of creating a Union include but are not limited to job security, improved wages and benefits, workplace safety, legal protection, career advancement, equitable compensation across races and ethnicities. Reported disadvantages are union dues, increased conflicts between management and labor, loss of independence, potential backlash from patients, peers, supervisors, and future employers.

Given the limited number of vascular surgeons in the USA, the path to unionization is expected to involve a collaborative approach with other healthcare professionals.

The sole intent of this questionnaire is to gauge the EVS members’ interest in further evaluating the subject of unionizing.