Most of Allina Health’s more than 550 primary and urgent care clinicians — including doctors, physician assistants, and nurse practitioners — voted to unionize. Photo by Max Nesterak/Minnesota Reformer.
Allina Health doctors, physician assistants and nurse practitioners voted to form the nation’s largest private-sector union of advanced care practitioners.
Federal labor officials tallied ballots on Friday from clinicians at 60 Allina primary and urgent care clinics in Minnesota plus one in Wisconsin, with 325 votes for and 200 against unionizing with Doctors Council SEIU.
The election results, which must still be certified, could prove a watershed moment in the increasingly consolidated health care industry, as doctors look to unions to claw back power over their practices usurped in recent years by sprawling health conglomerates.
Doctors’ unions are rare — just 7% of physicians are unionized, mostly in public hospitals. But the vote shows organizing highly paid professionals is possible in the private sector and could inspire a surge of unionization efforts like that seen among low-wage workers at universities and national chains like Starbucks, Trader Joe’s and REI.
Allina clinicians complain of unrealistic productivity demands and increasing bureaucratic tasks that force them to churn through patients with few support staff. One recent study found family medicine physicians spend more than half their time on paperwork — six hours out of their average 11-hour day.
Allina clinicians say burnout is high, and a union will give them a collective voice to advocate for working conditions that will improve care for patients.
In the leadup to the election, Allina executives urged doctors, physician assistants and nurse practitioners to vote against unionizing. They promised to address worker complaints but don’t want a third party preventing a direct working relationship.
Doctors in white coats and nurse practitioners in scrubs cheered and embraced one another after the ballots were counted in the federal office building in downtown Minneapolis by officials with the National Labor Relations Board, which oversees private-sector unions.
“We ask that Allina accept our union. We’re ready to get to the bargaining table. We want to make health care better,” said Dr. Matt Hoffman, a family physician at Allina Vadnais Heights Clinic north of St. Paul. “Unionizing is viable. This is a start to fix health care.”
In a statement, Allina said it was disappointed that some providers voted to be represented by a union and noted that the organization has been nationally recognized as one of the top places to work in health care.
“We remain committed to our ongoing work to create a culture where all employees feel supported and valued. Our focus now is on moving forward to ensure the best interests of our employees, patients and the communities we serve,” the statement said.
Allina did not say if it would challenge the results of the election.
The vote deals another blow to Allina’s fight against unions; physicians at its Mercy Hospital — with campuses in Coon Rapids and Fridley — are also seeking to unionize.
Over 100 doctors at Mercy voted by a margin of 2-to-1 to unionize in March. Allina challenged the results of the election, but a federal hearing officer sided with the union. Allina is appealing the decision.
Much of Allina’s hospital workforce is already unionized, including hospital nurses, nursing assistants, lab technicians, mental health workers, dieticians and other staff. Yet the vote by clinicians marks a significant expansion of organized labor into Allina’s primary and urgent care clinics, where far fewer workers are organized.
Allina is one of the state’s largest health systems, with 6 million clinic and urgent care visits in 2022 and revenues topping $5 billion. But the organization has also recently shown signs of financial strain. In July, Allina announced it would lay off around 350 workers, including at Mercy Hospital.
Allina has also faced national scrutiny after the New York Times revealed in June an Allina policy to cut off non-critical care to patients behind on medical bills. Following the story and public outcry, Allina stopped the practice.
The unionization drive reflects a consequence of rapid health care consolidation of the past decade. Years ago, unhappy doctors could start their own practices and have a great deal of control over their work. Today, doctors say they have little choice but to work within the system because the costs of running a primary care practice and complying with complex regulatory and insurance demands are simply too great.
Joining a physician-owned practice is an increasingly unrealistic alternative, too, as they are bought up by ever-larger health systems.
Over the past decade, the share of physicians who work in private practices dropped 13 percentage points, from 60% to 47%, according to the American Medical Association. At the same time, the share of physicians who work for hospitals and or health systems has ballooned from 26% to 52%, according to surveys sponsored by the Physicians Advocacy Institute.
That rise in consolidation has been a boon for health care administrators, who saw their ranks swell by 3,200% between 1975 and 2010, by one estimate. The number of physicians in the U.S., meanwhile, increased by 150% over the same period, roughly keeping up with population growth.
Jennifer Mehmel, a recently retired Allina pediatrician, was part-owner of a physician-managed practice, Aspen Medical Group, that merged with Allina about 15 years ago. She said many of her colleagues felt incredible pressure to be bought out because of the high cost of electronic medical records.
“We had to go somewhere. We couldn’t afford to do it on our own,” Mehmel said.
She said one person floated the idea of unionizing if Allina took over, but it never took hold.
“Most people thought, we’re not going to need that,” Mehmel said. “We were wrong.”
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