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Labor Unions in Medicine: The Intersection of Patient Advocacy and Self-advocacy

Manthous, Constantine A. MD

doi: 10.1097/MLR.0000000000000123

Background: Labor unions have been a weak force in the medical marketplace.

Objectives: To briefly review the history of physicians’ and nurses’ labor unions, explore the ethics of unions in medicine, and offer a solution that simultaneously serves patients and professionals.

Research Design: A selective review of the literature.

Results: Labor unions of medical professionals pose an ethical quandary, that is a tension between selfless patient advocacy versus self-advocacy. The primary role of labor unions has been to extract from management benefits for employees. The threat of work actions is the primary tool that labor unions can apply to encourage management to negotiate mutually acceptable conditions of employment. Work actions—namely slow-downs and strikes—may harm patients and may therefore run afoul of professionals’ primary duty to the primacy of patients’ welfare. An alternative model is offered wherein medical unions align self-centered and patient-centered interests and leverage the Public Good, in the form of public opinion, to encourage good-faith bargaining with management.

Conclusions: As medicine becomes increasingly corporatized, physicians will join nurses in “at-will employment” arrangements whereby self-advocacy and patient advocacy may be impacted. Although labor unions have been a means of counterbalancing unchecked discretion of corporate management, conventional labor unions may run afoul of medical ethical principles. Reconsideration and innovation, to address this ethical dilemma, could provide a solution that aligns both clinicians’ and patients’ welfare.

Private practitioner

The author declares no conflict of interest.

Reprints: Constantine A. Manthous, MD, 4450 Whitney Avenue, Hamden, CT 06518. E-mail:

© 2014 by Lippincott Williams & Wilkins.