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Anesthesiologists with Beverly Anesthesiology and Cedars-Sinai in Los Angeles have formed a union, part of a continued wave of physician unionization in the U.S.

About 75% of the anesthesiology group's voters were in favor of joining the Union of American Physicians and Dentists (UAPD) during a 2-day vote in mid-January. Among a total of 139 eligible voters, 103 cast their ballot, and 78 voted to unionize, .

"A lot of people felt we really had no leverage in this relationship" with the hospital, Gene Lee, MD, a member of the organizing committee, told MedPage Today. Beverly Anesthesiology is owned by Cedars-Sinai; they are joint employers of the doctors.

Lee and Ellis Lai, MD, another member of the organizing committee, pointed to burnout, understaffing, concerns about the quality of patient care, a heavy workload, not being able to take time off, and not replacing doctors who left as some of the key reasons for setting up a union.

Lai said staff had been trying to work with the hospital "for months, if not years," to try to improve working conditions for the anesthesiologists, to no avail.

And last summer, the hospital proposed amendments to a 5-year contract that had been signed in 2020 and would have led to a 10% pay cut, Lee said.

"It was very unfavorable, no one liked this contract," Lai said. The physicians tried to meet with the hospital to discuss the changes -- they even signed off on a letter with their concerns -- but the hospital declined a meeting, Lee said.

The anesthesiologists pondered their options and ultimately decided that their strategy would be to organize with UAPD. Lai said they were the ones to reach out to the union.

"We went on the UAPD website and gave them a call," Lai said. "None of us knew anything about unionization."

The anesthesiologists would hold Zoom calls during non-work hours -- often very early in the morning -- to have serious talks about unionization.

"It's like a political election," Lai said. "You have to talk with people. There are a lot of one-on-one discussions. Everybody has their concerns about the unknowns of starting a union versus staying with the current experience."

Eventually, they took the vote on January 9 and 11. They needed two days, Lai said, to work around their difficult schedules. Their election was certified on January 22.

The next step is to start to negotiate a contract focused on better patient care and working conditions, they said.

Stuart Bussey, MD, JD, president of UAPD, said in a statement that the physicians' "courageous step underscores the importance of collective advocacy in safeguarding the principles of healthcare against external pressures."

"In an era dominated by the corporatization of healthcare, it is truly extraordinary to witness the unity of Cedars-Sinai anesthesiologists," Bussey added. "By choosing to join forces and make their voices heard, these physicians exemplify a commitment to protecting the quality of care for their patients."

The California Society of Anesthesiologists (CSA) said it supports the group's unionization. In a statement to MedPage Today, CSA said it "respect[s] the judgment of our physician members to determine the best way to negotiate with their employers, and there are multiple ways to do that, including unionization."

"There are limited options available to physicians in dealing with other actors in the California healthcare marketplace to ensure healthcare is patient focused -- unionization is one of those few options," CSA stated.

Cedars-Sinai acknowledged the vote in a statement to MedPage Today and said it "continue[s] to believe that the best way to deliver exceptional patient care is working closely with our physicians, and we will continue to do so. Our shared success in caring for our patients and the community will continue to be rooted in our strong and supportive relationships and our common mission of healing."

Lai said he expects the physician unionization movement to "continue to gain strength across the country," as more physicians become employees rather than independent practice owners.

In 2023 alone, Allina Health in Minneapolis saw two healthcare unions come online: one at its involving more than 100 doctors, followed by another involving about 550 doctors, nurse practitioners, and physician assistants from its primary and urgent care clinics.

A group of emergency physicians, nurses, and other emergency department workers contracted by TeamHealth to work at Ascension St. John Hospital in Detroit also voted to unionize last summer.

This is in addition to a number of resident and fellow unions that have come online in the last year.

"There's a growing concern ... that these entities whose main goal is to maximize profit shouldn't be driving medicine," Lee said, and "that this isn't the best for patient care."

Correction: The anesthesiologists' original 5-year contract was signed in 2020, not 2022.

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