NPs, PAs, and Physicians Hope to Join Doctors' Union in Rare Alliance

Avery Hurt

August 31, 2023

Advanced practice providers (APPs) such as nurse practitioners (NPs) and physician assistants (PAs) have long been at odds with doctor groups over scope of practice issues. But in a rare alliance, more than 500 physicians, NPs, and PAs at Allina Health primary care and urgent care clinics in Minneapolis, Minnesota, recently filed a petition with the National Labor Relations Board to hold a union election in late September. If successful, the Allina group will join the Doctors Council SEIU, Local 10MD.

The Allina healthcare providers share concerns about their working conditions, such as understaffing and inadequate resources, limited decision-making authority, and health systems valuing productivity and profit over patient care.

Although doctors and APPs have told Medscape Medical News that they generally work well together, the relationship has been strained in recent years as APPs argue for greater scope of practice. Meanwhile, physician groups, such as the American Medical Association, believe that APPs need more oversight.

An Allina union organizer, Britta Kasmarik, CNP, acknowledges the tension between physicians and APPs. But she told Medscape that the union effort helped bond this group of healthcare providers. "We share common goals of providing high-quality care for patients in a safe way, and we see the same things day in and day out with our patients."

Matt Hoffman, MD, a primary care physician at Allina, told Medscape that APPs in his specialty perform the same job as doctors "and the working conditions are really identical. In our view, that means we should be unionizing together."

The decision to hold a union vote follows similar action by nearly 150 Allina Mercy Hospital physicians in March. Allina Health appealed the vote.

In response to a New York Times investigation, the Minnesota Attorney General's office began reviewing reports of aggressive billing practices and denied care at Allina Health.

The Allina Health system, which reports $4 billion in annual revenue, cut off nonemergency services to patients, including children, if their medical debt exceeded $4500, according to the New York Times article. For Allina's physicians and APPs, that meant leaving patients' illnesses untreated.

Less than a week after the attorney general announced its investigation, the health system ended this practice.

In a prepared statement to Medscape, Allina Health said that its providers are "critical members of our teams. …We deeply value and share their commitment to providing high-quality care to our patients."

The health system said it planned to make operational improvements, implement new communication tools, and provide additional well-being resources and enhanced employee benefits "to improve the provider experience." In addition, it hoped to continue to "foster a culture of collaboration with all our employees."

Having a union will allow healthcare providers to advocate for their patients and give healthcare providers more decision-making power instead of corporate leaders maintaining full authority, Kasmarik told Medscape.

Union organizers are also concerned with changes to the daily practice of medicine. "We don't want to be spending our time doing paperwork and calling insurance companies and filling out forms," says Hoffman. "We want to be in the exam room with a patient."

The Allina providers organized after multiple requests to corporate managers failed to address their concerns. Their demands include increased staffing and help with nonclinical work so that clinicians can spend more time with their patients.

"What I'm really excited about is that we will be able to work with the other unionized groups to make change…by being involved in healthcare policy at a state or national level," Hoffman said. For example, that involvement might include challenging insurance company decisions.

Doctors Council bills itself as the largest union for attending physicians in the country, with 3500 members, according to Joe Crane, national organizing director.

Despite an increase in union efforts since the pandemic, healthcare workers — particularly doctors — have been slow to join unions. Crane estimated that only about 3% of US physicians are currently union members. He cited union campaigns in Massachusetts, New York, and Washington, DC. For comparison, a minority of advanced practice registered nurses (APRNs) (9%) report union membership, according to Medscape's APRN compensation report last year.

Hoffman is confident the Allina healthcare providers will have enough votes to win the election to join the union. "We should have done this years ago."

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