Unions

Life in a Unionized Workplace

If a union is elected, it becomes the exclusive representative of bargaining-unit employees.1 This can change how many workplace issues are addressed and can limit the direct relationship between individual caregivers and management on matters subject to bargaining.

discipline

Union constitutions and bylaws may include internal rules addressing member conduct and may authorize fines, suspension, or other internal discipline in certain circumstances. 2

culture

Union representation may change workplace dynamics by mandating a more bureaucratic relationship between caregivers and leadership. This can impact collaboration, alignment and the speed at which concerns are addressed, as well as how new ideas are discussed and implemented. Instead of immediately making changes developed with clinician input, employers may need to negotiate those changes with a union which can take weeks, months or years, depending on the issue.

compensation and benefits

Union representation does not guarantee higher wages or enhanced benefits as a result of the negotiation process, even if Union representatives make those promises during an organizing drive.3 Any changes are determined through collective bargaining, which is a multi-step negotiation process that can take time.

What Could Life with a Union Mean for You?

Let’s take a look at the CBA of Providence St. Vincent Hospitalists, OB Hospitalists, Palliative Care Physicians and NPs (2025–2027) and compare their compensation and shift differences to their peers at Providence Portland Medical Center  to consider practical impact. 

Providence St. Vincent Hospitalists vs. Providence Portland Medical Center

Fair Pay
july 2023 baseline

Historical Context

Both medical centers began with identical compensation structures in July 2023.

Divergence
July 2024

The Divergence

Because the hospital was required by law to continue the compensation approach it had taken previously, PSVMC Hospitalists received only a 2.72% increase while PPMC Hospitalists received a 6.29% base salary increase.

Union Ratification
february 14, 2025

Union Contract Ratification

The union contract ratification on February 14, 2025 brought PSVMC compensation back into alignment with PPMC. PSVMC physicians received a 3.48% base salary increase while PPMC rates remained unchanged, effectively closing the gap. The shift requirements remained the same between both groups.

ProvOR union workplace less wages primary light

Strike and Union Dues Impact to PSVMC

Although the compensation structure is now aligned, PSVMC Hospitalists who participated in the strike experienced an estimated $52,000–$55,000 loss per physician during the period of labor action, while PPMC Hospitalists did not experience a comparable loss in compensation. In addition, PSVMC Hospitalists are now subject to union dues deducted from their paychecks, further reducing take-home compensation compared to PPMC Hospitalists.

impact to represented caregivers

Among the Women’s Clinic Provider and PSVMC Hospitalists CBAs, represented caregivers experience increased structure, predictability, and formal process.

  • Gains: predictability and formal guardrails
  • Trade‑offs: reduced flexibility, slower resolution, loss of individualized terms, wages (dues, fines, fees)

Potential Implications for Physicians and APCs

If a similar collective bargaining framework applied to Puget Sound clinicians, employment would shift from individualized, relationship based arrangements to standardized, collectively governed terms.

  • Clinic‑level flexibility could be replaced by contractual rules.
  • Medical Staff authority and clinical accountability could remain unchanged.
  • Bargaining and strike activity could require significant time away from work, patients and personal priorities, as the PSVMC Hospitalists experienced with 29 days in bargaining and 46 days on strike, totaling nearly one-quarter of the year, not including bargaining preparation time.

Highlights

Note that the St. Vincent Hospitalists did not leverage increased compensation outside of the standard in comparison to Hospitalists at Providence Portland Medical Center. PMG Heart Institute APPs have been in status quo since 2025.

129 U.S.C. § 159(a).
229 U.S.C. § 158 (b)(1)(A).
3Detroit Auto Auction v. NLRB, 528 U.S. 1074 (2000) (The U.S. Supreme Court allowed the Sixth Circuit’s ruling to stand that a union’s pre-election distribution of coupons promising employees $150 per week during a strike was permissible campaign literature, not unlawful vote-buying).