The email arrived on a Tuesday afternoon. It thanked everyone for their dedication, praised the organization’s proud history, and announced that the hospital had been acquired. There would be new leadership, new opportunities, and a town hall meeting the following week. Clinical operations would continue as usual.
There was one thing missing. No one had asked the physicians.
For generations, doctors assumed that if the ownership of a hospital or medical practice changed, they would at least have a meaningful voice in what came next. Increasingly, they discover that they are learning about the future of their workplace at exactly the same moment as everyone else: through an email sent after the decision has already been made. That realization has become one of the defining experiences of employed medicine.
On June 27, 2025, the U.S. Court of Appeals for the D.C. Circuit handed down a decision that most physicians will never read. The case, Universal Health Services v. NLRB, involved George Washington University Hospital and 1199SEIU United Healthcare Workers East. The union represented 150 service workers, cooks and cleaners, not physicians. The court upheld the National Labor Relations Board’s finding that the hospital had engaged in bad-faith surface bargaining, rejecting three management proposals that together, an expansive management rights clause, a blanket no-strike provision, and the elimination of binding arbitration, would have stripped the union of any meaningful representational role.
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Labor lawyers will debate the implications of the ruling. Most physicians will never read it. Perhaps they should. Not because it concerns physician unions. It does not. But because it raises a question physicians are beginning to ask from a different direction entirely.
Who speaks for the doctors when ownership changes?
It is a remarkable question because, not very long ago, few physicians would have imagined asking it. Medicine saw itself as a profession, not a workforce. Physicians negotiated individually, exercised considerable autonomy, and often held leadership positions within the institutions where they practiced. Collective bargaining seemed unnecessary, even incompatible with professional identity.
That world has changed, and the numbers are unambiguous. In 2024, just over 42 percent of physicians worked in private practices, representing an 18 percentage point decline since 2012. More than one-third now work in hospital-owned practices. Nearly 7 percent work in practices owned by private equity firms. The physician who owns or helps govern a practice, determines clinical priorities, and exercises meaningful influence over the direction of the organization has become the exception rather than the rule.
This matters because employment changes the nature of the professional relationship. Decisions about staffing, productivity targets, scheduling, documentation, compensation, and strategic direction are increasingly made by people who do not practice medicine. Hospital mergers, acquisitions, and private equity transactions can alter the conditions of physicians’ working lives without a single patient visit changing the next morning.
The patients are still there. The physicians are still there. The building is still there. Only the owner has changed.
Against this backdrop, it is worth noting what has happened to physician unionization. A December 2024 study in JAMA examined union petitions among attending physicians between 2000 and 2024. It identified 77 petitions. Forty-four were filed during the twenty-three years from 2000 through 2022. Thirty-three were filed in just the following two years. The annual rate of physician union petitions increased more than tenfold. Certification rates rose from 54 percent to 77 percent.
More revealing still were the reasons physicians gave for organizing. Eighty-five percent cited working conditions. Eighty-one percent cited lack of voice in management. Fifty-four percent cited concerns about patient care. Only 4 percent identified financial compensation as a primary motivation.
Read that again. Doctors are not primarily organizing over money. They are organizing because they feel they cannot be heard.
Whether one supports physician unions or opposes them is almost beside the point. Their growth tells us something important about the profession itself. Physicians who once relied on individual professional authority are searching for collective professional voice. That should give all of us pause.
The real story is not that doctors are becoming more interested in unions. The real story is that so many physicians have concluded they need another way to be heard.
Medicine has always depended on trust. Patients trust physicians. Physicians trust one another. Physicians have also trusted that the institutions employing them would, more often than not, place patient care and professional judgment ahead of purely financial considerations. When ownership changes repeatedly, that assumption becomes harder to sustain. Physicians begin to wonder not only who owns the hospital, but who now speaks for the people responsible for caring for its patients.
That is not merely a labor question. It is a professional one.
The D.C. Circuit’s decision involving George Washington University Hospital is about unions. The larger story is about something older and more unsettling. It is about what happens when physicians discover that the institution they joined can be bought and sold without their participation, while the responsibility for patients remains exactly where it has always been.
The question is no longer simply who owns the hospital. It is who speaks for the doctors.
Until physicians can answer that question with confidence, the growth of physician unions will be understood less as a political movement than as evidence that something fundamental has changed in the relationship between physicians and the institutions that employ them.
Patrick Hudson is a retired plastic and hand surgeon, former psychotherapist, and author. Trained at Westminster Hospital Medical School in London, he practiced for decades in both the U.K. and the U.S. before shifting his focus from surgical procedures to emotional repair—supporting physicians in navigating the hidden costs of their work and the quiet ways medicine reshapes identity. Patrick is board-certified in both surgery and coaching, a Fellow of the American College of Surgeons and the National Anger Management Association, and holds advanced degrees in counseling, liberal arts, and health care ethics.
Through his national coaching practice, CoachingforPhysicians.com, which he founded, Patrick provides 1:1 coaching and physician leadership training for doctors navigating complex personal and professional landscapes. He works with clinicians seeking clarity, renewal, and deeper connection in their professional lives. His focus includes leadership development and emotional intelligence for physicians who often find themselves in leadership roles they never planned for.
Patrick is the author of the Coaching for Physicians series, including:
- The Physician as Leader: Essential Skills for Doctors Who Didn’t Plan to Lead
- Ten Things I Wish I Had Known When I Started Medical School
He also writes under CFP Press, a small imprint he founded for reflective writing in medicine. To view his full catalog, visit his Amazon author page.
