ORIGINAL RESEARCH
Annie Koempel, PhD, RD; Madeline Byrd, MEd; Andrea Anderson, MD, MEd, FAAFP; Anam Siddiqi, MPH; Melissa K. Filippi, PhD, MPH
Corresponding Author: Annie Koempel, PhD, RD; American Board of Family Medicine.
Email: akoempel@theabfm.org
DOI: 10.3122/jabfm.2025.250391R3
Keywords: Family Medicine, Family Physicians, Labor Unions, Primary Health Care, Qualitative Research, Workforce
Dates: Submitted: 10-07-2025; Revised: 12-03-2025; 01-06-2026; 01-23-2026; Accepted: 02-09-2026
Status: In Press.
INTRODUCTION: Physician unionization efforts are gaining momentum in the United States; 33 of the 77 healthcare union petitions filed since 2000 were submitted between 2023 and 2024. While popular discourse and medical literature often conflate unionization with strikes or wage demands, physicians cite different motivations—primarily declining autonomy, deteriorating working conditions, and concerns about patient care quality. Little is known about union motivations specific to family medicine. This article describes family physician thoughts on unionization efforts.
METHODS: We recruited family physicians who completed the ABFM Continuing Certification Questionnaire in 2024 to participate in in-depth, semi-structured interviews. A trained qualitative researcher used Zoom to interview 27 demographically diverse physicians. All interviews were transcribed verbatim and analyzed utilizing NVivo software following an inductive content analysis approach.
RESULTS: Physicians who favored unionization saw unions as venues for community and collaboration as much as advocacy. They stressed the need for organized, collective action to counter administrators and systems with significantly more organization and power than healthcare workers. Physicians who did not favor unionization felt physicians could advocate as individuals or groups to enact changes within their clinic or healthcare system. They viewed unions as adding time commitments, paperwork, and bureaucracy.
CONCLUSION: Results suggest that regardless of family physician favorability of unionization, there is a strong belief that the United States healthcare system needs significant improvement. While unions may provide one avenue for improving scheduling and payment structures, family physicians articulated alternatives, such as individual leadership and group advocacy at the clinic-level, that may work better in some settings.