Physicians Are Unionizing. What Should CMOs Do?

While higher base compensation is a significant factor, there are other forces at play, particularly the sense that physicians have a seat at the table in decision-making, Bosslet explains. Physicians want to have a say in how quality measures are established, how their clinical definition is established, how their schedule is established, and how their care teams are defined.

“When they feel that these things are being dictated down to them, that is where they start to bristle,” Bosslet said.

Physicians are objecting to feeling that they are always on the clock and always on call, according to Bosslet.

“That is finally starting to reach a boiling point, where physicians are saying that they have to have clear lines of definition around when they are available and when they are not available,” Bosslet says. “That is sustainability of work-life balance.”

Physicians want to have a better understanding of the financial status of their health system or medical group, Bosslet explains.

“Where I am seeing successful physician engagement is when there is a willingness to sit across from all of the physicians and executives say how the health system is doing and how the medical group is doing,” Bosslet says. “There needs to be a willingness to share what is driving success.”

How CMOs can discourage unionization

One of the reasons why more physicians are seeking to unionize is the increase in direct employment of physicians over the past 20 years, according to Bosslet.

To discourage physicians from unionizing, CMOs and other healthcare leaders need to focus on ease of practice, Bosslet explains.

“They cannot layer on extra layers of bureaucracy, although there is usually a rationale behind it,” Bosslet says. “The extra electronic health record obligations and time commitments take physicians away from direct patient care. That is where they start to feel frustrated.”

CMOs should make sure their physicians feel respected and empowered, according to Bosslet. Physicians recognize their role in the success of health systems, and they want a degree of transparency from leadership.

“They do not need to sit with the CFO to comb through all the numbers,” Bosslet says. “But you need to make sure they have a degree of transparency into the financial health of the health system or the medical group. That makes them feel empowered.”

Physician engagement is critical to head off unionization efforts. CMOs should make an effort to check in with their physicians to see how they are doing.

“To the extent that you can survey your faculty and physicians to get a pulse check, or even better, try to meet with as many of them as possible on a regular basis, you can hear their problems and empathize with them,” Bosslet says. “That is what is going to keep physicians engaged in a positive way and keep them away from ultimately pursuing unionization.”

Physician unions pose a challenge to CMOs and other healthcare leaders, according to Bosslet.

“Once a union has been established, it adds a degree of rigidity and it adds a degree of separation,” Bosslet says. “Once a union is established, it adds a degree of formality to conversations. … When you have a union, it makes it harder to be nimble.”

To cut through this rigidity and formality, CMOs should compartmentalize union conversations, Bosslet explains.

“If you are a CMO, your clinical leaders can’t get engaged with union conversations. You are going to hear things from the providers,” Bosslet says. “It is important to show a degree of empathy and show a degree of respect. You need to make sure you are hearing concerns and taking them back to the proper representatives.”

The formation of a physician union should not result in a CMO being alienated from the doctors because everybody is ultimately pursuing the same mission, according to Bosslet.

“From the CMO’s perspective, at the end of the day, these are still your people,” Bosslet says. “They are in your clinics. They are in your operating rooms. They are in your ER. They are your people and your medical staff. They are part of your team keeping patients healthy. That must be at the forefront.”

CMOs should not let strains with union representatives strain the relationship with their physicians, Bosslet explains.

“No matter how adversarial the conversations with the union representatives might get, in the healthcare facilities, physicians are your people and there is no distance between you,” Bosslet says.