Unionization confers benefits on health care workers

06 January 2023

2 minute read


Ahmed does not disclose material financial information. He tells them he received grants from the National Institute on Aging during the course of the study. He please consult the study for the disclosures of all other authors.

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According to the researchers, health care workers who were unionized from 2009 to 2021 earned better wages and benefits than those who weren’t. Despite this, unionization rates were low.

There has been a recent resurgence of unionization efforts in the US, “with the National Labor Relations Board receiving a 57% increase in union election petitions in the first half of 2022,” Ahmed M. Ahmed, MPP, MSc, an MD candidate at Harvard Medical School, and colleagues wrote JAMA.

Data derived from: Ahmed AM, et al. JAMA. 2022;10.1001/jama.2022.22790.

“Workers across many sectors, including those in health care, are joining unions to bargain for better pay, better non-cash benefits and safer working conditions,” they wrote. “For healthcare workers, the toll of the COVID-19 pandemic — including struggles to obtain personal protective equipment, inconsistent testing and notification of positive COVID-19 exposures, and inadequate pay with increased work hours — on background of the increase in burnout before the pandemic has amplified calls for unionization to improve working conditions in the US health care system”.

There is limited research on the prevalence and benefits of unionization among US health care workers, according to Ahmed and colleagues. They conducted a cross-sectional study to better understand how healthcare unionization has changed over the years and the benefits workers gain from unionization.

The researchers analyzed data from 14,298 respondents — 81.5 percent of whom were female and 70.4 percent were white with a mean age of 41.6 years — including 6,350 technicians and support staff, 4,931 nurses, 1,072 doctors and dentists, 981 advanced practitioners and 964 therapists.

After weighting, the researchers found that 13.2% (95% CI, 12.5-13.8) of respondents were involved in a union. There were no significant trends in unionization from 2009 to 2021.

Compared with whites, those in underrepresented racial or ethnic groups were more likely to report union membership. People who resided in a metropolitan area were also more likely to report union membership.

The researchers found that unionization was linked to significantly higher weekly wages: $1,165 versus $1,042 (95% CI, 88-157). It was also associated with a greater likelihood of having retirement benefits such as occupational pensions (57.9% vs. 43.4%; RR = 1.33; 95% CI, 1.26-1.41) and having a employer-sponsored health insurance with full premium coverage (22.2% vs. 16.5%; RR = 1.35; 95% CI, 1.17-1.53).

Ahmed and colleagues also noted that union members reported slightly more hours worked: 37.4 versus 36.3, with a mean difference of 1.11 (95% CI, 0.46-1.75). ) per week.

Among nonunion workers, the researchers noted disparities. Whites had significantly higher median weekly wages than people from underrepresented racial and ethnic groups: $1,066 versus $1,001, with a mean difference of $65 (95% CI, 40-91).

However, among union workers, there was no significant difference between the two groups: $1,157 versus $1,170, with a mean difference of $13 (95% CI, 78 to 52).

“The benefits associated with unionization are surprising but not surprising,” Ahmed said in a press release. “Unions collectively bargain for their members, which appears to improve both employee pay and the pay gaps between workers.”

Xiaojuan Li, PhD, senior author and instructor in the department of population medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute, said in the release that future causal analysis of the relationships is needed.

“Given the toll of the COVID-19 pandemic on the health care workforce, it will be important to investigate whether unionization could help mitigate burnout,” Li said in the statement.


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