Perspectives on increasing corporate ownership and unionization in hospital medicine: An exploratory mixed methods study.

Abstract

Multiple workforce trends are reshaping the healthcare landscape including the growing influence of corporate ownership of healthcare systems and physician practices, including private equity (PE) and venture capital (VC) investments, and a rise of physician unionization. Explore experiences and perceptions regarding these trends. An exploratory embedded mixed methods design with a 15-question survey and semi-structured virtual focus groups held on May 14, 2024 and July 17, 2024 using rapid qualitative methods. Thirty-three individuals from 26 different organizations participated, with 28 participants completing the embedded survey. Most were physicians (93%) and leaders (36%) primarily from nonprofit or academic organizations. Participants (18%) stated that members in their hospitalist group were actively considering unionization. There were four themes: (1) the business of healthcare is perceived to create misalignment between clinicians and health systems, with corporatization, particularly PE, seen as adding to these challenges, (2) healthcare workers increasingly feel voiceless in a margin-focused environment, contributing to unionization efforts, (3) unionization was seen as an advocacy tool with benefits and drawbacks including conflicts with professional values, and (4) participants, primarily physicians, felt poorly informed about unionization and had a wide range of views on the topic. PE/VC was viewed as predominantly negative though varied by context. In this exploratory study, participants perceived corporatization, including PE investment, as influencing clinician interest in unionization. While causal relationships cannot be inferred, findings suggest that unionization may be used as a mechanism for clinicians to regain voice with participants also noting potential uncertainties and drawbacks.