By: Vint Blackburn, MD – Chair of the ACMS Delegation to PAMED & Member of the ACMS Advocacy Task Force
To unionize or not to unionize? This seems to be a significant question among doctors these days, especially those working in large corporate medical centers. At the Allegheny County Medical Society, as part of the Advocacy Task Force, we have been grappling with what position we should take as a medical society, and it has proven to be a complex and fraught subject.
I do not intend to try and answer that question here, but rather, I want to examine the very reason why the question has arisen in the first place: namely, the complete loss of control and power over how we practice medicine and treat patients. This change has been insidious, but its effect on the lives and practices of physicians has finally reached a tipping point that is difficult to ignore.
We have always had long working hours, and we have always dedicated more of our energy and our lives to our profession than is probably good for us. But there were always rewards, such as knowing we did what we do to help others and save lives. There was solace in knowing that, at the end of the day, we made a difference, even if our families often suffered in the process. Modern medicine is changing, and it is changing fast. As we move toward increasingly organized, corporatized medical models (whether they describe themselves as non-profit or not), we are seeing more and more constraints placed on our ability to do what is best for our patients.
Whether it is prior authorizations for simple medications, many of which seem designed to demoralize us into not pursuing them, or being told that a procedure we know is necessary must be preceded by several that are not, or simply being told we cannot do what we know a patient needs because a form was not completed in advance, many physicians feel completely powerless, or at the very least severely hamstrung. It is not as if our working hours have decreased or our quality of life has improved in other ways. We are still expected to work diligently and continuously, but now in an environment where we are told we cannot do what we know is right. We are effectively being pushed toward second-rate care by people who frame their decisions in terms of fraud and waste, or even suggest that we do not know what we are doing.
There was a time, not so very long ago, when the community physician was respected as a highly educated member of society whose opinion carried weight, often even outside medicine, though whether or not it should have is a separate question. Today’s practice feels like the opposite. It often seems as though we do not even have a voice within our own specialty, as if we must regularly justify our decisions to non-physicians, some at corporate levels, others in media and political spheres.
The point is that we feel unheard. One of the reasons I became involved with the Allegheny County Medical Society was advocacy, and in speaking with our members, it is clear that this is one of the most important priorities for many of them. I have had the privilege of attending numerous leadership events that included discussions with our representatives, and each time they report that they do not hear nearly enough from physicians. There is a good reason for this: the sheer volume of what we are already expected to do. Furthermore, feeling increasingly marginalized does not encourage us to reach out individually and challenge the perceived powers that be.
This is why the question of unionization is so relevant at this moment. Whether or not we as a medical society support it, or whether you as an individual practitioner (whether in private practice or employed by a large system) believe it is the answer, none of us can ignore the fact that we have a serious problem. And it is not a problem that will resolve itself unless we respond collectively. If we do not, conditions will continue to deteriorate in a system that is already barely sustainable. I am not certain what the solution is or how we should implement it, but at this point, inaction is no longer an option. We have to do something.
Advocacy Task Force: We Want to Hear from You
The Allegheny County Medical Society Advocacy Task Force welcomes member input on unionization, physician autonomy, administrative burden, and any other issues impacting the practice of medicine.
Please share your comments, concerns, or questions at board@acms.org for consideration by the Task Force.
Advocacy efforts already underway in 2026 include:
- Public immunization statements supporting evidence-based vaccine policy
- Statements regarding immigration enforcement in healthcare settings and protection of the physician-patient relationship
- ACMS Member Legislative Town Hall connecting physicians directly with elected officials and policy leaders