Physician Burnout and Unionization: Are You Ignoring the Elephant in the Room?
The conversation around physician burnout never been louder. Every day, we see headlines about doctors leaving medicine, new AI tools promising to reduce administrative burden, and, most notably, a rising wave of physician unionization efforts. But beneath these discussions lies a fundamental truth that too many health systems are unwilling to acknowledge: Why?
1. Loss of Autonomy & Administrative Burden
- Physicians feel increasingly like cogs in a machine rather than decision-makers in patient care.
- Excessive documentation (EHRs), prior authorizations, and bureaucratic hurdles drain time and energy.
2. Unsustainable Workloads & Staffing Shortages
- Many doctors face long hours, increased patient loads, and fewer support staff, leading to exhaustion.
- Hospitals and health systems prioritize productivity metrics, often at the expense of physician well-being.
3. Compensation Pressures & Financial Uncertainty
- Declining reimbursement rates, RVU-based pay models, and unpredictable compensation structures create stress.
- Physicians worry about financial sustainability, especially in employed settings where cost-cutting measures often impact pay.
The Warning Signs Are Clear, But Are We Addressing the Root of the Problem?
A recent survey found that 6 of 10 physicians think favorably of unionization even though only 1% of physicians are in a union today. That number should be a wake-up call. Distrust of leaders is the top reason cited for why physician unions have gained momentum.
We have also seen a shift in the physician workforce where a greater number of physicians in employed settings have never been in private practice, where you have the pressures of managing revenues and expenses. This shift has also changed perspectives on compensation, decision-making, and unionization efforts.
Historically, the fix for health systems and corporate entities in particular is about reducing clicks in the EMR, implementing ambient AI scribes, or rolling out resiliency training. These organizations admirably attempt to address physician’s administrative load but often ignore the elephant in the room.
The Disconnect Between Purpose and Pay
One of the biggest gaps we see in our work with medical groups is misalignment between mission and physician compensation. A majority of health system employed physicians are paid based on wRVU compensation models. In other words, they are paid based on each transaction and paid more or less based on the number of transactions. Imagine a health system executive getting paid for the number of meetings they had in a day. It signals I do not trust you to do your job. To make matters worse, wRVU-based compensation models directly contradict the organization's mission statement, which typically emphasizes improving community health.
Burnout isn’t just a workload problem—it’s a leadership problem. Physicians need a system that values their expertise, aligns their compensation with the organization’s purpose, and treats them as partners rather than productivity machines.
At Ancore, we believe financial sustainability and physician engagement are not mutually exclusive. A well-structured compensation plan can drive both economic success and physician investment in the organization. But the comp plan doesn’t start with a formula… it starts with alignment:
- Align mission with economics. If your medical group exists to improve community health, ensure that your compensation model supports that mission—not just revenue targets.
- Create real physician engagement. This means giving physicians a voice in strategic decisions and investing in physician leadership development, not just informing them after plans are made.
- Acknowledge the elephant in the room. Telling physicians to “just take care of patients” is like telling NBA basketball players to “just play basketball.” Physicians cannot be disconnected from the business of healthcare. They are essential to your financial sustainability.
The Bottom Line
If you’re seeing signs of physician burnout and lack of physician engagement in your organization, don’t just ask how to improve administrative burden—ask why it’s happening in the first place. If physicians aren’t aligned with both the mission and the economics of the organization, then it’s time to ask––are we finally ready to address the elephant in the room?
