Private Practice Is Still the Goal, But Physicians Deserve a Voice

The recent effort by hundreds of Banner Health physicians, nurse practitioners, and physician assistants in Arizona to unionize has generated considerable discussion throughout the medical community. As someone who spent nearly 15 years working within Banner Health and who has consistently advocated for physician autonomy, I have been asked whether I support the effort.

The answer is yes, although perhaps not for the reasons some might expect.

I have consistently argued that physician-owned private practice remains the best model in medicine. When physicians own the practice, they control the culture, staffing decisions, technology investments, compensation structure, and strategic direction of the organization. The people making the decisions are the same people caring for the patients and living with the consequences of those decisions. That level of alignment is difficult to replicate in large employed healthcare systems.

Unfortunately, healthcare consolidation has made physician ownership increasingly difficult. More physicians now work as employees of large health systems, academic centers, and corporate healthcare organizations where many important decisions are made far from the bedside, clinic, or reading room. When ownership is no longer an option, physicians still need meaningful representation and a mechanism to influence decisions that directly affect patient care and their professional lives. That is why I support the right of physicians to organize.

One aspect of this conversation that I find particularly interesting is how often physicians are compared to airline pilots. Whenever discussions arise about patient safety, fatigue, communication failures, checklists, or medical errors, we are told that healthcare should learn from aviation. We hear that pilots have created one of the safest industries in the world and that medicine should follow their example. In many respects, that comparison is fair. Both professions involve highly trained specialists making critical decisions where mistakes can have serious consequences.

What is rarely discussed, however, is another part of the aviation model. Airline pilots have spent decades building strong professional unions that have significantly improved compensation, scheduling, fatigue protections, workplace conditions, and their ability to influence decisions affecting safety and operations. While airlines and pilot unions do not always agree, few would argue that pilots have less control over their profession because of collective representation. If healthcare leaders want physicians to emulate pilots when it comes to safety and professionalism, perhaps it is worth considering why pilots have worked so hard to maintain a strong voice in their workplaces as well.

Many of the concerns being raised by Banner physicians are concerns that physicians across the country recognize. Staffing shortages, increasing productivity expectations, administrative burdens, burnout, and a growing sense that frontline physicians have less influence over operational decisions are not unique to Banner. These concerns have become increasingly common as healthcare systems continue to consolidate and as physicians become further removed from the decision-making process.

Ideally, every health system would create an environment where physicians feel heard, respected, and actively involved in decisions affecting patient care, operations, and workplace conditions. In those circumstances, unions may never be necessary. The fact that hundreds of clinicians felt compelled to pursue collective representation suggests that many do not believe existing structures are adequately addressing their concerns. Whether one ultimately supports or opposes unionization, that reality deserves thoughtful consideration rather than dismissal.

Supporting physicians’ right to unionize does not mean believing unions are superior to physician ownership. Given the choice, I would choose physician ownership every time. Ownership creates the greatest alignment between physicians, patients, and organizational leadership because physicians are not negotiating with management—they are management. However, for employed physicians who lack that option, collective bargaining may be one of the few remaining mechanisms available to ensure their voices are heard and their interests are represented.

The larger issue extends well beyond Banner Health. Across medicine, physicians are increasingly asking how they can maintain influence in a healthcare system that continues to consolidate. Some will pursue independent practice. Some will build physician-led organizations. Some will serve in medical staff leadership roles. Others may choose collective bargaining. Reasonable physicians can disagree about which approach is best, but the underlying principle should not be controversial: physicians deserve a seat at the table.

I will continue to advocate for physician ownership, physician leadership, and independent practice whenever possible. But when those options are unavailable, I also support physicians seeking lawful and organized ways to ensure their voices are heard. Medicine works best when physicians help shape the systems in which they practice, and patients benefit when those caring for them have meaningful influence over the decisions that affect their care.

Private practice remains my preferred model. Physician silence is not.