Collective bargaining: Physician unions and their implications for health care

Abstract

The analysis by Essex et al. 1 in this issue is a thorough and muchneeded review of physician strikes across numerous countries. It addresses an important question regarding the wisdom of extending labor law to physicians: whether allowing physicians to strike would lead to undesirable public health consequences. In finding little evidence that physician strikes are associated with higher mortality rates, it suggests that these concerns are relatively unfounded.We applaud the authors' efforts to counter the fear-mongering regarding physician unions, and we are not surprised by their findings. This is, in part, because concern over physician unions is largely based on a misunderstanding of what unions do and how US labor law manages disputes between workers and their employers. We begin with an introduction to US labor law and describe the governance roles that unions play in navigating labor disagreements. We ultimately argue that physician unions and collective bargaining can play a constructive role in improving patient outcomes. | WHAT IS A UNION?A union is an organization elected by a group of employees to bargain with its employer over "wages, hours, and other terms and conditions of employment." 2 The National Labor Relations Act does not require the employer to agree to employee demands, but to bargain in "good faith." 2 When a collectively bargained contract is reached, it binds all parties for the life of the agreement. The Act does not specify what "other terms and conditions of employment" means, but almost all contracts include agreements on wages, benefits, hours of work, work rules, and grievance procedures, as well as a prohibition on strikes and

Cultural tourism and socio-economic regeneration of rural communities: the Apo festival of Bono Takyiman, Ghana

“…This research approach advocates for data collection in a natural setting which is not manipulated. Being a qualitative research it involved an in-depth study using face-to-face interviews and participant observation as tools to collect data from rural tourism-related business owners in their natural settings (Bowling, 2004;McMillan & Schumacher, 2014). The study aimed at knowing the candid views of the tourism-related business owners on how the annual cultural celebration affects their businesses and the socio-economic development of the Bono Takyiman area.…”

“…Qualitative research is based on the assumption that 'reality' is multiple and socially constructed through the interaction of individuals who interpret issues by assigning meaning to their perceptions and experience (Bowling, 2004). Qualitative researchers view events and the social world through the eyes of the subjects that they are studying.…”

“…The issue of ethics is important consideration in any research that involves human participants. Bowling (2004) intimates that participants in a research project should not be harmed and must give their informed consent to participate. In this regard, the researcher informed all the participants the purpose of the study and sought their verbal consent before starting the data collection.…”

Restoring Physician Authority in an Era of Hospital Dominance

“…We note that although few US physicians are union members, this is mostly because until recently, few US physicians were employees and thus eligible to join unions. Future research should assess whether health care systems with unionized physicians offer more charity care, have different market or consolidation strategies, or represent physician interests more effectively …”

“…Future research should assess whether health care systems with unionized physicians offer more charity care, have different market or consolidation strategies, or represent physician interests more effectively. 14…”