Dr. Shirley Fox, an obstetric hospitalist with nearly 30 years at Oregon’s largest Providence hospital, never imagined herself on a picket line. After all, vanishingly few physicians have historically joined unions, much less strike.

Yet last week, Fox was marching outside Providence St. Vincent Medical Center in Portland. She and 70 other doctors unionized in 2023 and, after a year of negotiations over their first labor contract, joined nearly 5,000 nurses in the largest health worker strike in Oregon history. The strike is also the state’s first involving a doctors union.

Fox said her once-fulfilling job, defined by patient care and autonomy, shifted into a struggle against exhausting schedules and chronic understaffing.

“It’s crazy. There are days when we can’t eat, can’t sit and can’t even pee because we’re so busy,” Fox said. “We’ve been asking for just another body to help us in these critical times, but we can’t seem to get a hospital to do it.”

Doctors unions are growing more common across the country. While physicians historically sat atop the health care hierarchy, an increasingly consolidated health care sector has left them finding more affinity with nurses and other more commonly unionized colleagues.

“What’s notable about this strike is that the physicians are fighting alongside the nurses, which points to potentially evolving alliances in the health care sector,” said Hayden Rooke-Ley, a health law and policy fellow at Brown University who recently led a study on physician unionization. “There seems to be a growing recognition among physicians that their grievances with corporate medicine are similar to those faced by other caregivers, and even nonclinical health care workers.”

Rooke-Ley’s study, published in the Journal of the American Medical Association, found that the number of physicians unions formed between January 2023 and May 2024 nearly matched those over more than two decades prior, between 2000 to 2022.

Oregon’s wave of labor activity across the health care sector picked up in 2023 and included the hospitalists at St. Vincent and the physicians and providers at Providence’s women’s clinics. Legacy Health also saw more than 150 doctors across its six hospitals unionize.

Other health systems in the country, including Alina Health in Minnesota and Ascension St. John in Detroit, Michigan, also saw hundreds of doctors join a union.

Rooke-Ley said physicians are now grappling with the same issues — centralized decision-making, professional demoralization, and cost-cutting — that have long driven other workers to unionize. The pandemic and its aftermath amplified these dynamics, he said, heightening issues of understaffing, burnout, and threats to patient care.

“The pandemic turned many hospitals upside down financially,” Rooke-Ley said. “In response, one of the strategies has been to tighten labor costs while squeezing more patients in. … Hospitals are trying to generate more revenue or become profitable again, and that often comes at the expense of labor.”

Even with nearly 5,000 nurses on strike, Providence said the striking hospitalists and women’s clinic physicians and providers have created an unusual challenge.

While there’s a ready and willing workforce of traveling nurses willing to step in during a strike — usually at great cost — there’s no such backup for striking physicians.

In the lead-up to the strike, Providence broke from its usual stance of refusing last-minute talks, asking the doctors to try to negotiate an eleventh-hour deal. The doctors declined to return to mediation unless Providence agreed to bargain with nurses and other workers set to strike.

Providence filed an unfair labor practice complaint against the physicians for failing return to the table. (The Oregon Nurses Association, the labor union that represents the striking nurses and staffs the bargaining team for the striking doctors, says it’s Providence that has delayed negotiations.)

Providence, a nonprofit founded by an order of Catholic nuns, hasn’t been immune to the pressures that have affected the broader health care sector. Though it manages a multibillion-dollar investment portfolio, its medical operations have lost money over the last two years.

Jennifer Burrows, chief executive of Providence Oregon, said last week that Providence’s costs to provide care exceed insurance reimbursements. She said Providence has been trying to buoy its finances by selling off parts of its operations.

Providence sold lab operations in 2023 and signed on with Aetna to administer its self-funded health plans for employees. More recently, Providence has pursued a joint venture with a private equity-backed firm to run its home health and hospice operations.

The striking doctors say cost-cutting has also affected their ability to care for patients.

‘A pretty big deal’

Dr. Lesley Liu, an internal medicine and pediatric hospitalist at St. Vincent, said her team has been stretched thin for years but the pandemic only magnified the issue.

Like many physicians on the picket line, Liu said she was reluctant to rock the boat in the past. Her breaking point came after the peak of the pandemic, when conditions failed to improve as promised, she said.

“For us to be out here is a pretty big deal. It’s a moral and ethical dilemma, and I’m scared for patients,” Liu said. “Not being in the hospital taking care of people is very distressing, and I think the administration is trying to take advantage of that. But we’ve been suffering in silence for so many years that it’s to a point we can’t take this anymore.”

The Providence strike and its outcome could set a precedent for similar disputes nationwide, Rooke-Ley said. If nurses and doctors succeed in securing significant concessions through their alliance, it could inspire others across the country to do the same.