New study finds unionized healthcare workers

New study finds unionized healthcare workers

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Boston, Mass. – Unionized health care workers earned better pay and received better non-cash benefits, with little difference in working hours, compared to non-unionized workers, according to a new Trends in Unionization Among U.S. Health Care Workers, 2009-2021,” published on December 27, 2022 in JAMA.

“This study is the first to systematically examine the landscape of unionization among the US health care workforce and its associated economic effects,” said senior author Xiaojuan Li, PhD, instructor in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute.

Unionization efforts have been renewed in the US, and union membership has been shown to improve workers’ conditions in some industries. However, little is known about unions and their economic effects among healthcare workers. It remains unclear how health care unions have changed over the years and what benefits, if any, health care workers gain from unions.

To address this gap, the research team examined the prevalence of unionization among health care workers and its associations with employee pay, non-monetary benefits, and work hours among the health care workforce in the United States. The team surveyed healthcare workers who participated in the US Census Bureau’s Current Population Survey and the Annual Social and Economic Supplement between 2009 and 2021. This nationally representative, population-based household survey allows for a sample of over 14,000 self-identified healthcare workers, including doctors and dentists, advanced practitioners, nurses, therapists and technicians and support staff.

Study researchers found unionization rates to be low, with an overall prevalence of 13.2%, with no significant change from 2009 to 2021. Unions are associated with better pay and better benefits for healthcare workers. Union workers reported earning $123 more per week than non-union workers, receiving better health insurance from their employer (both in terms of employer contribution and type of insurance plan), and higher chance of having a pension or other retirement benefits at work. However, compared to non-union workers, unionized workers reported slightly more weekly hours worked.

“The associated benefits of unions are striking, but not surprising,” said Ahmed Ahmed, a fourth-year medical student at Harvard Medical School and first author of the study. “Unions bargain collectively for their members, which appears to improve both employee compensation and pay differentials between workers.”

“However, future causal analysis of the relationships is needed,” said Dr. Li. “And given the effects of the COVID-19 pandemic on the health care workforce, it will be important to explore whether unionization can help mitigate burnout.”


The Harvard Pilgrim Institute for Health Care Department of Folk Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Point32Health is the parent company of Harvard Pilgrim Health Care and Tufts Health Plan. Established in 1992, it was the first health plan-based medical school in the United States. The institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems and public health agencies.

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