Should Doctors Unionize? The Story of Why Physicians at Salem Hospital Joined a Union to Take Back Power with Dr. Sean Codier

Key Podcast Moments

• How worsening overcrowding, understaffing, and corporatization left Salem Hospital physicians feeling powerless and why they decided collective action was their only option.
• The surprising reality of physician unions: what they actually do, how they form, and how they’re being used to compel hospital leadership to negotiate.
• The fear tactics and misinformation often used to discourage doctors from organizing and the truth behind myths like “pay leveling” and “third-party interference.”
• The biggest questions and myths about unionization for physicians and what Salem Hospital physicians have seen since they unionized in terms of outcomes.

Dr. Sean Codier is an emergency physician at Salem Hospital and one of the organizers behind the first successful physician union within the Mass General Brigham system. What began as quiet frustration over unsafe staffing and shrinking clinical autonomy grew into a movement to restore the physician voice inside an increasingly corporate healthcare environment. For Sean and his colleagues, unionizing wasn’t about ideology – it was about survival.

On this episode of How I Doctor, Dr. Graham Walker sits down with Sean to understand how Salem physicians successfully organized, what unions offer beyond pay negotiations, and why so many hospitals fight to prevent them. They discuss the myths and fear tactics that often surround physician unions, the personal risks of leading one, and what this growing movement reveals about medicine’s identity crisis between serving corporate goals and serving patients.

Top 4 Takeaways

• Physicians are losing control and unions are one way to take it back.
  Sean describes how corporatization, private equity, and administrative bloat have stripped doctors of decision-making power over patient care. Years of overcrowding, unsafe staffing, and ignored feedback left clinicians feeling powerless. Unionizing wasn’t about politics, it was about restoring a say in how medicine is practiced and protecting the conditions that make safe, ethical care possible.
• The right to negotiate isn’t automatic, but unions do make it legally enforceable.
  While most physicians assume their institutions will listen to reason, Sean explains that hospital leadership often declines or delays any meeting that might challenge the status quo. Under U.S. labor law, a union compels administration to the table. It’s the only legal mechanism that forces those discussions to happen. For many doctors, that leverage is the difference between being heard and being ignored.
• Hospitals use myths and fear to keep physicians from organizing.
  Sean details how administrators spread myths like unions “level pay” across specialties, insert “third parties” between doctors and leadership, or diminish professionalism. These myths, he argues, are designed to protect control, not collaboration.
• Unionization is not just about money.
  Despite the rhetoric, pay wasn’t the top issue for most Salem physicians. What motivated them was the erosion of medicine’s moral core of the ability to do right by patients and communities. Sean believes unions offer a path to reclaim that purpose, ensuring doctors have both the power and protection to advocate for care over profit.

Are you part of a union? We want to hear from you on Offcall

Are you member of a union? We recently added a question to Offcall’s onboarding survey asking whether or not you’re member of a union, so that we can release data showing how joining a union has impacted your job satisfaction, compensation, workload, and job conditions. See a sample for what that looks like here:

Please sign up for an Offcall account (it’s free and anonymous) in order to tell us what your experience has been and so that we can publish data showing how joining a union is impacting physicians nationwide.