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Boston, MA – Unionized healthcare workers earned better pay and received better non-cash benefits, with little difference in their work hours when compared to non-unionized workers, according to a new study, “Trends in Labor Unionization Among US Health Care Workers, 2009-2021”, published on December 27, 2022, in JAMA.

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

Labor unionization efforts have resurged in the US, and union membership has been shown to improve worker conditions in some industries. However, little is known about labor unionization and its economic effects on healthcare workers. It remains unclear how labor unionization in health care has changed over the years and what benefits if any, health care workers gain from unionizing.

To bridge this gap, the study team examined the prevalence of labor unionization among healthcare workers and its associations with employee pay, non-cash benefits, and work hours across the healthcare workforce in the United States. The team studied healthcare workers participating in the US Census Bureau Current Population Survey and Annual Social and Economic Supplement between 2009 and 2021. This nationally representative, population-based household survey allowed for a sample of over 14,000 self-identified healthcare workers, including physicians and dentists, advanced practitioners, nurses, therapists, technicians, and support staff.

Study researchers found that labor unionization rates were low, at an overall prevalence of 13.2%, with no significant change from 2009 through 2021. Labor unionization was associated with better pay and better benefits for healthcare workers. Unionized workers reported earning $123 more per week than nonunionized workers, receiving better health insurance from their employer (both in terms of employer’s contribution and the kind of insurance plan), and having a higher chance of having a pension or other retirement benefits at work. However, compared with nonunionized, unionized workers reported slightly more weekly work hours.

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

“Future causal analysis of the relationships, however, is needed,” said Dr. Li. “And given the toll of the COVID-19 pandemic on the health care workforce, investigating whether unionizing could help mitigate burnout, will be important.”


The Harvard Pilgrim Health Care Institute’s Department of Population 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. Created in 1992, it is the first appointing medical school department in the United States based in a health plan. The Institute focuses on improving healthcare delivery and population health through innovative research and education in partnership with health plans, delivery systems, and public health agencies.

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