Physicians at ChristianaCare’s core New Castle County hospitals are organizing ahead of a vote on unionization in the coming month – a first in Delaware, and part of a nationwide wave of unionization efforts among health care professionals triggered in part by pandemic-era staffing shortages.
Physicians at Christiana Hospital and Wilmington Hospital, as well as the ChristianaCare Middletown Emergency Department, will be eligible to vote in the election; the first votes will be cast on June 20th, and the final poll will close on June 27th.
Two-thirds of the roughly 400 physicians eligible to join the bargaining unit– which would become a part of the Doctors Council of the Service Workers International Union (SEIU) – backed the petition to hold an election; organizers delivered the petition to the National Labor Relations Board last month.
Union organizers argue the move comes in response to critical understaffing and “the erosion of the physician-led model of care and the threat of corporate influence on medical decision-making” under current hospital leadership.
In a collective statement to Delaware Public Media, organizers asserted that securing collective bargaining rights would “improve working conditions in order to ensure safe patient care.”
“Time and time again,” organizers added, “ChristianaCare has placed profits over patients and physicians will no longer stand for it.”
Palliative care physician Dr. Mike Noonan estimates that his caseload — which entails assisting patients and families with end-of-life care and planning – has grown by roughly half in recent years.
Resignations and retirements in his department have exacerbated burnout; after the departure of a medical director, Noonan says administrators opted not to fill the vacancy. “[These are] not active cuts, but at least for palliative care, passive cuts,” he said.
Organizers also object to recent restructuring of ChristianaCare’s emergency medicine department. Until recently, ChristianaCare contracted with Doctors for Emergency Service (DFES), an independent physician-led organization, to staff its emergency department. In January 2024, the hospital opted not to renew the contract, instead asking DFES physicians to become ChristianaCare employees; according to a hospital spokesperson, the shift was necessary “to accelerate innovation and advancement in quality, safety and patient experience.”
But a quarter of DFES physicians opted not to join ChristianaCare as employees, and while ChristianaCare has since hired 25 new physicians, union organizers contend that the end of the DFES contract was a disservice to the emergency department.
“Since ChristianaCare took over control of the emergency department, there have been more than a dozen uncovered shifts every week leading to longer ER wait times and numerous patient safety concerns,” organizers wrote. “Despite the addition of these new physicians, the emergency department remains understaffed compared to when the emergency department was managed by DFES - by the physicians who also spent their time working in the ED. It is also difficult to compare these 25 new physicians with the hundreds of years of institutional experience lost with this decision.”
In Noonan’s view, ChristianaCare’s recent efforts to acquire struggling hospitals in the tri-state area – including an unsuccessful attempt in 2022 to purchase Crozer Health, a four-hospital system in Delaware County, Pennsylvania – provide yet another example of misalignment between the priorities of hospital staff and administrators. “Expansion seems to have occupied a lot of the administration's attention,” Noonan said, especially given the strain on physicians and other staff – as well as the system’s declining assets and rising liabilities, according to the past decade’s worth of federal tax filings.
More recently, ChristianaCare reached an agreement with federal prosecutors to pay $42.5 million to resolve allegations of health care fraud.
Despite rising liabilities, a ChristianaCare spokesman pointed out that administrators recently introduced a new compensation plan that invests an additional $21 million in physician salaries and benefits. “In many cases, the compensation redesign has resulted in net increases in total annual take-home pay for physicians,” he wrote.
Physician organizers, however, contend that “much of this funding has gone towards increasing work hours and workloads to justify the extra compensation” – and that the hospital has simultaneously cut back paid time off for employees.
Broadly, Noonan says he and colleagues hope that a collective bargaining agreement could increase accountability and realign priorities for hospital administrators.
“I hope that, beyond transparency, I hope that if we organize and show that we have power as physicians, they’ll be – I hate to say this – more professional, both in the conduct of their business and in the way they deal with us.”
While ChristianaCare underscored that it will respect the right of its physicians to vote on unionization, its spokesman also emphasized the administration’s opposition to the move. “We believe that continuing to have a direct relationship with physicians is an essential component of our continued shared success,” he wrote.
In an internal memo issued before organizers delivered their petition to the NLRB, medical group president Dr. Lisa Maxwell added that while pay, benefits and terms of employment are mandatory subjects of bargaining, budget transparency and operational decisions are not.
Though the unionization effort at ChristianaCare comes amidst a statewide debate about a proposed hospital oversight body to monitor rising healthcare costs, Noonan underscores that the move is unrelated to the tensions in the General Assembly; for now, he says, physicians are focused on getting a bargaining unit off the ground, not broader political goals.
If successful, the physicians would become the first collective bargaining unit within ChristianaCare – Delaware’s largest private employer. Other health care staff, including physician assistants, nurses and medical residents will not be eligible to vote in this month’s election.
In the past two years alone, union organizers — including the Doctors Council of SEIU — have emerged victorious from elections at hospital systems in Wisconsin, Minnesota, Massachusetts and Washington, DC, all citing burnout as a primary reason for the decision to seek collective bargaining agreements.
While the American Medical Association is not directly involved in the recent surge of union organizing among health care professionals, the organization released a collective bargaining guide for physicians in March of this year.