In the health care field, however, as doctors have increasingly become salaried employees rather than self-employed and nurses have played a more central role in the delivery of services to patients, the main grievances are no longer about income. Doctors and nurses are very interested in workplace control. They complain that administration has subverted their autonomy, that decisions concerning patients’ health are no longer the exclusive province of the health professional. Treatment regimes are now handed down to them, often dictated from above. Management exercises control over issues of diagnosis, treatment—including choice of medication—and the organization of the professional’s time. In effect, the doctor and the nurse have been reduced to functionaries of the health care machine. [...]

Now that health care is managed by large organizations, some of them for profit, the once independent physician works under constant surveillance. Are these developments topics for union intervention? Where doctors have become unionized—about 15,000 in several organizations, most of them affiliated with the Service Employees—questions of autonomy are a theme of organizing drives. Yet once a drive is over, health care unions revert to making traditional trade union demands regarding salaries and benefits, even though for most doctors and, recently, registered nurses, physician’s assistants, and nurse practitioners, these are not burning issues. The question of autonomy is, but doctors’ and nurses’ unions have not consistently raised it.