In 2014, when a hospital in Oregon proposed saving costs and gaining efficiencies by outsourcing their hospitalists to a management company, a third of their doctors gave notice, and the rest responded by forming a union, affiliating with the American Federation of Teachers. This forced the hospital’s leadership to back down from outsourcing, but their attempt to unionize highlights the increasing pressure doctors face in order to meet performance targets and metrics, with many being offered financial incentives to perform well under the requirements of the Affordable Health Act. This strikes at the profession’s intrinsic feeling that the patient-doctor relationship will suffer under financial incentives to see more patients, known as “skin in the game”.
See "Doctors Unionize to Resist the Medical Machine", Noam Scheiber, The New York Times, January 13, 2016