In the US doctors are increasingly employed by large, multibillion dollar health care systems. Some are unionized, but many are not. Even those who are unionized have little to no collective voice because of the rules governing how they can organize and use their memberships in order to achieve meaningful change. Others are in private practice, often as independent contractors, not eligible to join unions. Still more are in management positions at hospitals and academic medicine, where they may be subject to the whims of the business side of healthcare which has become dominated by non-physician managers.

This lack of a powerful voice is a global phenomenon. While some countries have national medical associations that impose standards, most do not. Most countries have local medical societies and colleges which do not cooperate, and in many cases are unaware of each other’s existence. These local groups are often devoted to different aspects of medical professionalism, and have different logos, email addresses and domains.

Despite these problems, doctors do have some means of organizing themselves at the local level to protect and advance their profession. Most physicians belong to their county or state medical society, and two thirds are members of their national medical society. Some also belong to the local branch of their specialty association, and some to a number of different professional organizations whose main function is advocacy.

In addition, many doctors are members of the American Medical Association (AMA), and have the opportunity to participate in its House of Delegates, its legislative body that sets policy that affects the profession. They can also join AMA sections which provide opportunities to shape policy, network with peers and grow professionally.

It’s possible to imagine a new organization of doctors which would be purely and solely focused on patients. It could have nothing to do with protecting the interests of physicians, and everything to do with restoring the essence of the doctor-patient relationship which has slipped away over the past four decades as the number of health-care administrators has increased thirty-two hundred per cent, while the number of doctors has only grown by a quarter of that amount.

Whether these doctors choose to organize themselves into a group that fights for patients or not, it is clear that they are frustrated with their working conditions and the deteriorating doctor-patient relationship. They feel burnt out, and a majority support unionization, but many believe it will take too long to gain the power that traditional unions can bring them. And even then, it will be hard for them to articulate the problems they see in terms of the bigger picture. This article is an attempt to help them do that.