In a first for Delaware, ChristianaCare, physicians’ union ratify contract

Why Should Delaware Care?
ChristianaCare is Delaware’s largest healthcare system and its largest private employer. In recent years it has faced external challenges from elected leaders and internal ones from its own employees, culminating in a unionization movement.

Hundreds of physicians at ChristianaCare ratified their first union contract with the healthcare system, marking a milestone for the industry in the First State.

The three-year contract, negotiated with Doctors Council Service Employees International Union and ratified by 97% of members, marks the first time any employee of Delaware’s large healthcare sector has reached a collective bargaining agreement.

It covers more than 500 physicians working at ChristianaCare’s four hospitals, making the union the country’s largest’s among private-sector physicians.

The contract includes a mutual prohibition on strikes or lockouts, but also creates committees for physicians to have a greater say in system operations along with payscale adjustments.

“This physician-centered agreement advances key shared priorities that support our physician workforce while protecting uninterrupted, high-quality care for the communities we serve. It reflects a mutual commitment to collaboration, stability and long-term partnership,” ChristianaCare said in a statement.

Notably, the healthcare system is still in negotiations on another contract with resident physicians, which includes doctors who have completed medical school but are still working toward their licenses

Physicians voted in June 2024 to unionize and enter negotiations. Those have been ongoing for two years.

Dr. Nisha Gandhi, a cardiologist at ChristianaCare and member of the bargaining team, told Spotlight Delaware the two-year period was not an unreasonable amount of time considering it was their first contract.

As physicians have increasingly become employed by healthcare systems rather than operating independent, affiliated practices, Gandhi said they have increasingly felt their voices were lost in the debate with administrative leaders.

The creation of committees with physician members will strengthen their ability to advocate for themselves and the patients they serve, she said.

“There’s a very clear pathway for our collective voice to be escalated now,” she said.

In terms of payscales, the new contract has shifted from an employer-focused model to more of a market-rate model, resulting in pay increases and decreases depending on what market averages are paying, Gandhi said. 

It also creates ceilings for how many patients some specialty physicians could be expected to see in a day. Others – such as surgeons – wouldn’t have maximum patient loads, but would be limited by other factors such as the nurses, technicians and operating rooms that are necessary.

“I think one thing that holds true is that safety is paramount for the physicians who sat at the bargaining table. How many patients should we see or how many patients can we see in a day is what really guided our requests and compromises,” Gandhi said.

The ratification of the contract comes just days after the murder of an intern and shooting of another within the halls of ChrisitanaCare’s Wilmington Hospital by a coworker. Gandhi, who works at the hospital, said it was an “absolutely shocking tragedy.”

“I think we’re all still reeling in many cases when gun violence occurs. Healthcare actually is one of the most dangerous places to work, not just from gun violence or physical violence, but you know the care that is provided can lead to impacts on mental or physical health for physicians,” she said.

Gandhi said that under the terms of their contract, physicians will be able to demand an evaluation of what can be done better to protect physicians. She expects that would have spillover benefits to other caregivers and the public.

“It is a little bit more reassuring that, as a collective voice, when we raise our voice and ask questions, that is taken more seriously than an individual physician questioning whether they are safe when they come to work,” she said.