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More than 500 Allina Health outpatient doctors and practitioners are preparing to vote on whether to form the nation's largest private sector union of clinicians.

Leaders of the Minnesota practice group announced Friday that they were notifying the National Labor Relations Board of their intent to unionize. Dr. Matt Hoffman, a lead organizer and family practitioner, said physicians have been worn down by administrative burdens that have reduced their time with patients and control over the quality of care.

"Unionization is really the path that we have in order to have our voices heard regarding patient care," said Hoffman, who practices at Allina's Vadnais Heights primary care clinic.

The physician-led organizing campaign is the second involving Allina. Roughly 150 inpatient doctors at Allina's Mercy Hospital in Coon Rapids took the initial steps to unionize in March. Both efforts involve the Doctors Council, a New York-based affiliate of the Service Employees International Union.

Minneapolis-based Allina said in a statement that it remains focused on collaborating with doctors on solutions to health care challenges and the burnout that is driving some to quit.

"We are actively engaged in listening to them and responding with changes to better support their well-being," the statement said.

The latest union effort involves 550 doctors, nurse practitioners and other clinicians employed by Allina Health Primary Care and Urgent Care — a group scattered from River Falls, Wis., to the Minnesota cities of Cambridge, Annandale and Faribault. The goal is to arrange a vote this summer or early fall.

Although about 6% of U.S. physicians have unionized, most are medical residents or doctors in federal health clinics or small emergency medicine practices, said Joe Crane, national organizing director for the Doctors Council.

"This will be the largest private sector group that I know of, by far, to unionize," Crane said.

Physician burnout increased dramatically in 2021 and 2022, according to survey results published by Mayo Clinic Proceedings. Depression levels increased only modestly among respondents, leading authors to believe that the increase was related more to work stress.

Among physician assistants planning to leave practices in Minnesota, the share citing burnout increased from 9% in 2019 to 26% in 2021, according to a state workforce survey.

Allina has responded over the past decade with a variety of strategies, including the use of scribes— clinic workers who input data into electronic records while doctors see patients — to help with recordkeeping and a reduction in bed alarms to reduce nurses' fatigue. Recent solutions by other health systems include North Memorial's hiring of a resiliency coach to help caregivers manage stress.

Hoffman said many burnout issues predate COVID-19, but that the pandemic created new stressors.

"We weren't really involved in the decisions regarding what is safe for patients in terms of PPE, in terms of which patients should be coming to the clinic," he said. "I think that brought [the lack of physician control] to light for a lot of people."

The pandemic also created a stronger environment for union organizing. A Gallup poll found public support for labor in general increased from 48% in 2009 to 68% in 2021.

Physician influence varies by practice model. Independent groups negotiate contract terms with the clinics and hospitals at which they practice. The Allina clinicians by comparison are health system employees.

Hoffman said unionization would allow the practitioners to negotiate more time for administrative work, more support staff and hopefully more time per patient.

"Our time with patients is the most valuable thing we have," he said.

The movement comes at a vulnerable time for Allina, which like many large health systems has struggled financially during the pandemic. The health system announced it was cutting 350 jobs last month and delaying construction of a new hospital in Cambridge following an operating loss of $101 million in this year's first financial quarter.