This analysis synthesizes 7 sources published the week ending Nov 7, 2026. Editorial analysis by the PhysEmp Editorial Team.
About 200 nurse practitioners and physician assistants at UI Health in Chicago could walk off the job on or after Nov. 11. Their union, SEIU Local 73, issued a 10-day notice after members voted in October to authorize a strike, according to Medical Daily. The trigger is small in dollars and large as a signal: a 2% raise that took effect in August for other campus workers but not for these providers, who the union says have gone more than two years without a raise or cost-of-living adjustment.
For anyone following Physician & Advanced Practice Jobs, the notice belongs to a pattern that tends to get reported one hospital at a time. NPs and PAs have been organizing at very different employers this year, and pay that stalls while the employer contests whether a union even exists keeps turning up near the center of it.
A raise frozen by a court fight
The UI Health dispute is mostly procedural, which is what makes it useful to study. The Illinois Educational Labor Relations Board certified the union in July 2025. The university is challenging that certification in court, and in June 2026 the Fourth District Appellate Court granted a stay that paused the university’s duty to bargain. The Illinois Supreme Court declined to intervene. Before the stay, the two sides bargained from January to June and reached several tentative agreements, which the union said in July covered nearly all non-economic provisions.
UI Health’s position is that the notice does not mean a strike will happen, that it considers a strike unlawful while the court order stands, and that it has contingency plans to keep University of Illinois Hospital & Clinics running. The union’s list goes beyond the raise to pay transparency and equity, safe staffing, meal breaks and use of earned sick time. “We would much rather settle this at the table than on a picket line,” Local 73 President Dian Palmer said.
The patient base raises the stakes. Sarah Ehrhardt, a PA, said in the union’s July release that the vast majority of the patients these providers serve are on Medicaid, and the union has tied the dispute to federal Medicaid cuts.
When the non-economic terms are nearly settled and the economics are frozen by litigation, the effect for the clinicians is a pay freeze carried out by procedure. Each month the stay holds is another month the 2% stays out of their checks.
The same fight in Michigan, Boston and Phoenix
UI Health is not an outlier. In January, 213 nurse practitioners, physician assistants and certified nurse midwives at University of Michigan Health-Sparrow voted to form a union with the Michigan Nurses Association, with 86% of participants voting yes. Providers said management had threatened to deny a scheduled pay increase. “Without a union, we would have no power to stop management from freezing our pay,” Pam Stave, PA-C, said in the association’s announcement.
Two weeks after the Sparrow vote, nearly 200 APPs at Mass General Brigham Cancer Institute, NPs and PAs among them, filed an NLRB petition after asking for voluntary recognition. In September, primary care physicians, NPs and PAs in Banner Health’s Arizona outpatient clinics voted 69% to unionize with the Union of American Physicians and Dentists. That unit has 243 employees and serves more than 500,000 patients a year across 31 clinic locations in metro Phoenix. As early as May, Becker’s had counted at least 10 groups that had announced plans to unionize or voted to join unions in 2026, including a primary care drive at Cleveland’s MetroHealth that would cover physicians, PAs, APRNs and certified nurse practitioners.
The common feature is structure more than militancy. These units put NPs and PAs together, and at Banner and MetroHealth, physicians too. Where APP pay is built as its own ladder, benchmarked only against other APPs, a mixed unit bargaining as one group makes that separation harder to hold.
Most coverage files each of these under local labor news. The economic connection it misses is scale. Where APP pay is set system-wide, a skipped raise or a delayed contract lands on a couple hundred clinicians at once, and those clinicians have an obvious reason to organize at the same level the decision was made.
Where NP pay actually sits
This week’s sharpest pay comparison came from a Nurse.org analysis of Census American Community Survey data for 2020 to 2024, in 2024 dollars. Full-time, year-round nurse practitioners had median annual wage income of $125,126. Nurse anesthetists had $217,853, a gap of more than $90,000. Registered nurses were at $83,958.
The analysis is mainly about racial representation, and on that measure NP work looks close to proportional: 8.9% of Black RNs work as NPs, against 8.3% of White RNs. Pay is another matter. An ACS model comparing Black and White NPs of the same sex, age, hours and state put the gap in annual wage income at 4.6%, a finding the author describes as near the edge of what the data can detect. Small as it is, it sits squarely inside the “pay transparency and equity” demand on the UI Health list.
Nurse anesthesia’s premium comes with a steep entry price: students starting on or after Jan. 1, 2022 must pursue a practice doctorate, and the AANA reports average student debt above $200,000. NP work has a wider door, and a wider door weakens any one clinician’s bargaining power on pay.
That is the gap a bargaining unit is designed to close. An individual NP negotiating against a set scale has one offer to compare. A unit of 200 can put a number on what the scale has failed to do over two years, which is exactly the argument SEIU Local 73 is making in Chicago.
For NPs weighing a move, the practical questions have shifted. When did the employer last make an across-the-board adjustment for APPs? Are APPs in a bargaining unit, organizing, or neither? Now that APP units exist at systems from Lansing to Phoenix, those answers describe the contract as much as the salary does. For employers and recruiters, an unresolved organizing fight is visible to candidates, and a two-year gap between raises is the kind of detail that comes up in the interview.
What to watch after Nov. 11
The immediate test is whether UI Health’s providers walk out while the appellate stay stands, and how the university staffs its clinics if they do. The longer test is first contracts. None of the coverage we read reports a first contract yet at Sparrow, Mass General Brigham Cancer Institute or Banner, and whichever settles first will publish what may be the most concrete APP pay benchmark in its region. Expect recruiters in Lansing, Boston and Phoenix to be quoting that number to candidates within months of its release.
Sources
Mass General Brigham Cancer Institute APPs pursue union vote – Becker’s Hospital Review
Clinicians push to unionize amid staffing, burnout concerns – Becker’s Hospital Review
Black Nurses Reach Advanced Practice. Nurse Anesthesia Is the Exception – Nurse.org