Accretion is not necessarily more straightforward or faster than creating a new unit. Accretion is a process that enables a union to add additional classifications to an existing unit. Where accretion would lead a unit to increase by 10% or more in size, the union petitioning for accretion has to show majority support from the employees it is seeking to accrete. Additionally, employers or other unions have the opportunity to challenge whether the proposed unit is appropriate under the California Higher Education Employer-Employee Relations Act (HEERA) and legal precedent interpreting HEERA. This can lead to a prolonged Public Employee Relations Board (PERB) investigation. PERB may find that accretion is not appropriate for a variety of reasons, including if the employees the union is seeking to accrete have job duties, educational or training requirements, and supervision that are different from that of the existing employees in the unit (i.e., community of interest factors). Petitioning for a new and appropriate physician-only unit from the get-go may help avoid these potentially arduous pitfalls.

Not necessarily. Even assuming that accretion is successful – a bold assumption given the intricacies of the accretion process – accretion does not mean that all provisions of an existing contract will seamlessly apply automatically to the accreted employees. Although accretion may make things faster when a union is trying to accrete similar occupational groups, the same strategy is likely to fall apart where a union is trying to accrete distinct occupational groups. Differences in pay structures, occupational requirements, advancement process and supervisory relationships may create complexities or conflicts that prevent an existing collective bargaining agreement from applying to accreted employees. These issues will likely need to be addressed through side letters, amendments, and other avenues that may take significant time to bargain.

Legal precedent created by California Public Employee Relations Board (PERB) decisions since 1981 makes clear that a physician only unit is appropriate. See e.g., Unit Determination for Employees of the California State University and Colleges Pursuant to Chapter 744 of the Statutes of 1978 (Higher Education Employer-Employee Relations Act) (1981) PERB Decision No. 173-H p. 10-13; Unit Determination for Professional Patient Care Employees of the University of California (1982) PERB Decision No. 248-H, p. 2,12. PERB has repeatedly declined to place physicians in units with other healthcare professionals, noting that physicians have distinct community of interest factors that warrant a separate unit. These include, but are not limited to, their licensure and regulatory requirements, legal and ethics responsibilities, supervisory authority with respect to patient care, and working conditions. Where a union proposes a mixed professional healthcare unit that includes physicians and other healthcare professionals, such a strategy may be successfully challenged by the employer and other unions. These challenges may lead to prolonged hearings as PERB investigates the question of unit appropriateness.

The California Higher Education Employer-Employee Act (“HEERA”) creates a presumption that “all employees within an occupational group or groups located principally within the state of California shall be included within a single representation unit.” Gov. Code § 3679(c).

When determining what patient care occupational groups within the UC system should be in a bargaining unit, the California Public Employment Relations Board (“PERB”), has consistently ruled in favor of a statewide, physicians-only unit.1 In Unit Determination for Employees of the California State University and Colleges Pursuant to Chapter 744 of the Statutes of 1978 (Higher Education Employer-Employee Relations Act) (1981) PERB Decision No. 173-H, PERB stated that “[t]he strong internal and occupational community of interest shared by the physicians, as indicated by their common education, training, skills, duties, working conditions, and pursuit of common goals, is separate and distinct from the interests of other employees” warranting a bargaining unit separate from what PERB calls “residual patient care professional employees [i.e. HX unit].” As recently as 2025, PERB restated the appropriateness of a physicians-only unit stating, ““[i]n a landmark decision establishing bargaining units for UC employees, the Board created two bargaining units for non-physicians, professional patient care employees: a nursing unit for most positions requiring a registered nurse license (the NX Unit), and a residual patient care professional unit for most other patient care professionals (the HX unit).” See Regents of the University of California (2025) PERB Decision No. A530H, p. 2.

Although California law (“HEERA”), generally disagrees with fragmentation of employee groups and any undue unit proliferation, PERB stated that “the possibility of a total of perhaps three systemwide units of patient care professionals [i.e nurses, physicians, and professional healthcare workers], would [not] have an adverse effect upon the efficient operations of the university.” See Unit Determination for Professional Patient Care Employees of the University of California (1982) PERB Decision No. 248-H, p. 9. Thus, any argument that fragmenting physicians from other professional healthcare workers in the UC system is contrary to the statute, is a mischaracterization of existing PERB precedent. A system-wide, physicians-only unit significantly lowers the risk of protracted litigation over the appropriateness of the bargaining unit and will most likely get physicians to the bargaining table sooner to negotiate improvements on working conditions and other issues important to physicians.

Even assuming that accretion is successful – a bold assumption given the intricacies of the accretion process – accretion does not mean that all provisions of an existing contract will seamlessly apply automatically to the accreted employees. Although accretion may make things faster when a union is trying to accrete similar occupational groups, the same strategy is likely to fall apart where a union is trying to accrete distinct occupational groups. Differences in pay structures, occupational requirements, advancement process and supervisory relationships may create complexities or conflicts that prevent an existing collective bargaining agreement from applying to accreted employees. These issues will likely need to be addressed through side letters, amendments, and other avenues that may take significant time to bargain. The Employer is required to engage in post-accretion bargaining for physician-specific issues and over provisions in the existing contract that did not clearly apply to newly accreted physicians. See Regents University of the University of California (2023) PERB Decision No. 2884-H. Post-accretion bargaining may be protracted, which is consistent with any collective bargaining negotiations. Id. at 11.

There are two issues that are taken into consideration to determine whether existing contract terms may be applied to physicians: (1) whether accretion into an existing bargaining unit will actually be successful; and (2) whether existing contract terms are clear and unambiguous in its application to the newly accreted employees. See, e.g. Regents of the University of California (2025) PERB Decision No. A525H, p. 19; Regents of California (2023) PERB Decision No. 2884-H. “In resolving a petition for . . . unit modification, we [PERB] normally approve a petitioner’s proposed unit if it would constitute an appropriate unit.” Regents of the University of California (2025) PERB Decision No. A525H, p. 19. The appropriateness of a bargaining unit is based on community of interest factors found in HEERA (Cal. Gov. Code §3579), including the internal and occupational community of interest shared by the physicians in comparison to non-physician professional patient care employees. Unit Determination for Employees of the California State University and Colleges Pursuant to Chapter 744 of the Statutes of 1978 (Higher Education Employer-Employee Relations Act) (1981) PERB Decision No. 173-H p. 10-13.

Yes. Employers are legally prohibited from acting in ways that “[i]mpose or threaten to impose reprisals on employees, to discriminate or threaten to discriminate against employees, or otherwise to interfere with, restrain, or coerce employees” in their right to “form, join and participate in the activities of employee organizations of their own choosing.” For example, employers may not state or imply that organizing will be futile or automatically result in reduced compensation or benefits. Such statements may amount to an unfair labor practice that can be legally challenged by employees or employee organizations.

Yes. Labor unions must ensure they are not behaving in ways that “interfere with, restrain, or coerce employees” in their right to “form, join and participate in the activities of employee organizations of their own choosing.” Deceptive conduct that interferes with workers’ ability to freely exercise their rights is considered an unfair labor practice and may be legally challenged by workers, employers or other employee organizations. For example, a labor union may not obtain a union authorization card from an employee using deceptive tactics or decline to recognize a revocation of a card by creating arbitrary revocation procedures.