Workers' rights have long been central to political discussions, with employees seeking fair compensation, a healthy work-life balance, and job security. However, some individuals still find themselves in less-than-ideal work situations where they feel powerless to initiate change. Many employees would be surprised to find just how much leverage they have.
For example, recruiting a new nurse can cost between $10,000 and $88,000, and a new physician between $88,000 and $1 million.1 This means that employee retention is crucial for a company's financial health.
This reality provides employees with leverage when their rights are compromised. Unions take advantage of this very principle that workers possess strength in numbers, enabling them to negotiate fair wages and benefits by leveraging their collective labor.
A brief history of unions
In 1933, President Franklin D. Roosevelt enacted the National Industrial Recovery Act (NIRA) to address the economic challenges following the Great Depression. The primary objective of NIRA was to create "codes of fair competition," which outlined acceptable business practices aimed at protecting workers, consumers, and small businesses.2
NIRA granted workers the legal right to organize and engage in collective bargaining. However, enforcing this provision proved challenging. The National Labor Board (NLB), established to mediate labor disputes, lacked substantial enforcement authority.
Similarly, the National Recovery Administration (NRA), responsible for overseeing NIRA's implementation, could only penalize non-compliant employers by revoking their privilege to display the Blue Eagle emblem, indicating NRA participation.2
Recognizing these enforcement deficiencies, Congress passed the National Labor Relations Act (NLRA) in 1935. This legislation established the National Labor Relations Board (NLRB), empowering it to enforce workers' rights rather than merely mediate disputes. The NLRA provided a more robust framework for upholding employees' rights to organize and bargain collectively.3
Union efforts in optometry
Unions in healthcare, specifically in eyecare/optometry, are vital to ensure fair labor practices and adequate insurance reimbursement, as seen in Ontario's newly negotiated optometry services agreement.4 The new service agreement was enacted due to collective bargaining from the Ontario Association of Optometrists (OAO), a professional organization representing over 2,000 optometrists in Ontario.
Through months of discussion with the Ministry of Health in Canada, the OAO was able to come to an agreement that “better reflects the latest best practices and expert advice.”5 These amendments included changes to the current fee schedule that increased reimbursements for periodic “oculo-visual assessments” for geriatric, pediatric, and general populations (Table 1).
The new agreement also introduced complexity modifiers that account for the extra time and expertise required to treat specific patient populations. These include a glaucoma complexity premium, a child cycloplegic refraction complexity premium, and a diabetes complexity premium.
The Ontario government, in conjunction with OAO, also made various changes to who and when individuals would be eligible for exams (Table 2). The new optometry services agreement represents a collaborative effort between the Ministry of Health and the OAO to modernize optometric care, improve compensation for providers, and ensure the sustainability of eyecare services within Ontario.5
Table 1: Fee schedule for April 2021 to April 2023 for two selected codes.
| Service Description | Fee Schedule Code | Previous Fee | New Fee | Percent Change |
|---|---|---|---|---|
| Periodic oculo-visual assessment for patients aged 19 years or less | V404 | $48.60 | $51.00 | 4.80% |
| Periodic oculo-visual assessment for patients aged 65 years or older | V406 | $60.00 | $80.00 | 33.30% |
Table 2: Table outlining selected changes from the Ontario government that went into effect on September 1st, 2023.
| Area | Current | Change | Rationale |
|---|---|---|---|
| Referral instructions | People need a referral letter from their primary care provider for an OHIP-insured eye exam | People with eligible medical conditions can receive OHIP-insured eye exam from an optometrist without a referral | Ensures appropriate care based on clinical evidence for people with eligible conditions |
| Diabetes | Documented history of diabetes required for eligibility of an insured eye exam | Optometrists can now clinically assess and verify if a patient has diabetes to determine eligibility for an insured eye exam | Empowers optometrists to assess patients directly, aligning with expert advice and practices in other provinces |
| Uveitis | Only people with reocurring uveitis receive an insured eye exam, regardless of current inflammation | OHIP will insure an eye exam for anyone with active uveitis, whether reocurring or not | Informed by clinical evidence and expert advice, treating active uveitis is more effective than monitoring, as it reduces the risk of reoccurrence |
Recent labor organizing efforts in optometry
Union efforts are not always as cooperative, however. This is evidenced by the University of California’s (UC's) University Professional and Technical Employees-Communication Workers of America Local 9119 union (UPTE-CWA 9119) strike.
A union consisting of more than 18,000 healthcare workers, including over 100 optometrists under the UC system, claimed that the UC system was in violation of state labor laws, that they would enter bargaining attempts in bad faith, and actively participated in union-busting tactics.6,7
The union was initially filed due to failed efforts to combat the “increasing patient load, short staffing, and below-market pay” that ultimately contributed to “recruitment and retention issues, which results in delayed care for patients.”
As a result of the bad faith bargaining and violation of state labor laws, a 2-day strike was held with over a thousand optometrists, UPTE members, other labor unions, and community supporters. The strike forced UC to sit down with UPTE optometrists and bargain in good faith.
More recently, members of UPTE-CWA 9119 and the American Federation of State, County, and Municipal Employees (AFSCME) unions held unfair labor practice strikes at all UC locations on May 1st, 2025.8,9 The outcome is still pending.
Current unions for optical workers
There are not many unions designed specifically for opticians, lab techs, and optical assistants due to it being a relatively niche and privatized field. That said, the Optical Workers Local 408 is a well-known union that has had great strides in representation.
Their most recent contract agreement was with Park-Sher Optical Company. In this agreement, the union was able to negotiate guaranteed hours for full-time and part-time workers. This stipulation required a minimum number of hours an employer can schedule a full-time/part-time employee, which helped ensure adequate pay regardless of staffing needs at any given time.
Overtime pay was also established, with a 1.5x rate for holidays/regular overtime, and 2x for Sundays. The union was also able to negotiate a required 2-week notice that the employer must give to an employee if they are being laid off.10
Like most unions, eligibility for Optical workers 408 is based on location and title. For specific information regarding the process of joining a union, it is best to contact the union directly. For Optical Workers Local 408, you may contact their president, Jason Johnson, at jjohnsonlocal408president@gmail.com.
Furthermore, the agreement included, but was not limited to:
- Better wages
- Yearly wage increases
- $450 per month employer-sponsored health insurance plan
- $600 / $500 coverage for eyeglasses / contacts respectively
- Increased vacation time
- Pay allotted for transfers away from one's regularly scheduled office location
- Required company 401(k) contributions
Similar agreements were made with workers at an Empire Vision Center Inc. located in Centereach, NY, Davis Vision Inc. located in Troy, NY, and Newton Square, PA, and a Balester Optical Company location in Wilkes-Barre, PA.10
Challenges in labor organizing in optometry
Optometrists and other healthcare providers face significant legal and practical barriers to unionization. Firstly, there are federal antitrust laws that state optometrists who own their own practices are classified as independent contractors rather than employees, making it illegal for them to collectively bargain over reimbursement rate.11
Additionally, even employed optometrists working within larger healthcare systems or retail settings often lack the collective bargaining power of traditional labor unions due to their classification as "supervisory" personnel, which limits their ability to unionize under the National Labor Relations Act.12 Employers that do not classify their optometrists as “supervisory” personnel are still able to unionize with other optometrists within their organization.
Consulting your contract or HR department can be helpful in determining if your company refers to you as supervisory personnel. Furthermore, vision plans, which set reimbursement rates, operate on a large scale, making it difficult for individual providers to negotiate better terms independently.11
Optometrists can address poor reimbursement from vision plans by engaging in a number of ways. Firstly, ODs can engage in legislative advocacy to support policies that provide greater negotiating power.11 They can also join professional organizations to collectively advocate for better reimbursement rates,11 and directly negotiate contract terms with vision plans when possible.
Educating patients on the limitations imposed by vision plans and encouraging them to advocate for improved coverage can also influence policy changes.11 Exploring alternative payment models, such as direct-pay services, can help reduce dependence on vision plans.
Additionally, legal professionals can assess whether restrictive vision plan policies violate state or federal laws, and optometrists can consider legal challenges where applicable.
The pros and cons of unionizing
Unionization offers several advantages to employees, such as higher wages, improved benefits, job security, better working conditions, formal dispute resolution processes, and collective bargaining.13
However, there are also notable disadvantages. Union fees can sometimes be high, and can be deducted directly from workers' paychecks.14 There may be individuals who feel the benefits received do not justify the costs.
Additionally, unions operate on a collective bargaining system, which may limit individual autonomy and result in personal preferences being overlooked.15 Seniority-based systems can disadvantage newer or high-performing employees, as promotions or layoffs may prioritize length of service over merit.
Furthermore, the adversarial relationship between employees and management can create workplace tension, fostering an "us vs. them" mentality that may strain employer-employee relations.
How to unionize
The process of unionization can occur with or without the recognition of the employer. There is a series of protected steps that one must take to start the process.
The first step is to contact your regional NLRB office to speak to your local representative. The NLRB offices near you can be found here.
Generally, there are two paths that can be taken to finalize the union:
1. Voluntary recognition
In this preferred method, employees demonstrate majority support for union representation, typically by signing “authorization cards.” The union then requests the employer to voluntarily recognize and bargain with it.
If the employer agrees, the union is recognized without the need for a formal election, allowing both parties to proceed directly to collective bargaining. This approach can be more expedient and less adversarial, fostering a cooperative relationship from the beginning.
2. NLRB election process
Alternatively, if the employer does not accept voluntary recognition, employees or a union can file a petition with the NLRB to hold a secret-ballot election. This requires showing that at least 30% of employees support unionization. The NLRB then conducts an election where all eligible employees vote on whether to unionize.
If a majority votes in favor, the NLRB certifies the union as the official representative, obligating the employer to engage in collective bargaining. This process provides a formal and legally binding outcome, but can be lengthier. A flyer describing both processes can be found here.
Final thoughts
In conclusion, labor organizing in optometry and eyecare serves as a powerful tool for professionals seeking to improve their working conditions and advocate for their rights.
However, it requires careful consideration of both its advantages and potential challenges to ensure that it aligns with the collective goals of the workforce.
