A one-day strike by as many as 600 Allina Health doctors and primary care practitioners on Wednesday is making history as the first such labor action of its kind in Minnesota and one of the largest in U.S. history.

While hospital nurses have held large walkouts, Wednesday’s strike is believed to be a first for doctors in the state. It follows 20 months of negotiations that failed to produce a contract for Allina’s primary care practitioners or address one of their key concerns: the rising amount of time they spend, at home and off the clock, completing paperwork and responding to patients’ online messages.

“We’re given so much paperwork and phone calls and medical messages, and that is important work. But we don’t have any time in our day to do that,” said Dr. Matt Hoffman, a family practice provider in Allina’s Vadnais Heights, Minnesota, clinic and a leader of the union movement. The practitioners, represented by the SEIU-affiliated Doctors Council, want four hours of paid, dedicated time each week for such purposes.

Doctors scheduled pickets Wednesday in Coon Rapids, Minneapolis and St. Paul, but the 61 Allina clinics under strike stretch from as far as Cambridge in the north to Faribault in the south.

Hoffman said the number of striking doctors and providers is expected to be bigger than the 325 who voted in fall 2023 to unionize. About 50 negotiating sessions have taken place since that time, including two since the doctors’ strike notice 10 days ago.

Allina said in a statement it is mobilizing doctors and practitioners in other areas of the health system to cover appointments during the strike, but more than 25% of the union doctors opted to continue to work. The Annandale clinic was closed on Wednesday and appointments were rescheduled.

The Minneapolis-based health system said it can’t afford the doctors’ demands amid “ongoing financial challenges,” including budget cuts by President Donald Trump’s administration that could reduce how much the federal Medicaid program reimburses providers for the treatment of low-income and disabled patients.

“It would be irresponsible for either party to agree to a contract that adds significant new expenses that will undermine access and increase costs to those who pay for care,” the statement said.

Strikes by doctors are a rarity in the U.S., because only about 8% have union representation. In 1975, doctors in California struck over rising malpractice costs while residents and interns in Chicago and New York struck over excessive hours and workloads. More recently, emergency room physicians engaged in a one-day strike of Ascension St. John Hospital in Detroit last year over working conditions and staffing shortages.

Strikes in health care have happened in Minnesota. Allina faced two strikes by its Twin Cities hospital nurses for a combined 44 days in 2016 in a dispute over health benefits. But union officials said a strike focused on doctors hasn’t happened before in the state.

Allina’s doctors have been at odds with their health system in the years following the COVID-19 pandemic. They publicly opposed a health system policy, which was later rescinded and then banned by state medical debt legislation, of denying nonemergency care to patients with substantial overdue bills. They criticized Allina’s recent decision to close five primary care clinics, where some doctors said they were so busy that they couldn’t take new patients.

Hoffman’s wife, Dr. Lauren Maurer, lost her position at Allina’s Maplewood clinic as part of the closures. She was hired to Allina’s Bandana Square clinic in St. Paul, where she started seeing patients on Monday. She was planning to picket Wednesday. Many health systems are facing similar dilemmas, so she said she wanted to stay in Allina to help see the negotiations through.

“The reasons we unionized,” she said, “are the reasons why I didn’t want to go to another place.”

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