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When people think about labor strife, they don’t often think of doctors. Union hero Norma Rae worked in a textile mill in North Carolina, not in a hospital in Portland.
But times have changed. Most doctors used to own practices. Now, many do shift work for someone else. In 2012, 60% of U.S. practices were owned by physicians, according to an article in JAMA Network, and only 5.6% of docs were direct hospital employees. Now, 74% of practicing physicians work for health systems or other corporate entities.
In Oregon and elsewhere, doctors are forming unions to offset the power of hospital conglomerates, which are growing larger by the day. Case in point: Oregon Health & Science University is in talks to buy Legacy Health, a combination that would create the biggest employer in the Portland metro area.
Oregon is a leader in unionizing doctors. In 2015, a group of hospitalists formed a union at PeaceHealth Sacred Heart Medical Center in Springfield, the first such union in the country, according to the American College of Physicians. (Hospitalists are primary care docs who work only in hospitals, doing rounds in shifts.)
Hospitalists in Portland joined the trend in November when 200 of them at five Legacy Health hospitals voted to join the Pacific Northwest Hospital Medicine Association, the union that grew out of the organizing effort in Springfield.
Now, the union is taking action against what it claims are unfair labor practices by Legacy. Union leaders say Legacy cut hours worked by hospitalists without sufficient bargaining. In response, the union filed a charge with the U.S. National Labor Relations Board on April 3.
“These changes were made over our objections,” says Dr. Mikeanne Minter, a Legacy hospitalist and member of the PNWHMA. “We didn’t agree to them.”
The new schedule means each doctor will have more patients to juggle during a given shift, Minter says. That’s going in the wrong direction in terms of quality of care, she says, because patients are much sicker now than they were before the pandemic.
Legacy would say little about the changes. “Legacy regularly adjusts scheduling in response to health care needs across our organization,” the company said in a statement. “We are always focused on staffing appropriately to provide the best possible patient care, and we will continue to work constructively with the union on this matter.”
The spat comes at a delicate time for Legacy. The proposed deal with OHSU came about in large part because Legacy is struggling to control surging costs as revenue stagnates. Wages and benefits, which often go up in union negotiations, rose 11% in the fiscal year that ended March 31, 2023.
Beyond patient care, the schedule changes are making it tough on doctors, whose jobs have gotten much harder since COVID-19 ravaged the health care system.
Legacy hospitalists are paid the same amount every week. If they work overtime, they accrue extra personal time off to use for vacations and sick days. If they don’t work enough shifts, Legacy deducts personal time off, keeping pay the same. If doctors run out of PTO before the end of the fiscal year March 31, and still have a shift deficit, they must pay Legacy.
“It seems like retaliation,” said one hospitalist who declined to be named.
Minter says she’s optimistic that the union and Legacy can learn to negotiate.
“Physician unions are new, and they are new to Legacy,” she says. “There are good people in administration at Legacy who want to work with the union. We just have to go through the appropriate channels.”