Hospitalists in Bellingham and Sedro-Woolley took an unprecedented step this week toward unionizing as both PeaceHealth and Sound Physicians employees.
These clinicians specialize in the general care of hospitalized patients at St. Joseph Medical Center and United General Medical Center, but are directly employed by Sound Physicians, a for-profit national labor management company. The hospitalists said the arrangement curtails their abilities to advocate for patients’ needs in the hospital and creates an environment that is fueling burnout.
A National Labor Relations Board ruling in favor of the clinicians on Wednesday, May 8, marks the first time clinicians have succeeded in creating a joint-employer union petition, legally connecting their labor management agency and the hospital they work at — forcing all key players to the table during negotiations.
“When we think about unionization, what we think about is collectively bargaining so that we can have a voice in our working conditions and the way that we care for our patients,” said Meg Lelonek, a physician who has been working in various roles at St. Joseph since 2014.
“I want to be able to provide the care to my patients that I would want for my family members to get if they walked through the door,” she said.
An increasing number of clinicians across the nation are looking to unionize as they lose their autonomy to advocate for patients or themselves as for-profit groups, such as Sound Physicians, are “trying to squeeze money out of health care,” said Joe Crane, an organizing coordinator for Union of American Physicians and Dentists.
“This [win] has the potential to ripple out to over 20 percent of the currently employed physicians in this country,” Crane said. “Other unions are going to be looking at what we did here.”
The group of about 30 physicians and nurse practitioners at the PeaceHealth facilities began behind-the-scenes discussions with the union in November.
With overwhelming support from their peers, the clinicians filed a unionization petition with the National Labor Relations Board (NLRB) on March 22, Lelonek said.
Typically, a vote would follow within a few weeks, but legal objections from PeaceHealth and Sound Physicians concerning employment classifications and the scope of the bargaining unit delayed the process.
PeaceHealth declined to comment for this story following the ruling by the board.
John Birkmeyer, medical group president with Sound Physicians, noted that the unionization efforts within the company are not unusual. Sound Physicians, which was acquired by UnitedHealth and venture capitalist firm Summit Partners for $2.2 billion in 2018, operates contracts with more than 4,000 clinicians across more than 40 states. Among these, the PeaceHealth hospitalists form one of its larger practices.
Birkmeyer said a relatively large number of practices driven by “passionate individuals” had gotten to the voting stage, but ultimately failed to convince a majority of the members of their practice to vote in favor of unionizing.
“We are confident that once our clinical team has a full understanding of the implications of unionization, they will choose not to pursue representation,” Sound Physicians spokesperson Anni Lange wrote before the ruling.
However, following the resounding win at the labor board, Crane said he was confident that the clinicians would vote to become the first union within Sound Physicians ranks, something that he said was only possible because the clinicians were willing to make themselves potential targets in advocating for change.
“These people are literally risking their jobs because that is a reality in this country,” Crane said, pointing to the firing of emergency room doctor Ming Lin from St. Joseph. Lin was let go after he publicly criticized safety practices at the hospital in the early days of the COVID-19 outbreak.
“They’re not doing this for money, they’re doing it for their community,” he said.
Strained system, voiceless clinicians
The working environment for the unionizing hospitalists has followed national trends of medical providers being asked to increase efficiency and the number of patients they see per day, clinicians told CDN. Yet, compensation for the clinicians was stagnant from 2017 — when Sound Physicians secured the PeaceHealth contract — to about 2023.
Negotiations for a new contract that included additional compensation for the Sound Physicians began in 2022. The clinicians themselves were not at the table.
While the contract marked the first change in compensation for years, it also increased the census — the number of patients the hospitalists are required to see per shift — by one person.
“Even that one patient felt like a stretch in the system that was already feeling overwhelmed and breaking,” Lelonek said, noting that the average hospital patient has become increasingly medically complex.
University of British Columbia researchers reviewing medical data from 2002 to 2017 discovered there was a significant increase in the complexity of hospital inpatients during that 15-year period, findings that matched clinician experiences.
More complicated patients require more time and resources to take care of, creating more work for hospitalists, explained study author Hiten Naik, a research fellow at the university.
He said his study implies that the increased pressure likely leads to more burnout, noting that the broad strokes of his findings are applicable to most developed countries.
Yet, the census barometer for measuring the clinicians’ success at the PeaceHealth facilities does not factor in how sick patients are, Lelonek said.
In addition to the census goals, the clinicians have daily, monthly and quarterly targets based on corporate-style efficiency metrics rather than prioritizing patient care, explained Martha Gillham, a veteran physician at PeaceHealth who started practicing in Bellingham in 1999.
As an example, hospitalists are financially incentivized to write discharge orders for 52.5% of their patients by 10 a.m. and 75% of patients’ orders by noon.
The system creates more stress and chaos, as well as raises concerns that there may be some room for errors as clinicians attempt to meet time-based goals, Lelonek said.
“That particular measure has been really stressful on our group,” Gillham said.
While Gillham said her first priority when arriving at work is attending to her sickest patients, she acknowledged the need to discharge patients at the busy, bed-limited hospital.
“I want to be clear that our team always prioritizes patient safety and patient care first,” said Rachel May, a unionizing nurse practitioner at St. Joseph who has been with the hospital in various capacities since 2011. “We do not meet the metric of getting 52.5% of our patients out by 10, because we can’t, safely, and that means we get paid less.”
The goals established for Sound Physicians’ clinicians vary from hospital to hospital, depending on the facility’s priorities. They are negotiated annually by the onsite Sound Physicians medical director, with input from the clinicians and Sound Physicians leadership, Birkmeyer said.
Both Lelonek and Gillham deny having their feedback and concerns included in the business-to-business discussions.
“None of us were in the room and those goals were set,” Lelonek said, noting no extra support was provided to the clinicians in meeting those targets. “There isn’t a safety net … It feels like we’re really at a breaking point.”
The physicians said they, like many others in their group, reduced their official hours in the wake of the new contract. Lelonek, who was already working less than full time, lowered her contract by an additional 18 hours a month.
“I wouldn’t be able to continue to provide full-time patient care for what I hope is going to be decades more of my future as a physician continuing to work at the current pace,” she said.
Challenges to unionization
Sound Physicians challenged the hospitalists’ unionization efforts during a three-day NLRB hearing in April on two primary points: the characterization of PeaceHealth and Sound Physicians as joint employers and the inclusion of the United General clinicians in the bargaining team.
The union was required to shoulder the burden of proof to demonstrate the joint employer relationship, establishing that PeaceHealth meaningfully affects wages, benefits, discipline, direction of work and more.
Ultimately, it did.
“If we would have lost this argument, Sound would sit at the bargaining table, and they would say, ‘There’s nothing we can do, that’s PeaceHealth’s decision,’” Crane said, noting that such dynamics throughout health care continue to rob physicians of their voice to advocate for themselves and their patients.
“It forces PeaceHealth to that bargaining table and PeaceHealth, in a place like Bellingham, is the health care system,” he added.
The union also defended its inclusion of Sound Physicians hospitalists at PeaceHealth medical centers in Bellingham and Sedro-Woolley. It said the move was justified for a number of reasons, including that the clinicians are used interchangeably between the two facilities.
While the process is contentious, members of the unionization effort who spoke to CDN said they care about PeaceHealth.
“Our goal with these unionization efforts is collaboration,” Lelonek said. “We really do appreciate so many things about PeaceHealth and their role in this community.”
Ballots will be mailed to eligible clinicians on May 21, and a final vote count will be on June 11.
A previous version of this story misstated the type of countries University of British Columbia fellow Hiten Naik’s research applied to. His work on the increase in complexity of hospital patients broadly applies to most developed countries. This story was updated at Tuesday, May 14 at 9:30 to reflect that change. Cascadia Daily News regrets the error.
Isaac Stone Simonelli is CDN’s enterprise/investigations reporter; reach him at isaacsimonelli@cascadiadaily.com; 360-922-3090 ext. 127.
