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Hospital physicians at Legacy Health likely to unionize

Citing working conditions and increased financial pressures, hospitalists at Legacy's eight hospitals expect to win a pending union vote
man in sweater shown in park-like area
Standing on a bluff overlooking the Willamette River in North Portland on Nov. 14, 2023, Dr. Eric Seymour said he was born pro-union, but that some of his fellow hospitalists employed by the Legacy Health System have needed convincing. | LILLIAN MONGEAU HUGHES/THE LUND REPORT
November 16, 2023

Dr. Eric Seymour, 40, grew up “poor and progressive” in Mississippi and that attuned him to the power of unions to improve working conditions. But neither his life experience nor his pro-labor leanings are common among doctors, he said.

“Doctors in general are a pretty privileged class and profession,” he said while sitting at a favorite coffee shop in the St. Johns neighborhood of Portland. “We collectively believe we have a little more leverage and autonomy at work.”

Nevertheless, Seymour and nearly 200 of his colleagues at the eight Legacy Health System hospitals in Oregon are on the brink of formalizing the realization that they don’t have quite as much autonomy as they’d like. After counting votes on Friday morning, organizers expect to announce the formation of the newest hospitalists union in the country.

Organizers say they’re also reacting to Legacy’s recent proposals to increase the number of hours doctors must work per week in order to keep their full-time status and benefits. Forming a union is also meant to help protect jobs ahead of Legacy’s planned merger with Oregon Health and Science University, the state's major research hospital. 

“Legacy respects an employee’s right to choose whether to be represented by a union and will respect the outcome of any petition to unionize,” said Legacy spokesperson Ryan Frank in a statement to The Lund Report. 

Even working as a team, doctors’ bargaining power may be limited by Legacy’s shaky finances. The hospital is facing a financial crisis driven by the rising cost of wages and supplies, patients staying longer due to fewer safe discharge options and insurance payments that cover less than the full cost of care, according to a video released by Legacy in July. The proposed merger with the much wealthier OHSU could ameliorate some of these issues, as previously covered by The Lund Report.

And though some of the changes they want may cost the hospital money, the fight at Legacy is more about working conditions than pay, Seymour and other hospitalists said. They would like to have more control over what they are responsible for at work so they can safely and effectively treat their patients in alignment with their moral obligations and state medical licenses. 

The changing employment landscape for doctors is driving that need, union organizers say.

Seymour is a pediatric hospitalist - it’s his job to care for kids admitted to the hospital for inpatient care. When he was a kid in the 1980’s, his job didn't exist. If a person was admitted to the hospital back then, their primary care physician would have come and treat them. At that time, doctors were mostly self-employed. 

But about 30 years ago, hospitals began to hire doctors like Seymour as full-time employees. The idea was that it was more cost-effective to have doctors on staff. And federal rule changes helped drive the shift. Around the same time, health systems began consolidating. That pushed hospitals to run more like businesses.

Now, a much higher percentage of doctors are employees at health systems they feel are focused more on profits than on patient care. That has prompted an uptick in unionization efforts among doctors nationally this year, including at Providence St. Vincent’s in Portland, at Allina Health in Minnesota and at Ascension St. John in Detroit. Physicians and other workers at St. Charles Medical Group in Bend also filed to unionize last year, but withdrew their petition in February.

“We probably didn’t previously need a union,” said Dr. Rob Morgan, another pro-union hospitalist at Legacy. “We used to have a doctor as CEO of the hospital. He ran it as a very principled person, taking care of our community at the forefront.”

But when Dr. George Brown retired as president and CEO in 2017, Morgan said, Legacy followed the pattern seen throughout the country. The Legacy board replaced the physician with Kathryn Corriea — who has a management background, not a medical degree. Ever since, Morgan said, he’s felt growing pressure to work longer hours and see more patients.

“Forcing every doctor in the hospital to work a lot more every year, that’s not going to be good for the health of our [doctors] or of our patients,” Morgan said.

Similar pressures at PeaceHealth Sacred Heart Medical Center in Eugene, Oregon prompted the formation of the first-ever hospitalists union in 2014. Dr. David Schwartz, now 59, helped lead that effort and he remembers some doctors being loath to give up their authority to a union.

“‘Are we now going to have a second employer?’” he remembers them asking. “Is the union going to tell us what to do? Are we going to be minions of the union?”

But Schwartz argued they’d already lost much of their authority to hospital administrators and it was time to take it back by banding together.

Thirty of the 33 voting members of the original hospitalists union ultimately decided unionizing was better than what they saw as the alternative – letting people with business degrees tell them how to treat patients. The early contract negotiations were long and grueling, Schwartz said. One time doctors staged an informational picket. But the most recent negotiation lasted just a cordial three months. They are organized as Local 6552 of the American Federation of Teachers.

Schwartz said the existence of the union has restored some of that earlier doctor authority because it guarantees them a seat at the table and a chance to explain to administrators what it takes to achieve high-quality patient care.

“The union just allows us to do our job as we’re supposed to do our job without the constant pressure of ‘if you don’t get your patients out, if you don’t get your metrics up, we’re going to fire you,’” Schwartz said. It has made him comfortable to speak up if he sees something that he considers unethical or bad patient care. And he doesn’t worry his job could change on a dime.

Back in St. Johns on Tuesday, one day before he cast his vote to unionize, Dr. Seymour wore a bright yellow sweater as he walked to a lookout where he could use his old film camera to shoot the Burlington Northern Railroad Bridge in the fall sunlight. A self-professed camera nerd, making photographs is one way he unwinds. 

In addition to the bargaining power and the improvements in patient care he hopes a union will bring, Seymour hopes this will help change that old medical culture of white-knuckling the bad days and ignoring physicians’ own needs for health and well-being.

"We're finally speaking up and saying there’s a better way," Seymour said of himself and his fellow doctors. "We can do this work and do it well, and we can also care for ourselves."