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Oregon Physicians File to Join Union

Analysis  |  By Christopher Cheney  
   June 13, 2022

A physician involved in the move to seek union representation says the main reason for the effort is to gain influence on administrative decision-making.

Physicians and other healthcare workers at Bend, Oregon-based St. Charles Medical Group have filed for union representation from the American Federation of Teachers.

Union representation of physicians is relatively rare. Several factors are contributing to efforts to unionize physicians, including burnout, the growing physician as employee model, and desire among physicians to have a stronger voice in healthcare organization administration.

St. Charles Medical Group is affiliated with St. Charles Health System, which features four acute-care hospitals in central Oregon. In addition to physicians, the union effort at St. Charles Medical Group includes nurse practitioners, physician assistants, behavioral health clinicians, licensed clinical social workers, and other healthcare workers.

The American Federation of Teachers is a national union with 1.7 million members, including about 200,000 healthcare workers.

A physician involved in the move to seek union representation at St. Charles Medical Group says the primary impetus of the effort is to gain decision-making authority at the medical group and St. Charles Health System.

"It is mainly concern about bad administrative decisions. It has gone from bad decisions to frustration and concern about the healthcare that we are providing. The term union tends to make people think about things like pay and strikes, and that is not a major part of the discussion. It is concern about patient care," Lester Dixon, MD, an emergency room physician at St. Charles Medical Group, told HealthLeaders.

A recent event cemented the move to unionize, he said. "There is a group called the Medical Governance Board that is about 10 providers that St. Charles Health System has supported, theoretically. The Medical Governance Board is supposed to provide guidance in monthly meetings with the administration to help steer the St. Charles Health System and St. Charles Medical Group. About three months ago, when things were starting to get heated up regarding finances, the leader of the Medical Governance Board, Dr. Richard Freeman, did not show up to a meeting. The health system CEO and chief medical officer said they had fired him. Members of the Medical Governance Board said they should be part of that decision, and they were essentially told they had no power."

Forming a union will boost the voice of physicians and other healthcare workers, Dixon said. "The expectation is that if you have a union, the administration cannot make unilateral changes because there is a contract. A union gives you a guaranteed decision-making position that would be much more powerful than what we have had in the past."

Clinicians have also been frustrated by the health system administration's handling of COVID-19 patients, he said. "They closed the main hospital to everything except COVID patients, which completely eliminated elective surgery in the operating rooms of the main hospital. That put us behind on surgeries and affected patient care, when we had three other hospitals that could have absorbed some of the COVID patients."

Health system's response

Jeff Absalon, MD, chief physician executive at St. Charles Health System, responded to the union effort in a prepared statement.

"As always, we want to reassure our community that patient care is and will continue to be our top priority. We greatly value our employed providers and respect their right to take this step, although we'd far prefer to work directly with them in partnership while navigating these unprecedented times. We know many healthcare workers are frustrated and exhausted after the past two years of the COVID-19 pandemic. Our focus as individuals and a health system needs to be on healing and recovering from the pandemic and stabilizing our finances so that we can preserve and strengthen the vital healthcare services that we provide to our community," he said.

Other union benefits

Forming a union will benefit physicians and other healthcare workers in three areas beyond the ability to have more influence on administrative decisions, Dixon said.

  • "It will give us assurances that we can staff adequately. The administration has just announced that as part of their cost-cutting measures, they are going to go from two to one provider at some of the facilities. That is obviously not patient-focused."
  • "There has also been talk that compensation is going to be related to productivity in the clinics, where you will be required to see a certain number of patients per hour or per shift. There are huge concerns about how that is going to work, especially if the administration is cutting back other staffing."
  • "Forming the union will also open the accounting book. The administration has made a lot of claims—sometimes stepping on their own prior claims—about how money is being spent. By opening the accounting book, we should be able to make sure that financial claims are addressed directly."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


Union representation of physicians is relatively rare.

In addition to seeking more influence on administrative decision-making, union advocates at St. Charles Medical Group are frustrated over their health system's handling of COVID-19 patients.

Medical group members hope joining a union will ensure adequate staffing and increase transparency in their health system's financial accounting.

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