There is an ongoing labor dispute at Unity Health regarding staff shortages

The concerns prompted about 150 Unity suppliers to form a union last winter and accuse management of unfair labor practices, such as a failure to negotiate in good faith on the first contract. They are looking for more administrative time to catch up on work, the ability to see fewer patients for longer visits and an increase in the cost of living, providers say.

Unity CEO Jessica Henderson Boyd rejected providers’ claims and said improved access to primary care and preventive services is the path to reducing racial disparities in life expectancy across the district.

“Our suppliers play a critical role in this work, and we continue to listen to and respond to their concerns while adhering to ongoing collective bargaining restrictions. Yes, the financial model is difficult and being in primary care today is challenging, but I believe in the power of FQHCs like Unity,” Boyd said in a statement.

Unity was founded in 1985 in a small space in a DC homeless shelter and now has nine community clinics, a presence in 10 shelters and two high school clinics, and a contract with the city to provide care at the DC jail, including an outpatient clinic and 24/7 medical care.

D.C. Council member Christina Henderson (at-large), chairwoman of the health committee, sent a letter to Unity on Friday urging management to improve relations with the newly formed union. She said a thriving community health network is critical to reversing the huge disparities in health outcomes for Black residents in the District.

The conflict at Unity reflects a conflict unfolding across the country in which health care providers feel a disconnect between their mission to provide comprehensive and equitable care and the way they are treated — fueling a resurgent labor movement in the private and nonprofit sectors. Nationally and locally, medical residents, nurses and other direct care providers are joining unions and becoming more active, inspired in part by Kaiser Permanente workers who last year staged the largest health care strike in U.S. history.

“The difficulty of providing high-quality patient care in the absence of sufficient staff is always, always, always at the forefront,” said Rebecca Givan, a professor of occupational sciences at Rutgers University.

As a federally qualified health center, Unity provides primary care regardless of patients’ ability to afford or eligibility for reimbursement under the Medicare and Medicaid programs. According to the center’s website, one in eight DC residents is a Unity patient.

Unity providers treat DC’s most vulnerable residents, many of whom have complex medical conditions and poor health literacy, as well as barriers to stable housing, food, transportation and child care.

The patient profile means that at each visit, Unity healthcare providers must manage chronic conditions such as diabetes and blood pressure, arrange preventive screenings such as mammograms and colonoscopies, and address mental health. Providers say the most rewarding but time-consuming part of the job is often discussing vaccine safety and effectiveness, which is part of building trust that keeps patients coming back.

But providers say the schedule established several years ago and the policy of admitting every patient, including walk-in clinics, means they will receive no relief, leading to burnout and contributing to high turnover rates, even in high-pressure local health care jobs .

The departures mean that patients who may already have deep skepticism of the medical facility often go to different doctors who have little time to review their history, workers say, increasing the risk that the patient won’t get the care he needs.

“They are withdrawing from the system. They use the ER more often. They end up in hospital more often. Or they will give up on care,” said James Tracy, a nurse at Unity Upper Cardozo Health Center in Northwest Washington.

Unity CEO Boyd, a pediatrician and Baltimore native, said in a statement that the high patient no-show rate means doctors are seeing an average of 16 patients a day and that the goal is 20, not 24 patients as the union claims, and that it is expected that mental health specialists and clinicians will see fewer patients than primary care physicians.

Unity listened to suppliers’ views and planned to withdraw the “wave schedule” when unionization thwarted their efforts to make major changes to working conditions, Boyd said.

Regina Lindsay, Unity’s human resources director, said through a spokeswoman that some of the service providers the union said have retired, been laid off or are still working.

Providers say the workload continues to exceed that of comparable community health centers such as Whitman-Walker Health, whose employees are longtime members of the Service Employees International Union. Employees at Mary’s Center, which serves mostly Spanish-speaking patients in D.C. and Maryland, joined SEIU last year and is also negotiating its first contract.

Unity employees are members of the Association of American Surgeons and Dentists.

Some providers say staffing shortages have contributed to a general lack of oversight that leaves them exposed to security risks.

Alli Rigel, a Unity physician, said work and family commitments mean patients can’t show up for follow-up appointments when their doctor runs out of time, which sometimes causes tension. Last fall, a patient slammed into their door as they tried to leave the exam room after learning she would have to return for a smear test because the 40-minute visit wasn’t long enough to meet all of her needs.

“We are the last line of defense against many injustices against our patients,” Rigel said. “What hurt me more was that my manager was about to give her a completely new appointment. My safety didn’t matter.”

Danielle Fincher, a primary care physician at Unity, announced the resignation of the hospital’s medical director The Washington prison meant that at 7:30 a.m. on April 10, she was shaken and upset, with no support, when an inmate lunged at her and spat in her face before corrections officers restrained him.

After informing her supervisor that she wanted to leave, she stated that she had to see more patients, could not leave until six hours after the incident, and that a risk assessment for exposure to bodily fluids was not performed until the end of the day and only because she had followed the recommendations upstream. .

“He spat on me, but… I ended up being attacked by a patient and Unity didn’t support me,” Fincher said.

Ryan Buchholz, acting medical director, said through a spokeswoman that a replacement doctor was found within hours and that proper protocols were followed.

Still, Fincher worries that mounting stressors threaten Unity’s existence.

“I’m afraid Unity will have to shut down,” Fincher said. “These are the poorest people in the city. They have nowhere to go. I feel like a sinking ship.”