Pennsylvania unions have filed a complaint with the Department of Justice alleging integrated hospital giant UPMC is abusing its dominant market position to suppress wages and retain workers.
On Thursday, SEIU Healthcare Pennsylvania and a coalition of labor unions filed a 55-page complaint against UPMC, the largest private employer in the state, saying the hospital system’s size has allowed it to stamp out wage growth, “drastically increase” workload and keep workers from departing to other jobs.
The unions are asking federal regulators to investigate UPMC for antitrust violations, citing its dominance of the healthcare market in select regions of Pennsylvania. UPMC denied allegations of wage suppression.
The Pittsburgh-based system has seen a rise in labor complaints, according to the unions, as the system has grown into its 41-hospital footprint through a series of mergers and acquisitions. UPMC, which also operates 800 doctors offices and clinics and a handful of health insurance offerings, reported $26 billion in operating revenue last year.
Attempts in the last decade to organize UPMC’s hourly workers have been unsuccessful, according to SEIU.
Matt Yarnell, president of SEIU Healthcare Pennsylvania, called the complaints groundbreaking on a Thursday call with reporters, saying that no entity has ever filed a complaint arguing that mobility restrictions and labor violations are anticompetitive, and in violation of antitrust law.
The complaint alleges that, for every 10% increase in market share, the wages of UPMC workers falls 30 to 57 cents an hour on average. UPMC hospital workers face an average 2% wage gap compared to non-UPMC facilities, according to a study cited in the complaint.
In addition, the labor groups allege that UPMC’s staffing ratios have fallen over the past decade, resulting in its staffing ratios being 19% lower on average compared with non-UPMC care sites as of 2020.
The unions are going after UPMC for being a “monopsony,” or a company that controls buying in a given marketplace, including controlling a large number of jobs. UPMC has some 92,000 workers, according to the complaint, and has cut off avenues of competition through non-compete agreements, in addition to preventing employees from unionizing.
“If, as we believe, UPMC is insulated from competitive market pressures, it will be able to keep workers’ wages and benefits — and patient quality — below competitive levels, while at the same time continually imposing further restraints and abuses on workers to maintain its market dominance,” the complaint states. “Because we believe this conduct is contrary to Section 2 of the Sherman Act, we respectfully urge the Department of Justice to investigate UPMC and take action to halt this conduct.”
In response to the allegations, UPMC said it has the highest entry-level pay of any provider in the state, and offers “above-industry” employee benefits. UPMC’s average wage is more than $78,000, Paul Wood, UPMC’s chief communications officer, told Healthcare Dive in a statement.
“There are no other employers of size and scope in the regions UPMC serves that provide good paying jobs at every level and an average wage of this magnitude,” Wood said.
Healthcare workers are increasingly pushing for better working conditions and pay amid the COVID-19 pandemic, as hospitals grapple with recruitment and retention issues driven by burnout and heightened labor costs.
Members of the California Nurses Association have reached a tentative agreement with Kaiser Permanente, averting a planned two-day strike by more than 21,000 registered nurses and nurse practitioners in Northern California.
Both sides announced the tentative agreement Nov. 17.
Union members at Kaiser Northern California facilities have been in negotiations since June, according to a CNA news release. Registered nurses and nurse practitioners in Northern California were set to strike Nov. 21 and Nov. 22.
The four-year tentative deal boosts wages for Northern California nurses by 22.5 percent over the life of the contract, according to a statement Oakland, Calif.-based Kaiser shared with Becker’s. Kaiser had previously proposed 21.25 percent in wage increases over four years.
“The tentative agreement is driven by the changing economy, including inflation, significant changes in the marketplace and our commitment to providing our employees with excellent pay and benefits to attract and retain the best nurses,” Kaiser’s statement says.
According to both sides, the tentative agreement also includes:
An agreement to add more than 2,000 new registered nurse and nurse practitioner positions.
Increased tuition reimbursement for nurses’ education.
The creation of a new regional equity, diversity and inclusion committee.
Language including agreement that healthcare is a human right.
“We are very pleased with this new contract, which will help us recruit new nurses and retain experienced RNs and nurse practitioners,” CNA President Cathy Kennedy, RN, said in a news release. “We not only won the biggest annual raises in 20 years, but we have also added more than 2,000 positions across our Northern California facilities. This will ensure safe staffing and better patient care.”
Ms. Kennedy also praised Kaiser’s commitment “to a workplace that is free from racism and discrimination” and the health system’s agreement “that we must fight racial and ethnic disparities in healthcare outcomes.”
“The tentative agreement honors our Northern California nurses with a market-based economic package that accounts for inflation, accelerates our investments in staffing, and addresses workplace safety, diversity and equity, remote work, and other key matters in a way that is sustainable and benefits our members and patients as well,” Kaiser’s statement reads.
Union members in Northern California will vote on approving the new four-year contract over the next few weeks. Registered nurses at Kaiser Permanente Los Angeles Medical Center also reached a tentative agreement and will vote on the deal Nov. 22.
Last week, over 1,200 resident physicians and interns at Montefiore Medical Center, one of the largest employers in New York City, with four hospitals in the Bronx, held an organizing vote and requested voluntary recognition of their bargaining unit. The residents organized under the Committee of Interns and Residents, a unit of the Service Employees International Union that claims 22K members and has established unions at five hospitals this year. Roughly seven percent of practicing doctors were unionized as of 2019; that number has grown in the wake of pandemic-induced burnout and industry consolidation. Montefiore Medical Center declined to voluntarily recognize the union and has requested that the union re-form via a secret ballot election.
The Gist: Health system executives may see the possibility of resident unions as another headache amid the ongoing labor crisis, but the drivers of the crisis—burnout, workplace safety concerns, work-life balance, and real-wage erosion—are responsible for the growing appeal of unions for physicians. Fueled by economy-wide stressors, unionization has been growing in nontraditional labor sectors, including among baristas and tech workers, and medical residents may be the next to join that wave.
Health systems worried about resident unionization should address residents’ concerns about working conditions proactively, which may involve reevaluating wages in light of residents’ significant contributions to operational and financial success.
About 15,000 nurses in Minnesota walked off the job Monday to protest understaffing and overwork — marking the largest strike of private-sector nurses in U.S. history.
Slated to last three days, the strike spotlights nationwide nursing shortages exacerbated by the coronavirus pandemic that often result in patients not receiving adequate care. Tensions remain high between nurses and health-care administrators across the country, and there are signs that work stoppages could spread to other states.
Minnesota nurses charge that some units go without a lead nurse on duty and that nurses fresh out of school are delegated assignments typically held by more experienced nurses, across some 16 hospitals where strikes are expected.
The nurses are demanding a role in staffing plans, changes to shift scheduling practices and higher wages.
“I can’t give my patients the care they deserve,” said Chris Rubesch, the vice president of the Minnesota Nurses Association and a nurse at Essentia Health in Duluth. “Call lights go unanswered. Patients should only be waiting for a few seconds or minutes if they’ve soiled themselves or their oxygen came unplugged or they need to go to the bathroom, but that can take 10 minutes or more. Those are things that can’t wait.”
Paul Omodt, a spokesman for the Twin Cities Hospital Group, which represents four hospital systems where nurses are striking in the Minneapolis-St. Paul area, said that the nurses union did not do everything it could to avoid a strike.
“Nurses have steadfastly refused to go to mediation,” Omodt said. “Their choice is to strike. This strike is on the nurses.”
Conny Bergerson, a spokeswoman for Allina Health, another hospital system in the Twin Cities where nurses are on strike, said “rushing to a strike before exhausting all options such as engaging a neutral federal mediator does not benefit our employees, patients or the communities we serve.”
The Minnesota Nurses Association, the nurses union, said hospital administrators have continued to “refuse solutions” on understaffing and safety in contract negotiations. It said nurses have increasingly been asked to take on more patients for bedside care to make up for labor shortages, exacerbating burnout and high turnover.
Some hospitals have offered increased safety protocols for reporting security incidents in negotiations, but have not budged on other safety- and staffing-related demands.
The union has proposed new mechanisms for nurses to have a stronger say in how wards are staffed, including a committee made up of nurses and management at each hospital that would determine appropriate staffing levels. It has also proposed protections against retaliation for nurses who report understaffing. Striking nurses at some hospitals said their shifts are often short five to 10 nurses, forcing nurses to take on more patients than they can handle.
Omodt said that while there was a rise in understaffing reports during the height of covid, conditions have improved, and nurses have made contradictory claims when it comes to staffing at their hospitals since then.
In the lead-up to the strike, Minnesota hospital groups filed unfair labor practices charges against the union for refusing to go to mediation, and asked the National Labor Relations Board to block the strike for a failure to provide enough notice. The NLRB has thrown out at least some of those charges.
Hospitals facing strikes have been recruiting traveling nurses from across the region and plan to maintain staffing levels during the strike, though they are preparing for reduced operations, according to some of the hospital groups facing strike activity.
For years, hospitals in the United States have faced understaffing problems. A surge in demand and increased safety risks for nurses during the pandemic accelerated those trends. The number of health-care workers in the United States has still not recovered to its pre-pandemic levels, down 37,000 workers compared with February 2020.
At the same time, demand for health-care services has steadily increased during the pandemic, with a backlog of people who delayed care now seeking medical attention. During the covid wave that swept across the United States this summer, states such as New York and Florida reported the worst nursing shortages in decades. Research shows that patients are more likely to die because of preventable reasons when health-care providers are overworked.
Nurses, who risked their lives during the pandemic, are quitting and retiring early in droves, because of increased workloads caused by short staffing and demanding schedules that make finding child care and having a life outside of work exceedingly difficult. The understaffing crisis is pronounced in Minnesota in part because of its aging population and its record low unemployment rate.
There are some signs that nurse- and other health-care-worker strikes could spill over to other states in the coming weeks. Four thousand nurses with the Michigan Nurses Association voted earlier this month to authorize a strike related to understaffing concerns, and 7,000 health-care workers in Oregon have also authorized a work stoppage. University of Wisconsin nurses narrowly averted a strike this week. Therapists and clinicians in Hawaii and California are currently in the fourth week of what has become the longest-running mental health care strike, over inadequate staffing levels.
In Minnesota, the Minnesota Nurses Association recorded a 300 percent increase in nurses’ reports of unsafe staffing levels on their shifts since 2014, up to 7,857 reports in 2021.
Kelley Anaas, 37, a nurse who works in the ICU at Abbott Northwestern in Minneapolis said nurses in her unit have been forced to double up on patient assignments and work with lead nurses who have less than a year of experience.
“It eats away at you. If that was my family member in that bed, I wouldn’t want to leave their side,” said Anaas, adding that her workload has increased steadily over her 14 years at Abbott Northwestern.
While the nurses say their main impetus for striking is staffing levels and not pay, they are also at odds with hospitals over wages. The Minnesota Nurses Association has proposed a 30 percent pay increase over the next three years, noting inflation is at a 40-year high, while health-care groups have proposed a pay increase of 10 to 12 percent.
“The union’s wage demands remain at 29 and 30 percent increases over three years, which we’ve told them is unrealistic and unaffordable,” Omodt said, noting that the average Minnesota nurse makes $80,960 a year.
Contracts expired in May and June, and the union has been in negotiations since March.
Nurses said they are frustrated the strike is happening, but the stakes are high for them and their patients.
“We’re really sad and disappointed that it has come to a strike,” said Brianna Hnath, a nurse at North Memorial in Robbinsdale. “But we feel like this is the only thing we can do to show administration how incredibly important a strong nursing core is to a hospital. Hospitals tell us it’s our fault, but we’ve been actively involved and getting nowhere.”
Members of the Michigan Nurses Association are accusing the University of Michigan of unlawfully refusing to negotiate over nurses’ workloads in its bargaining with the University of Michigan Professional Nurse Council.
The union, an affiliate of National Nurses United and AFL-CIO, represents about 13,000 registered nurses and healthcare professionals in Michigan, including workers employed by the University of Michigan. The University of Michigan regents hold the contract with the University of Michigan Professional Nurse Council, the largest bargaining unit of the Michigan Nurses Association.
A total of 6,200 University of Michigan Health nurses have been working without a new contract since July 1, and they are working under the terms of the expired agreement, according to hospital and union statements. The University of Michigan Health, the clinical division of Ann Arbor-based Michigan Medicine, told Becker’s in a statement that during negotiations, it has offered a 21 percent base pay increase for nurses over the life of the contract, as well as a new salary step program for nurse practitioners and the safe elimination of mandatory overtime.
The union contends the University of Michigan has refused to bargain over safe workloads regarding the number of patients assigned per nurse, which it says is tied directly to nurses’ patient safety concerns. As a result, it filed a lawsuit Aug. 15 in the Michigan Court of Claims.
“When nurses are forced to take care of too many people at once, patient care gets compromised and nurses are put in danger of injury or burnout, and that’s happening far too often at our hospital,” said Renee Curtis, RN, president of the University of Michigan Professional Nurse Council, said in a news release.
“University of Michigan Health makes staffing determinations with patient safety at the forefront of its decisions, and this has produced outstanding safety results,” the health system said in its statement. “The health system continuously receives recognition as Michigan’s safest hospital with recent recognitions by top agencies.”
University of Michigan Health also said it “plans to vigorously defend itself” against the union lawsuit.
California hospitals have launched a campaign to roll back Los Angeles’ newly enacted $25 per hour minimum wage for many private sector healthcare workers.
The Healthcare Workers Minimum Wage Ordinancewas signed Friday by Los Angeles Mayor Eric Garcetti after the city received a petition for the pay increase organized by the labor group SEIU-United Healthcare Workers West (SEIU-UHW) and signed by more than 145,000 people. Los Angeles’ current minimum wage is $16.04.
The pay bump is set to take effect 31 days after being published by the city clerk, will be adjusted annually for cost of living starting in 2024 and will raise wages for roughly 20,000 healthcare workers across the city, according to the mayor’s office. Those impacted include non-clinical staff, such as food service workers, groundskeepers and maintenance workers, according to the ordinance.
“Working long, grueling hours and absorbing insurmountable stress, the burnout being felt from the pressures of COVID-19 has been prevalent, causing an alarming number of healthcare workers to leave the profession altogether,” Los Angeles Councilmember Curren Price said in a statement. “The approval to raise their wages demonstrates to the countless workers that they are valued, seen, heard and above all, their lives matter.”
The group is now seeking enough signatures to put the wage hike in front of Los Angeles voters, which would block the increase from going into effect until a 2024 election yields a verdict. The hospitals-backed push would require nearly 41,000 signatures to be submitted within 30 days.
The coalition paints the Healthcare Workers Minimum Wage Ordinance as an “inequitable, arbitrary and discriminatory” move that would ultimately harm patients and workers.
Because it applies only to certain workers at private hospitals, hospital-based facilities and dialysis clinics, the “vast majority” of Los Angeles healthcare workers are excluded from the measure’s pay increase, the coalition said.
As such, the ordinance will drive a flight of talent from public hospitals and other non-covered facilities such as community health clinics, Planned Parenthood clinics and nursing homes, the group said.
Workforce shortages at these facilities would disproportionately harm the disadvantaged, underserved and uninsured communities whom these facilities more often serve, the coalition said. Service cuts would also be in the cards as provider organizations contend with tens of millions of dollars in increased annual costs, they said.
“We all agree healthcare workers are heroes, but this Unequal Pay Ordinance is deeply flawed, inequitable and will hurt workers and patients,” the coalition said.
The city and proponents of the measure viewed much of the opposition as a push for profits.
In the ordinance’s text, the city highlighted “huge profits in the billions of dollars” and “increasing profit margins” health systems have seen during the pandemic. The city government wrote that “the healthcare industry needs to use some of its profits to fairly compensate workers who are sacrificing every day to care for patients.”
In a release celebrating the ordinance’s signing, SEIU-UHW said healthcare employers “have failed to compensate us for our dedication and sacrifices” and “have more than enough to raise wages.”
The group noted similar wage increase efforts ongoing in eight other California cities as well as a push to bring the $25 minimum to all of the state’s healthcare workers.
In a statement to the Los Angeles Times, SEIU-UHW spokesperson Renée Saldaña said the hospitals “are out of step with local voters if they think the solution is to slash wages for the caregivers who got us through the pandemic. … The problem that needs to be addressed is bloated executive compensation that is driving up healthcare costs for Angelenos.”
George Greene, president and CEO of the Hospital Association of Southern California, told the paper that many of the region’s hospitals are “reeling” financially due to the pandemic. He also said the city passed the ordinance without conducting any type of analysis regarding the impact it would have on the area’s hospitals.
Health care workers nationwide are organizing and pushing for workplace changes like better pay or more favorable staffing ratios after waves of pandemic-fueled burnout and frustration.
Why it matters: COVID-19 and its aftereffects triggered an exodus of health care workers. Those who stayed are demanding more from health systems that claim to be reaching their own breaking points.
“The pandemic exacerbated a crisis that was already there,” Michelle Boyle, a Pittsburgh nurse told Axios. “It went from being a crisis to being a catastrophic freefall in staffing.”
Driving the news: About 1,400 resident physicians in public Los Angeles County hospitals have authorized a strike if their demands for pay parity with other local facilities aren’t met in contract negotiations this week.
A fight is brewing in Minnesota as contracts covering 15,000 nurses in several hospital systems are expiring.
Some 2,000 resident physicians and interns at Stanford University and the University of Vermont Medical Center joined an affiliate of the SEIU for medical workers that claims more than 20,000 members nationwide.
In North Carolina, where union membership is low, staff at Mission Health in Asheville voted to unionize largely over staffing concerns.
Less than half of the of nearly 12,000 nurses polled by the American Nurses Association last year believe their employer cares about their concerns, and 52% of those surveyed said they intend to leave their jobs or are considering doing so.
The other side: Hospital operators generally oppose unionization efforts, as well as mandated staffing ratios.
“The last thing we need is requirements set by somebody in Washington as to exactly how many nurses ought to be providing service at any given time,” said Chip Kahn, CEO of the Federation of American Hospitals. “That ought to be a local decision based on the need in the hospital at the time.”
The American Organization for Nursing Leadership, an affiliate of the American Hospital Association, also opposes staffing ratios.
The industry says decisions on staffing and workplace rules are best left to local executives who need to be flexible to meet shifting demand for care.
“You’re basically taking away the flexibility of those on the scene to determine what it takes to provide the needed patient care,” Kahn said.
Go deeper: The pandemic drove up labor costs significantly for hospitals that were forced to pay travel nurses to fill workforce gaps during COVID surges.
April marked the fourth month in a row this year that major hospitals and health care systems reported negative margins, a Kaufman Hall report found. And executives say things could worsen amid inflation and stubborn supply chain woes.
And yet, some big hospital chains like Tenet reported strong earnings in the first quarter.
Between the lines: California is the only state to have set staffing ratios for nurses, but hospital unions in other states have fought for similar requirements in their contracts.
In California, every nurse on a general hospital floor has no more than five patients to care for at a time; nurses in ICUs should care for no more than two patients.
Nurses want look-alike standards in states like Pennsylvania, where only some hospitals have staffing ratios, saying short-staffing threatens patients’ well-being.
What we’re watching: While many legislative proposals failed this year, unions representing health care workers say their message is getting across.
Unions in Illinois, Pennsylvania and Washington state are redoubling efforts for staffing ratio legislation modeled on California’s.
In New York, nurses passed a law that took effect in January mandating staffing committees at hospitals.
The bottom line: The labor tension is a sobering coda to a health crisis that’s stretched health systems and workers alike in unprecedented ways.
“What you’re seeing is nurses finally saying enough is enough and this system is broken and we need it to be fixed,” said Denelle Korin, a nurse alliance coordinator with Nurses of Pennsylvania.
Members of the Service Employees International Union-United Healthcare Workers West are set to begin a weeklong strike May 9 at Cedars-Sinai Medical Center in Los Angeles.
The union represents about 2,000 certified nursing assistants, surgical technicians, sterile processing technicians, transporters, environmental service workers, plant operation workers and food service technicians, according to NBC Los Angeles. Cedars-Sinai Medical Center has about 14,000 employees total.
Union members voted to authorize a strike in April. The union and hospital began negotiating a new labor contract March 21, according to NBC Los Angeles. A hospital spokesperson told the local news outlet that upon the start of negotiations, “Cedars-Sinai presented a strong economic proposal that would have continued our market leading pay by providing substantial pay increases to bargaining unit employees as early as March 27.”
The union contends that in its latest round of bargaining, Cedars-Sinai rejected proposals on PPE stockpiles, COVID-19 exposure notifications, keeping pregnant and immunocompromised workers away from COVID-19 patients and other safety measures. “We’re asking for basic workplace protections and respect for the lives and health of caregivers and patients,” an SEIU-UHW statement reads.
“We respect the rights of SEIU-UHW members to take this step,” the hospital said in a statement. “The most effective way to reach a fair agreement, however, is for both parties to stay at the bargaining table and finish negotiations.”
Resident and fellow physicians at Palo Alto, Calif.-based Stanford Health Care have voted in favor of representation by the Committee of Interns and Residents, according to a May 3 news release.
Of the nearly 1,050 ballots counted, 835 were in favor of representation, the National Labor Relations Board website showed.
The vote comes after resident physicians led a protest in December 2020 against Stanford’s COVID-19 vaccination plan that excluded house staff from the initial round of shots. The health system immediately revised the plan to prioritize resident physicians.
In February, physicians also demanded the health system voluntarily recognize the Committee of Interns and Residents as their exclusive representative for collective bargaining.
Now the union said its members are looking forward to negotiations.
“Our doctors are united by our desire to provide the best possible patient care and strong worker protections,” said Ben Solomon, MD, a pediatric resident physician, said in the release. “One thing the pandemic has made abundantly clear, in addition to the widespread equity issues in our healthcare system, is that our needs as physicians cannot be separated from those of our patients.”
The National Labor Relations Board must certify the election results before they are final. Stanford does not plan to challenge the results, the health system said in a statement shared with Becker’s on May 3.
“As we begin the collective bargaining process, our goal remains unchanged: providing our residents and fellows with a world-class training experience,” Stanford said. “We will bring this same focus to negotiations as we strive to support their development as physician leaders.”
The Committee of Interns and Residents is a local chapter of the Service Employees International Union. The union represents more than 20,000 resident physicians and fellows, including University of Massachusetts physicians in training, who unionized in March 2021.
Stanford Health Care and Lucile Packard Children’s Hospital administrators have notified union leaders that its nurse members who strike later in April risk losing pay and health benefits, according to Palo Alto Weekly.
The Committee for Recognition of Nursing Achievement, a union at Stanford Health Care and Stanford Children’s Health that represents about 5,000 nurses, has scheduled a strike to begin April 25. The nurses’ contract expired March 31.
If the strike moves forward, Stanford Health Care and the Lucile Packard Children’s Hospital, both based in Palo Alto, Calif., are prepared to continue to provide safe, quality healthcare, according to a statement from Dale Beatty, DNP, RN, chief nurse executive and vice president of patient care services for Stanford Health Care, and Jesus Cepero, PhD, RN, senior vice president of patient care and chief nursing officer for Stanford Children’s Health.
But the statement, which was shared with Becker’s, said nurses who choose to strike will not be paid for shifts they miss.
“In addition, employer-paid health benefits will cease on May 1 for nurses who go out on strike and remain out through the end of the month in which the strike begins,” Drs. Beatty and Cepero said.
The leaders quoted from Committee for Recognition of Nursing Achievement’s “contingency manual” that the union provided to nurses: “If a strike lasts beyond the end of the month in which it begins and the hospitals discontinue medical coverage, you will have the option to pay for continued coverage.”
Drs. Beatty and Cepero said nurses who strike may pay to continue their health coverage through the Consolidated Omnibus Budget Reconciliation Act.
In a separate statement shared with Becker’s, Committee for Recognition of Nursing Achievement President Colleen Borges called Stanford and Packard management’s move regarding nurses’ health benefits “cruel” and “immoral.”
“Health benefits should not be used against workers, especially against the very healthcare professionals who have made Stanford a world-class health system,” said Ms. Borges, who is also a pediatric oncology nurse at Lucile Packard Children’s Hospital. “We have spent our careers caring for others and putting others first — now more than ever we need solutions that will ensure sustainability, safe staffing and strong benefits to retain nurses. But instead of taking our proposals seriously, hospitals are spending their time and energy weaponizing our medical benefits. We refuse to be intimidated from standing up for the fair contracts that we need in order to continue delivering world-class patient care.”
The union has organized a petition to tell Stanford not to cut off medical benefits for nurses and their families during the strike. As of April 19, the petition had more than 25,150 signatures.