Workload concerns fuel labor fight at D.C.’s largest health clinic (2024)

The concerns drove about 150 Unity providers to form a union last winter, and they have accused management of unfair labor practices such as not bargaining in good faith for their first contract. They are seeking more administrative time to catch up on work, the ability to see fewer patients for longer appointments and cost of living increases, providers said.

Unity chief executive Jessica Henderson Boyd pushed back against providers’ claims, and said improved access to primary care and preventive services is the path to reduce racial disparities in life expectancy across the District.

“Our providers are critical to this work, and we continue to listen to and address their concerns, while following the current constraints due to collective bargaining. Yes, the financial model is challenging, and being in primary care right now 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 room in a D.C. homeless shelter and today has nine community clinics, a presence at 10 shelters and two high school-based clinics as well as a contract with the city to provide care at the D.C. jail, including an infirmary and an urgent care that is staffed around-the-clock.

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

The conflict at Unity mirrors one playing out across the country as health-care providers feel a disconnect between their mission to provide comprehensive and equitable care and how they are being treated — fueling a resurgent labor movement in private and nonprofit sectors. Nationally and locally, medical residents, nurses and other direct care providers are joining unions and stepping up their activism inspired partly by Kaiser Permanente workers, who last year staged the largest health-care strike in U.S. history.

“The difficulties of providing quality patient care when there aren’t sufficient staff are always, always, always at the top of the list,” said Rebecca Givan, a professor of labor studies at Rutgers University.

As a federally qualified health center, Unity provides primary care regardless of patients’ ability to pay and qualify for reimbursem*nt under Medicare and Medicaid. According to the center’s website, 1 out of 8 D.C. residents is a Unity patient.

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

The patient profile means that in every appointment, Unity providers must manage chronic conditions like diabetes and blood pressure, arrange preventive care screenings such as mammograms and colonoscopies, and address mental health. Providers say the most rewarding but time-consuming part of the job is often discussions about the safety and efficacy of vaccines, part of trust-building that keeps patients coming back.

But providers said a schedule instituted several years ago and a policy of seeing every patient, including walk-ins, mean they get no relief — leading to burnout and contributing to a turnover rate that is high even for taxing community health jobs.

The departures mean patients who may already have a deep skepticism of the medical establishment often see different doctors with little time to digest their history, workers say, increasing the chances a patient will not get the care they need.

“They fall back out of the system. They use the ER more. They end up in the hospital more. Or they are going to forgo care,” said James Tracy, a nurse practitioner at Unity’s Upper Cardozo Health Center in Northwest Washington.

Boyd, the Unity chief executive who is a pediatrician and D.C. native, said in a statement that a high patient no-show rate means providers see an average of 16 patients daily with a goal of 20, not the 24 patients the union claims, and that specialists and mental health clinicians are expected to see fewer patients than primary care doctors.

Unity heard feedback from providers and planned to roll back the “wave schedule” when the formation of the union precluded their efforts to make major changes to working conditions, Boyd said.

Regina Lindsay, Unity chief human resources officer, said through a spokeswoman that some of the providers the union says resigned actually retired, were terminated or are still on the job.

Providers say the workload still exceeds that of comparable community health centers, such as Whitman-Walker Health, where workers are longtime members of the Service Employees International Union. Workers at Mary’s Center, which primarily serves Spanish-speaking patients in D.C. and Maryland, joined SEIU last year and are also negotiating their first contract.

Unity workers are members of the Union of American Physicians and Dentists.

Some providers say staff shortages have contributed to an overall lack of oversight that leaves them vulnerable to safety risks.

Alli Rigel, a Unity physician, said patients’ work and family commitments mean they can’t get to follow-up appointments when a provider runs out of time, sometimes causing tension. A patient hit them with a door last fall as they tried to leave an exam room when the patient learned she would have to return for a Pap smear because a 40-minute visit was insufficient to address all her needs.

“We’re the last line of defense against a lot of injustices for our patients,” Rigel said. “What hurt more is my manager was just going to give her a whole new appointment. My safety did not matter.”

Danielle Fincher, a primary care physician at Unity, said the resignation of the medical director at the D.C. jail meant she was left shaken and upset with no support at 7:30 a.m. on April 10, when an inmate lunged at her, spitting in her face, before corrections officers restrained him.

After telling a supervisor she wanted to leave, she said she had to see more patients, couldn’t leave until six hours after incident, and a bodily fluid exposure risk assessment was not followed until the end of the day and only because she kept following up.

“He spit on me, but … ultimately, I was assaulted by a patient and Unity did not have my back,” Fincher said.

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

Still, Fincher worries that the compounding stressors threaten Unity’s very existence.

“I am worried Unity will have to close,” Fincher said. “These are the most disadvantaged people in the city. They have nowhere else to go. It feels like a sinking ship.”