A new labor union at Cambridge Health Alliance represents the kind of workers who typically don’t join unions but are increasingly signing up: doctors, psychologists and physician associates. They organized at CHA to get more of a say in working conditions because such things as rigid schedules and heavier caseloads are affecting their ability to care for patients, union members say.
“Not unionizing would cause me to burn out,” said Juliane Liberus, a physician associate who works at the CHA health center in Everett. “If something happened to a patient it would devastate me.”
David Cecere, spokesperson for the Alliance, said of the new union: “Cambridge Health Alliance is committed to working on a fair and equitable initial contract with Share CHA. Our patients, providers and all of our CHA community remain our utmost priority. We are meeting with them to build a collaborative relationship and discuss the logistics of negotiations.”
Cecere didn’t comment on the specific changes in scheduling and other working conditions mentioned by union members. His statement that CHA wants to work with the union echoes the union’s focus on collaboration.
“We want this to be very positive,” said Emily Chen, a physician at the health care system’s primary-care clinic near Porter Square. “I want to work at CHA for the rest of my career. I don’t have any desire to make things difficult.”
“For us it’s very important to build a constructive relationship with CHA,” Share organizer Andrea Caceres said. “We really want CHA to succeed financially.” She added that traditional union issues such as wages and benefits may also get attention, but the union’s primary purpose is to give members “a voice at the table.”
Union broadens its reach
Share is an acronym that originally stood for State Health care and Research Employees, but the union has broadened its reach. Established in 1997, Share represents clinicians and other employees at University of Massachusetts institutions – its Memorial Medical Center, Memorial Marlborough Hospital and Chan Medical School – and includes the Harvard University Clerical and Technical Employees union. It’s affiliated with the AFL-CIO’s government employees arm, the American Federation of State, County and Municipal Employees.
The new union at CHA was certified by the state last month to represent employees. It isn’t the first to represent medical professionals at the Alliance; social workers organized a Share union at the Alliance in 2000. Nurses belong to the Massachusetts Nurses Association, and doctors-in-training are represented by the Committee of Interns and Residents.
It’s also not the first time clinicians at CHA have gone public with concerns about excessive caseload and changes in management philosophy that have affected patients. In 2021, psychiatrists, psychologists and social workers wrote a letter to the board of trustees warning that an exodus of dissatisfied mental health staff had lengthened the wait for treatment and disrupted patient care. Pioneering psychiatrist Judith Herman blamed new management at the psychiatry department that she said had adopted “a factory model of care.”
That campaign helped spark organization of the new union, some members said.
The cause: Less indepedendence
As more and more physicians become employees rather than independent practitioners – almost half of doctors were in that category in 2022, according to the American Medical Association – unionization becomes more attractive. An “epidemic” of burnout has also led doctors to join unions, though the number represented by unions is still a tiny proportion of the total of practicing doctors, the AMA said in a 2023 article on the trend.
“In the past decade or two, many physicians switched from independent practitioners to employees,” Chen said. “For-profit corporations bought out health care organizations. They put a focus on productivity and income.”
That emphasis “often makes me feel that someone else is dictating how I provide care,” Chen said. “That is scary for myself and for my patients.”
“I took an oath,” she said, referring to the Hippocratic oath affirming that doctors will do no harm to their patients. Without control over working conditions, “I worry that the quality of care is suffering.”
The Alliance, known as a safety net system because it serves a high number of poor or uninsured patients, has struggled for years to stabilize its finances in the black. CHA expects to lose $6.4 million in the fiscal year that ends June 30.
CHA has been working with Huron Consulting Group of Chicago to improve its financial situation, according to a summary of the fiscal 2025 budget. The document said the Alliance will “move forward” to carry out Huron’s recommendations “on an accelerated basis” during this fiscal year.
Packing in the patients
Union members interviewed by Cambridge Day said they are being expected to see an increasing number of patients, as many as 13 in a four-hour period – their workdays are split into two four-hour shifts. They said their schedules are outlined in “templates” listing patient “slots,” with no flexibility for patients who might need more than 15 minutes.
Clinicians with more “no-shows” – patients who don’t keep their appointments – can expect to get a heavier caseload. Patients with unusual numbers of missed appointments may have to wait longer for new ones.
Psychologist Drew Madore said he is expected to terminate patients after they miss a certain number of appointments although they may need treatment the most – their problems are why they don’t show up, he said.
“They’ve been increasing patient load,” he said, and the template “is a way they’re trying to assess provider productivity based on how many slots on the template are filled.” The increased caseload means patients sometimes wait two or three weeks between appointments, Madore said.
“It’s all in the name of efficiency – making sure we see the most number of patients,” he said. “If every slot is full, we have no openings for when I need to call a patient’s parents or someone is suicidal and needs a second session.”
Equal decision makers
The Alliance has also reduced support for clinicians by assigning nurse managers, medical directors and other knowledgeable employees to cover multiple primary care clinics; these workers used to supervise one clinic and be stationed there where doctors and patients could consult them easily, said Liberus, the physician associate
“Now if you have a question you have to wait,” she said.
She and other union members said they chose to work at CHA because of the health care system’s dedication to caring for disadvantaged patients. “We’re the last public hospital in the state,” Chen said. “A lot of us are here because we feel a strong moral and ethical pull to serve this population.”
Members said they’re hopeful that their focus on “relationship-building” with CHA managers will bring them a voice in decisions about working conditions. “We want to be equal decision makers in the decisions that affect our patients and our ability to care for them,” primary care physician Jeremy Stricsek said.
The union is now choosing a negotiating team to hold preliminary meetings with CHA leaders. “I think I’m hopeful,” primary care physician Emily Hanson said. “I truly love what I do,” she said. “My hope is that if we do this collectively we will get to a place that’s sustainable for everyone.”
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