Update: A majority of workers at Unity Health Care, D.C.’s largest federally-qualified health center, have voted to unionize.

The vote was overwhelmingly in favor of the union, with 102 votes for and 17 against, according to a tally of the ballots released on Friday and shared with DCist/WAMU. The workers voted to join the Union of American Physicians and Dentists in the hopes that a collective bargaining agreement could ease their workload and improve patient care.

Unity Health Care management have until Dec. 1 to object to the election outcome, according to UAPD field organizer Rachel Flores. A Unity spokesperson did not immediately respond to request for comment.

Original: Medical providers at Unity Health Care, the District’s largest federally-qualified health center that serves tens of thousands of the city’s most vulnerable patients, are trying to form a union.

An in-person election through the National Labor Relations Board is scheduled for Thursday, Oct. 26. Some workers can vote by mail; with ballots coming in on Friday, according to the NLRB.

The doctors’ and other providers’ initial request of Unity Health Care CEO Dr. Jessica Henderson Boyd and the board of trustees for voluntary recognition was denied, according to multiple workers organizing the drive. They tell DCist/WAMU they are confident that a majority of Unity’s more than 170 medical providers will vote in favor of a union, which would include doctors, physician assistants, nurse practitioners, midwives, dentists, and mental health clinicians.

Providers are unionizing because of what they say is Unity’s newfound emphasis on seeing as many patients as possible which they believe is coming at the cost of patient care. Despite Unity’s mission to provide “compassionate, comprehensive, high-quality health,” they are forced to prioritize quantity over quality which is leading to provider burnout and turnover, according to four doctors who spoke to DCist/WAMU. They all requested anonymity because their Unity contract, reviewed by DCist/WAMU, does not allow them to speak to the press without prior consent of the CEO.

“We love this place,” says one doctor. “We are not going to ask for something that will put it out of business. What we are asking for is to be better for patients.”

In an email, a spokesperson says an election will allow workers to “make their own choice.” The spokesperson also acknowledged staff retention, adding that it is an issue across the health care sector. But the spokesperson ultimately defended Unity’s scheduling practices, calling it “standard practice” amongst providers.

“We are deeply committed to the health and wellness of our providers and entire staff,” says Boyd in an email. “Unity’s leadership team (and I) are actively engaged in identifying solutions to meet these challenges while progressing our important mission.”

The only other federally-qualified health center in D.C. that’s unionized is Whitman-Walker. These are nonprofits that largely serve low-income residents who are on public insurance, if they have insurance at all. When it launched in 1985, Unity used to only serve residents at one homeless shelter but it has since expanded to 21 sites that include homeless shelters, schools, and D.C. Jail.

Doctor involvement in the drive is also notable. Nationwide, unionization amongst physicians is low (5.9% as of 2021). But more and more are turning to labor unions in the hope of addressing worsening working conditions. In D.C., medical residents and fellows at George Washington University voted to unionize in the spring.

“It’s getting more and more commonplace where people are not being heard in their workplace,” says Stuart Bussey, president of the Union of American Physicians and Dentists (UAPD), which Unity workers are looking to join. “It’s become an industry where the physician is becoming increasingly a pawn in the economic plans where profits are over patients.”

UAPD field organizer Rachel Flores says that the Unity medical professionals she’s talked to haven’t named compensation as a primary motivation for unionizing. Instead, she says what they hope to secure in a bargaining contract is more time for and support of their work with patients. They also believe a union will enable more discussion and transparency around changes to their workplace.

Multiple Unity doctors who work in community-based clinics tell DCist/WAMU they are scheduled to see 24 patients per day for just 20 minutes each — regardless of whether the patient has a complex history or requires a difficult procedure. They say doctors are also regularly double booked, and only get a few hours per week to do administrative tasks.

One doctor recalls needing extra time with a refugee who walked in for a physical exam without an appointment. The woman opened up about her struggles with depression and multiple experiences of assault, the doctor says. Twenty minutes in, the doctor says she hadn’t even started the physical because she was focused on the patient’s mental health.

“How am I supposed to cut that person off?” she said.

That same doctor says that while leadership does allow her to take more time with a patient, they won’t adjust her schedule accordingly. Consequently, she says she runs behind on appointments and is forced to work through lunch or outside scheduled shifts without additional pay. The doctor says she’d even take a pay cut if it means seeing fewer patients.

“Under these conditions, I don’t want to be a doctor anymore,” she says.

A spokesperson defends Unity’s scheduling, citing the Journal of the American Medical Association that has said primary care providers spend an average of 18.9 minutes with patients. (A recent JAMA investigation has found that more complex patients didn’t always get sufficient time and suggested the possibility of providers have two different visit lengths to better suit patients.)

The spokesperson notes that not all providers have similar schedules, saying specialists and dentists can get longer appointments with patients. The spokesperson also says scheduling does not always reflect the reality, given that 25% of patients are no shows. Primary care physicians see an average of 16 patients per day and other types of providers see even fewer. (Two Unity doctors pushed back, saying the average patient load at the nine community-based clinics is higher as they regularly see over 20 patients.)

The schedule is rooted in Unity’s mission and financial stability, says the spokesperson. “It is critical if a patient walks in with an urgent health need that members of our team are able to respond,” the spokesperson adds. “Patient visits are an important source of Unity’s revenue, and this goes largely to support our provider and other staff salaries, our largest expense.”

A doctor who’s been at Unity for more than a decade says providers used to have more autonomy over their appointments and schedules. Providers who are medical directors were also empowered to make adjustments at community clinics based on staff feedback in meetings, she says. But that all changed during the COVID-19 pandemic when founder Vincent A. Keane retired.

Multiple doctors say changes at Unity coincided with Boyd’s arrival. She joined as chief medical officer in 2019 and took over as CEO at the start of 2022. Multiple doctors say new leadership is turning the federally qualified health center into an urgent care, with providers pushed to see every patient that walks in despite management failing to hire sufficient trained staff to keep up with the demand.

A Unity spokesperson says they updated scheduling in 2021, giving providers 20 minutes instead of 15 minutes and reducing the overall number of appointments per provider.

Treating the high volume of patients they are currently seeing has left doctors feeling utterly exhausted. This comes on the heels of an especially taxing time caring for the city’s high risk patients during COVID-19.

“I feel bad taking care of patients how I’m feeling,” says a third doctor who’s worked at Unity for several years. “I wouldn’t want someone in my position taking care of my parents.”

Two doctors say their burnout is so bad they often seek a reprieve from the pace of the clinics by working at D.C. Jail. A shortage of correctional officers means they generally see fewer patients there.

A Unity spokesperson says the attrition rate has been a challenge adding that Unity is actively recruiting for 18 unfilled provider positions.

While doctors see a union as enabling a more collaborative, transparent approach with management to solve burnout and high turnover, the CEO sees things differently. Boyd is against a union, she told staff in early September in an email shared with DCist/WAMU.

“I want to be clear that I do not believe a union is the best solution for Unity or its providers,” Boyd wrote. “Adding a third party will restrict everyone’s ability to collaborate and will add additional barriers to existing challenges.”

In the note, she says a union will restrict Unity’s ability to meet obstacles in a “nimble, responsive, and thoughtful” way. She acknowledges there are problems surfaced by the pandemic but believes they cannot all be resolved at once.

Unity should know the fate of their union soon. According to NLRB, the ballot count is scheduled for November 17th.

The story has been updated to clarify that Unity’s election is both in-person and by mail and that not all providers have similar packed schedules.