At Chase Brexton Health Care, over 100 physicians, behavioral therapists, social workers, nurses and pharmacists are organizing to join 1199SEIU United Healthcare Workers East. This action is the result of both recent changes in the structure of health care delivery in the country at large and a crisis of leadership in our own health center. We ask: Why have the clinical experts who actually deliver health care lost the opportunity to have a voice in its structure and content?
With the Affordable Care Act's Medicaid expansion and the increase in numbers of American citizens with health insurance, Federally Qualified Health Centers such as Chase Brexton are rapidly expanding to accommodate the influx of new patients. Many of our patients have limited access to opportunities that allow for healthy lives: wholesome food options, recreation centers, libraries, community centers, supportive schools. Families are divided by the epidemic of imprisonment. Community violence keeps people inside without access to resources.
It increasingly falls on non-profit community health centers to expand health care opportunities with these disparities in mind. The socio-economic fallout from poor health is immense. As physicians we try to advise patients about how to stay healthy, but our patients cannot always follow our advice, and we cannot always adequately deliver it — especially if it must be dispensed as part of a 15-minute visit. Delivery of "preventive services" needs to go way beyond vaccinations and cancer screening, but currently that's what is reimbursable by federal guidelines.
Chase Brexton has a unique and crucial place in the Baltimore health community. Our roots in serving HIV positive and LGBT populations have guided our inclusive approach to care, and expanded services now include primary care for all ages, integrated addictions care, gender-affirming care, reproductive health care, and culturally competent trauma-informed behavioral care for many of Maryland's most vulnerable citizens.
A few years ago, the providers at Chase Brexton participated in developing a new model of integrated care delivery. Clinicians, social workers, behavioral therapists, nurses and medical assistants joined as members of care teams working to provide wrap-around services at medical visits. Outreach visits into the community were common. Pharmacists, patient navigators and mental health professionals collaborated in the provision of care.
This deliberately constructed integrated-care delivery model is now being dismantled by administrators. We have relentless pressure to focus on productivity. Chase Brexton providers have been informed we must accept a new salary structure with decreased base pay but "opportunity" for productivity-based bonuses; the plan incentivizes patient visits (at $50 per visit) creating pressure to shorten visits in order to increase numbers. This comes at a cost beyond the $50 — the cost is comprehensive care, quality, patient engagement and even patient safety. This is unacceptable.
Although we did not anticipate the need for unionization of health care professionals when we trained as physicians, it is not a new phenomenon. Well-respected, analogous medical centers like Whitman-Walker in D.C. and Callen Lorde in New York City unionized in 1994 and 2015. Without assured collective bargaining, clinicians have become disempowered workers struggling to fulfill mandates and scorecards while attempting to give patient-specific care in ever-shorter visits. Loss of job integrity, increased staff burnout and decreased staff retention have led us to seek more control; this has been met with incomprehensible firings of invaluable staff in an effort to block our unionizing efforts.
We recognize that productivity pressures are not unique to Chase Brexton; to the contrary, on a systems-level, health care's top-heavy structures have allowed the financial and operational sectors to usurp the design of health care delivery. Clinicians are allied with patients at the front lines but have somehow lost the opportunity to have a voice in the structure and content of their work environments.
Success in reducing health care disparities in our city and state depends on a cohesive strategy set forth between various sectors, and clinicians must be included in the conversation. We see every day how patients are affected by current "quality" measures. We want to decrease spending, but we submit that cost savings cannot be achieved by minimizing the time patients spend with their clinicians. Unionization is now the viable way for us to regain our voice at the table when advocating for our patients. We feel certain that in the long run it will benefit both our patients and Chase Brexton.
Dr. Natalie Spicyn (Twitter: @nataliespicyn) is an internist and pediatrician who cares for patients across the age spectrum at Chase Brexton. Dr. Catherine Maslen (firstname.lastname@example.org)has been a staff physician at Chase Brexton for almost 17 years and currently leads a program for patients with complex chronic disease.