Front-line doctors and nurses at the district’s largest community health center say widespread staffing shortages and safety concerns at clinics across the city, including the jail, have forced dozens to resign, putting them at risk. to their vulnerable patients.
Unity Health Care workers say a grueling schedule forces them to arrive late or rush appointments, disappointing patients struggling with complex problems and creating a chaotic environment that has led to 25 resignations since Jan. 1. a number the nonprofit health center disputes. Providers are scheduled to see up to 24 patients in a day, workers say.
The concerns led about 150 Unity suppliers to form a union last winter, and they have accused management of unfair labor practices, such as failing to negotiate their first contract in good faith. They are looking for more administrative time to catch up on work, the ability to see fewer patients for longer appointments and an increased cost of living, providers said.
Unity CEO Jessica Henderson Boyd rejected the providers’ claims and said better access to primary care and preventive services is the path to reducing racial disparities in life expectancy across the District.
“Our suppliers are critical to this work and we continue to listen to and address their concerns, while following current limitations due to collective bargaining. Yes, the financial model is a challenge, and being in primary care right now is a challenge, 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 homeless shelter in DC and today has nine community clinics, a presence in 10 shelters and two high school clinics, as well as a contract with the city to provide jail care of DC, including a nursing home and urgent care staffed 24 hours a day.
Christina Henderson (I-General), a member of the D.C. Council and chair of the health committee, sent a letter to Unity on Friday urging management to improve relations with the newly formed union. She said a thriving community health network is critical for the District to reverse stark disparities in health outcomes for Black residents.
The conflict at Unity mirrors one playing out across the country, where health care providers feel a disconnect between their mission to provide comprehensive and equitable care and the way they are being treated. — driving a resurgence of the labor movement in the private and nonprofit sectors. Nationally and locally, medical residents, nurses and other direct care providers are joining unions and stepping up their activism, inspired in part by Kaiser Permanente workers who last year staged the largest health care strike in U.S. history. USA.
“The difficulties of providing quality care to patients when there are not enough staff are always, always, always at the top of the list,” said Rebecca Givan, 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 reimbursement under Medicare and Medicaid. One in eight D.C. residents is a Unity patient, according to the center’s website.
Unity providers treat DC’s most vulnerable residents, many of whom have complex medical conditions and poor health literacy, as well as barriers to stable housing, food, transportation, and child care.
Patient profiling means that at each appointment, Unity providers must monitor chronic conditions such as diabetes and blood pressure, arrange for 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 the discussions about the safety and effectiveness of vaccines, part of the trust-building that keeps patients coming back.
But Providers said a schedule instituted several years ago and a policy of seeing all patients, including walk-ins, mean they get no relief, leading to burnout and contributing to a turnover rate that is high even for community health work.
The departures mean that patients who may already have a deep skepticism toward the medical system often see different doctors with little time to digest their story, workers say, increasing the chances that a patient won’t get the care they want. needs.
“They fall back out of the system. They use the emergency room more. They end up in the hospital more. Or they will forego care,” said James Tracy, a nurse practitioner at Unity’s Upper Cardozo Health Center in northwest Washington.
Boyd, Unity’s CEO, a pediatrician and Baltimore native, said in a statement that a high no-show rate means providers see an average of 16 patients daily with a goal of 20, not the 24 patients the report claims. union, and that mental health specialists and doctors are expected to see fewer patients than primary care doctors.
Unity listened to feedback from suppliers and planned to reverse the “surge schedule” when the formation of the union impeded its efforts to make major changes to working conditions, Boyd said.
Regina Lindsay, Unity’s human resources director, said through a spokeswoman that some of the providers the union says quit have actually retired, been laid off 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 in Mary’s Center, which primarily serves Spanish-speaking patients in D.C. and Maryland, joined SEIU last year and is also negotiating its first contract.
Unity workers are members of the Union of American Physicians and Dentists.
Unity physician Alli Rigel said patients’ work and family commitments mean they can’t keep follow-up appointments when a provider runs out of time, sometimes causing tension. A patient hit them with a door last fall as they were trying to leave an exam room when she learned she would have to return for a Pap test because a 40-minute visit wasn’t enough to meet all of her needs. .
“We are the last line of defense against many injustices that our patients suffer,” Rigel said. “What hurt me the most is that my boss was going to give him a completely new appointment. “My safety didn’t matter.”
Danielle Fincher, a primary care physician at Unity, said the resignation of the medical director of the The D.C. jail left her shaken and upset without support at 7:30 a.m. on April 10, when an inmate lunged at her and spit in her face, before correctional officers restrained him.
After telling a supervisor he wanted to leave, he said he had to see more patients, couldn’t leave until six hours after the incident, and that a bodily fluid exposure risk assessment was not followed until the end of the day and was only because it continued up.
“He spit on me, but… in the end, I was assaulted by a patient and Unity didn’t support me,” Fincher said.
Ryan Buchholz, interim medical director, said through a spokeswoman that a replacement doctor was found within a few hours and proper protocols were followed.
Still, Fincher worries that compounding stressors threaten Unity’s very existence.
“I’m worried that 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.”
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