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Published Friday, February 3, 2023 in the Everett Herald


Amid Patient Woes, CHC of Snohomish County Staffers Push for a Union

Doctors and nurse practitioners are worried about providers being shut out from clinical decisions, which hurts patient care.

Amid patient woes, CHC of Snohomish County staffers push for a unionby Joy Borkholder

EVERETT — Doctors and other providers at Community Health Center of Snohomish County filed a petition this week for a union election.

The group of 37 providers — including physicians, physician assistants and nurse practitioners — would join the Union of American Physicians & Dentists if a majority votes in favor of forming a union. The National Labor Relations Board has not set an election date.

A doctor at Community Health Center, who asked for anonymity due to fears of retaliation, said the staff has two main goals in organizing a union: “No. 1 is improving patient access and service, because it has suffered significantly with the changes that have been made by our administration. And No. 2, is more respect for and involvement of providers in decisions that are made by our administration.”

After Community Health Center implemented a new electronic health records system in the spring of 2022, providers claimed the system caused long delays in communicating with patients, processing referrals and getting lab results, said the doctor. It also added significant time to their administrative workload. And the problems have continued, providers said. They have tried to raise concerns, but they feel dismissed.

For a while, they felt like they had an advocate in one clinic director. But when CHC fired the director in September, it triggered more anger and fear among providers, according to the doctor. Many of the providers concluded CHC had fired the clinic director for speaking out.

Reached by a Daily Herald reporter, the clinic director declined to comment for this article because of fears of retaliation.

Staffers submitted a letter to the CHC board of directors in September, claiming 42 had signed on, but keeping the names anonymous. In that letter shared with The Herald, providers expressed concerns about high turnover, low morale, long patient wait times and the quality of patient care.

They asked for a review of the clinical director termination, as well as the ability to communicate with the board about clinical issues. The doctor said they never got any acknowledgement from management or the board about the letter. Nor have they been asked to share concerns with the board or allowed to attend board meetings.

Now many have left, around 12, according to the doctor and another provider. Those who remained have seen patient wait times increase, the doctor said. And one of the doctor’s patients ended up in urgent care because they couldn’t get an appointment.

The doctor who spoke with The Herald has faced long wait times on the phone and in urgent care to get care for their own child. And they hear some patients are looking for primary care at other clinics because of the long wait times to get an appointment at CHC.

The providers would like a formal way to communicate with the board of directors, as well as more transparency.

“A lot of us would like to see more transparency from administration,” the doctor said. “Because if there’s a vision here that we’re not seeing, we just need to understand what’s going on. What is the vision that led to us choosing a very ineffective electronic health record that’s led to several providers leaving?”

Stuart Bussey, the president of the Union of American Physicians & Dentists, wrote in a statement that providers want a voice in the health care that they deliver: “Providers feel they are being shut out of those key decisions, and that is not good for thousands of patients who rely on them.”

CHC provided a written statement in response to the union election and providers’ concerns: “CHC respects the right of employees to decide whether or not to be represented by a union. The organization will comply with its obligations under the National Labor Relations Act. CHC remains committed to its mission of providing our diverse community with access to high quality, affordable primary health care,” spokesperson Rachael Woods shared with The Herald.

CHC serves over 70,000 patients, predominantly low-income patients and those with Medicaid or Medicare insurance. Nearly half of all patients identify as a “racial or ethnic minority,” according to federal data.
Angelica Montanari, a former CHC board member, saw management and the board dismiss providers’ concerns in the fall.

“The providers really care about their patients,” she said. “And I think that’s one of the main reasons they come and stay at CHC. So I think one of the biggest struggles with retention is changes that are happening are affecting patient care. And that is frustrating the providers.”

Montanari, who works as a nurse in the emergency department at Harborview Medical Center in Seattle, saw her role on the board as an advocate for patients. She has been a patient there for about 15 years, starting when she lacked insurance but still received great care at CHC.

In November, Montanari experienced personally what it means to have long wait times at CHC. She was worried about some vision loss in one eye, especially with a history of multiple sclerosis in her family. But urgent care couldn’t order an MRI — only her primary care provider or the emergency department could.

She would’ve had to wait to see her provider for three months, so she went to the Providence emergency department. While the test ruled out multiple sclerosis and provided some peace of mind, she waited all day and paid a large bill.

And her 18-month-old daughter is now on her third pediatrician because of provider turnover. They had to wait days to see the pediatrician for what Montanari suspected was a urinary tract infection. She has started to schedule her daughter for a clinic outside of the CHC system. With private employer-sponsored insurance, she can do that more easily than someone with Medicaid.

“I have a love for CHC,” Montanari said. “CHC is a wonderful organization. And this whole situation has really made me distraught at times.”

Given Montanari’s personal and professional experience, seeing emergency departments backed up right now, she thinks timely access to primary care is more important than ever. She said the system is in crisis, including at CHC, where the providers keep leaving.

“And so when you can’t get into your doctor to get your blood pressure medications taken care of or your mental health meds refilled, it’s an issue and it can lead to harm,” Montanari said.

On Feb. 1, the CHC careers website listed openings for eight physicians, as well as nine nurse practitioners or physician assistants. In December 2021, the same site listed openings for a total of six similar positions.
Some staffers have stayed at CHC because of relationships with patients, fantastic colleagues and the mission of a community clinic, said the doctor who asked to remain anonymous. The doctor called it “heartbreaking” to consider leaving.

“Everybody that works at CHC is very dedicated — very similar to me — to our community, to trying to make things better for people who have struggled, who have a hard time finding health care elsewhere,” the doctor said.

Montanari voiced her support for the providers.

“I think an important thing is to let them know that we support them in unionizing,” she said. “You know, they take care of us, it’s time that we take care of them a little bit. And that way they can continue to take care of us.”