After months of what Unity Health Care providers deem inhumane scheduling practices, along with provider resignations, and mass support staff firings and layoffs, the union of the District’s leading health care clinic are fighting to restore deteriorating workplace conditions.
On Aug. 13, Unity union members held an event to garner support and strategize toward salvaging the damage that providers are afraid could close the health care center’s doors for good.
The following morning, union members reported support staff were told to report to the main office on New Jersey Avenue under the guise that they were there for special training. Instead, they were abruptly told it was their last day, a week before members were slated to vote on the potential move to join Metropolitan District 1199 DC of the National Union of Hospital and Health Care Employees (NUHHCE).
In response to the layoffs, staff received an email communication from Unity’s CEO, Dr. Jessica Henderson Boyd, sharing “difficult news.”
“Unity continues to generate less revenue than monthly expenses and has implemented a restructuring plan leading to furloughs, the elimination of some positions and the realignment of others,” Boyd wrote in the email.
Boyd, the current chief executive, was appointed by the Unity board of directors in January 2022 after serving as Unity’s chief medical officer for two years.
Unity Health Care’s Background, Current Clinic Challenges
Unity Health Care, originally founded in 1985 by Dr. Jesse Barber and Dr. Janelle Goetcheus, started in a D.C. homeless shelter, providing comprehensive re-entry programs where social workers and providers addressed medical problems, along with social, housing, and other concerns for returning citizens and unhoused people.
Being the largest federally qualified health center in Washington, D.C., Unity has seen thousands of residents coming through their doors, as providers have treated innumerable patients with a “manageable” flow over the years. However, union members credit the down spiral of efficient scheduling and patient care to the new management who seemingly disregards the clinic’s mission and dire needs of the patients they serve.
In an effort to combat growing operational challenges within the network of community health care clinics, Unity Health Care providers teamed with the Union of American Physicians and Dentists (UAPD) last December, to improve workplace protocol and safety, underscoring needed improvements to scheduling, management-to-provider transparency, and increased time spent with their patients.
“It has become clear that Unity and their expensive, union-busting lawyers have no intention of treating Washington, D.C.’s frontline providers with the respect they deserve,” said UAPD President, Dr. Stuart Bussey. “Unity and other federally qualified health centers (FQHCs) provide essential care to the District’s most vulnerable patients. Their disrespect ends now.”
The UAPD estimates around 40 providers remain peppered throughout the clinic’s campuses, with just 14 of those being full-time clinical physicians. The significant downsizing leaves thousands of patients scrambling for treatment between few available providers who are now responsible for seeing over 85,000 underserved patients across the city.
Scheduling challenges and downsizing became a major strain on the facility, explained Dr. Kate Sugarman, MD, a family medicine physician at the Unity Health Upper Cardozo Health Center. She said the clinic’s scheduling became unmanageable roughly a year ago when the new management pushed claims that Unity was losing money, consequently forcing providers to see an uptick of patients.
However, union members and the bargaining team have found no legitimacy to these claims, arguing that if the health care center was working in good faith amid financial restraints, there would be structured protocol to properly disperse treatment without unreasonably overwhelming providers with increasing patient appointments.
“We started getting flooded with emergency emails [stating that] Unity is losing money, [and] you have to see a lot more patients. It was just relentless,” Sugarman told The Informer. “But, we know what a true public health crisis is, because we were all on the front lines of COVID. It was this artificial, manufactured crisis. Work life became very unmanageable, very untenable, very intolerable.”
Union members state that management has refused to bargain with the ongoing scheduling issues, leaving underserved patients in vulnerable positions with longer than usual wait-times and less personal time to consult with their doctors.
“It’s really had a terrible impact, because so many doctors and providers have quit, that patients can’t get appointments. Patients are literally told, ‘Well, come line up at 6 or 7 a.m.,’ and then when the very few slots that we have fill up, ‘Well, try again tomorrow,” Sugarman said. “It’s like survival of the fittest, and for people who are weak or vulnerable, they’re just going to give up.”
She further emphasized why such scheduling crises can create challenges for the people who look to Unity for care.
“Our patients have chronic conditions that really need regular follow-up, and chronic conditions that may not have symptoms until it’s too late,” Sugarman told The Informer. “The trusting relationship with the doctor, the provider, is so important, and people are so upset that some of their doctors and providers have quit.”
Dr. Jualenda Boschulte, ophthalmology specialist at Unity Health Upper Cardozo Health Center, illustrated the significant shift among her workspace, with provider resignations and layoffs leaving empty office spaces and concerned patients lamenting for better care.
“I can tell you just before the pandemic, or even during, we used to fight to maintain our own space in the clinic. I have an exam room that is geared toward us, but if I wanted to borrow the room next door, usually I couldn’t because a provider was using it,” Boschulte said. “We were jam-packed with flow, lots of medical assistants moving in and out of the hallway. Now, I can use any room I want in addition to my room.”
In response to the union’s concerns, Unity Health Care provided a statement addressing the points of contention:
“Regarding provider schedules, Unity has had the same minimum expected patients per session policy for years, predating current leadership, and that is in line with other medical systems. …
“Regarding the organization’s recent restructure, Unity has been transparent about the financial obstacles facing the organization for nearly a year and restructure considerations began earlier this year. The restructuring was a difficult but necessary decision to right-size the organization and to ensure the future financial viability of the organization so that we can continue to provide care for patients.”
Hope for the Future
While many remaining providers at Unity Health Care are frustrated about challenges, they hold onto hope as they offer care to patients.
“I have never seen any providers as unhappy today over the past 18 years. There are people who felt stressed for all kinds of different reasons and moved on. Some moved on and came back, but it was never because you didn’t feel that your voice didn’t matter,” Boschulte said.
Despite the lack of support for their extensive efforts and service, providers staunchly stand behind the founding clinic’s core mission.
They are hopeful to continue the critical work treating patients across their nine community clinics, as well as shelters, and D.C. jail.
“We want unity to thrive. We want the vision to remain. We want what Dr. Goetcheus stood for, to still be what we stand for today,” Boschulte said to attending listeners at the Aug. 13 gathering. “We need you all to be our extended voices to complain to the City Council, to bombard the mayor with letters, with emails, show up and let her know that if Unity dies, 100,000 people die with it.”