Just over half a year after Logan Health primary care providers unionized, providers signed a vote of no confidence in the hospital’s primary care leadership. Despite months of being in the bargaining process with Logan Health and representatives from the Union of American Physicians and Dentists (UAPD), providers wrote they “no longer have confidence that primary care leadership is acting in the best interests of providers, staff, or patients.”
A vote of no confidence is often used by labor unions as an “actionable item,” UAPD representative Alexandria Honey said, which unions can then use to apply pressure on administrators.
“This decision is not made lightly,” providers wrote in a letter explaining the vote. “It reflects an ongoing pattern of decisions and leadership practices that have eroded trust, harmed morale, negatively impacted patient care, and contributed to significant provider turnover.”
They listed six reasons for the loss of confidence, including: a lack of honesty and transparency; the hospital’s continued use of centralized scheduling despite providers’ concerns; decisions that continue to negatively impact patient care and provider retention; failure to follow the medical staff bylaws; a misuse of patient satisfaction scores; and a consistently unilateral style of decision making.
“Admin just never seems to listen,” said one Logan Health provider who asked not to be named out of fear of retaliation. “Administration says they do allow providers to be a part of these processes, and they do. They allow physicians and providers to have some input, but don’t change what they do.”
One of those processes is centralized scheduling. The system routes all patients to a consolidated scheduling group at the hospital to make appointments at particular clinics, meaning that scheduling decisions are made without a doctor’s input. Instead of improving access to care, providers say it has decreased the amount of patients they can see per day, making the system more inefficient and disrupting continuity of care. Despite repeatedly raising those concerns to administration, providers say they’ve gone unaddressed.
Primary care staff has also criticized the hospital’s decision to not renew its contract with Dr. Ruben Hipolito after seven years as a family practice provider. Hospital administration at the time said that the decision involved Hipolito’s patient satisfaction scores. Union representatives argued it appeared to be retaliation due to Hipolito’s role leading organizing efforts behind the scenes and serving as head of the provider’s bargaining committee since April.
Providers say the hospital inappropriately used patient satisfaction scores for disciplinary action, due to the influence of factors outside of providers’ control, including scheduling, staffing shortages and wait times.
Primary care providers also claim the hospital failed to follow medical staff bylaws that guide decisions about provider discipline, non-renewal, and termination. They no longer believe “bylaws are being applied consistently, fairly, and transparently, raising serious concerns about the integrity of leadership’s decision-making process.”
After the primary care union approved the vote of no confidence on Aug. 16, the union’s chief organizer Tim Jenkins emailed Logan Health’s new president Josh Neff and the Billings Clinic – Logan Health system CEO Clint Seger, requesting they meet with a delegation of physicians and advanced practice providers (APP). Neff declined, pointing to physician and APP meet-and-greets he already had lined up and a desire to keep the first meetings “informal and largely unstructured.” Without a response from Seger, Jenkins forwarded the two hospital administrators the primary care providers’ vote of no confidence letter.
“Recently, our members conducted a vote in which a majority stated they do not have confidence in current leadership,” Jenkins said in an Aug. 31 email. “This outcome reflects the frustration our members felt and is important to communicate to both of you. We want to be clear that many of the underlying issues driving this vote predate your respective tenures. Neither of you created these conditions, and we don’t view this vote as a judgment of either of you personally. Rather, it reflects accumulated concerns about morale, culture, and working conditions.”
Two days later, Austin Neese, the vice president of human resources, responded to Jenkins.
“We understand UAPD’s role as the bargaining representative and the union’s right to raise concerns on behalf of its members,” Neese wrote. “Your only standing, however, is as the bargaining representative. Matters relating to Logan Health’s leadership, organizational structure, and designation of its representatives are internal management matters and the union has no role in this.
Neese added that Logan Health administration “respectfully disagree with a number of the factual assertions and characterizations,” and in several instances “believe Logan Health’s positions and prior discussions have not been accurately reflected.”
“While we recognize that negotiations can involve strongly held positions and differing perspectives, maintaining accuracy and professionalism in our communications is important to both parties and to the integrity of the bargaining process,” Neese wrote. “While we disagree with many of the assertions proffered, we nonetheless take the concerns seriously and will review them through the appropriate internal channels.”
Dr. Cory Short, the chief medical officer at Logan Health Medical Center, responded to the vote in a statement Friday morning.
“We are disappointed that an out-of-state organization is using disruptive tactics and public theater instead of focusing on constructive dialogue at the bargaining table,” Short said. “This most recent targeted attack on primary care leaders who have dedicated themselves to serving this community is beneath the dignity of any legitimate labor organization.”
“Our leadership is fully engaged in the established bargaining process, which is the proper legal channel for addressing all workplace matters,” Short continued. “Though we have no use for divisive theatrical stunts, we look forward to continuing honest, direct bargaining that respects both our dedicated local workforce and the community we are privileged to serve.”