Public Health Professionals Unite: Unionizing PHMC

By: Matteo MacDermant

Nurses, nurses’ aides, physicians’ assistants, doctors, and staff at six clinics run by the Public Health Management Corporation (PHMC) voted on July 18th to unionize. Together, they brought the problems in their workplace to light and began to develop a common solution. They are on their way to officially joining the Services Employees International Union (SEIU),  Local 668

Who is PHMC?

PHMC is a nonprofit institution that has been working with governments, foundations, and businesses in the Greater Philadelphia region since 1972. They provide outreach, health promotion, education, research, planning, technical assistance, and direct services throughout the region.

PHMC has 2500 employees in 350 programs, across 70 different sites. They also directly run six public health clinics in Philadelphia. It is at these six clinics where the union is being organized. 

Why do PHMC workers want a union?

Chris Aiggerattacs, a nurse’s aide with PHMC, spoke about the situation and explained that “this is not about money or benefits.” The staff just want “a seat at the table,” she said. The staff want to be respected and have a say in how the clinic runs. “It is far too often,” she said, “that things change suddenly and none of us are consulted in any way or prepared to carry out the changes management forces upon us. There are no boundaries.”

Chris was one of ten PHMC workers who formed a union exploratory committee in January 2019, mostly in response to a new policy aimed at increasing productivity. 

Management created a plan to intensify the staff’s workload to “serve more patients.” The plan asked the staff to: 

  • Work Saturday hours; 
  • See one more patient before the day began;
  • See one more patient at the end of the day;
  • And see a patient during the lunch hour.

The plan was supposed to allow the clinics to serve more patients, but there were some problems with this plan. The clinics were understaffed: the staff were already overworked and stressed with the existing patient load. 
The patients need careful medical attention because many are homeless or live in poverty. Some have not seen a doctor in years. They need more time, not less. This issue is greatly exacerbated by high turnover rates, which Chris believes are in no small part due to burnout from poor working conditions at the clinics.

In the end, this policy proved to be a failure. Chris explained that it just couldn’t work considering the constraints of the staff. “People are worked to the max and we can’t cut time from patients so the policy just made the clinic less efficient with longer wait times and more frustration for everyone.”

PHMC Management, claiming to have an open door policy and an ear to worker concerns, had heard many times why this plan and other managerial decisions were not in the best interest of the workers, patients, and ultimately the clinics. The staff gave many suggestions and voiced concerns repeatedly. They received many rounds of, “We hear you,” followed by no changes. It was with great frustration from not being heard, deteriorating conditions at the clinics, and a declining work-life balance, that PHMC workers decided it was time to organize and take collective action.

Starting the Union

The union exploratory committee was formed in January 2019 and began looking for national unions who could help them organize and become official. They contacted PA SNAP (Pennsylvania Association of Staff Nurses and Allied Professionals) and SEIU PA (Service Employees International Union of Pennsylvania). These unions are both aimed at organizing and fighting for the livelihood of medical professionals. However, neither was interested in working with a public health clinic which they perceived as being more social work than health care. 

SEIU PA instead directed PHMC union organizers to SEIU 668, a social work local operating in Southeastern Pennsylvania. SEIU 668 showed interest but asked the committee to prove that they had enough support. They would take on the fight, but only if a certain threshold of support was met.

The committee spent the next several months organizing and building a critical mass of support. In every clinic at least one unionizer was agitating and educating fellow workers about the deteriorating situation they were facing and the path forward through collective action.

Management soon caught wind of the organizing happening under their noses and launched a counter-strategy.

The Anti-Union Campaign

Management began holding “information sessions” run by consultants trained in the art of anti-union propaganda in Spring 2019. In these meetings they deployed common anti-union propaganda by arguing that unions will do nothing more than: 

  • Get in the way; 
  • Create a bunch of red tape; 
  • Prevent managers from addressing worker concerns;
  • Create unnecessary rules that just make everything worse;
  • Create barriers between management and workers; 
  • Threaten the open door policy; 
  • And most of all, they will take money out of workers’ pockets.

“We want to work with you,” management insisted, “but the union will tie our hands and prevent us from doing so.” 

Anti-union consultants are standard practice. Workers who try to organize are almost always met with resistance. “Information sessions” to “teach the truth” about unions are usually the first step in a misinformation and (if need be)  retaliation campaign. This is the warning shot and it is designed to scare or propagandize workers out of organizing. 

This can sometimes be enough to undo a unionizing drive. That is why it’s critical to inoculate workers against the anti-union backlash. Inoculation, a term borrowed from medicine, is the process of feeding a weakened or dead virus to patients to stimulate an immune response. It is very much applicable to union organizing.  Workers who are inoculated have immunity against backlash and are thus better prepared to respond effectively to attacks instead of acting impulsively or retreating under pressure. 

If and when these sessions and tough talk are not enough to end the campaign, management usually resorts to “no more Mr. Nice Guy” tactics. They begin enforcing rules that weren’t previously enforced and punishing workers for petty violations. They look for ways to separate workers who they think are organizing together. They try to make things difficult for everyone. Sometimes they try to turn those on the fence or workers who have not expressed union sympathies against those who are organizing. 

Chris reported that much of this was the case at the clinics after the initial tactics failed to stop the push for a union. Unsurprisingly, it was the lowest paid and most vulnerable workers, especially immigrants and people with families who are dependent on PHMC income, who bore the brunt of this retaliation. 

The Yes Vote and Beyond

Retaliation and anti-union sessions were ultimately a failure. On July 18th all six clinics voted in favor of unionizing. 

The official negotiations will soon begin. Chris and her comrades at PHMC will soon get that “seat at the table.” That is when the real organizing begins. It is yet to be seen if management will, even in the face of organized labor, begin to listen to PHMC workers and give them the respect they deserve. 

Organizing and unionizing is a great first step. Considering the growing field of public health, home healthcare, and other non-hospital healthcare professionals, it is a critical step for organized labor. Chris was optimistic that things would change and that they would be trailblazers in healthcare worker organizing, inspiring other clinics around the city and country to follow suit and build their collective power.

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