About 135 medical professionals at Legacy Health say they will begin an open-ended strike on Dec. 2, after more than a year and a half of stalled contract talks.
The workers — a group of advanced practice providers including nurse practitioners, physician associates and clinical nurse specialists — work across Legacy’s hospitals and clinics in Oregon and southwest Washington. They provide a wide range of frontline care, from primary care visits to specialty services.
Officials with the Oregon Nurses Association, the union that represents the workers, said the move comes after the workers voted overwhelmingly last month to authorize a strike. The workers have been trying to negotiate a new contract since they unionized in late 2023.
Union leaders said that after the October vote, workers met with Legacy management seven times, but Legacy’s legal team later walked away from talks and said it wouldn’t consider more proposals. They said the workers have continued to offer bargaining dates and are committed to reaching an agreement and avoiding a strike.
The workers formally notified Legacy management of their plans to strike Thursday evening, according to union officials. Health workers are required to give 10 days notice before beginning a strike.
In a statement, Legacy officials said negotiators met with the union more than 30 times over the past year and a half to reach “a fair and market-aligned” proposal — including an average 10% pay increase based on regional and national compensation data.
“Now that we have received a strike notice, bargaining will be paused during the 10 days leading up to and throughout the duration of the strike,” Legacy officials said, adding that they have “activated contingency plans” to maintain patient care during the strike and will notify patients if any scheduled appointments are affected.
Advanced practice providers said they are still far from a deal with Legacy leadership on pay and working conditions. A major concern, they said, is the large amount of unpaid administrative and nonclinical work they are expected to do outside their scheduled shifts — work they argue contributes to burnout and turnover.
Leigh Warsing, a trauma physician associate at Legacy Emanuel Medical Center, said she often stays past her shift to finish patient care, especially during emergencies. But because she is salaried, Warsing said, those extra hours go unpaid.
“Even when I go home, I should turn off my EPIC inbox, but most of us don’t,” she said. “We keep answering nurses’ questions when they come in or put in orders if they ask us to. So we do a lot when we’re not on shift but we’re not being paid for it.”
April Callister, a physician associate in cardiothoracic surgery at Legacy Emanuel and Legacy Good Samaritan, said being on call makes the workload even heavier. She said she’s responsible for 24-hour call shifts on weekdays and is required to be continuously available from Friday evening through Monday morning, on top of her full-time schedule.
“But any work that I do at home while on call is not compensated,” she said. “It could be anything related to helping take care of patients. Sometimes it’s getting a call from a patient and deciding whether they need to go to the ER or answering questions from overnight nurse staff.”
Callister said physician associates and nurse practitioners are asking for more sustainable working conditions and wages that better reflect regional standards at systems like Oregon Health & Science University and Kaiser Permanente.
Union officials said direct comparisons between Legacy and OHSU are difficult because the organizations structure their advanced practice provider workforce differently. But union spokesperson Peter Starzynski said Legacy’s proposed wages are, on average, at least 10% lower than what OHSU pays its non-faculty advanced practice workers who primarily provide patient care — and as much as 20% lower than Kaiser’s pay for similar roles.
“That’s just wages,” Starzynski said. “When you look at working at OHSU and the benefits of pension, retirement, health care benefits and everything else, it drops drastically lower. Overall, compensation is far lower.”
OHSU recently reached a tentative labor agreement with 700 nurse practitioners, physician associates and nurse midwives represented by the Oregon Nurses Association, following its own strike authorization.
Under the deal, new non-faculty physician associates and nurse practitioners in primary and specialty care would start at about $167,000 annually, while experienced advanced practice providers at the top of the scale would earn just over $202,000.
Legacy officials, however, argued that it’s important to look at the broader market for advanced practice providers and that its “exhaustive” review of regional job postings found many health systems offering lower salaries than what it has put on the table.
Legacy officials said the hospital system’s financial outlook limits how much it can increase pay. They said the health system treats a large share of patients on Medicaid and other government programs, and those reimbursements often don’t cover the full cost of care.
“This reality puts sustained pressure on our finances,” the statement said. “We must balance fair and competitive compensation with the financial constraints required to keep our organization viable — especially during a time when we continue to run unsustainable operating losses.”
The looming strike is unfolding against a backdrop of ongoing labor unrest across Oregon’s health care sector. At the same time, many hospital systems in the region have warned that rising costs and anticipated Medicaid cuts are putting their finances under significant strain.
Earlier this week, more than 8,000 OHSU employees represented by Local 328 of the American Federation of State, County and Municipal Employees voted to authorize a strike after nearly a year of bargaining.
Last month, about 4,000 Kaiser Permanente workers in Oregon and southwest Washington held a five-day walkout. And earlier this year, nearly 5,000 Providence workers at eight Oregon hospitals staged a 46-day strike.
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