Advanced practice providers at Legacy Health medical centers in Portland remain on strike this week, and say they’ll stay on their picket lines until they reach an agreement for a new labor contract.

“The energy is high,” Megan Barckert, a nurse practitioner at Legacy Cancer Services, told the Mercury from a rain-soaked picket line at Legacy Good Samaritan. “Our members are motivated and united in terms of our cause.”

Advanced practice providers (APPs) are often nurse practitioners and physician assistants who, while not physicians themselves, have specialized training and are licensed to diagnose and treat a number of medical conditions. 

The 135 APPs at Legacy facilities in Portland represented by the Oregon Nurses Association (ONA) began their strike on December 2 after months of bargaining with Legacy failed to yield a contract. The two sides were set to resume negotiations with a mediator on Monday morning. 

Compensation has been a major sticking point in the negotiations. Legacy APPs say their rate of pay has fallen well behind that offered by other area hospitals like OHSU and Kaiser, which has meant that a number of APPs have departed Legacy for other opportunities. 

Kevin Mealy, communications manager for ONA, said a new contract at OHSU means Legacy APPs are now being paid 10 to 12 percent less than their OHSU colleagues and are receiving eight to nine percent less in retirement pay—opening up a 20-plus percent gap in total compensation. 

Barckert said the effect of that gap is already clear. Because of how specialized their roles are, the departure of even small numbers of APPs can have effects across the Legacy system. Barckert pointed to the loss of an APP in palliative care, for instance, as impacting patients who never even worked with the provider. 

“The loss of that provider [means] that we can’t get our oncology patients into care soon enough for pain management,” Barckert said. “These are real issues happening now, and we need them to be addressed.” 

A Legacy Health spokesperson wrote to the Mercury that the health system has offered a 10 percent pay increase on average, but that the union is asking for “roughly double that amount” and has not presented a counterproposal or reduced its salary demands. 

“We remain willing to meet with the union if the focus of both parties is bargaining,” the spokesperson wrote. “However, since the union has said it is striking and that this group of APPs will not be performing patient care in the coming weeks, the priority of our leaders is directed 100% to ensuring continuity of patient care. We will resume meeting with the union when this work stoppage has concluded.” 

Legacy has also noted the relatively small size of the APP bargaining unit and a responsibility to “balance the needs of the entire organization” as drivers of its contract proposals.

But Rob Brookshire, a physician associate at Legacy Emanuel Medical Center and member of the ONA bargaining team, said Legacy has not clarified how they are proposing to deliver that 10 percent raise—suggesting that Legacy is getting to that number by offering lower raises to APPs at the top of the wage scale at higher raises to APPs toward the bottom. 

According to a union-produced compensation calculator, a tenth-year APP would make $102.55 per hour under the ONA proposal and just $88.70 per hour under the current Legacy proposal. 

Brookshire, who has worked at Legacy for more than two decades, said a broader issue throughout the months-long bargaining process has been a lack of knowledge on Legacy’s part of the specialized labor APPs provide in their hospitals. 

“Many times what we’re doing isn’t billable; they can’t run a spreadsheet and see the money we’ve brought into the system,” he said. 

The union is negotiating on more specific fronts as well. One pertains to work APPs say they are currently being asked to do off the clock, an issue they say was addressed at OHSU in their new contract.

“One really good example is our in-patient groups,” Barckert said. “They work 12-hour shifts and then have to do handoff. Often, they have to stay extra to do that handoff, often they’re working more like 13 or 14 hours, or, if there’s an emergent issue that’s going on where they have to stay around, they aren’t compensated for any of that time.” 

Not only do the two sides remain at odds over compensation and a select number of other issues, but the bargaining process itself has been contentious—with both Brookshire and Barckert saying APPs have been shown “disrespect” at the table. 

“It’s definitely kind of devolved into this antagonistic relationship with the executive leadership and the bargaining team, and that’s unfortunate,” Brookshire said. 

Multiple APP sources said Legacy’s lead attorney in the bargaining process has been particularly combative in bargaining sessions, with Barckert noting that nurses at Legacy Mount Hood Medical Center agreed to a contract over the summer after a bargaining process that included different Legacy personnel. 

Mealy, meanwhile, blamed Legacy’s leadership for the challenges at the bargaining table. 

“Usually the hospital executives and their lawyer are moving in lockstep, so anything that is coming from that side of the table is generally because that’s what they want proposed, or that's the behavior that they’ve instructed their lawyers to take,” he said. 

The difficulty of the process led the union to ask for a mediator over the summer—an ask that Legacy, they say, finally acquiesced to after the strike began. The two sides last met to bargain the week before Thanksgiving.

Brookshire said the process is more evidence of the extent to which he believes Legacy’s leadership has “devolved” in recent years, pointing to the health system’s failed merger with OHSU as another example of an approach that may have threatened the quality of patient care. 

“This boils down to a multibillion dollar health care conglomerate that’s looking, I feel, to make an example of 135 advanced practice providers and make an effort to financially crush these employees,” Brookshire said. 

That has left APPs with little option, Brookshire said, but to walk off the job. The strike, unlike some other health care strikes, is not time-limited and will continue for the foreseeable future—with APPs raising money for their strike fund and receiving support from other area health care unions. 

“It is completely heartbreaking for us not to be taking care of our patients,” Barckert said. “We want to be at work, doing what we all love. On the other side, we are energized to fight for what we deserve—what we and our patients and our communities deserve.”