Roughly 4,000 Oregon health care workers are on strike. This time, the picket lines include physicians. by Abe Asher The largest health care worker strike in Oregon history is continuing this week, with thousands of Providence nurses and a number of doctors taking to picket lines across the state.  Health care workers began their strike on Friday, January 10. They have two central points of contention with Providence: staffing levels and compensation. Providence, a nonprofit, Catholic health care organization, has dealt with several strikes in recent years, including in the summer of 2023 and last summer. This one, however, is notable for several reasons.  One is its scope: According to the Oregon Nurses Association (ONA), the union representing Providence nurses, some 4,000 nurses have joined the strike from all eight Providence hospitals across the state, including several facilities in the Portland area.  This year, the striking workers also include around 150 physicians and advanced practitioners from Providence St. Vincent and Providence Women’s Clinics who have formed unions under the umbrella of the American Federation of Teachers (AFT). ONA is also affiliated with the AFT.  To keep its facilities open while the strike continues, Providence has hired around 2,000 replacement nurses. But the health organization says its operations during the strike will not be “business as usual,” especially at the facilities where physicians are out on strike. According to Robin Richards, a physician at the Providence Women’s Clinic, the issues around compensation and staffing are connected. Richards said not only do Providence nurses and doctors want to be paid their market value, but without pay raises, the hospital won’t be able to hire new doctors who can make more money at hospitals or practices elsewhere in the city.  “We are asking to be on par with the local community so we can recruit and retain more physicians,” Richards said. “But they don’t have a lot of incentive to do that. They love being understaffed—understaffing is a way for these health care facilities to make a profit.” Providence workers gather for a rally amid a labor strike. oregon Nurses association Gary Walker, the executive director of communication at Providence Oregon, told the Mercury that the health system’s current compensation structure is comparable with area hospitals.  Nevertheless, Providence claims it has already offered nurses a 20 percent raise over the next three years. But nurses may want a larger raise and for that raise to be backdated to the point when their previous contract expired, which, in some cases, was more than a year ago. Providence has responded by offering all nurses a signing bonus of up to $5,000. Nurses are also demanding better health insurance plans and more paid time off, including in the form of sick leave. Absent those benefits, the union argues, Providence will continue to struggle to retain and hire new physicians and nurses.  Richards, who grew up in Portland and arrived at Providence in 2020, said the staffing issue in particular has gotten considerably worse during her time with the health system.  “We’ve been pressured to see more and more patients on a day-to-day basis,” Robinson said. “And then we’re rushing—we don't have as much time to spend with individual patients because we're trying to see more patients and have more throughput.” The pressure to see more patients daily, Richards said, affects her ability to do effective and careful work.  “I deal with pregnancy loss, I deal with PTSD and trauma, I deal with [sensitive] pelvic exams. I need to take careful histories—I cannot be rushed,” Richards said. The issue for physicians like Richards is that, at this point, there is no cap on the number of patients she can be asked to see in a day. Doctors are asking that Providence take steps like capping hospital admissions, which the health system has indicated it may be willing to do.  Nurses are theoretically better protected from the issues associated with understaffing following the implementation last year of House Bill 2697, which made Oregon the first state in the country to cap nurse-to-patient ratios, but several hospitals have been accused of disregarding the new regulations.  As of December, ONA had already filed complaints over the conduct of five different Providence hospitals—and language about nurse-to-patient ratios remains a significant issue in the current contract dispute.  Providence withdrew from negotiations with its nurses in late December after ONA delivered a 10-day strike notice, which prompted ONA to file a complaint with the National Labor Relations Board (NLRB) claiming that Providence’s decision to leave the bargaining table amounted to an attempt to intimidate workers.  Providence officials said Tuesday they are now prepared to re-enter negotiations with nurses at all hospitals, with ONA in a statement calling on the health system to “reach a fair contract that prioritizes patients and frontline caregivers instead of profits.” While the striking workers have received support from a number of local elected officials and labor leaders, Providence has been quick to point out that some 600 unionized nurses, or 13 percent of the total number of nurses, have continued to work through the strike. But while a larger cohort of nurses has chosen to continue working, the presence of doctors within the ranks of the striking workers may have consequences well beyond the particulars of this labor action.  Kevin Mealy, ONA’s communications manager, said that as it’s become more expensive and more difficult for doctors to operate independently, more and more doctors have gone to work for large health care conglomerates—losing a measure of autonomy in the process.  “I think they’re seeing a lot of the same problems that nurses do: As healthcare companies get larger and larger, we also have to get stronger to push back and ensure that patients get the care they need,” Mealy said.  Richards sounded a similar note, arguing that doctors who do work for large health care systems must begin to see themselves as workers in a way that previous generations of doctors largely did not.  “Physicians are no longer autonomous in their businesses,” Richards said. “They’re becoming employed. And what we need to get over as physicians is this ego around the idea that this is a calling and we have our autonomy and we don't want to make it about money and finance so we've been slow to unionize, but the truth is, we are labor. We’re getting treated that way.” Richards said her hope is that doctors around the city and beyond take note of the physician participation in the Providence strike and think about organizing themselves.  “There’s a lot of skepticism or weariness of unions—unions are also big organizations with a lot of power and money, but what I am learning is that we have no other option,” Richards said. “The union is taking very good care of us, and really we need this mechanism to get to collective bargaining.”