That’s a term one hears often while speaking with the medical providers who care and treat many of the region’s most economically vulnerable patients at Piedmont Health Services (PHS), which employs 600 people and operates eight community health centers in Alamance, Caswell, Chatham, Lee, Orange, Person, and Randolph Counties.

“As medical providers, we are not focused on salaries. We’re content with our salaries,” Rupal Yu, a family physician who has worked with PHS since 2012, told the INDY last week. “The kind of people working at Piedmont Health aren’t going to work for Duke Health. We care for patients who have very little, and we are trained to meet their needs, to close those gaps in a powerful and meaningful way.”

The acceptance of relatively modest salaries notwithstanding, Yu, along with nearly 50 other physicians and medical providers at PHS, is focused on having a seat at the table.

On November 23, PHS physicians and medical providers petitioned the National Labor Relations Board to form the Piedmont Health Services Providers United and submitted a petition to PHS CEO Brian Toomey that explained why they felt it was important to form a union.

The petition noted that the petitioners are “a diverse, united group of physicians, nurse practitioners, physician assistants and nurse midwives who have chosen to work at this organization because of our alignment to the PHS mission: ‘To improve the health and well being of the community by providing high quality, affordable and comprehensive primary health care.’”

Chief among their concerns is not having a voice in organizational decisions that affect how they deliver patient care.  

“We see how our patients must overcome multiple hurdles to access our care,” the group stated in the petition. “They suffer when basic clinic functions are neglected and staff experience burnout. We are tired of not having the time, tools, and support we need to do our work. Every time we fail to meet our patients’ needs, we feel the pulse of our beloved PHS growing weaker.”

The group emphasized the importance of collective bargaining and asked Toomey “to recognize our union.” 

Toomey could not be reached for comment.

But the same day the petition was filed with the National Labor Relations Board, PHS responded by hiring Ogletree, Deakins, Nash, Smoak & Stewart, a powerhouse law firm with a national reputation for union-busting.

This spring, Duke University officials hired the law firm after Duke University Press (DUP) employees announced their intention to form a union.

Ogletree Deakins was a formidable opponent, but the DUP workers prevailed. 

“[This fall] the National Labor Board ruled in our favor,” Sandra Korn, an assistant editor with DUP, told the INDY this week. “The workers won the vote, but Duke has not yet recognized us. So at the moment, we’re without legal recognition. It’s as if their anti-union law firm will pull some legal feat to delay as long as possible. It’s like [Ogletree Deakins’s] business model is to intimidate workers and prevent people from having the power in the workplace that they deserve.”

PHS Providers Union members are awaiting the outcome of a pre-election hearing Tuesday with Ogletree Deakins attorneys at the NLRB offices in Winston-Salem, Michaela McCuddy, a family medicine doctor at the PHS center in Siler City, told the INDY.

“It is occurring because [PHS CEO] Mr. Toomey refuses to recognize our supermajority outright, and the purpose is to sort out the details of our election,” McCuddy said.

“We find it reprehensible that our management is squandering our precious resources to delay our election,” Yu said about this week’s hearing. “We are ready to have a union election. We are ready to vote, and that needs to be done. We have work that needs to be done with patients that need our care and this is a needless distraction and delay.”

Ogletree Deakins officials were not available for comment.

PHS’s seemingly anti-union stance appears counterintuitive to its origins, a little over a half century ago, as a federally qualified health center that’s eligible for reimbursement under Medicare and Medicaid. Agencies like PHS function as a medical safety net that offers high-quality primary care regardless of a patient’s ability to pay, according to ruralhealthinfo.org.

Company officials on the PHS website note the health care provider was started in 1970 by UNC–Chapel Hill health care professionals and community members who were concerned about access to primary health care in their communities. Then known as Orange-Chatham Comprehensive Health Services, the organization placed “special emphasis on those who weren’t receiving proper healthcare and who lacked access to services,” according to its website.

Piedmont’s mission is why Yu, a family physician and UNC–Chapel Hill medical school graduate, started working at PHS after completing her residency with UNC Family Medicine.

Yu was attracted to PHS because of its reputation as one of the largest providers of community health services in the country and its mission of inclusiveness that translates into 50,000 people being treated each year.

“The majority are uninsured or receive Medicaid,” Yu said. “I worked there at two clinics as a medical student and really looked up to the physicians and medical providers I worked with, who are all brilliant and dedicated. So I knew I wanted to come here after my training. It was a no-brainer because I’m mission-driven.”

McCuddy echoed Yu’s sentiment about PHS.

“I always wanted to be here and work in this specific community in Siler City,” she said. 

McCuddy said she decided to work in rural, Spanish-speaking, Latinx communities while attending UNC medical school. That’s also when she first became aware of PHS.

“I wanted to bring care where it’s needed most,” she explained. “I love rural medicine. As a doctor, it’s like I’m part of the family in some regards. You can be a pillar in the community in so many different realms, inside and outside the clinic.”

McCuddy said a close friend told her about an opening at PHS’s Siler City clinic.

“Siler City is close to me. I felt compelled,” she said. “I felt like, ‘Yes. This is where I want to be.’”

Krishna Kothary is a family nurse practitioner who earned her advanced degree in nursing from Johns Hopkins University. In 2018, she began working at PHS’s Burlington and Carrboro clinics. Along with being a primary nurse practitioner, her expertise is in addictions, gender-affirming care, and HIV care.

For her, PHS was a natural fit.

“Community health is where my heart and soul is, for all of my career,” Kothary told the INDY last week. “It’s a mission that I wanted to be a part of. I’m passionate about caring for underserved communities.”

Kothary says the work is about treating high-risk patients who are challenged by a complexity of barriers, including economic and language obstacles. She treats a significant number of Spanish-speaking patients.

“Those barriers can affect their health and also affect their ability to obtain health care,” Kothary said. “There are these social determinants of health: unsafe neighborhoods with poor air quality, intergenerational trauma, poverty, a kid living in poverty whose asthma is worse because of poor housing or a relative who smokes …. It’s what I treat every day.”

But the medical providers who spoke with the INDY say PHS has strayed from its roots. They point to workplaces where they have no input in decisions that affect the lives of their patients and their own, where they feel bullied when they ask for change, and where there exists high employee turnover because of frustration, increased workloads, and cuts in their own health coverage.

McCuddy said that even though the Siler City clinic is exactly where she wants to be because people bring so much passion to their work, she’s beginning to see issues with PHS’s ability to retain its employees.

“People want to be there,” she said. “They feel supported by the other providers, but they don’t have a voice in the organization. Every other week, or every three weeks, someone leaves, and people are sad to be leaving. They want to be here.”

Yu said frustration has been “building up quite a while” among her colleagues. She added that those frustrations have been exacerbated by the pandemic. In addition to a lot of staff turnover, she decried patterns of poor management by managers who don’t have the expertise or support to do their job. 

“We need to have a mechanism in place to raise issues,” Yu said. “The issues are many. The problem is we have no mechanism. We need to have a seat at the table.”

Kothary said the PHS system is “an added barrier to barriers that our patients already have.”

“One of the main reasons I want a union is to have a say in the system,” Kothary said. “A lot of medical providers apologize [to their patients] for the system. There’s not one day I don’t apologize for the system.”

Kothary added that it’s one thing to apologize to her patients because of the challenges they have to endure and quite another to apologize for a system that’s supposed to help them but feels more like it’s exploitative.

“My heart is breaking at this point at how the system represents itself and has become a hindrance,” she said.

Yu said that as agents of nonprofit health care centers, PHS medical providers “have an obligation to serve our vulnerable population with dignity and respect.”

“And we believe a strong medical providers’ voice will create stability and enhance our mission and make Piedmont Health a better place for all.” 

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Follow Durham Staff Writer Thomasi McDonald on Twitter or send an email to tmcdonald@indyweek.com.