Pediatricians Accuse Employer of Union Retaliation

Politicians, colleagues, and patients are defending two Cleveland pediatricians who were fired after they used an online directory to find co-workers to contact about a unionization effort.

The University Hospitals healthcare system says “the decision to terminate these two physicians had absolutely nothing to do with union organizing” and instead is due to their inappropriate accessing of private employee information.

But Valerie Fouts-Fowler, DO, and Lauren Beene, MD, claim they are victims of illegal retaliation and said they filed a complaint with the National Labor Relations Board (NLRB).

“They fired us for using the phone book,” Beene told Medscape Medical News in an interview. “They’re trying to silence the movement by scaring other doctors by making an example of us.”

According to Beene, the effort to unionize the private health system’s 2000 physicians began in May 2024 amid a decline in access to pediatric specialists.

“Patients were no longer able to get specialist care within a timely fashion,” she said. “We decided we couldn’t take it anymore.”

Unionization made sense as a strategy to help physicians be heard, she said.

“In our increasingly corporate healthcare systems, where the majority of physicians are now employed, the physicians that are on the front line really don’t have a way to be able to speak up effectively about concerns that we encounter in our day-to-day interactions with our patients,” Beene said. “By supporting a union, you create power in numbers, and you also establish legal protections for your voice that enable you to be a better advocate.”

“If University Hospitals gets away with firing two well-established general pediatricians in this manner, that sets a dangerous precedent for workers across the country,” she added.

Union Organizing On the Rise for Physicians

Union drives among physicians — at least those in the private sector — have become more common in recent years, although the proportion of unionized doctors remains small.

As Medscape Medical News reported in 2024, a JAMA study counted 21 private-sector union drives among physicians in 2023 and 12 in the first 5 months of 2024. In contrast, nearly all years from 2000 to 2022 saw just zero, one, or two union drives.

An estimated 8% of all US doctors are union members. There are challenges to boosting this number. As a 2024 report noted, “the different classifications of doctors (eg, employees, supervisors, or independent contractors) lead to legal obstacles in unionizing.”

Reaching Out via an Employee Database

As part of their outreach to colleagues, the two Cleveland pediatricians accessed the phone numbers of their co-workers through a company app, which Beene described as a “digital Rolodex.” Then they texted hundreds of physicians about the unionization effort.

It’s common to use the app for informal communications, Fouts-Fowler said. “One doctor told me, ‘Recently, somebody reached out through the app to see if I wanted Girl Scout cookies.’ Somebody else planned a baby shower, and someone else was going to run a race, and they were trying to raise money for it.”

The health system learned about use of the database and fired the two physicians. Beene, who worked part-time, and Fouts-Fowler, who worked full-time, said they have about 5000 patients between them.

While companies often decline to speak publicly about personnel matters, University Hospitals has publicly discussed the firing of the pediatricians.

“The only reason we launched an investigation into this matter was because of complaints from UH [University Hospitals] physicians about being sent unsolicited text messages,” the system said in a statement provided to Medscape Medical News. “An investigation determined these two physicians went into a care coordination app, accessed the personal data of 4000 colleagues, and repeatedly sent them unsolicited text messages that had nothing to do with care coordination.”

Cliff Megerian, MD, CEO of University Hospitals, told WEWS that the pediatricians violated at least five policies. “They denied it. We found out they did, and as you can expect, that’s what led to the issue.”

Legal Complexities

A key legal question centers on whether the hospital allowed other employees to use the system for nonwork purposes, said Kate L. Bronfenbrenner, PhD, director of Labor Education Research and senior lecturer at Cornell University’s School of Industrial and Labor Relations, Ithaca, New York.

Bronfenbrenner, a former union organizer, told Medscape Medical News that “under labor law, doctors, as long as they aren’t considered managers, have the right to concerted activity” — working together.

The standard legal test, she said, examines whether employees are permitted to use company systems for other personal communications. “If they allow workers to use it for anything else — if employees could send out a notice that they were selling Girl Scout cookies or helping raise money for the United Way — then they can’t say there’s a rule just for union activity.”

NLRB Remains Offline

However, it may not matter if the pediatricians have a better legal argument, at least for the time being. The NLRB currently lacks a quorum, raising questions about whether workers’ rights claims can be enforced, Bronfenbrenner said.

There may be other legal hurdles for the two physicians. In 2019, during the first Trump administration, the board overturned an Obama-era ruling, saying a company could forbid the use of its workplace email system for nonwork purposes such as union organizing.

The board also highlighted that companies have “property rights” over “employer-provided equipment.”

‘We Love Our Jobs’

Dozens of supporters have protested the firings, and dozens of Democratic state leaders are calling for an investigation into the terminations. An online petition seeking the reinstatement of the pediatricians has raised about 7000 signatures.

Beene and Fouts-Fowler said they’re continuing to try to organize the health system’s physicians, and they still want their jobs back. “Val and I don’t want to look for other work,” Beene said. “We love our jobs. These are our careers, and we have a duty to continue to provide care for these patients.”

Advice for Starting a Union — or Fighting Off One

If you’re thinking about starting a union at your workplace and you’re covered by the National Labor Relations Act, here’s some guidance from the NLRB:

• DO understand that you can talk with co-workers about your pay and engage in “concerted activity” even if you’re just one person.
• DON’T try to organize co-workers during work time — “working time is for work” — if your workplace has a policy against it. However, you can advocate during work breaks and off time. And “your employer cannot prohibit you from talking about the union during working time if it permits you to talk about other nonwork-related matters during working time.
• DO “understand your right to distribute union literature, wear union buttons T-shirts, or other insignia (except in unusual ‘special circumstances’), solicit co-workers to sign union authorization cards, and discuss the union with co-workers…. You can’t be fired, disciplined, demoted, or penalized in any way for engaging in these activities.”
• DON’T rely on the National Labor Relations Act if you work for a federal, state, or local government or work as an independent contractor. In those cases, it doesn’t cover you.

And if you’re an employer trying to prevent workers from unionizing, the Reliant Labor Consultants firm offers this guidance:

• DO “continue to share factually accurate information” regarding topics such as benefits and wages.
• DO “give examples of history, background, and outcomes of unionized employers (eg, strikes, loss of jobs, shutdowns, etc.),” as long as they can be proven.
• DON’T make threats regarding unionization “such as cutting benefits, wages, and hours; laying off or discharging; shutting down or moving a facility; discontinuing existing employee programs or other incentives.”
• DON’T “spy on employees’ union activity, such as going to a union meeting or place where a meeting will be held, or ask another employee to report back any union activity.”