In July 2024, labor organizer Andrew Guttman got text messages early in the morning from clinicians at a Colorado health system who’d been trying to unionize via the Union of American Physicians and Dentists (UAPD).

The four physicians and a nurse practitioner said they had just been fired without cause and believed it was because of their union activity, Guttman recalled.

Now, Peak Vista Community Health Centers has agreed to settle a federal labor complaint by paying $1.2 million to the clinicians, who chose not to ask for their jobs back. 

The labor organizing drive began when Peak Vista pushed clinicians to see more patients, spend less time with them, and work more unpaid hours, according to UAPD. 

“Providers who questioned these changes or raised concerns about the impact on patient care were silenced, dismissed, or forced to resign, leaving thousands of patients without a primary care provider and creating widespread disruption across the community,” the union said in a statement.

Peak Vista serves about 75,000 people in the Colorado Springs area and gets grant money to treat lower-income and underinsured patients. The system has about 750 employees, including 100 medical providers. 

Health System Doesn’t Admit Wrongdoing 

The system’s president and CEO, Jaeson Fournier, DC, MPH, said the settlement doesn’t include any admission of wrongdoing but added that the system is committed to honoring employees’ rights.

As part of the settlement, Peak Vista agreed to post a flier that lists unionization rights and things that the company “WILL NOT” do, such as “suspend or fire you because of your union membership or support,” “block access to X in order to interfere with your Section 7 rights,” or “engage in electronic surveillance or monitoring of your communications in order to interfere with your Section 7 rights.” (Section 7 of the National Labor Relations Act addresses the rights of employees to unionize.)

Specifically, the flier says the system will not cull “through your work email accounts, put search results in a spreadsheet, create a separate mailbox for the receipt and retention of the results of those searches, place conditional access on your private email accounts, and cull through our systems to identify the author of ‘Colorado Springs Doctor.’”

Peak Vista also agreed to “remove from our files all records created from any searches of employees’ Section 7 activities in our IT [information technology] systems, including any spreadsheets and mailboxes used for search results” and “remove any conditional access we placed on any employee’s personal email account.”

Michael C. Duff, JD, a labor specialist and law professor at Saint Louis University School of Law, St. Louis, Missouri, told Medscape Medical News that “by saying what the employer will ‘not’ do, we learn what the NLRB [National Labor Relations Board] found it did.”

Meanwhile, the system is challenging the ongoing unionization effort with the NLRB, Fournier said.

Allegations of Electronic Surveillance of Union Chatter

In a 2024 unfair labor practices complaint on behalf of the five clinicians, UAPD alleged that the healthcare system surveilled its workers.

An inside source told the union that they were “instructed to set up ways of getting notified when people started reaching out to each other and using keywords” via electronic communication, Guttman said.

Also, “when we held a rally within sight of the main Peak Vista location, executive leadership had people climb up to the roof to monitor us.”

More Settlement Details: Back Pay and ‘Front’ Pay

The settlement agrees to pay the four physicians between $130,000 and $416,000 each, and the nurse practitioner will get $101,000. The funds are for back pay, “front” pay, expenses, interest, and excess tax.

“Front pay is less common,” labor specialist and law professor Jeffrey M. Hirsch, MD, MPP, of the University of North Carolina at Chapel Hill, told Medscape Medical News. “It’s a substitute for the normal remedy of reinstating an unlawfully fired employee.”

Duff said that if the $1.2 million total appears low, “that may be because you were expecting some type of ‘damages’ like in a personal injury lawsuit. Those kinds of penalties simply don’t exist under labor law.”

Unionization Effort Faces Challenge from Peak Vista

A group of clinicians voted to unionize in January 2025, but Peak Vista has challenged the election results. According to Fournier, the bargaining unit should expand beyond physicians, nurse practitioners, physician assistants, and certified nurse midwives to include dentists, dental hygienists, and potentially behavioral health providers.

Peak Vista has “been challenging every ruling and every result,” said Guttman, the union organizer.

The petition for reconsideration of the labor election results remains pending with the NLRB. 

Physicians Rarely Unionize, but Labor Drives Are More Common

It’s estimated that fewer than 10% of US physicians belong to unions. However, physician union drives are becoming more common, with a 2024 study reporting that community health centers like Peak Vista accounted for 38% of 66 unionization efforts between 2000 and 2024. Nearly two thirds of the 66 unionization efforts were certified.

“Traditionally, doctors were far less likely to unionize because people higher up in the hierarchy have fewer workplace issues,” Hirsch said. 

The 2024 study’s analysis of news reports found that physicians in unionization efforts were most motivated by working conditions (85%), lack of voice in management (81%), patient care concerns (54%), and pay (4%).

A Medscape Medical News analysis found that the average total compensation for physicians in 2024 was $374,000, with specialists averaging $404,000 and the highest-paid seven specialties clocking in at more than $500,000. Seven specialties averaged less than $300,000.

“Do not be afraid to organize,” Stuart Bussey, MD, president of UPAD, which has about 7000 members, said in an interview with Medscape Medical News. “Living in a situation where you’re surveilled and dominated by bullies is no way to live.”