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Exempt vs Nonexempt

Exempt vs Nonexempt Cont.

Town Hall Notes

Decertification Vote

Collective Bargaining

Seniority

Future Topics

PA Supervisory Role

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What happens to the PA supervisory role once a contract is ratified?

We know that anyone in the union cannot manage another member within the union. Therefore, with a ratified contract, the PA supervisory role disappears.

If leadership positions are developed, it could be similar to site leads with PAs working in concert with management, but not in a management role.

Why am I even bringing this up? If we want to be fully informed PAs, we need to know about our history and with being in a union, what we stand to gain and what we have to give up.

The idea of the PA supervisory role developed in 2013 with the goal of propelling PAs into leadership roles within Kaiser. The template for this arose from leadership roles developed in KP Colorado. As it stood, we had APICs and chiefs managing the doctors, nurses managing nurses, and PTs managing PTs. PAs did not have any representation, and some in leadership began the long road to try and change that.

The infrastructure was slowly put into place, with site leads appointed. Those site leads would eventually be promoted to the supervisory role. To obtain that, support and funding had to come from the departments and medical centers where the PAs worked. Covid and a change in leadership (where the PA supervisory role was not at the top of their list) slowed its implementation. Finally, in 2021, it began to take shape.

Several site leads were appointed as PA supervisors, but only a handful would be fully integrated into a managerial role, which gave them the major responsibilities/essential functions of hiring, training and supervising PAs, developing or supervising schedules, developing and monitoring budget and resource allocation, monitoring department financial performance, and assisting in the development of new programs.

The overreaching goal was to have PA supervisors overseeing all departments (departments with a small number of PAs would be combined with other departments within their medical office building or hospital). Once established, regional and system-wide meetings would allow for sharing of best practices and to help with troubleshooting difficulties facing the varying departments.

This was the vision on paper. Could it happen? The process was slowly taking shape, but even the development of the PA supervisory role was a bit rocky. Some sites blocked the implementation of the role, whereas others incorporated it, but the PA did not fully matriculate into the "direct report"/managerial role. When the union formed, because the PA supervisory role was not system-wide (which has been my understanding after speaking with several people), the “project” was abandoned and all PAs were placed into the union.

If you ask enough people about this role, you will get varying answers. Some felt it was necessary and celebrated it, others felt it was ineffective. Some were deflated by their department/site obstruction to developing and implementing the role. Some saw the momentum building and change taking place. In the end, some saw the vision and its early implementation, whereas others did not.

The role continues to exist in our status quo setting. The moment a contract is ratified, the supervisory role will be absorbed by managers appointed to oversee departments. If site leads are negotiated into our contracts, any role they have with hiring, training, and scheduling will need to be negotiated in. Otherwise, it will move to away from the PA to administration or nurse managers.

Exempt vs Nonexempt

Our current status quo is our Exempt status with special pay practices. A counterproposal for a change to Nonexempt has been made. If a contract is ratified with acceptance of a Nonexempt status, departments and PA roles may change.

What follows is some research that has been accumulated regarding the nonexempt status and the impact it may have on surgical specialties. Consider this a downstream effect, which can be more impactful than the immediate effects most are aware of.

In no way is this intended to sway public opinion. Rather, this is intended to provide information. The overreaching goal is to educate, to generate questions, and to ensure everyone can be confident with their decision making when the contract is ready to be ratified.

If individuals feel this information is incorrect, if it is questioned, or if this is new information because some were unaware of these potential changes, please take this to regional leadership, present it to them and have a conversation. Ask questions. Learn as much as you can about your region and your department and the future that may lie ahead.

To begin, any significant changes are unlikely to happen right away. Many departments may wish to avoid reorganization because things are functioning well within a system that has been in place for years. However, considering finances ultimately drive all decision making, if your department’s budget is impacted by PAs accruing overtime, change will be inevitable.

Where the changes take place will vary as well. If your department is paying out large chunks of OT because your current schedule allows PAs to work 6-7 days in a row, that will be an easy target. There will be no working beyond 5 days. With weekends being a part of this, departments may have to get creative with alternating PA coverage for the weekends and not scheduling them during weekdays of that same week (this may already be in effect in several locations), or they shift the weekend responsibility to the doctors, and then it becomes their responsibility to round and cover any additional weekend responsibilities the PAs normally take care of.

A feature of this is covering the OR, and this is something that will not be isolated to the weekends. This can be expected to merge into our after-hours call schedule.

For example, in departments where PAs take call and earn their standby pay and hourly pay when called in, if PAs are continuously being called in for after-hours work, if financial constraints are imposed, two expected scenarios can take place. First, Orthopedic Technicians (OTs) will begin to be hired and utilized for surgical assist purposes. As you may imagine, this will be a slow build because the need for the increase in demand of OTs will need to be established and staff will need be hired (pain before change). Consider it a scenario where PAs are phased out and Ortho Techs are phased in.

In a second scenario where PAs are continuously being utilized after hours due to high demand, evening shift work may be instituted. This is where PAs are separated into day shift and evening shift, and if the high demand areas also have PAs covering call from midnight to 7:00 am, either the doctors will have to absorb that or a midnight shift would have to be created. How departments determine the distribution of the shift work is likely to be based on seniority. The most senior will get the first choice and so on.

Some departments may get creative and introduce 10- and 12-hour shift work, but possibilities of that will depend on the language the contracts allow for.

The pros of moving to ortho techs is the cost benefits. The current cons are the restrictions imposed by their nonexempt status. If we move to nonexempt, then we will be bound to the same restrictions, which then turns the decision of hiring an Ortho Tech or PA a mere financial one. Because Ortho Techs cannot close incisions, that would slow OR time down, which could negate the cost advantages, but that argument may have to be made locally. There is also the argument regarding their training and knowledge base and how that can impact things. The doctors will want to keep their PAs in the OR, but returning to the concept that financials drive all decisions, in the end, they may not have a choice. This would be mirroring the playbook of SoCal, where regional fluctuations are in effect. In one region, ortho techs cover the after-hours cases and hand cases, and in another region, they cover all OR cases and the PAs are primarily utilized in the clinic.

In this scenario, PAs are not eliminated (because that would be illegal), but as need expands, the question will be whether the department hires an ortho tech or another PA. Thus, phasing in. This decision would also solve any overtime issues.

If the question arises if this eventual move can happen regardless of whether we are exempt vs nonexempt, unless your department is consistently over budget, I would say no. If an appropriate and functioning system is in place, your leadership and doctors will not want to change that. Currently, your department’s budget covers your present situation in an exempt status with special pay practices, with that budget based on FTE. But if things get too expensive for the allotted FTE (i.e., due to accrued overtime), then changes will have to be implemented.

At the end of the day, it is a business decision.

On a side note, where shift work may become realized sooner than later, is in settings where the PAs are on call for the ER (meaning they are the direct contact for the ER, not the doctors). This is not a nonexempt issue, but what can further force change into shift work. Due to EMTALA law, PAs/NPs cannot take direct call from the ER. The ER needs to contact the doctor first, and then the doctor can direct the PA or NP to the ER with their recommendations (fracture reductions, seeing a hip fracture, etc.). The work around is to create the shift work so the PA is not “on call,” which allows them to receive communication from the ER without violating EMTALA.

This would allow doctors to maintain their own “status quo” of having the PAs be the first contact from the ER.

Exempt vs Nonexempt cont:
Do we know if the proposal to move to nonexempt is majority based?

Without releasing the results of the initial survey, and without a new vote put forth by the union, that data will never be known. However, if a true majority existed, and if those voices do not feel they are being heard, that may pose a problem for contract ratification.

A previous letter summed up a concern regarding this issue:

“I want to express a growing concern shared by many of us regarding the current direction of our union’s negotiations. It is becoming increasingly clear that the process has significantly deviated from the contract we were originally presented when the vote to unionize took place.

Despite multiple efforts to communicate that the majority of us do not support the proposed shift to non-exempt status, our concerns have been repeatedly dismissed. We have simply asked for a vote to confirm where the majority stands on this matter—yet even that basic request has been refused.

The union frequently refers to a survey as justification, but that survey never explicitly addressed a status change. This has caused confusion and frustration, especially given that our colleagues in other roles, such as PTs and CRNAs, have successfully negotiated contracts without transitioning to non-exempt status. There were viable alternatives that were never genuinely pursued.

At this point, it feels as though the union is bargaining in bad faith. If we wait until a final contract is negotiated, we risk losing any meaningful leverage and may be forced to accept terms that do not represent the will of the majority.”

In response to this, and after speaking with several individuals across multiple regions, a decision was made to reach out to the National Labor Relations Board (NLRB) and file a charge against the bargaining team for bargaining in bad faith.

When asked what the motive was behind the charge, or better yet, what we were hoping to achieve with the charge, the answer was simple. We were acting on the desires of several voices who felt ignored or who felt their questions were never answered. What we hoped to achieve was nothing more than to obtain a new vote to determine if the majority truly wished to remain exempt.

In the end, the charge was dismissed. One reason was that regardless of any decision or any particular direction the bargaining team went, they are democratically elected individuals, and the membership has an opportunity to vote down any decision they make. Second, at the time of the charge, a tentative agreement had yet to be reached, which meant nothing was finalized and decisions could still change.

Although no further investigation would arise from the matter, it was healthy to have an unbiased third party provide us with insight into the process, which allowed us to fully appreciate what options were available.

Therefore, if the membership feels strongly enough about remaining exempt, they will have the option to vote against the contract and prevent it from being ratified.

Town Hall Notes

Town Hall Notes 8/26/2025

Notes will be posted following the Town Halls

Decertification
Vote

If you wish to know why I had this information placed here, the answer is simple. I wanted to know all my options, and I felt it was important for everyone involved to know their options.

Decertification is the process where employees can vote to remove or replace an existing union as their exclusive representative for collective bargaining.

Is it possible? Yes, with stipulations.

In the first official year of the union, a vote for decertification cannot take place (think of it as a probationary period) (we have passed that mark). After that, and prior to contract ratification, a decertification vote can take place.

After a contract is ratified, a decertification vote cannot take place for three years. In that time frame, if a vote for decertification is pursued, the petition/application for decertification has a precise window, where it must be submitted from 60-90 days prior to the expiration of the contract. However, beyond the three-year period, a decertification petition can be filed anytime.

For a decertification vote to take place, three things are needed:

Showing of Interest – Individual cards/forms signed indicating an individual no longer wishes to be represented by their union. This is typically achieved through signatures on a petition clearly stating the employee no longer wishes to be represented by the incumbent union.

It is crucial to gather signatures on non-work time and in non-work areas, and avoid any involvement from your employer in soliciting support for decertification, as it could be deemed an unfair labor practice.
30% of individual votes are needed for this.
Once enough signatures are obtained, it is submitted to the National Labor Relations Board (NLRB). They will need to investigate to ensure the credibility of the votes and whether a true 30% vote was obtained.

Petition of decertification – This is a formal form asking to decertify, served to NLRB, the employer and the union.

This is form NLRB – 502 (RD) found on the NLRB website.

Copy of certificate of service – Form NLRB – 5544 found on NLRB website, completed and submitted to the NLRB (additional forms will need to be attached to this form). This form indicates the date the copy was given to the employer and union.

Once the investigation is complete and the petition has been formally received, a formal vote will need to be obtained (either performed by the union itself or the NLRB). In order to obtain enough votes to decertify and remove the present union, a simple majority will be needed (50% +1).

Collective Bargaining