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Exempt vs Nonexempt

Exempt vs Nonexempt Cont.

Town Hall Notes

Decertification Vote

Collective Bargaining

Why We Unionize

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

Town Hall Notes 9/11/2025

Town Hall Notes 11/13/2025

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

Employees have a stronger voice when they collaborate. That cannot be refuted.

Collective bargaining may be the strongest attribute of a union, where items and agendas can be introduced and negotiated, with outcomes being more beneficial than what can be achieved outside of that setting. Wages are a major aspect of that. Specific employee protections and clearly stated rules can be another.

Conflicts with collective bargaining arise are when there are disagreements on viewpoints or the focus of the negotiations (i.e., exempt vs nonexempt). This can lead to additional conflicts when a universal contract is ratified. Though beneficial for some, the boundaries imposed can reduce individual autonomy and force unnecessary changes to the workflows for several departments (as an example, consider the effects of moving to nonexempt and the changes that may have on surgical specialties - see the discussion topic on exempt vs nonexempt).

In the end, collective bargaining can move a needle that otherwise could not be moved. It is only one aspect of a union, but it can be a significant draw for some, especially when the topic of economics may be what drew them into the union in the first place.

Why We Unionize (and why we do not)

Some time ago I came across a very interesting article about the motivations behind an individual's decision to unionize. I have included the article here, as well as a link to published version.

I recommend reading it a few times. It provides a unique perspective on decision making and why we find ourselves on one side of the argument versus the other.

Following the article are a few considerations to keep in mind.

What Behavioral Psychology Has to Do With Union Avoidance: Reflections From a Labor Lawyer

October 19, 2017 By Matthew J. Kelley

As a traditional labor lawyer, I spend a great deal of time traveling the country to assist clients, and I spend a lot of that time in airports and on airplanes reading. On a recent trip, I read The Undoing Project: A Friendship That Changed Our Minds by Michael Lewis, which discusses the research two psychologists conducted on the psychology of decision-making. The research, which concluded that people often err when making decisions despite access to information that should help them, got me thinking about how employees act in the face of union campaigns.

The Thought Experiment

As a part of one project, the psychologists asked thousands of people across diverse educational and socio-economic strata to answer two questions. The questions present two scenarios and require you to choose one. The answers to these questions—both your own and those of the average person—might surprise you. From a traditional labor relations perspective, the answers might tell you an awful lot about companies that maintain positive, union-free working environments.

Question One: (a) I flip a coin—heads you win $1,000; tails you win $0; (b) I give you $400 right now and do not flip the coin. Which scenario did you choose?

Question Two: (a) I flip a coin—heads, you lose $1,000; tails, you lose $0; (b) you give me $400 right now not to flip the coin. How did you answer?

The Results of the Experiment

Most people overwhelmingly answer “b” to the first question and “a” to the second question. They take the sure thing of the $400 win rather than the coin flip to win $1,000, and gamble on the coin flip rather than give $400 away. The “expected value” of the bet is $500 on the first question and a negative $500 on the second question. From an economically rational perspective, people should give the opposite answer to both questions. There is more economic utility in gambling on the first flip and paying the “insurance” on the second flip, but most people don’t behave that way. People become risk seekers when they have two potentially negative outcomes, but are generally risk averse when they have two potentially positive outcomes. There are all manner of reasons for this: the economic positions of the actors, the immediate need for money, etc. Generally, psychologists found people have a “greater sensitivity to negative rather than positive changes.” For most people the happiness in getting something is outweighed by the unhappiness involved in losing the same thing.

I have posed these questions in seminars, workshops, and meetings for about a year now, and my own anecdotal surveys confirm these outcomes.

Positive Employee Relations?

How can we apply these predictions about human behavior to positive employee relations? What I have seen in my own practice is that a good company may be able to insulate itself, to some degree, from union organizing by being a better company. When employees are faced with the potential for a winning gamble or a sure, positive outcome, they are more likely to choose the sure, positive outcome—even if the potential of the gamble might sound better at first blush.

Take, for example, a typical union sales pitch that promises increased wages and benefits, better working conditions, and, overall, an improvement in the quality of life. This pitch might sound attractive to employees. But if a company already provides competitive wages and benefits and a good working environment, the company has, in effect, recreated the conditions for the psychologists’ questions. The choice is straightforward: a risky gamble that may result in something more, something less, or something exactly the same as what employees already have, or maintaining (and not unsettling) a sure, solid, work environment. Most people will take a sure benefit (i.e., the already good, positive workplace) rather than gamble on the promises made in a typical union organizing drive.

If a company creates a situation in which the arguments become a choice between two negatives—a known bad or indifferent company with mediocre benefits and poor leadership versus a risky newcomer union with a promising scheme—a set of variables akin to those found in question two are now in play. The company will likely argue that collective bargaining is not a sure thing, that work stoppages are a fact of life, and that unions are questionable organizations. But in this case, the company will now be arguing for the lesser of two potentially negative outcomes—a mediocre work environment versus a potentially worse one. Generally, people are more likely to gamble when faced with two bad options. In my mind, that translates to a situation in which employees are more likely to gamble on union representation.

Conclusion

The moral of the story is clear. Union organizing drives can be affected by whether employees are faced with a choice between the gamble of union representation and a work environment that’s either positive or negative. Creating a positive culture of teamwork, respect, and collaboration is key to success before organizing begins. Create environments where employees feel valued and heard and you might be able to avoid the coin flip.

QUESTIONS

Can this model can be applied to our environment?
- The simple answer: Yes
- If a PA is part of a department that has good leadership and that PA also believes they have good wages, one would surmise that person (or group) would be less likely to unionize. However, if there is poor leadership and wages are substandard, that individual (or individuals) would find themselves on the other side of the argument and be more likely to unionize.
- In our profession and under the umbrella of the company we work for, I imagine responses to the questions posed in the article would be mixed. Some departments have good leadership, whereas others do not. When discussing wages, for the most part, if compared to market value, PAs throughout our company may consider their wages to be quite good. However, if those PAs were to compare themselves to the wages of NorCal NPs (which has been the topic of much debate), they may consider the wages to be poor. Therefore, some will find themselves on one side of the argument versus the other, whereas others may find themselves on both sides of the argument.
What happens if you have poor leadership but believe you have good wages?
- When the PA finds themselves on both sides of the argument, where they lean may depend on their situation. I am not sure if a union can impact poor leadership, but can it prevent changes implemented by poor leadership? Those leaning in favor of union support may feel the union and its contract can create clear language, which in turn can prevent misinterpretation and abuse where it can be avoided.
- However, taking a "risk" on unionization means a person must be ready to give something up to gain what they want, or they will need to be prepared to not get everything they were expecting. I say "risk" because no one has the option to review a contract before voting to unionize. Rather, the vote for unionization takes place, and then everyone must wait to see what type of contract can be negotiated.
- When the contract is ready to be voted on, the clearly defined language can be expected be there, but it remains unknown if something will be retracted from the original “nonunion” contract currently serving as our baseline. For some, the move to a nonexempt status is already considered a loss. Others see it as either neutral or a gain. The other thing yet to be finalized is the benefits package. Based on what management had proposed, if it is accepted, it would be a loss (wages are not expected to decline).
- If this is the case, then it is up to the individual to determine if they will accept the loss and vote to ratify the contract, or they will not accept the loss and vote down the ratification and force ongoing negotiations.
For those standing outside our company and looking in, the question has been raised about those who find themselves in the poor leadership and poor wage category. If a particular PA, or group of PAs, find themselves in that situation, why not leave their position and find employment elsewhere?
- Although this may appear to be an obvious option, I understand many would argue it is not as simple as that. I do believe everyone has their reasons for staying in their environment, and I believe most of those individuals would like to eventually end their career with this company. Direct answers to the question would have to come from the mouths of the individuals making that decision, but I suspect a high proportion of those individuals remain where they are, subsequently remaining with the company, because of the benefits (i.e., pension).
- If that is the case, if the benefits are that good, and individuals are willing to endure poor leadership and poor wages, then why not unionize? From that perspective, the benefits of unionizing may easily outweigh the risks, to where any change would be good. That would be provided those individuals do not lose what is keeping them in that environment in the first place (i.e., pension).
This raises another interesting question. If the benefits are that good that it keeps a population of PAs enduring poor leadership, are the wages truly that poor? Would it be more than a pension that is preventing the PAs from leaving the company? Could the wages be favorable enough that these PAs would not be able to find comparable wages elsewhere? Or can they find the comparable wages but without any of the benefits?
- Answering this question multifactorial and cannot not be answered here. Not only would it require market analysis, but it may also require further research into behavioral psychology.

Link to Article