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Clinicians at opioid use disorder (OUD) treatment provider Bicycle Health have filed to unionize with the Union of American Physicians and Dentists (UAPD).
Bicycle Health told its workers in an email that the company was working with the National Labor Relations Board to arrange a secret ballot vote on Monday, April 8. If successful, Bicycle clinicians will be among the first digital behavioral health care providers to unionize.
Boston-based Bicycle provides virtual therapy, medications for opioid use disorder (MOUD), as well as customized treatment plans and peer support groups. The startup raised $50 million in a Series B funding round in 2022, bringing its total funding to $83 million.
Multiple anonymous Bicycle clinicians told Addiction Treatment Business that the unionization efforts are due to “a shift away from taking care of the employee and towards taking care of the profit margin.”
The clinicians are mainly seeking “a seat at the table.” They also hope to have more control over their schedules and receive benefits for increased tenures at the company.
A group of clinicians submitted a letter of concern to Bicycle leadership, sources told ATB. Individual clinicians have also repeatedly met with medical directors and leaders.
Their qualms include that insufficient time is allocated for follow-up appointments with existing patients, with priority given to new patients, that billing practices have become obtuse and led to higher bills for patients, and opportunities for clinicians to give feedback have been eliminated.
“If changes are not made, and we continue on the same trajectory, then patient care will suffer,” one source told ATB. “Patients will suffer.”
Bicycle maintains that the company has a great relationship with its medical team.
“Stakeholders from our medical team are involved in every major decision in our organization, and every bit of feedback they provide is considered in the decision we make for our business,” Bicycle said in a statement to ATB.
The company acknowledges that it has recently made changes to scheduling and billing practices.
A large proportion of its providers are happy with how new patient appointments are scheduled, Bicycle said. Billing practices had to evolve as the company entered contracts with more health insurance providers.
“We are constantly working to improve communication with patients around billing as we add new insurance contracts and services,” the statement read.
While some national companies, including Starbucks and REI, have recently experienced high-profile unionization attempts, overall union membership rates remain low in the U.S.
In 2023, 10% of wage and salary workers were members of a union, according to the latest data from the U.S. Bureau of Labor Statistics. That figure is little changed from the previous year, which had the lowest percentage of unionized workers on record.
Telehealth providers have been due to begin to unionize, according to Stuart Bussey, president of the Union of American Physicians and Dentists.
“With the rise of telehealth in 2020, we anticipated it was only a matter of time before the providers would start to unionize,” Bussey said in a statement. “The tech industry prides itself on being innovative and disruptive, but it shouldn’t come at the cost of providers and their ability to provide quality patient care.”
Just over half of Americans believe unions positively impact the country, while 41% say they have a negative impact, according to Pew Research.
The digital health industry has relatively few experiences with unionization attempts. Notably, clinicians at venture-backed Resilience Lab voted in favor of unionization in early 2023.
Resilience Lab co-founder and CEO Marc Goldberg told Behavioral Health Business in 2023 that the company was surprised by the move to unionize, but took responsibility for the workers’ complaints.
“Should we have done a better job at communicating with our teams? Yes, absolutely,” Goldberg said. “Are we accountable for the result? Yes. Did we ever envision that this was going to develop that way? Of course not.”
Resilience Lab continued to expand its service lines after the unionization.
Behavioral health clinicians may have the upper hand in negotiations because of the widespread worker shortage, Matthew Burr, the owner of Burr Consulting LLC and human resources consultant, previously told Behavioral Health Business.
Bicycle clinicians, however, think that the company could replace their current employees relatively quickly, but they maintain that clinician quality would decline.
One anonymous employee told ATB that she does not want to leave the company because she worries about what would happen to her patients. She had this advice for employers looking to avoid unionization attempts:
“Listen to the providers. We are the ones on the front lines every single day doing the work. We know what’s working, what’s not working, and we always have a suggestion.”
