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Rogers Wasn't an Anomaly. It Was a Warning Shot.
If you run a behavioral health platform and you read the Rogers vote as a Wisconsin problem, you are missing the point. Therapists, nurses, and clinicians at two Rogers Behavioral Health outpatient clinics in Wisconsin voted overwhelmingly to join the National Union of Healthcare Workers in April 2026, with about 93% support in West Allis and 86% in Madison. Caseload concerns. Staffing ratios. Pay. The same themes I have been hearing in every clinical setting from Seattle to Boston for three years.
Rogers is not the outlier. NUHW already represents Rogers clinicians at three California sites and one in Philadelphia, and three of those four were recognized voluntarily. Kaiser Permanente mental health clinicians in Southern California just ended a 196-day strike, the longest mental health strike in U.S. History, ratifying a contract that includes a defined-benefit pension and 20% raises over four years. Therapists at Resilience Lab, telehealth clinicians at Bicycle Health, and clinicians at community mental health centers in Oregon, Minnesota, and New York have either organized or are in active conversations.
The macro number is what should get every CEO’s attention. The National Labor Relations Board received 3,286 union election petitions in FY 2024, up 27% from FY 2023 and more than double FY 2021. Behavioral health is now where hospital nursing was in 2018. The activity is rising, the workforce is exhausted, and the operators who think their culture will protect them are the same operators who haven’t read their own employee handbook in two years.
Organizing Campaigns Don't Start With Pay. They Start With Disrespect.
I have sat with two CEOs in the eighteen months after a card campaign went public. In neither case was pay the actual driver. When you peel back what the clinicians said, you find a manager who never did 1:1s, a PTO policy that said one thing and was administered another way depending on who asked, corrective actions that landed on the quiet people and skipped the loud ones, and pay bands nobody could explain when a tech in the next pod made two dollars more for the same job.
The Rogers clinicians said the same thing in public. T’Anna Holst, a therapist at the West Allis clinic, told the Wisconsin Examiner that “as time goes on, caseloads kept increasing for therapists” and that program changes reduced individual patient time. Another nurse practitioner described leadership replacing a nuanced productivity model with “metrics like visits per day”. That is not a pay dispute. That is a people-ops failure that translated into a representation petition.
Here is what invites organizing in a clinical setting:
- Managers promoted from clinical roles with zero manager training, who avoid hard conversations until they explode
- An employee handbook that hasn’t been touched since 2021 and contradicts what payroll actually does
- Inconsistent corrective action. Progressive discipline on paper, gut-feel in practice
- PTO policies that don’t account for state-specific accrual and payout rules in Colorado, California, Maine, or Illinois
- Exempt vs non-exempt misclassifications on clinical supervisors and intake coordinators
- No pay transparency in states like Washington, Colorado, New York, and California where it’s now legally required on every posting
None of this is exotic. This is the basics. And the basics are what get you organized.
The Compliance Layer Operators Keep Underestimating
Once a campaign starts, every HR file becomes evidence. Every inconsistency becomes an unfair labor practice charge waiting to happen. NUHW has already filed ULP charges with the NLRB against Rogers, claiming that three employees fired shortly after the union campaign went public were terminated in illegal retaliation. Rogers denies the firings violated any law, but the charges are now public, and any documentation inconsistency Rogers produced in those three personnel files is going to be examined under a microscope by an NLRB regional director.
I watched a CEO in Pennsylvania learn this the hard way when a terminated employee’s file showed three different documented reasons across three different documents. The NLRB noticed. ULP filings are not theoretical. 21,292 unfair labor practice charges were filed in FY 2024, a 7% jump over the prior year.
If you operate in multiple states, and most behavioral health platforms now do, your exposure compounds. A Massachusetts clinician, a Florida biller, and a remote utilization reviewer in Oregon are governed by three different sets of wage, leave, and termination rules. Your handbook needs state addenda. Your managers need to know which rules apply to whom. Your I-9 and E-Verify processes need to be clean before USCIS or ICE shows up on a separate track, because once one charge opens the door, other agencies walk through it.
And the 1099 question. Please. If you have therapists you are calling contractors because it was easier at startup, fix it now. The U.S. Department of Labor’s 2024 final rule, effective March 11, 2024, adopted a six-factor economic reality test that narrowed the window considerably. The IRS has its own common-law test that does not perfectly align with DOL’s, and state agencies like the California Employment Development Department apply the stricter ABC test under AB 5. 1099 misclassification is one of the first things plaintiffs’ attorneys and union organizers point at when they are building a case that the employer cuts corners.
And do not forget the accreditors. If you carry Joint Commission Behavioral Health Care accreditation or CARF, surveyors will ask about staffing plans, supervision ratios, and human resources files during the survey window. A unionization campaign tied to caseload complaints can surface in a Joint Commission HR chapter review or a CARF Section 2 personnel review faster than CEOs expect.
What to Do in the Next 90 Days
You cannot union-proof an organization. That is not legal and it is not the goal. What you can do is remove the legitimate grievances that make organizing feel like the only option, and tighten the compliance posture so that if a campaign comes, you are defending from solid ground.
Practical steps, in order:
- Audit your handbook against every state you employ in. Not just where you are headquartered. Pay attention to PTO accrual and payout, sick leave, final pay timing, and pay transparency posting requirements enforced by state labor commissioners and, in California, the Civil Rights Department.
- Run a wage and classification review. Exempt vs non-exempt on every clinical supervisor, BCBA, and team lead under DOL Wage and Hour Division rules. 1099 vs W-2 on anyone delivering recurring services. Pay equity scan across protected classes within job families, with EEOC exposure in mind.
- Train your managers. Real training. How to deliver feedback, how to document, how to administer corrective action consistently, and what they legally can and cannot say under NLRB Section 7 and Section 8(a)(1) rules if union conversations start. Most behavioral health managers have never been taught any of this.
- Standardize corrective action and performance management. One process. Documented. Applied evenly. If your top biller and your struggling tech get treated differently for the same behavior, you have a problem that will surface eventually.
- Listen. Skip-levels, stay interviews, exit interview themes. The information is already in your building. Most operators just are not collecting it.
The proactive version of this work is dramatically cheaper than the reactive one. Kaiser’s reactive version cost shareholders more than $230 million in penalties since 2023 for mental health violations in California, including a $50 million fine from the California Department of Managed Health Care and a $31 million parity settlement with the U.S. Department of Labor. That number does not include the 196 days of strike costs, the recruitment damage, or the reputational hit.
The Question Isn't Whether. It's Whether You've Looked.
Rogers happened in Wisconsin. The next campaign might happen in your building in Tennessee or Arizona or New Jersey. The question is not whether your clinicians would have reasons to organize. Most clinical teams in behavioral health right now have at least one or two real reasons. The question is whether you, as CEO or COO, have actually looked at your own handbook, your own classification practices, your own manager training program, and your own corrective action history with the same scrutiny an NLRB regional director or a DOL Wage and Hour Division investigator would apply.
This is the work AHS does as fractional HR for behavioral health and SUD operators. Handbook rebuilds. Wage and hour reviews. Manager training programs. Campaign response when the petition has already been filed. The pre-campaign engagement is faster, cheaper, and dramatically less stressful than the post-campaign one. Pick which version you want to live through.
Frequently asked questions
What actually happened at Rogers Behavioral Health and which union won?
Clinicians at Rogers Behavioral Health outpatient clinics in West Allis and Madison, Wisconsin voted to join the National Union of Healthcare Workers (NUHW) in NLRB-supervised elections on April 22, 2026. The West Allis vote was 53-4 and the Madison vote was 26-4, roughly 93% and 86% support. NUHW already represents Rogers employees at three California clinics and one in Philadelphia, and three of those four were recognized voluntarily. The Wisconsin campaigns followed reports of increased caseloads and a shift to visits-per-day productivity metrics.
How many union election petitions are being filed with the NLRB and is the trend continuing?
The National Labor Relations Board received 3,286 union election petitions in FY 2024, up 27% from 2,593 in FY 2023 and more than double the 1,638 petitions filed in FY 2021. Unfair labor practice charge filings hit 21,292 in FY 2024, a 7% increase year over year. Healthcare and behavioral health are among the sectors driving the increase, with elections at Kaiser Permanente, Rogers Behavioral Health, and multiple community mental health centers contributing to the volume.
What changed with the DOL independent contractor rule and how does it affect behavioral health 1099 therapists?
The U.S. Department of Labor Wage and Hour Division final rule on independent contractor classification under the Fair Labor Standards Act took effect March 11, 2024. It applies a six-factor economic reality test weighing opportunity for profit or loss, investments by the worker and employer, degree of permanence, nature and degree of control, whether the work is integral to the business, and skill and initiative, with no single factor controlling. For behavioral health platforms paying clinicians on a 1099 to deliver recurring patient care, the integral-to-business factor and economic-dependence analysis often weigh toward employee status. The IRS common-law test and state-level rules like California’s ABC test under AB 5 apply on top of DOL. Misclassification exposes operators to back wages, overtime, liquidated damages, and is frequently the first thread plaintiffs’ attorneys and union organizers pull.
What does a behavioral health operator actually do in the first 90 days to reduce union risk?
Audit the employee handbook against every state where you employ workers, not just the headquarters state, with attention to PTO accrual and payout, sick leave, final pay timing, and pay transparency posting requirements in states like Washington, Colorado, California, and New York. Run a wage and classification review covering exempt vs non-exempt status on clinical supervisors, BCBAs, and team leads under DOL rules, plus 1099 vs W-2 status on anyone delivering recurring services. Train managers on documentation, corrective action, and what they legally can and cannot say under NLRB Section 7 and Section 8(a)(1) if union conversations begin. Standardize corrective action so the top biller and the struggling tech get the same process. Listen through skip-levels, stay interviews, and exit interview themes, because the information is already in the building.
References
- Behavioral Healthcare Network: Rogers Behavioral Health Workers in Wisconsin Unionize (April 2026)
- Wisconsin Examiner: Judge rejects motion to block union elections at Madison, West Allis clinics
- Wisconsin Examiner: Employees at two Wisconsin mental health clinics seek union representation
- National Labor Relations Board: Union Petitions Filed with NLRB Double Since FY 2021, Up 27% Since FY 2023
- NUHW: Kaiser mental health workers ratify contract after 196-day strike
- NUHW: Kaiser agreed to pay over $230 million in penalties since 2023 for mental health violations in California
- U.S. Department of Labor Wage and Hour Division: Employee or Independent Contractor Classification Under the FLSA (Final Rule, effective March 11, 2024)
- NUHW summary of California Department of Managed Health Care 88-page survey report on Kaiser mental health violations