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Rogers Wasn't an Anomaly. It Was a Warning Shot.
Direct answer: On April 22, 2026, clinicians at two Rogers Behavioral Health outpatient clinics in Wisconsin voted by lopsided margins to join the National Union of Healthcare Workers (NUHW), and behavioral health operators reading this as a Wisconsin story are missing the point. This was a signal to every CEO running a multi-site treatment platform that labor relations is no longer an HR footnote.
The numbers are not close. In West Allis, employees voted 53-4, and in Madison the vote was 26-4, with National Labor Relations Board officials supervising both counts. That works out to roughly 93% support at West Allis and 86% at Madison, and NUHW already represented Rogers employees in the San Francisco Bay Area, Los Angeles and San Diego before Wisconsin.
Caseload. Staffing ratios. Pay. The themes I hear operators wrestle with from Seattle to Boston.
Rogers workers began organizing after the company reclassified mental health clinicians from salaried to hourly and lifted caseload caps. That is not a pay dispute. That is a people-ops failure that translated into a representation petition.
The macro number should get every behavioral health CEO’s attention. The NLRB received 3,286 union election petitions in FY 2024, up 27% from FY 2023 and more than double the 1,638 petitions filed in FY 2021. Behavioral health is now where hospital nursing was in 2018.
Organizing Campaigns Don't Start With Pay. They Start With Disrespect.
I have worked with two behavioral health CEOs in the eighteen months after a card campaign went public. In neither case was pay the actual driver. Peel back what the clinicians said and you find a manager who never did 1:1s, a PTO policy administered differently 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. The reclassification from salaried to hourly led to workers being called off when the patient census dipped, resulting in higher patient volumes for the remaining staff, and Rogers lifted caseload caps, forcing caregivers to be responsible for far more patients than before. That is a management decision that produced a labor consequence.
Here is what invites organizing in a clinical setting:
- Directors promoted from clinical roles with zero manager training, who avoid hard conversations until they explode
- An employee handbook that has not been touched since 2021 and contradicts what payroll actually does
- Supervisors who apply progressive discipline on paper and gut-feel in practice
- PTO policies that ignore state-specific accrual and payout rules in Colorado, Maine, Illinois, or Massachusetts
- Exempt vs non-exempt misclassifications on clinical supervisors and intake coordinators
- Owners who skip pay transparency requirements in Washington and Colorado where posting is already law
None of this is exotic. This is the basics. And the basics are what get an operator 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 reported Rogers fired three additional workers at its West Allis clinic after the vote, bringing the total number of terminated union supporters to six. The union alleges Rogers illegally fired two nurse practitioners and one physician at the West Allis clinic on February 9 after they approached management asking for recognition of their union, and NUHW has filed unfair labor practice charges claiming the firings were illegal retaliation. Any documentation inconsistency in those personnel files will now 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 regional office noticed.
ULP filings are not theoretical. Unfair labor practice charge filings increased 7% between FY 2023 and FY 2024, from 19,869 to 21,292 cases, and the NLRB’s field offices received a total of 24,578 cases, the highest total case intake in over a decade. 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.
Then there is the 1099 question. If you have therapists you are calling contractors because it was easier at startup, fix it now. The U.S. Department of Labor’s final rule on independent contractor classification under the FLSA took effect March 11, 2024, and applies a six-factor economic reality test analyzed under the totality of the circumstances with no factor carrying predetermined weight. The IRS common-law test does not perfectly align with DOL’s, and states like Massachusetts and New Jersey continue to apply the stricter ABC test on top, and the FLSA does not preempt state laws that protect workers more. Note the current wrinkle: the 2024 rule remains in effect and although the DOL is not likely to enforce it, the agency has refused to expressly cease enforcement while litigation is on hold, meaning private plaintiffs can still cite it. Misclassification is one of the first things plaintiffs’ attorneys and union organizers point at when they build a case that the employer cuts corners.
Do not forget accreditors. Surveyors from The Joint Commission or CARF will ask about staffing plans, supervision ratios, and HR files during the survey window. A campaign tied to caseload complaints can surface in an HR chapter review or personnel-file review faster than most 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 your compliance posture so that if a campaign comes, your team defends from solid ground.
- Audit your handbook against every state you employ in. Not just where you are headquartered. PTO accrual and payout, sick leave, final pay timing, and pay transparency posting requirements enforced by state labor commissioners.
- Run a wage and classification review. Exempt vs non-exempt on every clinical supervisor and team lead under DOL Wage and Hour Division rules. 1099 vs W-2 on anyone delivering recurring services. Pay equity scan across job families, with EEOC exposure in mind.
- Train your managers. Real training. How to give 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.
- 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 is dramatically cheaper than the reactive one. On October 12, 2023, the California Department of Managed Health Care announced a settlement with Kaiser Foundation Health Plan that included a $50 million fine and required $150 million in behavioral health investments over five years. The DMHC also found Kaiser had canceled at least 111,803 behavioral health appointments in 2022 during a 10-week worker strike. That is what happens when the labor problem, the access problem, and the compliance problem collide in the same building.
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, Arizona, or New Jersey. Most clinical teams in behavioral health right now have at least one or two real reasons to organize.
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.
NLRB General Counsel Jennifer Abruzzo attributed the surge in cases to “workers knowing and exercising their rights under the National Labor Relations Act”. Read that as an operator. Your clinicians are more aware of their rights than they have been in decades, and NLRB regional offices are processing more cases than they have in over ten years.
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 on April 22, 2026 to join the National Union of Healthcare Workers (NUHW) in NLRB-supervised elections. West Allis voted 53-4 and Madison voted 26-4, roughly 93% and 86% support (Wisconsin Examiner; Behavioral Health Business). NUHW already represented Rogers employees in the San Francisco Bay Area, Los Angeles, San Diego and Philadelphia. Union supporters told reporters the campaign followed a reclassification of clinicians from salaried to hourly, schedule changes that increased patient volumes, and higher caseload caps.
How many union election petitions is the NLRB seeing and is the trend continuing?
According to the NLRB press release dated October 14, 2024, the agency 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% year-over-year increase, and total case intake of 24,578 was the highest in over a decade. Healthcare, including behavioral health, is one of the sectors driving the increase.
What changed with the DOL independent contractor rule and how does it affect 1099 behavioral health therapists?
The U.S. Department of Labor’s final rule on independent contractor classification under the FLSA took effect March 11, 2024. It applies a six-factor economic reality test weighing opportunity for profit or loss, investments, permanence, control, whether the work is integral to the business, and skill and initiative, under a totality-of-the-circumstances analysis with no single factor controlling. Under the current administration, the DOL is not actively enforcing the 2024 rule in its own investigations, but Jackson Lewis notes the rule remains on the books and can still be cited by private plaintiffs. State tests such as Massachusetts’s ABC test apply separately and are frequently stricter.
What did Kaiser Permanente’s behavioral health enforcement action actually cost?
According to the California Department of Managed Health Care’s October 12, 2023 press release, DMHC reached a $200 million settlement with Kaiser Foundation Health Plan that included a $50 million fine, the largest ever issued by DMHC, plus $150 million in behavioral health investments over five years. Healthcare Brew reported DMHC found Kaiser had canceled at least 111,803 behavioral health appointments in 2022 during a 10-week worker strike, with the plan still required to provide timely access to appointments during a strike.
References
- NLRB press release: Union Petitions Filed with NLRB Double Since FY 2021, Up 27% Since FY 2023 (Oct. 14, 2024)
- Wisconsin Examiner: Workers at Two Mental Health Clinics Elect Union by Large Majorities (Apr. 23, 2026)
- Behavioral Health Business: Rogers Behavioral Health Workers in Wisconsin Unionize (Apr. 24, 2026)
- NUHW press release: Refusing to Be Intimidated, Rogers Wisconsin Workers Join NUHW (Apr. 27, 2026)
- Becker’s Behavioral Health: Rogers Behavioral Health Workers Vote to Unionize
- U.S. Department of Labor: Final Rule. Employee or Independent Contractor Classification Under the FLSA
- Federal Register: Employee or Independent Contractor Classification Under the FLSA (89 Fed. Reg. 1638)
- Jackson Lewis: Employers Still Need to Abide 2024 Independent Contractor Rule Despite DOL Hints of Dropping It (2025)
- California DMHC press release: Kaiser Behavioral Health Settlement (Oct. 12, 2023)
- Healthcare Brew: Kaiser to Overhaul Behavioral Health Services Following $200M Settlement