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Rogers Wasn't an Anomaly. It Was a Warning Shot.
In May 2024, therapists and clinicians at Rogers Behavioral Health in Oconomowoc, Wisconsin voted to unionize with SEIU Healthcare Wisconsin. Caseload concerns. Staffing ratios. Pay. The same themes we’ve been hearing in every clinical setting from Seattle to Boston for the last three years.
If you run a behavioral health organization and you read that vote as “a Wisconsin problem,” you are missing the point.
Kaiser mental health clinicians in California struck for over six months. Therapists at Lifestance, Allegheny Health Network, and a growing list of community mental health centers in Oregon, Minnesota, and New York have either organized or are actively in conversations. The NLRB filings are public. Go look.
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’ve sat in the room after the card campaign goes public. Twice in the last eighteen months. Both times, when you peel back what the clinicians actually said, it wasn’t really about wages.
It was about 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. Pay bands that nobody could explain when a tech in the next pod made two dollars more for the same job.
That’s the pattern. Pay is the headline. People-ops hygiene is the cause.
Here’s 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 you have becomes evidence. Every inconsistency becomes an unfair labor practice charge waiting to happen. I’ve 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.
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 anyone files a charge that opens the door to a broader audit.
And the 1099 question. Please. If you have therapists you’re calling contractors because it was easier at startup, fix it now. The DOL’s 2024 independent contractor rule narrowed the window considerably, and 1099 misclassification is one of the first things plaintiffs’ attorneys and union organizers point at when they’re building a case that the employer cuts corners.
What to Do in the Next 90 Days
You can’t union-proof an organization. That’s not legal and it’s 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’re defending from solid ground.
Practical steps, in order:
- Audit your handbook against every state you employ in. Not just where you’re headquartered. Pay attention to PTO accrual and payout, sick leave, final pay timing, and pay transparency posting requirements.
- Run a wage and classification review. Exempt vs non-exempt on every clinical supervisor, BCBA, and team lead. 1099 vs W-2 on anyone delivering recurring services. Pay equity scan across protected classes within job families.
- Train your managers. Real training. How to deliver feedback, how to document, how to administer corrective action consistently, what they legally can and cannot say 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 aren’t collecting it.
This is the work AHS does as fractional HR for behavioral health and SUD operators. We’ve sat in the seat. We’ve handled the campaign. We’ve rebuilt the handbook at 11 pm because something hit the fan. The proactive version of this engagement is dramatically cheaper than the reactive one, both in dollars and in the trust you keep with your clinicians.
Rogers happened in Wisconsin. The next one might happen in your building. The question isn’t whether your team would have reasons to organize. The question is whether you’ve actually looked.
References
- SEIU Healthcare Wisconsin, Rogers Behavioral Health organizing announcement
- National Labor Relations Board, Case search and election filings
- U.S. Department of Labor, Independent Contractor Rule (2024)
- Bureau of Labor Statistics, Union Members Summary
- Colorado Equal Pay for Equal Work Act, Pay transparency requirements
- Washington State Equal Pay and Opportunities Act