Hospitals Are Desperately Understaffed. Could Co-ops Be an Answer?

But that’s only part of the problem. Roughly 60% of America’s healthcare workforce is employed in what the industry calls ​“allied health” roles: medical assistants, technicians, physical therapists and others who make up much of the background infrastructure of American medicine. 

Every imaging test and every blood draw relies on a large web of personnel that’s also strained.

A 2022 survey of some 1,000 healthcare facilities around the country found that more than 85% of them were short allied health workers. And the pipeline for educating and training them leaves much to be desired. According to a report by the Community College Research Center, 64% of those graduating from allied medical assistant training programs in the 2019-2020 academic year had gone to private, for-profit colleges, with all the risks of added debt and exploitation that entailed.

Allied health shortages are particularly acute in California, where it was estimated in 2021 that 500,000 new allied health workers would have been needed to adequately meet state healthcare demand by 2024. And in a survey of more than 30,000 allied health workers across the state conducted by the SEIU-United Healthcare Workers West the following year, 83% of respondents reported that the departments they worked in were understaffed, and 65% reported that patient care was delayed as a result. Nearly half said shortages forced them to skip meals or breaks.

The SEIU-UHW came away with a simple but daunting set of recommendations, including the training of 200,000 new allied health workers per year for the next three years. And the union also committed to doing its own part to fill the gap — creating a pipeline for new workers that could stand as an alternative to the for-profits. ​“They borrow money, they end up in debt — $10, $15, $20, $25,000,” says SEIU-UHW President Dave Regan. 

“And then they’re not able to work — they’re actually in a more vulnerable position at the end of it, than the beginning,” Regan adds. ​“And so we asked ourselves, ​‘Well, if we and our members feel like we are short staffed, we need more people. And could we use the mechanism of collective bargaining to secure the resources to provide training and recruit the candidates to be trained?’”

The SEIU-UHW threw its support and resources behind two ventures — Futuro Health, a nonprofit it founded with Kaiser Permanente to provide tuition-free allied health training, and AlliedUP, an allied health staffing firm. And though they are separate entities, the SEIU has worked to integrate them as a pathway from education to stable allied health employment. 

“The SEIU recruits students,” AlliedUP CEO Milissa Ales-Barnicoat explains. ​“Then they go to Futuro Health, which puts them into training schools throughout the state of California. And then AlliedUP is the placement arm for those students.”

AlliedUP in particular stands out as a novelty in allied health, offering its workers more than just job placement. ​“We do our intake call with them where we gather information on where they are in their career path, what’s going on in their life as well,” says AlliedUP Career Coach Francisco Sigaran.

​“Some of these scholars, you know, might be facing homelessness, some of them are just leaving abusive relationships. So there’s more to that than just career coaching.”

Barnicoat adds that ​“85% of the people we work with are women between the ages of 18 to 32.”

“And they’re women of color. They’re generally from more underserved communities,” Barnicoat says. ​“And so we provide to those scholars as they’re going through that journey coaching. And the coaching is around how to prepare a resume, how to get ready to interview, how to show up for an interview, how to translate your past experience into relevance for your new career in healthcare.”

The workers who join AlliedUP are not only prepared but empowered to an extent that’s highly unusual in healthcare staffing — AlliedUP is a cooperative, co-owned by its worker members who are each entitled to a share of the 80% of the firm’s profits reserved for employees, the opportunity to run for election to one of the worker slots on the company’s board of directors, as well as a vote on major firm decisions.

“We have a monthly cooperative meeting where we share the good, the bad, and the ugly — more good than anything,” Barnicoat laughs. ​“We’re really open about all our books, what we are spending money on and where, what we are doing to be good stewards financially. We also run through our targets for the year — we set the targets; everybody agrees these are our targets.”

AlliedUP and Futuro Health have also helped grow the SEIU-UHW’s ranks and built deeper connections between their workers and the union than they might otherwise have. 

“Their entry point to the union was, ​‘This is the organization that trained me to be a phlebotomist or a medical assistant,’” Regan explains, noting that the efforts also create upward pressure on wages and benefits for all allied health workers in the state by filling some of the sector’s shortages with union labor. 

The SEIU-UHW’s pipeline, of course, could only ever fill a small proportion of the sector’s shortages at best — Regan says the union’s efforts have trained about 10,000 allied workers in the last four years, a fraction of the 200,000 workers per year goal outlined in its report. And one of the obstacles AlliedUP has faced in placing the workers it does train in jobs, he adds, has been suspicion from healthcare providers. 

“People realize that it’s connected to the union — there are employers that think that this is some sneaky way to organize their traditional hospital,” Regan says.

Still, AlliedUP has made a difference for the workers it has managed to place. ​“Earlier this year I was working with a candidate who was a phlebotomist — he was applying to multiple places, and no one was giving him a call back,” Sigaran says. ​“So, helping him identify roles was a big help to him. He ended up landing three interviews, which we prepped for and proudly enough, he landed a role with a hospital here in southern California, working as a phlebotomist. He’s making $25.78 per hour — before that he was actually making $16 an hour. So, he went on a big jump.” 

Maria Gamboa, AlliedUP’s operations manager who came to the cooperative after 15 years in mostly industrial staffing, says she’s been moved by the outsized impact the firm has had on its worker-members relative to the rest of the staffing industry. 

“I have one guy that was working at Whole Foods for I don’t know how many years, and he’s like, ​‘My dad, all my family members are in the medical field. I’m the only one that’s not,’” Gamboa says. ​“He’s like, ​‘I don’t care if I start as a receptionist, because I know I’m gonna get my medical assistant certification and I’m gonna keep going.’ And that’s where he’s going. He has not missed a day.”

“It’s those types of stories,” she continues. ​“There’s no way it compares to a regular temporary agency where it’s just, ​‘Hey, could I get a body for tomorrow at 5:00 a.m. from 5:00 to 1:30, 5:00 to 2:00, 5:00 to 3:00, and the next day have another person. Oh, that person didn’t work out. Another person, another person.’ No, it’s nothing like that.”

The challenge of filling our healthcare shortages aside, AlliedUP’s model seems like a promising way to shore up workers in unsteady or increasingly casualized fields, especially those aspiring workers who enter by seeking training and certifications doled out by for-profit colleges. Rather than getting the requisite training and having to fend for oneself in the job hunt and at work, unionized staffing cooperatives like AlliedUP can offer workers not only better pay and benefits, but an integrated network of resources, potential advocates for their rights and their careers, and a measure of democratic agency. And Regan believes they hold a tremendous amount of potential for the labor movement as well.

“The prevailing model of unionism in America is based on large firms and long careers,” he says. ​“It’s not portable. And if we don’t have a model of unionism that’s portable and accessible to people, the part of the economy that we have some limited strength left in is just shrinking and not replicable.”

“To me, the thing that’s worth exploring is that co-ops could be that organization,” he continues. ​“At some point you have to say to the firms, we will be the employer of record. We will send you what you need. … We need a model for union membership that is much more like the actual economy that people are operating in.”