​​Critical Condition: How UPMC’s Monopoly Power Harms Workers and Patients

January 19, 2023 HealthcareState and Local Policy


In a recent survey, 93 percent of Pittsburgh hospital workers said they think about leaving their jobs at least once a month. 90 percent reported that their units don’t have the staff to keep up with their workload. Behind those numbers are seemingly endless stories of hospital staff – real people with families and hopes, dreams, and ambitions – who have been pushed to their limit and unable to care for their patients. All because there simply weren’t enough hands available or hours in the day.

“In my seven years of nursing, staffing has never been this bad. The emergency room has become one of the largest in-patient departments in the entire hospital. Patients are spending days on end in ED beds because there are not enough beds due to staff shortages in every single department,” said Jackie Strange, a UPMC RN, at a hearing we held in September to examine the healthcare worker crisis in Western Pennsylvania. “When your staff is overworked like this, they’re going to miss something. The stress is detrimental, and my coworkers and I leave feeling completely devastated. Our patients don’t deserve this. No one does. We work at one of the biggest and best hospitals in the city — we should have the resources we need to care for our patients.”

Stories like Jackie’s and many others don’t just happen; they result from hospital systems prioritizing profits over the people they employ and care for. Western Pennsylvania’s hospital systems chose to prioritize expansion and profit generation over staffing and patient care, even during a global pandemic. These decisions continue to result in pervasive understaffing and low job satisfaction among employees. With its size and dominance, UPMC drives this trend for the entire market, leaving competitors with little choice but to follow suit. UPMC has abused the privileges afforded to it as a non-profit medical system to build a monopoly over healthcare in Western Pennsylvania.

In the last ten years alone, UPMC used a relentless string of acquisitions and construction of new facilities to grow from a system of 12 hospitals into a network of 40 hospitals with 8,800 licensed beds, an insurance network that covers more than 4 million people and to become the employer of 92,000 workers. It has embedded itself into every nook and cranny of Western Pennsylvania’s
healthcare system.

The COVID-19 pandemic laid bare the consequences of UPMC’s consolidation: Creating a healthcare system with too few workers, misappropriated resources, and ultimately, the inability to provide the standard of care, the community benefits, or the sort of workplace that Pennsylvanians demand and deserve. Like the steel corporations of the last century, UPMC has used its power to depress wages, degrade working conditions, extract money from the public, and, ultimately, create a crisis for the communities in which it operates and in which we live.

“Despite having a Bachelor’s Degree and advanced training for my specialty, my years of experience, and working at a hospital system that saw over a billion dollars in excess revenue, my family’s financial security balances on a knife’s edge,” said Walter Gates, a UPMC MRI Technician. “After we pay our mortgage, daycare for our 7-month-old daughter, utilities, and other expenses, we have about $150 left for everything else. We would like to have another child, but we can’t afford daycare for two children, so we’re not sure when we’ll be able to grow our family. Knowing how much money UPMC makes on the backs of its workers and patients – and the taxpayers – and the struggle and stress of trying to stay afloat; it makes me angry. It’s a grotesque abuse of power and lack of responsibility.”

We expect more from our non-profit hospitals and largest employers who control not only our health but also a large segment of our economy. Ensuring quality healthcare for everyone in Western Pennsylvania requires us to challenge UPMC’s monopoly power and increase workers’ bargaining power by protecting their right to form unions.

There is no silver bullet for making that happen, but government officials can immediately take several concrete steps.

First, there must be a concerted effort from public officials at all levels of government to support the brave workers who have been pushing for a union at UPMC for years, not just with words but with policy and the imposition of real consequences for union busting. Second, we must reintroduce significant competition into Western Pennsylvania’s healthcare market and break UPMC’s monopoly power. This will require passing new laws designed to promote worker- and consumer-friendly markets, as well as ensuring courts and regulators enforce existing laws. The result will be better jobs for workers and better health outcomes for the more than 1 million people in the region.

We outline a host of measures below for leaders at the state, county, and local levels to consider that will start to address these challenges. It is not an exhaustive list but a starting point. We hope policymakers, workers, and everyday people across Western Pennsylvania, and the rest of the state, join us in this effort. There is simply no more time to waste with the stability of our healthcare system at stake.


Rep. Sara Innamorato and Congresswoman Summer Lee

Co-conveners of the Pittsburgh Hospital Workers Task Force