In a historic development for the digital healthcare and substance use disorder (SUD) treatment space, Bicycle Health unionization marks a pivotal moment for telehealth providers. On Monday, April 15, the National Labor Relations Board (NLRB) announced that 64% of Bicycle Health clinicians voted to join the Union of American Physicians and Dentists (UAPD). This victory is one of the first major unionization efforts in the fast-growing digital SUD sector, which has largely operated without formal labor representation.
Why Unionization? Clinicians Speak Out On Challenging Work Conditions And Patient Care Concerns
For clinicians at Bicycle Health, this union win represents more than just a labor milestone—it reflects a necessary pushback against conditions they say have become untenable. In a joint statement, the providers emphasized that the pressures imposed by Bicycle Health over the past few years have increasingly threatened both their own wellbeing and their ability to deliver quality care to patients battling opioid addiction.
“Today marks an important win for us as providers and for our patients,” they said. “For the past couple of years, Bicycle Health has placed increasingly untenable pressure on us, negatively impacting our well-being and our ability to take care of our patients struggling with opioid addiction. … Now that we have unionized, we hope that Bicycle Health leadership will finally listen.”
Clinicians pointed to several specific concerns that fueled their decision to unionize. According to anonymous employees who spoke with Addiction Treatment Business (ATB), the company has reduced the time clinicians can spend on critical follow-up appointments with existing patients—an issue that can directly impact the continuity and effectiveness of care. Additionally, billing practices have grown more opaque, making administrative tasks more complex and time-consuming. The company has also eliminated opportunities for clinicians to provide feedback on workflow and treatment protocols.
One clinician warned, “If changes are not made, and we continue on the same trajectory, then patient care will suffer. Patients will suffer.” These sentiments underscore the critical link between clinician work conditions and the quality of care delivered, especially in a field as sensitive as opioid use disorder treatment.
Bicycle Health Responds To Unionization And Recent Layoffs
Bicycle Health, headquartered in Boston, was founded in 2017 and specializes in virtual therapy and medications for opioid use disorder (MOUD), supplemented by customized treatment plans and peer support groups. The startup has attracted significant investment, raising $83 million to date as it seeks to scale its digital-first approach to addiction care.
In a statement responding to the Bicycle Health unionization, Bicycle Health confirmed the clinicians’ decision to unionize, stating: “We can confirm that our physicians and providers have agreed to unionize. We will continue to work with our medical team to provide the highest standard of care to patients as they seek and maintain long-term recovery.”
The union vote followed closely on the heels of a workforce reduction by Bicycle Health, where approximately 15% of employees were laid off just weeks after clinicians filed their petition to unionize in late February. The company insists that these two events are unrelated, clarifying that the layoffs were planned before the union bid became public.
“These two events are wholly unrelated,” Bicycle Health said in a statement. “Our reduction in force plans were in place before we became aware of the union bid.”
Despite these reassurances, some clinicians remain skeptical. The timing of the layoffs in relation to the union efforts has raised concerns among workers about potential retaliation or pressure tactics.
Unionization In Telehealth: A Rare But Growing Phenomenon
Union drives in the telehealth industry remain rare, making Bicycle Health unionization even more noteworthy. The digital health sector has largely operated without organized labor representation, but recent efforts indicate that clinicians at telehealth companies are seeking greater workplace protections.
The notable exception prior to Bicycle Health was Resilience Lab, another digital SUD provider whose clinicians voted to unionize in early 2023. These developments suggest a growing recognition among telehealth clinicians that they need collective bargaining power to address unique challenges in virtual care settings.
Dr. Stuart Bussey, president of the Union of American Physicians and Dentists (UAPD), emphasized the importance of union representation for healthcare workers in telehealth. “As telehealth continues to grow, it’s critical that the healthcare providers employed at these tech companies have workplace protections,” he said in a statement regarding Bicycle Health unionization and other efforts.
Balancing Profits And Patient Care: Clinicians Push For Contracts That Protect Rights And Treatment Quality
Clinicians at Bicycle Health expressed a clear critique of the broader healthcare industry’s current trajectory. They observe an increasing dominance of investors, shareholders, private equity, and venture capital firms who prioritize profits and return on investment over the needs of patients and providers.
“We see the writing on the wall,” the clinicians said. “The healthcare industry is increasingly driven by investors, shareholders, private equity and venture capital for whom profits and ROIs matter more than patient care.”
The unionized clinicians are calling on Bicycle Health leadership to engage in good-faith negotiations to finalize a contract that protects their rights as healthcare workers and safeguards their ability to deliver high-quality care. Their mission goes beyond labor concerns—they view unionization as a way to better serve millions of people affected by the opioid epidemic in the United States.
“We hope that [Bicycle leadership] will do the right thing and negotiate with us in finalizing a contract that protects our rights as health care workers and our ability to meet the needs of millions of people in the U.S. affected by the devastating opioid epidemic,” clinicians stated. “Today, we took a big step towards fighting for each other in order to fulfill our greater mission of fighting for our patients and their families and communities.”
What This Means For The Future Of Digital SUD Treatment
Bicycle Health unionization signals a broader shift in how labor relations might evolve in digital healthcare. Telehealth providers, particularly those focused on behavioral health and SUD treatment, face unique operational challenges as they scale. These include maintaining clinician wellbeing, ensuring continuity and quality of care, and balancing the demands of venture-backed growth with ethical patient treatment.
As telehealth continues to become a dominant mode of healthcare delivery, the need for stable, fair, and transparent working conditions will grow more urgent. Bicycle Health unionization sets a precedent for others in the digital health space to follow, pushing for workplace protections that prioritize both provider wellbeing and patient outcomes.
The path ahead will likely include negotiations on workload, compensation, administrative support, and decision-making authority for clinicians—all factors crucial to sustainable, effective care in virtual addiction treatment.
This landmark union victory is more than just a labor story; it is a significant chapter in the evolving relationship between digital health technology, healthcare providers, and the patients they serve. The ultimate success of telehealth in treating substance use disorder will depend not only on technological innovation but also on creating work environments where clinicians can thrive and patients receive the compassionate, attentive care they deserve.