SF Frontline Workers Who Help People on Streets, In Shelters Call for Fair Pay

[Editor’s Note: This story was updated at 10:30 a.m. to clarify UCSF’s response to a KQED reporter’s questions about pay parity.]

Brenna Alexander fills her backpack before her shift with granola bars, taxi vouchers and Narcan, the opioid overdose reversal medication.

The UC San Francisco clinical social worker then goes to single-room occupancy hotels in the city, knocking on doors and slowly gaining the trust of residents, many with mental health conditions, so she can help them stay housed.

Safety is always a concern.

Her colleagues on the roving teams in the Tenderloin and the Mission have witnessed stabbings and have been robbed, she said. They endure verbal abuse almost daily.

UCSF “campus” social workers like Alexander earn about one-third less than employees with similar qualifications at the university’s large medical centers, according to the union that represents the employees. Many campus social workers, who treat non-hospitalized people in streets, shelters and outpatient clinics, say they feel discouraged and undervalued.

“We cannot show up for clients like we need to when we are burnt out and left to feel like the last priority,” said Alexander, 32. “This cannot be the way forward. Campus social workers deserve equitable compensation.”

The pay disparity contributes to understaffing and burnout for a workforce that is critical to San Francisco’s response to substance abuse, homelessness and mental health crises, University Professional and Technical Employees members and officials said. As campus social workers quit their jobs for higher-paying positions at UCSF medical centers or elsewhere, disadvantaged patients are left languishing on growing waitlists.

At a town hall organized by UPTE on Oct. 3, dozens of clinical social workers booed loudly when speakers said colleagues at UCSF’s Parnassus, Mission Bay and other medical centers made 31% more on average per year.

The problem stems from UCSF hiring campus social workers at lower-paid job classifications, making it more difficult for these employees to move up, even when they have the same licensure and experience as higher-paid colleagues at medical centers and hospitals, according to salary data the union obtained from the public university.

UCSF, the city’s second-largest employer, reported $10.2 billion in revenue in fiscal year 2022-2023. San Francisco has approved 13 contracts worth roughly $300 million with UCSF since 2017 for public health and homelessness services, according to a union analysis of records from the Controller’s Office. But that’s not a comprehensive list, so total city and county payments to the university could be higher.

Board of Supervisors President Aaron Peskin, who attended the town hall, said San Francisco must use its economic power to push for equitable pay at UCSF.

“If these people leave these jobs, it is just going to exacerbate the spiraling problem that we have on our streets,” said Peskin, a mayoral candidate who was one of seven supervisors to approve a resolution last month urging the university to address the wage and advancement inequities.

“There’s rightfully a cry to address the abject misery we see on our streets,” he said. “We have to have these workers devote their lives and their professional training to making a difference, and it starts with making sure that they’re compensated appropriately.”

UCSF failed to deliver services to help transition people into housing in at least one contract staffed by campus social workers, according to the San Francisco Department of Homelessness and Supportive Housing. In a letter sent to the Homelessness Oversight Commission in May, department staffers noted that the university had spent just 45% of a $1.5 million budget over two years of the contract.

“The underspending of funds can be attributed primarily to challenges in staff hiring, turnover and retention. Moreover, the constant flux in personnel led to noncompliance in service delivery,” Marion Sanders, the department’s chief deputy director, wrote.

Union officials said they are pushing for UCSF to offer fair pay and career progression, including by reclassifying employees into job titles that accurately reflect their credentials and work. UC and the union have been negotiating a new contract covering more than 18,000 employees since June.

The university’s most recent offer includes raises of 5% starting in mid-2025, 3% in 2026 and up to 3% in 2027. The union countered that the proposal doesn’t make up for inflation costs and shrinks some existing benefits.

UCSF forwarded KQED’s questions to the UC Office of the President, which declined to comment on specific questions about pay parity.

“UC is optimistic we’ll reach an agreement soon,” Heather Hansen, a spokesperson with the Office of the President, said in a statement. “As part of our negotiations, we have representatives from each of our campuses and health centers to collaborate to address union concerns and put forth meaningful proposals so that UPTE-represented members are recognized for their contributions.”

Differences in the daily tasks of campus and medical center social workers, as well as the sources of funding for each group, could impact their salaries, according to experts at the National Association of Social Workers and the Clinical Social Work Association.

Campus professionals often provide one-on-one psychotherapy services, while clinical social workers at hospitals coordinate the care of patients who are discharged, for instance. Medi-Cal, California’s public health insurance program, is an important source of funding for campus social work. Private insurance pays for a larger share of services at medical centers.

Matias Campos, UPTE’s statewide executive vice president, said that regardless of how UCSF crafts its budget, it can easily stop underpaying campus social workers in San Francisco. He pointed to UCSF’s construction of new hospitals in San Francisco and Oakland and the big raise in its chancellor’s pay to nearly $1.2 million per year, which was approved last month.

“Why are these the priorities of a university and not fixing the inequities that they already have? The funds are there,” said Campos, a UCSF pharmacist who is part of the union’s bargaining team.

Another large health care employer, Kaiser Permanente, does not have significant compensation disparities among behavioral and social services employees with similar licensure requirements, according to the workers’ union, Service Employees International Union-United Healthcare Workers.

“Part of our contract negotiations with the Coalition of Kaiser Permanente Unions last year was to ensure wage parity amongst workers in various locations and settings,” said Renée Saldaña, a SEIU-UHW spokeswoman.

Juliette Suarez, a campus clinical social worker at UCSF for four years, said she was deeply bothered that choosing to provide therapy and other services at a small clinic in the Mission for people with severe trauma meant taking a pay cut.

The 31-year-old San Francisco native, who grew up in the Mission neighborhood, said she was priced out of the city. She would like to live closer to the community that she serves, but she can’t afford it.

“I’m in the red. I can’t afford a medical emergency as a health care provider,” said Suarez, who works at the UCSF Trauma Recovery Center. “I’ve seen colleagues that are struggling with the physical and emotional impacts of the stress and also the inability to fully afford taking care of themselves while they do this work.”