Unionized doctors and dentists who work at hospitals and other health facilities run by Los Angeles County will get cost-of-living increases and bonuses under new agreements with the county, reached after more than two years of bargaining and threats of a strike.

The tentative agreements with a pair of bargaining units represented by the Union of American Physicians and Dentists are expected to be voted on this month by the Los Angeles County Board of Supervisors.

Members of the Union of American Physicians and Dentists had geared up to go on strike in December, complaining that inadequate benefits had hampered recruitment and retention and driven up vacancy rates for crucial positions in county facilities, including for psychiatrists in its jails.

Much of the dispute centered on the “Megaflex” benefits package that L.A. County provides to more than 14,000 employees including managerial and administrative staff, most of whom are not unionized. That package gives workers an additional 14.5% to 19% over their base pay to buy benefits and allows them to keep any unspent portion as income, according to county officials.

UAPD pushed for its members to get those benefits. The Department of Health Services countered that they already had an “extensive benefits package” — the same one in place for more than 35,000 other county workers — and that giving all of them a more costly package would prevent the county from concentrating its incentives on the hardest-to-recruit workers.

The two sides also sparred over the costs of expanding Megaflex: At one point, UAPD officials estimated the added costs at roughly $20 million a year based on current wages, but county officials had pegged the expected expense at more than $86 million a year, with costs rising with any salary increase.

The planned strike in December was put on hold after the county and the union agreed to seek opinions from outside experts about the implications of expanding Megaflex.

In late April, the UAPD announced that its negotiating teams had reached tentative agreements with the county, which were ratified by union members by the end of May.

Under the deal, the workers would get cost-of-living increases that match those received by other county employees, with additional hikes for some positions ranging from 2.75% to 19.25%, according to the county chief executive office. Starting wages were also increased for some medical specialties such as neurology.

In addition, the county agreed to bolster benefits “no later than January 1, 2026,” according to the chief executive office. The added benefits include a 401(k) plan, as well as short-term disability benefits for physicians, who had complained that doctors were not getting enough paid time off to recover from childbirth.

The existing set of benefits put female physicians planning to become pregnant “at a disadvantage compared to private hospitals in the area,” said Dr. Michelle Armacost, a physician specializing in neurology at one of the county facilities, in a statement released by the union. “We demanded equitable benefits, and we were willing to strike for them. The county heard us, and we prevailed.”

Beyond those increases, county workers who are not covered by Megaflex will get an annual bonus of $14,000 on top of their base salary, according to the chief executive office. Union officials also said the deal features a “physician loyalty bonus for residents who choose to remain with the county after residency.”

“These new agreements set competitive wages and attractive benefits that we hope will allow us to fill critical vacancies at our county-run hospitals and other facilities and retain the talented healthcare workers already providing essential services to our county residents,” the chief executive office said in a statement.

County officials did not immediately provide an estimate of the costs of the new contract with the unionized doctors.

Benefits have long been a bone of contention for county physicians. Doctors employed by L.A. County were cut off from Megaflex benefits more than two decades ago, a few years after they had voted to unionize.

At the time, county officials said such benefits were available only to nonunionized employees. “The doctors, they knew full well what they were getting into,” then-Supervisor Don Knabe said in 2001.

Labor officials decried it as a move to break the fledgling union, calculating the value of the benefits package at $19,000 or more to some senior doctors at the time. State lawmakers then banned the county from removing workers from a benefits plan because they unionized, making the law retroactive to before the L.A. County move. The UAPD also sued the county, eventually securing over $10 million in settlement.

The union later negotiated a new agreement with the county that grandfathered in existing workers on Megaflex, but put new hires on a different plan, the county chief executive office said. As of December, only a small number of UAPD members — fewer than 200 — had Megaflex benefits, according to the county.

In a report last year to county supervisors, Dr. Christina R. Ghaly, director of the Department of Health Services, said that over the years, “steady increases in salary were negotiated while factoring in that this group does not receive Megaflex benefits.”

UAPD President Dr. Stuart Bussey rejected the idea that they had “bargained Megaflex away” at a public rally last year. In the past, “recruitment wasn’t as bad as it is now,” and a state law limiting pension benefits for government employees wasn’t in effect, Bussey told the crowd. “Times have changed.”

In a recent statement to union members, Bussey said that UAPD members had “refused to settle until we secured a collective bargaining agreement that prioritizes patient care with competitive pay and benefits.”

“Your determination and patience paid off, and we look forward to collaborating with the county to fill vacant positions.”