Mounting pressure on healthcare professionals is increasingly evident, and a recent development in Boston underscores this growing strain. Nearly 300 primary care physicians affiliated with Mass General Brigham (MGB), the largest health system in Massachusetts, have signaled their intent to unionize. This move, communicated to federal authorities, highlights critical issues of “burnout” and the perceived “corporatization of medicine” within the healthcare giant.
These physicians represent a significant majority of primary care doctors from Massachusetts General Hospital and Brigham and Women’s Hospital. Dr. Michael Barnett, a primary care physician at Brigham and associate professor at Harvard T.H. Chan School of Public Health, is among the organizers. He confirmed that the doctors have signed cards expressing their desire to join the Doctors Council of the Service Employees International Union, Local 10MD. These cards, along with a petition for a union election, were submitted to the National Labor Relations Board in Boston on Friday.
The Doctors Council, recognized as the oldest and largest union for fully trained physicians in the US, currently represents approximately 4,000 attending physicians nationwide, primarily in New York.
A unionization vote could be scheduled within two months, according to the Doctors Council. If successful, this bargaining unit would become the largest collective of attending physicians in Massachusetts, marking a significant shift in the state’s healthcare landscape.
In response, an MGB spokesperson acknowledged the “unprecedented volume and stress” facing primary care physicians. However, the health system argues that a direct partnership approach is more effective in tackling these challenges than unionization, which they believe “can lead to conflict and potentially risk the continuity of patient care.”
David E. Williams, president of the Boston-based consulting firm Health Business Group, describes the move by MGB primary care physicians as a “big deal.” He suggests it could inspire similar unionization efforts among primary care doctors in other health systems. “Traditionally, physicians haven’t unionized,” Williams noted. “They’ve been viewed as independent professionals with considerable autonomy, authority, and advanced education.”
Dr. Kristen Gunning, a primary care physician at Massachusetts General Hospital for over 16 years, shared that unionization was never on her radar until about a year ago. Now, she and her colleagues are grappling with overwhelming workloads, inadequate compensation for their hours, insufficient office support staff, and frequent doctor turnover within their practices.
“We are the foundational glue of our medical center,” Dr. Gunning emphasized. “Witnessing colleagues leave for concierge medicine, early retirement, or industry positions is disheartening because we see how much they loved their original calling.” The current environment is pushing experienced and dedicated primary care doctors in Boston away from traditional practice.
This filing is the third instance in the past year and a half where MGB physicians have taken steps towards unionization, a concept previously considered improbable.
In June 2023, over 1,200 residents and fellows across various MGB hospitals voted to join the Committee of Interns and Residents under the Service Employees International Union. Dr. Lee Richman, a third-year pathology resident at Brigham and a bargaining team member, mentioned that negotiations for their first contract are ongoing, with key issues like acceptable pay raises still unresolved after approximately 13 months.
Dr. Richman expressed that residents and fellows were “super excited” about the primary care doctors’ unionization initiative. “It’s about time they advocated for themselves and their patients’ needs,” he stated.
Earlier, in March of this year, 112 physicians at Salem Hospital, also part of MGB, joined Council 93 of the American Federation of State, County and Municipal Employees. These doctors became the first among MGB’s 7,500 attending physicians to form a union.
Dr. Sean Codier, an emergency room physician and union organizer at Salem, noted that contract negotiations are yet to commence. However, the hospital has already begun to address understaffing by hiring more physicians, including several in the emergency department. This proactive step suggests the potential positive impact of unionization even before formal agreements.
Speculation about further unionization within MGB has been growing, fueled by the health system’s ongoing merger of its two flagship Harvard-affiliated medical centers. This consolidation effort has led to frustration and resentment among many physicians, who feel a diminishing sense of autonomy.
During an April online “town hall,” physicians voiced their concerns and skepticism to MGB leaders. One physician questioned how executives planned to rebuild trust when many felt “unheard, devalued, disempowered, and unseen.”
MGB chief executive Dr. Anne Klibanski acknowledged the issues during the forum, stating, “We know there are problems… The answer isn’t more surveys. Now is the time to listen and show results.” However, for many primary care doctors in Boston, listening may no longer be sufficient without tangible changes and a stronger voice.
The crisis in primary care medicine has been developing for decades nationwide. Primary care doctors frequently report long hours, increasing responsibilities, and stagnant compensation and resources. This situation is acutely felt in Boston, a major hub for healthcare.
Dr. Gunning, practicing near Mass General, describes her “part-time” designation despite working 45 to 50 hours weekly. Officially, her part-time status is based on 16 hours of patient appointments and 4 hours of administrative tasks. However, the reality involves significantly more administrative work, including patient communication, test result reviews, prescription management, and insurance interactions.
Dr. Barnett, based in Jamaica Plain, indicated that the situation reached a breaking point a few years prior. “MGB has become increasingly corporate in physician management,” he explained. “Policy decisions and unaddressed challenges have made it clear that we lack the autonomy to deliver the care we are committed to providing.” This sentiment is widely shared among primary care doctors in Boston, driving the unionization effort.
In their mission statement, the primary care doctors declared, “We will not allow the corporatization of medicine to undermine primary care delivery,” and affirmed their commitment to “fight against burnout.” This statement encapsulates the core motivations behind their unionization push.
The physicians informed MGB’s head of human resources, Mary Ellen Schopp, of their unionization effort on Friday, requesting voluntary recognition of their bargaining unit. However, union organizers reported no response, indicating a potential standoff.
Gabrielle Hanley, an organizer for the Doctors Council, explained that historically, physician unionization was uncommon due to practice ownership. However, the shift towards health system employment has granted physicians the legal right to unionize. Currently, nearly 70% of US physicians are employed by health systems, making unionization a relevant and increasingly considered option.
Healthcare consultant Williams suggested that primary care doctors in Boston might be taking cues from nurse practitioners and nurses, who frequently belong to unions and, with overtime, can sometimes earn more than primary care physicians. This comparison highlights the changing dynamics within the healthcare workforce and the evolving perspectives of physicians towards collective bargaining.
The Massachusetts Medical Society cited a study indicating that approximately 70,000 active US physicians were union members as of October 2022. While this represents less than 8% of the total physician workforce, it marks a nearly 27% increase since 2014, signaling a growing trend in physician unionization and a potential shift in the future of healthcare labor relations, especially among primary care doctors.
