5 days ago
‘We're losing doctors every day': As Mass General Brigham primary care doctors vote on union, effort is slowed by Trump
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But MGB, the corporate parent of Massachusetts General Hospital and Brigham and Women's Hospital,
MGB filed an appeal with the labor board last week challenging the makeup of the prospective bargaining unit, likely putting the matter in limbo indefinitely. That's because
'[MGB is] appealing, knowing that cases won't be heard,' said Dr. Mark Eisenberg, a primary care doctor at Mass. General and one of the union organizers. 'They want to take away our democratic vote. They want to make doctors feel like it's hopeless to fight against a giant.'
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MGB said in a May 21 memo to employees that its legal challenge 'isn't about the outcome of the election — it's about making sure the bargaining unit follows established legal guidelines.'
The health system says the NLRB regional director in Boston erred by allowing 237 primary care doctors at 29 practices to vote on whether to form their own union.
In fact, MGB says, as many as three-quarters of those physicians were ineligible to vote under NLRB rules because they work in practices that are integrated into acute-care hospitals with other kinds of doctors. Under the rules, MGB contends, the proposed union would have to include all physicians at those hospitals, an argument the regional director previously rejected.
'Even when there is a quorum [at NLRB], this is not an unusual strategy,' she said. 'But now [MGB leaders] get the added benefit that the delay is likely to be even longer because there's not even a chance of getting a decision right now.'
The National Labor Relations Board seal at its headquarters in Washington, D.C.
Andrew Harrer/Bloomberg
A week after his inauguration, Trump fired Gwynne Wilcox, the first Black woman to serve on the NLRB, even though her term didn't expire until 2028. The Supreme Court on May 22 allowed Trump to remove Wilcox while legal proceedings over her firing move forward. With only two members, one below the minimum required to fully function, the NLRB is adrift.
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The MGB union election comes as primary care faces a crisis in much of the nation and more doctors are organizing unions. In 2023, primary care physicians at Minneapolis-based Allina Health formed a chapter of the Doctors Council that included more than 600 members. They have been seeking a contract for over a year.
'This idea that attending physicians are more interested in organizing is a very recent phenomenon over the last two to three years,' said Dr. Kevin Schulman, a professor of medicine at Stanford University.
From 2000 to 2022, attending physicians
Although Massachusetts has some of the most coveted physicians in the world, primary care medicine is broken here, state officials said
Among the woes identified by the Health Policy Commission: more patients reporting difficulty finding doctors; physicians struggling with workloads; an aging and burned-out workforce; short-staffed practices; and a meager pipeline of new clinicians.
The outlook is unlikely to improve any time soon. Over the next decade,
Economics explains the anemic growth. A newly minted doctor can graduate from medical school with over $200,000 in debt. To pay it off, many opt to become specialists, who typically earn much more than primary care doctors. (On average, a full-time family physician with 20 or more years in practice made $292,373 a year in the United States, according to 2022 data from the American Academy of Family Physicians.)
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At MGB, primary care doctors say they are grappling with similar problems faced elsewhere plus some resulting from upheaval at their health system. In particular, they say,
'We have, drip by drip, lost resources and investment that had been given to primary care over the years,' said Dr. Michael Barnett, a primary care doctor at Brigham and a union organizer. 'We are just a chopping block when they need to save money.'
Dr. Kristen Gunning, who has been a primary care physician at Mass. General for 17 years, said she had never considered joining a union before she began participating in the effort about 18 months ago.
Gunning is considered a part-time employee because she sees patients for 16 hours a week and, in theory, performs four hours of administrative duties. In reality, she said, she works 45 to 50 hours a week because her duties continue to grow, with much of her work taking place before and after she sees patients.
That includes answering questions from patients who call her or use the online portal, reading lab and diagnostic test results, reviewing cases of patients who have been hospitalized, calling in prescriptions, and dealing with insurance companies.
Primary care doctors picket outside of Brigham and Women's Hospital on Dec. 13, 2024.
David L. Ryan/Globe Staff
Gunning said Mass. General's leaders promised primary care doctors their first raise in 10 years last fall but withdrew the offer after the physicians petitioned the NLRB to let them form a union. (MGB says NLRB rules barred the system from changing salaries with a union election pending.) Some physicians are so frustrated, Gunning said, that they are retiring earlier than expected, leaving to work at other health systems, or starting concierge practices.
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'We're losing doctors every day,' she said.
MGB says it recognizes the challenges facing primary care doctors and is taking ambitious steps to address them.
Klibanski said the money will pay for more than 90 new support staffers and four more doctors. It will also provide more support for 'practices that serve highly complex patients, patients with social needs, and our aging population,' she wrote in an email to staff. The system also intends to create a new position, MGB chief of primary care.
MGB gave few details on what else the investment will finance. Nor would the system say where it will get the money; it has complained of financial challenges and recently completed
Barnett, like several other primary care doctors, said Klibanski made her announcement largely because of the impending vote to join the Doctors Council, which is part of the Service Employees International Union. (Klibanski says the health system held focus groups with primary care physicians early last year to hear about their challenges.)
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Even if MGB bolsters primary care, said Barnett, an associate professor of health policy and management at the Harvard T.H. Chan School of Public Health, 'there's absolutely nothing stopping them from cutting it again.' That's why, he said, it's crucial for MGB and unionized doctors to negotiate improvements to primary care in a contract.
The ballot-counting at the NLRB regional office on Friday will mark the third time that physicians at MGB have taken steps to form a union in the past two years.
In June 2023, about 2,600 doctors-in-training at multiple MGB hospitals voted to join the Committee of Interns and Residents of the SEIU. (Last week,
Jonathan Saltzman can be reached at
