In a significant and unprecedented move, several hundred primary care physicians at Mass General Brigham (MGB) expressed their intention to unionize, officially notifying the National Labor Relations Board on Friday. This landmark petition is emblematic of a growing trend among medical professionals nationwide who are advocating for better working conditions.
The decision to affiliate with the Doctors Council, a union dedicated to protecting physicians’ rights, was influenced by a range of persistent and troubling challenges facing primary care. Dr. Michael Barnett, an internist at MGB and associate professor at Harvard Medical School and the Harvard School of Public Health, elaborated on the multifaceted motivations behind this historic initiative.
Through unionization, these doctors aim to address what they see as excessive bureaucratic layers that obstruct their ability to engage with leadership regarding pressing issues affecting their practices and patient care. Barnett emphasized that the current structure has become a substantial barrier to effectively addressing their concerns.
They cited alarming examples, such as the expectation for primary care physicians to work significantly longer hours than their counterparts in other specialties to maintain full-time status. Additionally, critical issues like staff turnover remain insufficiently addressed, and the rise in patient emails since the onset of the pandemic has left many physicians feeling inundated with unmanageable workloads.
Barnett pointed out that MGB’s leadership appears oblivious to the increasing strain placed on primary care doctors. He remarked, “Within both MGH and Brigham, there has been a collective neglect and series of unfulfilled promises that were accumulating over many years, and it was clear that things were not going to get better.” He highlighted the challenges posed by corporatization at MGB, which he feels has fostered a financially-driven leadership culture that stifles physician input.
The disparities in workload management were further illustrated by Barnett’s comments regarding coverage protocols. “Whereas in primary care, we have to cover our colleagues all the time… it’s like an unfunded mandate for us to carry 10% or 20% more at any time across the year,” he explained, contrasting this with more supportive arrangements in other medical specialties.
A news release announcing the election petition detailed the adverse effects of “growing corporatization of healthcare, collapsing primary care patient access, and the moral injury caused by systemic challenges” that have intensified the need for union representation.
Before the unionization effort can proceed, it must undergo a formal election process, anticipated to occur in the coming months, and receive acknowledgment from the NLRB. While there are approximately 400 primary care physicians at MGB, Barnett noted that many hold management roles that disqualify them from union participation. Nonetheless, around 300 primary care providers are eligible, and a substantial majority have demonstrated their eagerness to join the union.
In response to the doctors’ unionization efforts, an MGB spokesperson acknowledged the critical role of primary care physicians, stating, “Primary care physicians are critical to the health of our patients and community.” The spokesperson noted the unprecedented challenges facing primary care physicians statewide, stemming from a combination of external pressures beyond MGB’s control.
Reaffirming MGB’s commitment to patient care, the spokesperson added, “We share the common goal of offering world-class, comprehensive care for our patients and believe we can achieve this best by working together in direct partnership, rather than through representatives in a process that can lead to conflict and potentially risk the continuity of patient care.” The statement concluded with an assurance of ongoing dialogue and support for primary care physicians as they navigate these tumultuous times.
This movement to unionize at MGB is indicative of a broader wave of physicians across the United States seeking to organize and advocate for their rights within hospital systems. This reflects a widespread feeling of discontent regarding the growing disparities between their professional ideals and the realities of their working conditions.
Notably, over 2,000 residents and fellows in training at MGB successfully voted to unionize last year, and now more established physicians are joining the collective effort. The momentum is palpable, as exemplified by the recent actions of 550 doctors and healthcare providers at Allina Health in Minneapolis, who filed to unionize in August 2023, and over 400 physicians from multiple facilities under ChristianaCare in Delaware who pursued similar unionization efforts earlier in the year.
Furthermore, in Oregon, physicians, physician assistants, and nurse practitioners at Legacy Health recently announced their intentions to unionize. Additionally, around 40 clinicians at Skagit Valley Hospital and Cascade Valley Hospital in Washington successfully voted to unionize this past summer, signaling a robust movement towards organized labor within the healthcare sector.
What are the primary reasons behind the unionization efforts among physicians at Mass General Brigham?
**Interview with Dr. Michael Barnett on Mass General Brigham Physicians’ Unionization Efforts**
**Editor:** Thank you for joining us today, Dr. Barnett. To start, can you explain what led several hundred primary care physicians at Mass General Brigham to pursue unionization?
**Dr. Barnett:** Thank you for having me. Our decision to unionize was motivated by a culmination of persistent challenges we face in primary care. We’ve seen increasing bureaucratic hurdles that prevent us from addressing significant issues impacting patient care and our working conditions. The decision to affiliate with the Doctors Council represents a unified response to those ongoing struggles.
**Editor:** You mentioned excessive workloads and poor management responses. Can you elaborate on how these factors have impacted your daily practice?
**Dr. Barnett:** Absolutely. Many of us are expected to work significantly longer hours than our colleagues in different specialties just to maintain our full-time status. The influx of patient emails since the pandemic has also left us feeling overwhelmed. Particularly concerning is the lack of support for staffing, which creates a heavy burden on primary care providers who are already stretched thin.
**Editor:** You describe a prevailing sense of neglect from MGB leadership. Can you share more about how this has manifested in your operations?
**Dr. Barnett:** There is a palpable disconnect between MGB’s leadership and the realities we face on the ground. Over the years, we’ve encountered unfulfilled promises and a growing corporatization that prioritizes financial metrics over the insights of those providing direct patient care. This has led to our frustrations being ignored, making effective communication about our concerns nearly impossible.
**Editor:** In your recent press release, you mention ”systemic challenges” contributing to moral injury. Can you explain what you mean by that?
**Dr. Barnett:** “Moral injury” refers to the emotional distress we experience when we’re unable to deliver the standard of care our patients deserve due to system constrictions. The systemic issues within healthcare — like collapsing patient access and high turnover rates — create a distressing environment where providers feel they can’t meet their ethical obligations to patients.
**Editor:** What does the path forward look like for your unionization efforts?
**Dr. Barnett:** For us to proceed, we must go through a formal election process led by the National Labor Relations Board, which we anticipate will happen in the coming months. While some physicians in management positions are ineligible to join the union, we have a strong majority of around 300 primary care providers who are excited about representing our interests through unionization.
**Editor:** how has MGB responded to your organizing efforts?
**Dr. Barnett:** MGB has acknowledged the critical role of primary care physicians, which is a positive note. However, they have attributed many of our challenges to external pressures beyond their control. Our hope is that by organizing, we can advocate for the changes we need to better support both providers and patients.
**Editor:** Thank you, Dr. Barnett, for sharing your insights with us. We look forward to following the developments in this significant movement.
**Dr. Barnett:** Thank you for having me. I appreciate the opportunity to discuss this crucial issue in healthcare.