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Cutbacks for some doctors and nurses as they battle on the front line

Hospitals and medical practices are deferring pay and raises as they get hit with sudden shortfalls

Beth Israel Deaconess Medical Center in Boston.
Beth Israel Deaconess Medical Center in Boston.David L. Ryan/Globe Staff

Emergency room doctors at Beth Israel Deaconess Medical Center have been told some of their accrued pay is being held back. More than 1,100 Atrius Health physicians and staffers are facing reduced paychecks or unpaid furloughs, while pay raises for medical staff at South Shore Health, set for April, are being delayed.

These financial cutbacks, coming in response to sudden shortfalls during the coronavirus outbreak, have triggered an outcry from doctors and nurses who are already working grueling shifts in demanding working conditions, including the risk of infection from patients who are critically ill with COVID-19.

“This is at a time when many of us have moved out to live like lepers separate from family to prevent spreading infection, and have already been working huge extra hours trying to scrape together [personal protective equipment] and otherwise brace for COVID-19,” said Dr. Matt Bivens, an ER doctor at Beth Israel Deaconess Medical Center and St. Luke’s Hospital in New Bedford.

The burdens of the current health care crisis have fallen especially hard on front-line medical workers. Widespread shortages of protective masks, gloves, and other gear have put not only them at risk of infection, but their family members as well. An alarming rise in the number of hospital workers who have tested positive for COVID-19 is depleting institutions of much-needed personnel, forcing both those staff and often their co-workers into quarantine.

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Top executives at hospitals and medical practices defend the financial cutbacks, saying their institutions are not immune to the loss of revenue being felt everywhere in the country during the pandemic. To make way for critically ill patients and comply with new state directives stopping “nonessential” procedures, they have canceled elective surgeries, an important source of revenue. Other sources of revenue, including physician visits, are also being canceled as patients stay away during this time.

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“Like many other health care and physician organizations, the economics of the care we provide has changed quickly and dramatically,” wrote Dr. Alexa B. Kimball, chief executive of the Harvard Medical Faculty Physicians group practice at Beth Israel Deaconess Medical Center, in an e-mail Thursday to doctors that was obtained by the Globe. “I wish I had better news to convey as I know all of you are making sacrifices every day in all sorts of ways.”

In that e-mail, the physicians group announced that effective April 1, it is suspending employer contributions to the retirement plan for doctors in the group, as well as at an affiliated group that staffs many other hospitals in the state, Associated Physicians of Harvard Medical Faculty Physicians at BIDMC. There are 1,600 doctors in both groups, and the majority of them are affected by the cutback, according to a company spokesperson.

The physicians group also told ER doctors this week that it is withholding and deferring half of their quarterly “bonuses” scheduled for March 30, according to another e-mail shared with the Globe. Those payments, which can reach tens of thousands of dollars per quarter, are based on extra shifts or additional patients the ER doctors took on months earlier, according to the doctors.

“The bonus is just pay we’ve earned,” Bivens explained. “It’s analogous to re-branding ‘overtime pay’ as ‘your bonus.’" Meanwhile physicians in other specialties in the group will not be receiving bonuses at all on March 30, according to the e-mail.

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When asked about the deferments, Kimball said in a statement: “Like hospitals, physicians are battling on two fronts — facing severe financial issues and a public health crisis on the front lines. Like many others, we need relief from federal and state sources to support our doctors who selflessly take care of our patients.”

The financial cutbacks come as Congress has authorized close to $200 billion in support for health care institutions as part of the $2 trillion coronavirus stimulus bill that President Trump signed on Friday.

Even so, the Massachusetts Medical Society on Friday sent a letter to Governor Charlie Baker urging him, in part, to consider “direct financial support, grants, no-interest or forgivable small business loans for physician practices, deferment of medical student loan payments, and other health care business grants to assist practices.”

A spokesman for the Massachusetts Nurses Association called for direct federal and state funding to support the health care industry. “No doctor, no nurse, and no hospital cleaning person should lose their job or should lose their pay,” he told the Globe.

Massachusetts General Hospital and Brigham and Women’s Hospital are not currently contemplating financial cutbacks for health care providers, according to a spokesman for their parent company, Partners HealthCare. Tufts Medical Center says it has not taken such steps. And at UMass Memorial Health Care, where many departments are closed, downsized, or operating remotely, staff can be redeployed to areas where the need is greatest, or take paid time off or accrued earned time off, according to a spokesman.

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Atrius Health, a network of more than 1,100 physicians, primary care providers, and clinicians in Eastern Massachusetts that includes Harvard Vanguard Medical Associates, announced extensive cutbacks this week. Some nonphysicians whose work is in less demand will take a one-month unpaid furlough, with health benefits, according to an internal e-mail sent by its CEO, Dr. Steven Strongwater, and shared with the Globe.

The remaining staff still working, Strongwater said in his e-mail, will have anywhere from 10 percent to 25 percent of their pay withheld through early May, with the understanding that Atrius anticipates paying them back later. Strongwater added that employees with salaries below $55,000 would be exempted from this measure and that all merit increases would also be delayed.

“Like every healthcare organization here and across the country, we are operating in uncharted waters,” said Marci Sindell, Atrius senior vice president of external affairs, in a statement to the Globe. “In light of the realities we face as a result of the drop in routine patient visits and cancellation of elective surgeries, our practice must adapt quickly and decisively to protect our patients and to preserve our mission.”

Meanwhile, South Shore Health, the largest independent health system in Southeastern Massachusetts, told doctors, nurses, and other staff last week that it is deferring all scheduled pay increases indefinitely, starting the first week of April.

“Factors contributing to this include: cancellation of elective surgeries, closure of many outpatient programs, and a significant decrease in overall patient volume in every area of our health system,” according to a statement from South Shore Health.

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A nurse at South Shore Health who requested anonymity because of career concerns decried the move: “Health care workers at South Shore Health are working hard to keep the community safe and deserve what they were promised,” the nurse said.

Some health care providers who spoke to the Globe wondered whether company financial reserves could be used to help weather the crisis, instead of dipping into their paychecks.

Several ER doctors from the BIDMC-affiliated physicians groups, who requested anonymity out of concern for potential career consequences, spoke vividly about how the financial hit was one more strain as they step up to combat the pandemic at work, all while trying to keep their families safe.

“It’s a privilege and an honor to have this job,” said one ER doctor. “It seems crazy that we’ll be compensated less as we work more and put ourselves in harm’s way.”

“We’re human, too,” another ER doctor said simply. “It’s just blow after blow after blow, on top of showing up for work and feeling potentially like I could not come home, too.”


Rebecca Ostriker can be reached at rebecca.ostriker@globe.com. Follow her on Twitter @GlobeOstriker.