Discontent among Mass General Brigham doctors had been at a slow burn for years. But when an unexpected announcement from the chief executive titled “A message about our future” popped into inboxes one morning last month, that frustration seemed to fully ignite.
Mass General Brigham, a dominant force in Boston medicine, was launching the latest and perhaps most contentious step in its ongoing effort to merge its two flagship Harvard-affiliated medical centers: combine all departments and divisions at both hospitals in a move that executives argued would improve patient care and access.
But after years of feeling shut out of decisions amid grinding work schedules, many doctors worried the changes would lead to layoffs, demotions, and an even greater loss of autonomy. During an online ‘‘town hall’' on April 4, they inundated leaders with skeptical questions. One physician asked how executives planned to build trust with faculty when so many felt “unheard, devalued, disempowered, and unseen.”
“We know there are problems,’’ conceded chief executive Dr. Anne Klibanski to hundreds of doctors who logged on to the live broadcast — which the Globe also listened to — to hear from her and four other executives. “We have taken the surveys. The answer isn’t more surveys. Now is the time to listen and show results,” said Klibanski, promising renewed efforts to address physician burnout.
As Mass General Brigham tries to remake itself into a fully combined system, the vision and priorities of leaders and front-line physicians have clashed. The unrest has led to what was once unimaginable: Some of the 6,000 full-time physicians at the two hospitals are seriously discussing unionizing.
Mass. General and the Brigham, long the frenemies of Boston medicine, are bound by a partnership formed 30 years ago to use market power to leverage higher reimbursement rates from health insurers but at times divided by competition and disparate cultures. At Mass. General, physicians and trainees are accustomed to greater independence when treating patients. Physicians there are paid significantly more on average than their Brigham counterparts. The Brigham, meanwhile, is considered a kinder and gentler workplace, and interns — doctors-in-training — generally receive more oversight from senior physicians, doctors said.
A merger of the two hospitals’ clinical operations had been discussed for years, but doctors complained that the announcement from Klibanski came out of the blue, with no input from front-line staff. Even the department heads and division chiefs, some of whom will lose their administrative roles and the pay and prestige that comes with them, were notified only two hours before Klibanski sent the hospital-wide email March 13.
“We have been ignored in this whole process,” Dr. Walter O’Donnell, clinical director of the pulmonary critical care unit at Mass. General, said in an interview. “Staff feel they have not been listened to and have not been treated well.”
Dr. Lawrence Casalino, an emeritus professor at Weill Cornell Medical School, said discontent among doctors is surging nationally. Many lament that hospital boards largely composed of business people and C-suite executives are increasingly taking over how patient care is managed — a shift doctors refer to as the corporatization of medicine. Private equity firms are buying up physician practices; hospitals and insurance companies are morphing into conglomerates, Casalino said, and even nonprofit organizations such as Mass General Brigham act more like for-profit companies in their pursuit of efficiency and homogenization.
“At large corporations, it’s hard not to treat people like widgets,” he said.
Mass General Brigham physicians note that the transformation of their system is being driven by three corporate executives on the system’s board of directors: Scott Sperling, a private equity heavyweight, who chairs the Mass General Brigham board; Jonathan Kraft, president of the New England Patriots, who heads the Mass. General board; and construction magnate John Fish, who chairs the Brigham board.
Dr. Suhas Gondi, a resident at the Brigham, recently coauthored a study that found that 44 percent of board members at 15 academic medical centers work or had worked in financial services, mostly private equity and wealth management, while just 15 percent are medical professionals.
“The integration [at Mass General Brigham] is really something that emanates from this larger trend,’' toward corporatization, he said. These board members “know how to generate value from mergers. That is a common bread and butter tactic of private equity.”
The changes have led doctors to consider whether unionization would give them more leverage. That idea is not as far-fetched as it once was; at Salem Hospital, a small community hospital that is part of Mass General Brigham, physicians overwhelmingly voted in March to join a union, while residents and fellows at multiple Mass General Brigham hospitals unionized last year. In October, hundreds of doctors and other medical professionals in one of Minnesota’s largest health care systems, Allina Health, voted to join the Doctors Council, a national affiliate of Service Employees International Union.
During the town hall, Klibanski and the other executives, all of whom are also physicians, repeatedly reassured doctors the merger process would be inclusive and transparent. They said that while the Mass General Brigham board approved the merger, exactly how to combine 19 clinical departments at Massachusetts General Hospital with 16 clinical departments at Brigham and Women’s Hospital would be up to doctors.
Dr. Giles Boland, the Brigham hospital president, said leaders recognize that physicians are overwhelmed by a crush of complicated patients, especially since the pandemic, while responding to constant emails with questions about treatment plans, insurance forms, and quality metrics. He said executives are embarking on an urgent new initiative to improve physician well-being and working conditions.
“We recognize we have to do much more and we have to do it now,” he said.
In response to questions from the Globe, Mass General Brigham executives would not say how many demotions or layoffs they expect as a result of the merger — some corresponding departments at the two hospitals already have a single chair, and some chairs are close to retirement — or how the salary gap between the two academic medical centers will be addressed. They said a compensation analysis is underway.
Mass General Brigham leaders outlined problems the merger is intended to solve in a presentation to department chairs on March 13, including that the two hospitals compete for patients, trainees, and faculty; equity programs are “diffuse and uncoordinated”; quality measures are not standard; and it is difficult for doctors to refer patients to specialists or for additional testing outside their own hospital because that may mean lost revenue for their department or institution. Under the new structure, corresponding departments at the two hospitals will be considered one entity, and major disease areas like cancer and heart will be organized into single institutes.
“Embracing change is difficult and yet it is essential for our evolution as a healthcare system,” said Dr. David Brown, president of academic medical centers for Mass General Brigham, in a statement to the Globe.
But many physicians are skeptical after years of directives from above that they feel have been disrespectful to staff, including mishandling COVID vaccination sign-ups for employees and temporarily suspending company pension contributions during the height of the pandemic. The Globe interviewed more than a dozen doctors, but most did not want to be identified because they feared repercussions at work.
O’Donnell said he and more than 200 other physicians signed a petition in 2021 requesting “complete transparency and full collaboration” from leaders on the restructuring. “It was ignored and never answered,” he said. Last summer and fall, doctors met in small groups with Brown and Dr. Marcela del Carmen, now president of Mass. General Hospital, he said.
As part of the recent restructuring, del Carmen and Giles will remain as heads of the Mass General and Brigham physicians organizations, respectively, while taking on additional roles as president of their respective hospitals. Executives said the change allows for quicker decision-making, but doctors believe it is another way to diminish their voices.
For Brigham doctors, the last year has been especially unsettling as the Dana-Farber Cancer Institute announced it would dissolve its longstanding clinical relationship with the Brigham to partner with Beth Israel Deaconess Medical Center — a dramatic move some believe the Mass. General board could have prevented. About 40 percent of surgeries at the Brigham are cancer-related.
Dana-Farber’s decision shocked many doctors, said Gondi, the Brigham resident. The announcement about the merger of departments generated a similarly intense reaction. “People have built their entire careers within these departments that are now clearly going to be turned over in the name of integration and cost synergies,” he said. “Many people feel they are at risk.”
Liz Kowalczyk can be reached at lizbeth.kowalczyk@globe.com or on Signal at kowalczyk.55.