Healthcare Insights: Doctors Continue to Organize

On May 30, 2025, primary care physicians at Mass General/Brigham Health system in Boston voted overwhelmingly in favor of building a Union with Doctors Council SEIU. The Doctors Council released the following statement:

In a historic move, approximately 250 academic primary care physicians at Mass General Hospital (MGH) and Brigham and Women's Hospital (BWH) have voted overwhelmingly to unionize, forming the first union of academic primary care physicians in Massachusetts. Representing 29 clinics, the physicians voted by 183-26 to join Doctors Council SEIU to improve primary care for their patients and fight against the corporatization of healthcare. Despite the overwhelming support for forming a union, Mass General Brigham (MGB) appears poised to refuse to come to the bargaining table while it appeals the common-sense bargaining unit of primary care physicians that was set for election.

Physicians voted by mail between May 6 and May 29; ballots were counted on the afternoon of May 30. The physicians look forward to their union being certified and collaborating with MGB to secure the necessary resources, staffing, and support systems that will allow them to deliver high-quality care for their patients. This win comes at the heels of MGB
residents ratifying their first contract with 98% support.

“Primary care is drowning, and with today’s vote to unionize, we are building a raft,” said Dr. Michael Barnett of Brigham and Women's Advanced Primary Care Associates, South Huntington. “We need to rebuild our primary care practices, empower physicians, and ensure that our patients get the care they deserve. We can make this happen by working with MGB leadership to implement their pledge of $400 million of investment in primary care. We are ready for MGB to recognize our union and move forward.”

The efforts of 250 primary care physicians at one of the largest and most prestigious academic medical centers in the nation is a story of necessity, opportunity, and obstacles. It is a story that unfolds at a time when attending physicians as never before are showing interest in organizing unions.

My review of this organizing campaign shows some of the inherent obstacles in how the traditional organizing model of bargaining unit by bargaining unit, employer by employer rules under the National Labor Relations Act (NLRA) can inhibit the growing desire by physicians to demand a collective voice. New strategies will emerge as the desire for doctors to organize grows.

And when we consider the issues that physicians care about, as identified by Dr. Michael Barnett having to do with the foundations of healthcare delivery, traditional bargaining has severe limitations as well.

Primary care doctors at Massachusetts General Hospital started their organizing campaign in October of 2023. As of this writing in July, 2025, only a tiny fraction of the physicians (approximately 250 out of 4000) have been able to win a union election. Even that small number of doctors in the system winning a union appears to have threatened the hospital leadership. The hospital leadership is taking steps allowed under the rules to further discourage unionization among the rest of the doctors by forcing delays in the recognition of the victorious doctors’ union.

The employer has filed a Request for Review of the Decision and Direction of Election by the Regional Director of the National Labor Relations Board (NLRB). The employer has taken exception to the inclusion and exclusion of certain physicians to be eligible to vote, and has refused to recognize the union even though the Regional NLRB has certified the election and ordered the employer to bargain.

In brief, from the original desire to organize in October of 2023, and though successful in hearings and the election, more than a year and a half later, the doctors remain voiceless and without their union.

Mergers, consolidation, and the challenges to organize

Further complicating the organizing campaign, Mass General Hospital merged with Brigham and Women’s Hospital during this effort, creating a new entity entirely: Mass General/Brigham (MGB). The union had to expand its organizing campaign from Mass General primary care doctors to include the primary care doctors at Brigham. While this corporate restructuring slowed the campaign, the union successfully identified an appropriate bargaining unit of doctors who desired unionization. 

The union has experience with carving out groups of physicians in a large health system. At Allina Health in Minnesota, a primary care group of nearly 500 was successfully carved out of a much larger health system. Those doctors won an election and are bargaining their first contract. 

However, each time a union attempts to organize doctors, it must take care to accurately understand corporate structures and organizational control over the many components of large health systems, such as multi-hospitals and medical groups, clinics, both in-patient and outpatient services that historically had been separate entities. Post consolidation and merger, the lines of authority are often unclear, and as such are often open to interpretation by the employer and how the NLRB will make decisions about definitions of bargaining units.

The union filed a representation petition for the new combined unit on November 18, 2024. The employer requested a formal hearing before the Regional NLRB as to the composition of the bargaining unit and which doctors would be eligible to vote in a union representation election.

On April 18, 2025, the Regional Director issued a Decision and Direction of Election finding in favor of all of the union’s arguments as to eligibility for voting. A mail secret ballot election was ordered, and on May 30, 2025, 88% of the doctors voted in favor of the union.

This set of events occurred during the time when the National Labor Relations Board had been operating without a quorum. Without a quorum, the Board ceases to function with regard to deciding cases that come before it, such as in this case of the definition of the bargaining unit at Mass General. This lack of certainty about the adjudication of this case added substantial anxiety to the union and the doctors as to the time it might take to win their union.

The overwhelming majority vote now awaits a decision from the newly constituted NLRB. Union representatives acknowledge an undetermined but long wait for a decision.

The deeper story of why doctors are organizing lies in an article from the Boston Globe about the then-proposed merger of Mass General and Brigham in April 2024: “Devalued, disempowered, and unseen”: Mass General Brigham doctors react to latest merger step. 

Last year, I wrote an article on the growing consolidation in the healthcare industry,

In article by Jake Miller at Harvard Medical School he finds that healthcare consolidation has not produced promised benefits for patients and communities.

A salient theme of his article and many similar articles explains the lofty but unrealized rationale for consolidation:

Miller writes : “During those years, proponents of consolidation have argued that physicians and hospitals working together in integrated, coordinated systems would not only provide better care for patients, but would do so more efficiently than independent physician practices and hospitals, driving quality of care up while holding spending steady and even driving costs down.

One of the key arguments for hospital mergers and practice acquisition was that health systems would deliver better-value care for patients. “This study provides the most comprehensive evidence yet that this isn’t happening,” said study first author Nancy Beaulieu, a research associate in the Department of Health Care Policy in the Blavatnik Institute at Harvard Medical School.

Today, these systems are responsible for a large proportion of the medical care delivered in the United States. Some of them employ thousands of physicians, while others are much smaller and rooted in local communities. But questions about just how much care is delivered by such systems, or how good that care is compared with care delivered outside of systems, have lingered unanswered."

It is clear that these trends represent danger signs that appear to be deepening.

With all the turmoil at Mass General and Brigham, it is fair to ask: why didn’t all the 4000 doctors unionize at once? Instead a small group of doctors went ahead in primary care and now find themselves with a victory at the ballot box but without a union contract that would begin to address many of the issues that motivated them to organize in the first place. 

Through no fault of their own, but due to the complex opportunities for delay exerted by the employer as shown in the timeline of events above, time passes, and the issues of patient access, quality of care, and physician well-being go unaddressed. There is no one answer as to why the vast majority of doctors have not yet organized. This is a common problem in health care organizing: it is extremely difficult to unify large groups of employees in a large enterprise where there are so many different interests and concerns among thousands of people. 

Then there is the arduous and complex determination of appropriate bargaining units, subject to interpretation, hearing, appeal, and delay. There are many medical specialties in a large health system, and doctors historically have been able to negotiate their own individual contracts with their hospitals based on their specialized skill, experience, and professional standing. Evolving from individual contracting to collective bargaining is a major change in the dynamics of physician power and voice.

Today, the doctors at Mass General/Brigham are employed, and no longer have the ability to negotiate. They need a collective voice to do so effectively. This is a new experience for doctors. We are watching closely across the nation as this dynamic is unfolding.

Dr. Michael Barnett, quoted early in this article shared some thoughts with me about why doctors must organize. He is a primary care doctor and a professor of health policy services and practice at Brown University. He previously taught at the Harvard School of Public Health.

“No one is going to help,” Barnett stated emphatically. Our communities need primary care first and foremost, and at Mass General/Brigham and across the country, primary care is undervalued.”

He added, “Doctors must organize to speak out in the interest of restoring primary care access for people at a time when investments in primary care are drying up and at a time when people need it most. There is no current sustainable business model for primary care, and as a result, health systems are not standing up for what people need most.”

Compensation models for primary care doctors are far below the market: an accurate advertisement for primary care would read: “Come and work harder and get paid less.”

In my view, the day is rapidly approaching when doctors will come together and overcome the many obstacles that have historically discouraged their desire and ability or seek and attain a collective voice. Why?

Just recently, the largest specialty organization of doctors in the country, the American College of Physicians (ACP) issued a Policy Paper: entitled “Empowering Physicians Through Collective Action”. The ACP which represents 160,000 internal medicine primary care doctors has made a detailed and emphatic statement to encourage organization and collective action.

Quoting from the paper: “We use the term ‘collective empowerment’ throughout the paper to describe actions that physicians may take, including advocacy, engaging the organized medical staff, and collective bargaining, to achieve better patient care, physician well-being, and other goals.”

More on this paper and its impact on doctors ‘organizing in the next Healthcare Insights.

For now, the story of the small group of primary care physicians at Mass General/Brigham to unionize illustrates the urgent need for doctors, unions, and their professional organizations to address the many obstacles standing in the way of what they acknowledge must occur: collective action to attain collective voice in healthcare.

It will take new forms of organization and collective bargaining which is an exciting and necessary challenge for unions, doctors, and professional organizations to be able to address the deepening crisis in healthcare.

John August is the Scheinman Institute’s Director of Healthcare and Partner Programs. His expertise in healthcare and labor relations spans 40 years. John previously served as the Executive Director of the Coalition of Kaiser Permanente Unions from April 2006 until July 2013. With revenues of 88 billion dollars and over 300,000 employees, Kaiser is one of the largest healthcare plans in the US. While serving as Executive Director of the Coalition, John was the co-chair of the Labor-Management Partnership at Kaiser Permanente, the largest, most complex, and most successful labor management partnership in U.S. history. He also led the Coalition as chief negotiator in three successful rounds of National Bargaining in 2008, 2010, and 2012 on behalf of 100,000 members of the Coalition.