Labor Board Ruling Sides with Union Against Mass General Brigham

The National Labor Relations Board has rejected the health system's bargaining unit objection.

The National Labor Relations Board (NLRB) has ruled in favor of Mass General Brigham (MGB) primary care physicians who are seeking to unionize.

Primary care physicians at MGB began organizing efforts for a union last year with the Doctors Council, the country's oldest and largest union of attending physicians. MGB filed with the NLRB seeking to block the unionization effort by arguing that many of the 400 doctors trying to unionize did not belong in the same bargaining unit.

The April 18 NLRB ruling rejected MGB's claim, clearing the way for the primary care physicians to hold a union election in May.

MGB declined a HealthLeaders' request for an interview about the NLRB ruling, but the health system provided a prepared statement.

"Primary care physicians are critical to the health of our patients and community," the prepared statement says. "We know that PCPs across the Commonwealth are facing unprecedented volume and stress as a result of a confluence of factors that are not unique to our organization. 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 prepared statement says MGB is reviewing the NLRB ruling.

Zoe Tseng, MD, a primary care physician at Brigham and Women's Primary Care Associates of Longwood and a union organizer, told HealthLeaders that her colleagues were confident the NLRB would rule in their favor.

"We expected this outcome," Tseng said. "We were confident that the bargaining unit that we had established was the proper one—it included all primary care physicians."

Tseng called MGB's bargaining unit objection a delay tactic.

Doctors' motivations for forming a union

MGB's primary care physicians are seeking to unionize for several reasons, including the lack of a voice in decision making and onerous working conditions, according to Tseng.

"We have had a very limited voice in the decisions over the years, and it has gotten worse," Tseng said. "We want to be able to represent the patients and the clinical staff that we work with. We want to advocate for resources and the services we need to do adequate primary care for our patients."

"We have understaffing—there are not enough staff to help us with administrative tasks, whether that be paperwork, getting patients the prescriptions they need authorized, or answering phone calls," Tseng said. "That burden is falling on primary care physicians as we try to see patients."

MGB has not invested in primary care, instead concentrating on more lucrative specialty care, according to Tseng.

"They have had the opportunity to lead in investing in primary care as a world-class institution, but they have chosen not to," Tseng said. "Instead, they have built up their specialty care."

Primary care is an essential service for a high-functioning health system, Tseng explained.

"You get into a crisis when you do not build a foundation for primary care," Tseng said.

Forming a union will give the primary care physicians more sway at MGB, according to Tseng.

"The reason for the union is so we can hold them accountable for all of the things that we need and they have promised," Tseng said. "As we have seen over the years, promises have often been empty."

Photo: Primary care physicians affiliated with Mass General Hospital and Brigham and Women's Hospital (BWH) hold an informational picket line outside BWH in December.