Corporations and the Crisis of Care

This article appears in the June 2026 issue of The American Prospect magazine. If you’d like to receive our next issue in your mailbox, please subscribe here.

Primary care physicians—internists, general practitioners, family doctors, and pediatricians—are the key point of patient contact with the medical system. They have been leaving the medical profession in droves because their conditions of practice have become intolerable. These doctors are being pressured to see more patients in shorter appointments despite ever more complex cases and treatment options, even as they are required to spend more time at computer terminals entering patient data. One recent paper in the Journal of General Internal Medicine calculates that primary care doctors, to meet all of their clinical and clerical obligations, would literally need to work 26.7 hours a day.

More from Robert Kuttner

Doctors find themselves working evenings and weekends to catch up with administrative work. My own internist typically responds to questions via the hospital’s “Patient Site” at about 2 a.m. Some doctors compensate by nominally going part-time, but often work full-time for half pay to keep up with the demands. Others take early retirement or move to boutique “concierge” practices, where they can conscientiously care for affluent patients who pay out of pocket. A fine internist I know, still in her forties, prized her work and her patients but could not take the pressure anymore. She quit to go to work for an insurance company reviewing claims.

The result of this exodus is even more pressure on doctors who remain, worsening the cycle. The U.S. is now said to be short at least 20,000 primary care physicians, but one recent study found that the shortage would rise to 208,000 if all Americans had good health insurance.

In Boston, site of several world-class teaching hospitals, a study found that as of 2020, one-third of primary care doctors are over 60. As older primary care doctors retire, they are not being replaced. Young residents get a close look at their exhausted and demoralized mentors when they do primary care rotations, and most opt for other less taxing, more rewarding specialties. According to Dr. Wayne Altman, chair of family medicine at Tufts Medical School, when residents and hospitals did their annual matchup for new doctors in March, just 3.9 percent of incoming physicians chose family medicine. He told me, “They look at us and say, you are doing the Lord’s work and good luck to you.”

WHAT IS DRIVING THIS SYNDROME, and what might fix it? I spoke to more than 30 of the people who have given this question the most careful attention, including former heads of Medicare and Medicaid, hospital CEOs, and leading health policy researchers. I read numerous studies and interviewed several primary care doctors. The story is both simple and complicated.

At the 30,000-foot level, one can view a collision of several separate factors, all of which add up to more pressure on primary care doctors. As I wrote in an investigative piece for the Prospect on Epic Systems, the near-monopoly vendor of electronic databases for hospitals, the system has become a time sink. Doctors, especially primary care doctors, are required to enter scads of data after each patient visit. The computer will not let the doctor proceed until every question is answered. One study found that physicians spend two hours entering data for every hour with patients.

The purpose is less clinical than commercial. Under rules laid out by Medicare, more than half a century ago, patient visits and procedures get elaborate codes called CPT codes that in turn dictate payments. Epic facilitates upcoding, so that hospitals can squeeze out maximum reimbursements from private insurers (or so Medicare Advantage insurers, which many doctors work for, can overbill the government). “Doctors—highly trained professionals—are reduced to performing clerical and administrative tasks,” says Dr. David Bor of Cambridge Health Alliance.

A second factor is the systematic bias in payment systems against primary care. The American Medical Association, dominated by specialists, has captured the coding system. The AMA owns the codes, of which there are more than 11,000. Every time a code is used, even for routine tests, the AMA captures a royalty. The AMA makes about $285 million a year from these payments, or about half its total income.

The code formulas are systematically biased in favor of specialists and against primary care doctors. Under Republican and Democratic administrations alike, the government’s Centers for Medicare & Medicaid Services (CMS) has deferred to the AMA-owned and -dominated system. Commercial insurers tend to follow the Medicare guidelines. The AMA has used its political influence to block every attempt at reform.

Third, as doctor-owned practices have been overwhelmed with byzantine bureaucratic demands from both commercial insurance companies and the government, physicians have been selling their practices to hospitals, private equity companies, or even insurance conglomerates. Hospitals, whether nominally nonprofit or for-profit, emphasize maximizing income. Likewise insurers or private equity firms.

The doctors’ new masters only intensify the time squeeze. Hospitals like to own primary care practices, not because they are moneymakers—due to the bias in payment formulas, they tend to be money-losers—but as sources of referrals to lucrative, procedure-intensive specialties, such as cardiology, oncology, and orthopedics.

But lately, hospitals have been turning away from primary care entirely, because of the low compensation for physicians and the odd way that hospitals calculate their costs. When a doctor practices at a hospital, the hospital charges rent and attributes other indirect costs to the physician practice. One recently retired CEO of a major hospital group told me, “I lost about $100,000 on every [primary care] physician.” Average doctor earnings of about $250,000 year, plus attributed indirect costs, were well above what the hospital could bill insurers.

By contrast, specialists are big profit centers. The big hospitals have found other ways of getting referrals to their specialists; they have gone on acquisition binges to take over community hospitals and created referral networks. So they no longer need in-house primary care as a referral source. Many are deliberately shrinking primary care or are happy to let the number of primary care doctors dwindle. At the prestigious Massachusetts General Hospital, between 2023 and 2025 an astounding 78 primary care physicians quit out of about 250—either retiring, leaving for another facility, or opting for concierge practice. Not all were replaced. (See below.)

The squeeze on primary care is exacerbated by the invention of countless new drugs, medical devices, tests and diagnostic decisions, all of which consume time. Half a century ago, there were no MRIs or CT scans, and far fewer standard pharmaceutical drugs and tests. Dr. Michael Barnett, an internist and health policy researcher at Boston’s Brigham and Women’s Hospital, told me, “The old norm that a primary care doctor should be responsible for a panel of 1,800 to 2,000 patients is an anachronism.” He cites the example of a heart valve disorder that can now be treated with new elegant forms of costly surgery. But when the primary care doctor spends time making the diagnosis and refers the patient to the surgeon, it is the surgeon who is well compensated, while the primary care doctor is underpaid.

Thus the paradox: Specialists, as profit centers, get along with this new complexity just fine. They make plenty of money off it and are not suffering the same level of burnout. But since the coding and payment system is based largely on procedures and specialized expertise, primary care doctors are systematically undercompensated for listening, evaluating, writing up process notes, and coordinating care, all of which is the essence of their job.

AT THE HEART OF THE STORY is the relentless commercialization of medicine. According to the American Hospital Association, about 68 percent of community hospitals are now part of chains. Slightly more than half of the nation’s roughly 6,100 hospitals are nominally nonprofits, but most are trying to emulate for-profits. Mass General is one of the worst offenders and is all too emblematic of the emerging business model of most academic medical centers.

Mass General was chartered in 1811 by the Massachusetts legislature as a hospital that would treat anyone in need of medical care, regardless of ability to pay. The facility became the first Harvard Medical School teaching hospital, training and supervising interns and residents, as well as a leading research facility.

But as the entire medical system became more commercialized and profit-oriented, so did Mass General. In the 1990s, it began pursuing greater market share, partly as a source of increased bargaining power over insurer payments. The idea was to make it inconceivable for an insurer to threaten to deny patients the right to use the hospital. In 1994, Mass General undertook a partial merger with one of Boston’s other renowned teaching hospitals, Brigham and Women’s Hospital, creating a parent corporation called Partners HealthCare.

The hospital hired costly branding consultants. They realized that Mass General and Brigham and Women’s were prestigious brands, while “Partners” had no resonance. So the corporation spent over $100 million to rebrand Partners as Mass General Brigham (MGB). One of their highest-paid executives is Mark Bohen, chief marketing and communications officer. He previously worked for Nabisco, where he marketed Oreos and Ritz Crackers. MGB displays slogans like “One System, One Mission, One Mass General Brigham.” But that branding has also backfired, since it tends to confuse people about which hospital it refers to.

Since the 1990s, business tycoons and not doctors have been added to the MGB board, first as a source of donations, and then as dominant influences on corporate strategy. Today, the board chair is Scott Sperling. His day job is co-CEO of Thomas H. Lee Partners, a private equity firm described as “focused on investing in middle market growth companies in three core sectors: financial services, healthcare, and technology and business solutions.” So Sperling brings his private equity mentality to how MGB is run.

One vice chair is billionaire Jonathan Kraft, president of The Kraft Group, the holding company of the Kraft family’s business interests. He is also president of one of the family properties, the New England Patriots. The other vice chair is John Fish, chairman and CEO of Suffolk Construction, Boston’s pre-eminent construction firm, which has profited from several Boston health care projects.

In February and March 2025, MGB announced some 1,500 layoffs, citing a shortfall in the system’s operating budget. But when the 2025 fiscal year numbers were announced in December, MGB ran an operating profit of $59.2 million for the fiscal year and a total profit of $2.4 billion, reflecting earnings from surplus capital invested in the stock market. The hospital had plenty of money to avert layoffs. At last count, Mass General had some 30,000 patients in its system who did not have a primary care physician, and was turning to AI to do thousands of initial screenings.

In the meantime, Anne Klibanski, CEO of MGB, has received several raises in recent years. She nearly doubled her annual compensation in just four years, from $4.3 million in 2020 to $8.4 million in 2024. At least 16 MGB executives make more than a million dollars a year. The more profit that the hospital books, the more money there is to pay executives—but evidently not primary care doctors and their support staff.

When MGB announced the layoffs, the hospital system emphasized that they were all “non-clinical” personnel. But many played vital support functions that now had to be filled by doctors and nurses, cutting further into clinical time. One primary care doctor in a large practice at MGB, Claire Bloom, told a reporter that her practice manager was abruptly laid off. “That person’s work still needs to be done, right? It’s not like you can eliminate the tasks … they just have to be transferred to other people. Those other [clinical] people already have full time jobs. Those people are going to be overworked and burnt out, and it’s just not possible.”

THE RESULT OF ALL THESE PRESSURES is that primary care doctors have experienced worsening de-professionalization. Dr. Bor of Cambridge Health Alliance observes, citing author Daniel Pink, that professions, in contrast to ordinary occupations, are distinguished by three factors: autonomy, mastery, and purpose. Each has been crushed by the corporate takeover of medicine. Before profit maximization became paramount, physicians set their own schedules and governed their own practices. Today, they are treated like any other corporate employee. “The next generation doesn’t expect autonomy as part of their profession,” Bor says. “They have internalized the new rules. They are less likely to see their profession as a calling.” Their sense of purpose is eroded, he adds, as is their capacity to master and use their knowledge.

“When I was a young clinician,” Bor says, “I learned a great deal from talking with my peers. I don’t see doctors having lunch together in the cafeteria. They’re all busy at their computers.”

Dr. Tait Shanafelt, a hematologist at Stanford Medical School and a leading researcher on doctor burnout, began systematically studying the phenomenon in 2001. He has found a steady increase in doctor stress, exhaustion, fatigue, depression, and social isolation, leading to negative effects on patient care.

Primary care doctors find themselves demoralized, in both senses of the word. They are dejected, but also the medical care they are being forced to practice is at odds with their own sense of moral behavior. In 2018, Dr. Wendy Dean popularized the concept of moral injury. Dean and her collaborator, surgeon Simon Talbot, argued that terms like “burnout” missed much of what was really going on.

Moral injury occurs when doctors’ deeply felt duty to their patients is at odds with their conditions of work and their necessary care of themselves. Even though it is not their fault, doctors feel shame that they are failing their patients and drive themselves even harder, creating an impossible moral bind. Dean writes that the experience of physician moral injury is akin to post-traumatic stress disorder (PTSD), in which veterans feel shame at what they saw and did on the battlefield.

Dean’s 2023 book elaborating the concept is titled If I Betray These Words. The title is from the Hippocratic oath. The extended quote is “In honor of the knowledge I’ve received from my teachers, I swear to care for anyone who suffers, prince or slave. If ever I break this oath, let my gods take away my knowledge and my own health … May I be destroyed if I betray these words.”

One of my personal heroes, the economist and moral philosopher Albert Hirschman, wrote a profound book with the odd title Exit, Voice, and Loyalty. Hirschman’s insight was that there are two ways of exerting influence: voice and exit. If you are given voice, that engenders loyalty. When you are denied voice, whether in employment, a marriage, or a nation, you ultimately may exit. Demoralized doctors denied voice eventually exit the profession. As Dean writes, in extreme cases of moral injury, some commit the ultimate form of exit—suicide.

Dean tells several stories of the excruciating pressure on doctors to cut corners and calls for an end to the corporate domination of medicine. But the corruption and debasement of the nonprofit part of the system is such that reform would need to go even deeper.

THE SIMPLE REMEDY FOR THIS TANGLED MESS would be national health insurance. If implemented properly, a national health program could dispense with the profiteering, the middlemen, the costly insurance billing and upcoding games, and save trillions of dollars by redirecting the savings to care. It could also pay primary care doctors decently, increase the time they can spend with patients, and reduce the use and payment of specialists. In Canada, with a universal system, primary care doctors are about half of all doctors, compared to about one-quarter in the U.S.

But national health insurance is not coming to America anytime soon. Short of that, partial reforms of payment systems could help. There have been several efforts to break the AMA’s specialist-dominated lock on payment codes. All have failed.

In the 1970s, when Joseph Califano was Jimmy Carter’s secretary of Health, Education, and Welfare (the predecessor of the Department of Health and Human Services, or HHS), leaders of Medicare and Medicaid attempted to substitute the public-domain system of coding used internationally for the AMA’s proprietary one. But the Carter administration needed the AMA’s support for pending health legislation. Califano, who was lobbied by his own doctor, told the Medicare people to back off.

Similar sagas have occurred since. Bill Clinton needed the AMA’s support for pending patient privacy legislation, the Kennedy-Kassebaum bill, which became the Health Insurance Portability and Accountability Act of 1996 (HIPAA). And in 2003, the Senate passed legislation to switch to the international coding system. But the AMA reportedly got that killed by agreeing to support the Medicare Modernization Act, which added privatized Medicare drug coverage.

Ironically, there may be a window for reform this year. HHS Secretary Robert F. Kennedy, Jr. has a vendetta against the AMA. One well-placed source tells me that Kennedy has authorized one of his top aides to work on taking the coding system away from the AMA, a position shared by Sen. Bill Cassidy (R-LA), a doctor, who chairs the Senate Health, Education, Labor and Pensions Committee. Cassidy announced last October that he had begun an investigation into the AMA abuses of the codes. Cassidy wrote, “I am particularly offended by the AMA abusing its government-endorsed CPT monopoly to charge every stakeholder in the health care system significant amounts of money while advancing an anti-patient agenda.”

The Senate Finance Committee has jurisdiction over Medicare, and its leader, chair Sen. Mike Crapo (R-ID), favors this reform. However, the window could soon close. Cassidy, who is up for re-election and is opposed by Trump, may lose his primary; and RFK Jr. seems to be rapidly losing political capital.

Some efforts at payment reform have backfired. In 2006, health policy reformers came up with a concept called the Medicare Shared Savings Program (MSSP). The idea was that a hospital, clinic, or doctor practice would form a group known as an accountable care organization (ACO) and be financially rewarded for hitting certain goals of quality and efficiency. The savings could then be directed to better primary care. ACOs were duly created in 2010 by statute as part of President Obama’s Affordable Care Act.

What actually happened was that private equity companies realized they could acquire ACOs as a way of buying doctor practices. They could extract the savings and then squeeze the employees to see more patients and increase billings. Doctors went from the frying pan to the fire. Between 2012 and 2021, some 5,779 physician practices in 307 metropolitan areas were sold to private equity.

Why would doctors do this to themselves? Because when a practice sells out to private equity, the doctors that owned the practice get a one-time payment that can be upwards of a million dollars. This can be very attractive to a doctor nearing retirement—at the expense of younger colleagues.

Insurance conglomerates like Optum, a division of the health care giant UnitedHealth, have also been buying up doctor practices, and executing the same kind of squeeze, especially on primary care physicians. Today, UnitedHealth is the largest employer of doctors in the country, and old-fashioned freestanding primary care physician practices are rare. The largest category of owner is hospitals, followed by private equity; 22 percent of for-profit hospitals are themselves owned by private equity. All told, about 78 percent of physician practices are now owned by corporate entities.

In most of the country, this is actually a crime. Corporate practice of medicine laws require physicians and not conglomerates or other corporate structures to own medical practices in 33 states and the District of Columbia. But private equity and other entities get around this by using figurehead physicians to “own” the practice while all the business decisions are made by the firms or affiliated “management service organizations.” In several states, bills have been introduced to tighten these laws and end the shell game. The only one that has passed is in Oregon, which prohibits private equity owners from dictating clinical decisions, but does not fully prohibit their involvement. Oregon’s implementation will be closely watched by other states looking to reduce corporate control of health care.

At the state level, it’s possible to mandate a partial shift in payment formulas. Dr. Altman of Tufts Medical School is a national leader on payment reform and founder of the Massachusetts Primary Care Alliance for Patients. Altman has been working with a group of state legislators in Massachusetts to pass legislation that would shift from fee-for-service payments to advance payments, a reform that would effectively double state spending on primary care from 6 to 8 percent to 12 to 15 percent. Altman told me that the reform would so improve preventive care that it would pay for itself within two years.

However, the argument that increased spending on primary care saves money on net is controversial. Some studies have found that in some cases when primary care doctors have more time to spend with patients, they are more likely to find conditions that will in turn require costly treatments. This will keep more people alive and well but may not produce net savings for the system. “I don’t think advocates of more investment in primary care should be emphasizing the financial savings,” says Dr. Barnett of Brigham and Women’s Hospital. “We need more investment in primary care because it’s the right thing to do.”

At the hospital level, some facilities that are still mission-driven have tried to be counterweights to these larger trends. Dr. Shanafelt, who became Stanford’s first chief wellness officer, is a leading national missionary for the idea that changes in how hospitals operate can make a difference. His research shows wide variations in rates of physician burnout. At Stanford, where Shanafelt directs a program called WellMD, hospital leaders do a lot of active listening to doctor frustrations and make adjustments. They use support staff and clinician teams to relieve extreme points of doctor stress. “If we optimize efficiency at the local level, it can help … and above all have leaders who listen,” Shanafelt told me.

The approach is the exact opposite of how management proceeds at Mass General Brigham. Rather than responding to suggestions, health professionals tell me, they ignore doctor concerns and exacerbate stress with layoffs of support staff and redoubled demands for doctor productivity. For more hospital executives, MGB is an unfortunate role model.

THE MOST ILLUMINATING EXAMPLE we have of a partial reform that brings far better primary care is found in freestanding health plans that bypass the entire insurance and hospital industry. Some years ago, I wrote an article for the Prospect about the best of them, the health plan of the New York hotel workers union, which serves about 85,000 union members, retirees, and families.

Local 6 of UNITE HERE is one of the most powerful unions on the country. It has organized large hotels in Manhattan, wall to wall. One of the benefits it has negotiated is membership in the union’s own health plan, which is like no other. The plan operates five freestanding health centers in New York’s five boroughs. There are no deductibles, no ceilings, no insurance billing, no waiting lists, and infrequent co-pays and prior authorizations. It includes full optical and dental care. Drugs used in long-term therapies are free; other prescriptions have a nominal charge of $10 to $20. All doctors are on salary, typically around $200,000 to $250,000. The average physician panel size is around 1,000 patients, about half that of hospital-based doctor practices.

Dr. Robert Greenspan, the longtime director of the health plan, said of its operating philosophy for patients: “We want you to come in. We want unlimited access to primary care. It pays off over the long term. All of the co-pays and deductibles do the opposite of what is claimed. They don’t assure that scarce medical resources are used as efficiently as possible or deter excessive use. They are simply barriers to care.”

Doctors and patients in the union health plan both have the highest satisfaction rates in New York. With all the money that the system saves, the cost (paid entirely by employers) is about one-fourth that of the average commercial health plan in New York, according to the plan’s current director, Dr. David Jacobson.

When I first reported on the union health plan for the Prospect in 2011, I interviewed management as well as union people. Joseph Spinnato, the longtime president of the Hotel Association of New York City, who takes great pride in the plan, told me, “I could not duplicate this on the private market for anything like what we pay. When you measure it against what our member hotels pay to cover their non-union employees and what they get, there is simply no comparison.”

The costliest part of the plan is inpatient care, which has to be negotiated with local hospitals that are far less efficient and more focused on profits. The plan is now working to bring more procedures and tests inside its own system.

According to Dr. Jacobson, who has directed the plan since 2020, New York has just approved the construction of three casinos, the first of which will be opening later this year. As part of the approval agreement, all three will be union operations. So Local 6 will gain some 10,000 to 12,000 new members, and the health plan will gain many more because it includes their families. This increased membership and income gives Jacobson the basis for building a whole new health center in Manhattan. For the first time, it will have several services that ordinarily require expensive referrals to hospitals, such as CT scanners, MRIs, and an endoscopy suite.

The union health plan is a cousin to the first generation of staff-model, nonprofit prepaid group health plans, such as Group Health of Puget Sound, HIP of Greater New York, and the early versions of Kaiser. All of these had salaried doctors, no deductibles or co-pays, and no insurance companies. But as prepaid group plans morphed into HMOs, most became just another part of the commercial system. The radical alternative Local 6 health plan is something like national health insurance in one sector.

Could that model be duplicated? Dr. Jacobson thinks that large employers or groups of employers might sponsor their own health facilities like Local 6 does and cut out insurers entirely, while saving lots of money and providing better care. And he told me the following story.

Some years ago, the then-president of the union met with New York City’s mayor at the time, whom he did not name. The union leader pointed out that the city had some 300,000 municipal employees on its payroll, about ten times the number of Local 6 members. The city was paying a fortune for their health coverage, which was decent, since all city employees are members of unions. The union leader proposed, why not do what we do and set up your own medical plan and facilities.

“But the mayor wasn’t interested,” Jacobson said. “It was too socialistic.”

Over to you, Zohran Mamdani.

The Degradation of a Marquee Hospital

Mass General Brigham is a cautionary tale.

With a total of some 85,000 employees, Mass General Brigham (MGB) is the largest private-sector employer in Massachusetts, giving it immense political clout. Since Mass General and Brigham and Women’s Hospital consummated a partial merger in the 1990s, they have systematically bought up community hospitals as both referral networks and profit centers. MGB, with Harvard teaching hospitals, can bill at premium rates for services at formerly independent community hospitals that often still have lower costs.

Because of MGB’s political influence, state authorities seldom intervene in a pattern of attempted market domination that should raise antitrust and cost concerns. A rare exception occurred in November 2021, when then-Attorney General Maura Healey, who is now governor, warned that MGB’s planned creation of three new surgery centers in Westborough, Westwood, and Woburn would increase market share “at the expense of lower-priced providers.” MGB shelved the plans.

Like most states, Massachusetts requires proposed new medical facilities to apply for certificates of need to prevent wasteful and duplicative investment, but MGB regularly runs roughshod over the process. MGB is spending just under $2 billion to build two new towers next to its historic downtown Boston campus. They will house 482 new beds plus a new cancer center.

The rival Beth Israel Deaconess system is also building a new cancer facility in partnership with the Dana-Farber Cancer Institute. It’s far from clear that Boston needs this new capacity, but cancer treatment is a huge profit center, and the two systems compete for market share. The state is allowing both to proceed.

Amid all this new construction for specialty care, conditions for primary care have continued to deteriorate. Instead of rebuilding primary care in-house, MGB launched a partnership with CVS, which offers “Minute Clinics” at some of its pharmacies. Under the plan, CVS will hire or redeploy 80 “Primary Care Advanced Practice Providers,” mostly nurse practitioners, who will be responsible for patient panels of 1,500 each. MGB will lend its brand and patient database to CVS and share profits. This idea raised significant clinical and financial concerns. In April, the Massachusetts Health Policy Commission issued a report warning that the deal could raise costs, and the commission solicited further comments.

By 2024, conditions for primary care doctors had become so intolerable that MGB doctors organized a union. “Doctors are far from ideal candidates for a union,” one of the leaders of the effort, Dr. Mark Eisenberg, an internist at Brigham and Women’s, told me. Yet an astounding 88 percent of primary care doctors at the two hospitals signed union cards, and the union went on to win the election by a similar margin.

As Eisenberg points out, doctors are so squeezed by management at MGB that they don’t even get paid sick days. If a doctor calls in sick, it comes out of vacation time. “Either that or the doctor goes to work and risks infecting patients,” Eisenberg said.

Nurses at Brigham and Women’s had long been unionized, and medical residents had recently succeeded in organizing a union. “They were getting regular raises and improved conditions while primary care work lives were becoming increasingly unsustainable,” said Eisenberg. “We were inspired by the residents.” Residents recently approved a contract that includes 7 percent raises and improved working conditions.

Most employers would recognize the overwhelming level of support and accept the result. But not Mass General Brigham. Executives hired the nation’s largest union-busting law firm, Littler Mendelson, whose clients include Starbucks, McDonald’s, and Nissan. Littler Mendelson resorted to the usual playbook. The regional NLRB certified the election result, but MGB appealed to the national NLRB, which at the time lacked a quorum, putting the election on hold.

Management also challenged the composition of the proposed bargaining unit—all primary care physicians—and argued that if doctors at MGB wanted to organize physicians, they had to organize all physicians and not just those in primary care. The regional NLRB ruling also rejected that ploy.

Recently, Trump’s appointees to the NLRB have given it a quorum, so the appeal will proceed. The union, affiliated with the Doctors Council of the SEIU, has resorted to community pressure on management to drop the appeal and recognize the union, including informational pickets at the hospitals and a letter of support from 39 state legislators.

As part of its union resistance campaign, MGB, supposedly short of funds, abruptly announced plans for new spending of $400 million on primary care. No input had been solicited from doctors, and no details were disclosed.

This article appears in Jun 2026 issue.