Doctors are unionizing, from Mass General Brigham to Beth Israel. Here’s why.

The hospital was going to close the clinic as part of cost-saving efforts, Tseng recalled. The six doctors and two physician assistants would be transferred to other practices. The remaining employees would be offered jobs elsewhere at Brigham, one of MGB’s two flagship hospitals.
On a Friday afternoon in July, a handful of administrators from Brigham and Women’s Hospital gathered the practice’s roughly 35 employees at the clinic to deliver bad news.
When Dr. Zoe Tseng explains why she decided to help start a union of primary care physicians at Mass General Brigham — and join a wave of doctors organizing nationwide — she recounts what happened in 2023 at the Newton medical practice where she had worked for a decade.
Tseng and her co-workers were stunned, she said. Several began to cry. Tseng worried about her patients, especially those who lived near the practice. Would they follow her wherever she landed?
“We were all essentially blindsided,” said Tseng, 40, who moved to a Brigham clinic in Longwood after the Newton practice closed in December 2023. She was particularly upset by “the lack of autonomy and lack of feeling that I had any say in this decision,” she added. “The decision had been made.”
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Tseng is now among nearly 300 primary care physicians at MGB who petitioned the National Labor Relations Board in November to let them vote to form a chapter of the Doctors Council of the Service Employees International Union. They have cited overwhelming workloads, insufficient pay for the hours they worked, a shortage of office staff, and lack of a voice in decisions made by MGB.
The unionizing effort is part of a flurry of labor organizing by attending physicians and doctors in training at several large health systems in Massachusetts and Rhode Island. Just last year, doctorsapproved, or took steps toward approving, unions at Salem Hospital (which is part of MGB), Cambridge Health Alliance, Beth Israel Deaconess Medical Center, and Brown University Health and Care New England, both in Rhode Island.
The mobilizing mirrors a national trend. Between 2014 and 2019, the number of physicians belonging to unions grew by 26 percent, from 46,689 to 67,673, although they still only represent a small fraction of all doctors, according to Dr. Kevin Schulman, a professor of medicine at Stanford University in California, who has studied the issue. And the trend has only accelerated since then.
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Primary care doctors from Brigham and Women’s Hospital and Massachusetts General Hospital picketed outside the Brigham on Dec. 13. David L. Ryan/Globe Staff
Unlike the primary care doctors at MGB, the bulk of physicians pushing for collective bargaining rights — both in Massachusetts and nationally — are medical residents and fellows, who are still in training and have unionized for decades. But seasoned doctors like Tseng, who traditionally didn’t join unions, have also begun to organize.
“The idea of unionization of residents is not new,” said Schulman. “But the idea of practicing physicians joining unions is very new.”
To be sure, the concerns of trainees often differ from those of veteran attending physicians. Residents, who sometimes put in 80-hour weeks while earning an average of $68,000 a year in the United States, according to a recent Medscape report, are far more likely than seasoned physicians to complain that they struggle to afford to live in Massachusetts. On average, a full-time family physician with 20 or more years in practice made $292,373 a year in the United States, according to 2022 data released by the American Academy of Family Physicians.
But the two groups share at least one thing: a conviction that their employers are increasingly prioritizing business considerations over medical ones, making it harder for doctors to provide the level of care patients deserve.
“What we are both hoping for — and I think not just hoping for, but demanding — is a seat at the table in how we deliver care to our patients and how we are supported in doing that work,” said Dr. Chris Schenck, a second-year resident at Massachusetts General Hospital.
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Schenck is among 2,600 MGB residents and fellows who in 2023 formed a chapter of the Committee of Interns and Residents, or CIR, of the Services Employees International Union. About 400 of them recently held rallies outside Brigham and MGH and accused MGB of bargaining in bad faith as the union seeks its first contract. Schenck, who used a bullhorn to lead a chant of “union power,” said he repeatedly sold his plasma to a blood bank for $100 as a first-year resident to make ends meet on an annual salary of $88,000.
Dr. Chris Schenck, a second-year resident, said he sold his plasma to a blood bank at least six times to help cover his living expenses. He was among hundreds of residents and fellows with the Committee of Interns and Residents who demonstrated on Dec. 5 outside Massachusetts General Hospital and Brigham and Women’s Hospital. David L. Ryan/Globe Staff
Immediately after the rallies, Jessica Pastore, an MGB spokesperson, said her employer was committed to bargaining in good faith. About two weeks later, Pastore said health care organizations across the country are grappling with physicians unionizing as the medical delivery system “continues to encounter enormous stress.”
MGB’s chief executive, Dr. Anne Klibanski, addressed the pressures on doctors during a recent appearance before the state Health Policy Commission. She said primary care physicians are “an extraordinarily over-administratively burdened group of doctors with massive [caseloads] and a lot of chronically ill patients.” MGB, she said, is trying to ease their burdens by allowing doctors to see some urgent care patients online and to rely more on artificial intelligence to take medical notes.
Pastore also said MGB has been adjusting pay for a range of employees, including residents and fellows, whose annual stipend on top of their salaries rose from $3,500 to $10,000 in 2023. The stipend is supposed to help with costs such as housing and child care. “Though health systems across the country are facing unprecedented financial challenges, we understand our greatest resource is our people,” Pastore said.
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Massachusetts is hardly unique in its surge of organizing by doctors. Primary care physicians at Minneapolis-based Allina Health, anesthesiologists at Cedars-Sinai Medical Center in Los Angeles, and residents at Stanford Health Care and Penn Medicine have all recently formed bargaining units.
Two major changes in the US health care delivery landscape have led to unionizing, Schulman cowrote in April in the New England Journal of Medicine.
First, since the 1990s, hospitals have been consolidating to form massive health systems that now have monopolies in many health care markets. Second, since approval of the Affordable Care Act in 2010, these systems have begun to aggressively acquire physician practices.
The result has been a tectonic shift in how such practices are structured, according to Schulman. In 2012, only about 29 percent of US physicians were directly or indirectly employed by a hospital, he cowrote. By 2022, some 74 percent of doctors had become employees of hospitals or corporate entities.
“Most physicians now face the possibly new experience of being employees of increasingly large organizations, a challenging scenario for a profession that has [zealously] guarded its independence and autonomy,” cowrote Schulman. Not coincidentally, he added, more of those doctors are now carrying union cards.
Primary care doctors from Brigham and Massachusetts General Hospital picketed Dec. 13 outside the Brigham. They are trying to unionize Mass General Brigham. David L. Ryan/Globe Staff
The statistics about residents are particularly eye-popping. In the past four years, the number of trainees represented by the Committee of Interns and Residents has roughly doubled to 34,000, according to Dr. A. Taylor Walker, president of the New York-based union, who works part time as a family physician at Cambridge Health Alliance. That’s where she did her residency, which she completed in 2023.
Walker cites the demands placed on residents and fellows during the pandemic as a driving force for the union growth.
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“Residents were really on the front lines of COVID,” said Walker. “I remember walking into my residency and being handed a brown paper bag with five N95 masks, and they said, ‘Wear one per day, and then put it aside for five days and go on to the next mask, and then go back to the first mask after you’ve gone through the rotation.’ I wore those five masks until they literally crumbled in my hand.”
With such experiences fresh in their minds, residents in Massachusetts and Rhode Island are pushing for better pay and benefits.
The residents at MGB, for example, have sought a raise of almost 20 percent over three years, retroactive to July 2023.
Because residents often delay having children due to the rigors of work, MGB trainees are also seeking “fertility and family building benefits,” such as elective egg-freezing, even if they know of no fertility problems.
MGB’s primary care doctors have different goals, according to Dr. Michael Barnett, a primary care physician at the Brigham and associate professor of health policy and management at Harvard T.H. Chan School of Public Health.
Primary care doctors are trying to unionize Mass General Brigham. David L. Ryan/Globe Staff
For one thing, they want MGB to reduce the number of patients they treat and to hire more primary care doctors. Barnett is responsible for 450 to 500 patients even though he only spends about a quarter of his work week in the clinic; the rest of his time he devotes to research and teaching.
The doctors also want MGB to restore innovative programs that kept patients healthy without requiring them to visit the clinic, such as remote blood-pressure monitoring. Barnett said the Brigham had several such programs but scaled them back or scrapped them.
“We feel like we’ve lost autonomy to advocate for things we feel are important,” said Barnett, one of the organizers of the union. “We walk into work one day, and a program we’ve grown to love is dead.”
Jonathan Saltzman can be reached at jonathan.saltzman@globe.com.