On Feb. 10, the same day Mass General Brigham announced that it would lay off hundreds of employees, two veteran physician-scientists who ran a clinical trial center at Massachusetts General Hospital learned they would be dismissed that week.
Dr. David Nathan and Dr. Mason Freeman, both of whom are endocrinologists, said they were floored. Each had worked at the hospital for more than 40 years. MGB, their hospital’s corporate parent, had said the layoffs would involve administrators and managers, and spare front-line medical workers. But as Nathan and Freeman frantically explained to MGB in an email, they oversaw the care of hundreds of sick patients annually who receive experimental treatments at the 18-bed center. The patients have everything from ALS to a rare childhood neurological disorder.
Before the week was out, Nathan and Freeman said, MGB told them it had made a mistake and they wouldn’t be terminated after all. They would remain at the center as codirectors while the health system merged it with a similar unit at Brigham and Women’s Hospital. The two physician-scientists agreed to help the leader of the new combined center during a transition period, although neither of them knows how long that will last or exactly what their status is.
“Maybe I need to grow up, and this is just the way businesses operate,’’ said Nathan, 75, an internationally renowned diabetes expert.
“It’s just not the MGH I was used to. It’s like Elon Musk and the DOGE guys.’’
Jessica Pastore, an MGB spokesperson, said in a statement that Nathan and Freeman’s account of the episode was “inaccurate,’’ but declined to specify how or comment further on the circumstances.
Still, the episode illustrates the upheaval affecting workers at MGB as the state’s largest private employer makes the most layoffs in its history. The dismissals, which are reportedly expected to total 1,500 out of about 82,000 employees, are happening in two waves: the first came in February; the second is scheduled this month.
In the meantime, doctors said they remain uncertain who will run clinical departments and who will be axed.
Many physicians said the corporation, which changed its name from Partners HealthCare in 2019, is making decisions without consulting them and without considering patients’ best interests.
MGB has for several years slowly worked on integrating operations — including emergency medicine, radiology, anesthesiology, and pathology — at the health system’s 12 hospitals. But the effort accelerated a year ago after the system announced it would merge all clinical departments at its two flagship Harvard-affiliated medical centers, MGH and the Brigham. Those two storied hospitals were longtime rivals despite having had the same owner for 30 years.
The consolidation will combine all of MGH’s and Brigham’s 35 clinical departments into about 18 single departments, each with one chief, said Pastore. MGB said the merger contributed to its recent decision to initiate layoffs, as did a projected budget gap of $250 million within two years as a result of costs outpacing revenues.
MGB leaders have said the sweeping reorganization will improve patient care and streamline operations.
For too long, they said, MGH and Brigham competed for patients, trainees, and faculty; quality measures were not standardized; and it was difficult for doctors to refer patients to specialists or for testing outside their own hospital because that might mean lost revenue for their institution.
“If we want to be the best, highest-quality, safest, and most respected health system in the country in service of our patients, the great departments across our academic centers must plan and work together as one,’’ MGB’s chief executive, Dr. Anne Klibanski, said last year.
Several MGB leaders said the consolidation will standardize care regardless of where patients seek it. For example, MGB plans to open a new central laboratory that will enhance the consistency and quality of its 70 million lab tests each year, from routine blood work to complex genetic analyses, said Dr. David Louis, MGB’s head of pathology.
Dr. Patrick Ellinor, who was appointed in December as executive director of the new MGB Heart and Vascular Institute, said he wants to make it easier for patients to quickly make appointments for diagnostic tests, citing the trouble a relative of his recently had obtaining an echocardiogram for heart problems.
Dr. Gerard Doherty, who was named surgeon-in-chief overseeing cancer care at MGB a year ago, said it’s hardly surprising some doctors are unhappy with changes taking place. He said the system has launched three major initiatives: the merging of clinical departments; reduction of administrative layers; and creation of a Mass General Brigham Cancer Institute.
“Any one of those would be distracting and disturbing and a lot of change for people to incorporate into their daily lives,’’ Doherty said.
Although MGB executives said the merger will improve care and position the organization for financial success, a number of doctors expressed skepticism about the direction MGB is heading.
The skepticism isn’t new. A confidential internal survey of physicians at Mass. General conducted in February and March of last year showed that only 33 percent of more than 2,300 physicians agreed with this statement: “I understand the rationale behind MGB integration.’’ The survey resulted in a 59-page report in August recently obtained by the Globe.
The survey found fewer than one-quarter of respondents said they were satisfied with MGB leadership, down from 36 percent in 2021. And only 28 percent said it was “true’’ or “moderately true’’ that their input is valued in important administrative decisions.
The survey was mostly conducted before Klibanski announced in March 2024 plans to combine all clinical departments at MGH and Brigham. That timing helps explain why physicians were largely not on board with the move, MGB representatives say, noting that after the announcement, the organization explained the plans, held a virtual town hall, and received staff feedback.
“Health care is changing rapidly, and we must adapt to ensure we can meet the evolving needs of our patients, our physicians, and our communities,’’ Dr. Marcela del Carmen, president of MGH, said in a recent statement about the reorganization. Integrating departments, she added, will “help our clinicians and staff do their jobs.’’
Del Carmen said MGB began another survey in January that shows more than half of responding physicians “better understand the reasons for integrating, and a greater number have confidence in the future of Mass General Brigham overall.’’ (An MGB spokesperson said the system couldn’t share that survey because it hasn’t been completed and is an internal questionnaire.)
However, several physicians disputed that perceptions of the merger have improved over the past year.
“Morale is as low as I’ve seen it,’’ said Nathan, who spent most of his career doing research. “These mergers were announced as a fait accompli.’’
An MGH pathologist recently told the Globe the reorganization “is a tremendous disruption, and it’s thrown the whole organizational structure into chaos.’’
“Nobody knows who their boss is anymore,’’ said the pathologist, who insisted on anonymity because of the sensitivity of the topic. Nonetheless, the pathologist said, the recently announced layoffs were warranted because of “administrative bloat.’’
The consolidation of MGH and Brigham, which are just 4 miles apart but have operated independently for most of their history, has drawn fire from doctors who fear upheaval, a loss of autonomy, and diminished influence in melded departments.
“I have not spoken to one doctor who is happy with the merger — not primary care doctors, not specialists, not surgeons,’’ said Dr. Mark Eisenberg, a veteran primary care doctor at MGH. “No one wants their boss to be working on the other side of town. . . . If the head of cardiology is sitting at the Brigham, then the Mass. General cardiologists are going to feel sidelined without much opportunity to interact with [their] boss, who will likely look out more for their own troops.’’
Eisenberg also said MGB leaders could have avoided some layoffs if they took salary cuts. At least 16 executives had compensation totaling more than $1 million in 2022, including Klibanski, who received more than $6 million, according to the corporation’s most recent filing with the IRS.
Another critic of MGB’s direction is Dr. Andrea Young, one of nine primary care doctors who recently defected from a single Brigham practice in Chestnut Hill to join a new practice in Wellesley affiliated with rival Beth Israel Lahey Health.
She said Brigham leaders didn’t give the doctors enough time to do their work outside the examining room, including reviewing lab results, calling in prescriptions, and answering questions on the patient portal. For every four hours she treated patients, she said, she spent at least as many hours doing that work. The doctors repeatedly told management their caseloads were too big and their office staff was underpaid, which led to high turnover.
“MGB is running a profit-driven business, not a medical system that’s prioritizing patient care, so the decisions are being made for financial gain and not so much for what patients need,’’ Young said. “That’s the reason that physicians are feeling unhappy.’’
In November, nearly 300 primary care physicians employed by MGB notified federal authorities that they want to join a union, citing “burnout’’ and the “corporatization of medicine.’’
MGB said it has sought to address burnout partly by starting to roll out an artificial-intelligence tool that records patient visits and produces a clinical note within 60 seconds.
For Nathan and Freeman, the codirectors of Mass. General’s Translational and Clinical Research Centers, the increasing corporatization of MGB hit home when they were told they were being laid off. In hastily called meetings, they said, a top administrator thanked them for their contributions but said their jobs were being eliminated.
Nathan and Freeman, both of whom are nearing retirement, said it sounded like the administrator was reading a script.
“It was like that George Clooney movie,’’ Nathan said, referring to “Up in the Air,’’ the 2009 film about a corporate “downsizer’’ who travels around the country laying off people. “ ‘Thank you for your service.’ ’’
Jonathan Saltzman can be reached at jonathan. saltzman@globe.com.
