At the second largest Massachusetts hospital system, Beth Israel Lahey, president and CEO Kevin Tabb saw a reported 25% pay decrease between 2020 and 2022, according to tax documents reported through GuideStar. Though his compensation dropped to $2.8 million in 2022, it briefly spiked to $5.3 million in 2021.

While there might not have been sufficient financial pressure for the sprawling 12-hospital system to overcome the hurdles of integration before, there certainly is now.

Mass General Brigham announced layoffs for hundreds of administrative and management employees on Monday in anticipation of a $250 million budget gap, an unprecedented decision for Massachusetts’ largest private employer.

Wentworth-Douglass Hospital was not spared from layoffs by Mass General Brigham as it cited an anticipated "budget gap" of $250 million.

MGB said the layoffs are necessary to get ahead of an anticipated budget shortfall of $250 million over the next two years.

Mass General Brigham attributed the layoffs to an expected budget shortfall of $250 billion over the next two years.

At least three high-level employees at Nantucket Cottage Hospital left abruptly recently, after the parent company of the island's only hospital announced layoffs last week.

The layoffs could potentially impact employees at 12 hospitals under the MGB umbrella: While executives say the sweeping cuts are aimed at management and administrative-level employees with no impact on front-line workers, Boston University School of Public Health’s David Rosenbloom suspects the changes could reach patients.