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.

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

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

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.

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.

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