Officials’ announcement earlier this month that GW reached a preliminary agreement with Universal Health Services to cofund the Medical Faculty Associates marked a critical step toward addressing the University’s mounting financial challenges. After years of stakeholders urging officials to cut monetary ties with the medical enterprise — which sits $444 million in debt and caused GW’s credit rating outlook to drop for the first time in available records — we’re encouraged by the news of ongoing negotiations. But with so much at stake, from the MFA’s central role in GW’s medical education to concerns over UHS’ anti-union labor practices, simply knowing that talks are underway isn’t enough to ease our concerns.

In negotiating with UHS, GW is deepening its relationship with a healthcare management company known for its anti-union stance, history of unfair labor practice charges and a pattern of fostering a negative work environment. GW is also giving up sole ownership of its third patient-facing facility, having sold its remaining 20 percent stake in GW Hospital to UHS in 2022 and entered a 2018 agreement with UHS to open Cedar Hill Regional Medical Center GW Health. Last year, the MFA — which UHS now cofunds with GW under their preliminary agreement — filed a lawsuit against the company, alleging it withheld Medicare reimbursements, a dispute they settled in July. By striking a deal with UHS, GW is placing its physicians under the control of a company deemed “one of the most anti-union health care companies” by a representative for the University’s nurses union.

The MFA is also heavily tied to the success of GW’s medical education. SMHS defines the MFA as its clinical pillar, where “as SMHS faculty members, the GW MFA physicians serve as teachers and mentors for medical students, residents, and researchers.” The MFA is not merely a staffing arm but the crucial link between GW’s medical education and its clinical operations, providing the real-world experience needed to produce the “exceptionally prepared health care professionals” SMHS touts. Under the preliminary agreement, GW will continue funding the MFA’s clinical education — an arrangement officials are likely to prioritize, given the direct link between the medical enterprise and the quality of the Medical School. It will be crucial for the community to closely monitor how this deal affects both medical education and the treatment of employees within the enterprise.

We acknowledge that ongoing negotiations and legal constraints may limit how much GW can currently disclose about its partnership with UHS. But as GW engages with an anti-union company, officials must share as many details as possible and actively seek input from the physicians, students and other stakeholders directly affected by this leadership shift. Above all, we urge GW to remember that while discussions about severing financial ties with the MFA have dominated the conversation, they are not the only priorities the community cares about as all parties weigh the future of the medical enterprise.

To be clear, the MFA’s toll on GW’s finances has been severe, and we’re relieved to see officials taking meaningful action to confront it. The medical enterprise, which GW acquired in 2018, has consistently lost millions of dollars over the last six fiscal years — $100 million in FY2025, $107 million in FY2024, $78 million in FY2023, $78 million in FY2022, $48 million in FY2021 and $43 million in FY2020. These persistent losses prompted GW’s two credit rating agencies to revise their credit rating outlook from stable to negative for the first time in available records — a downgrade that experts warned could prompt the University’s lenders to hike interest rates, add millions of dollars in borrowing costs and reduce long-term investment flexibility. 

News of the MFA’s FY2025 losses and GW’s downgraded credit rating came as the University grapples with a budget deficit that prompted University-wide cuts, staff layoffs and ongoing reductions to campus operations and services. At a time when GW is struggling financially and bracing for hits from President Donald Trump’s higher education policies — including cuts to federal loans and grant programs, declining international student enrollment and a crackdown on diversity, equity and inclusion programs — we believe the University is in no position to keep extending financial support to the medical enterprise. For this reason, we were heartened to see GW taking a meaningful step to disentangle itself.

But that does not diminish our concern over GW’s growing partnership with a company that has mounting accusations of mistreating the University’s nurses and service workers. UHS is a for-profit Fortune 500 and one of the country’s largest hospital management companies. GW first partnered with the company in 1997 to run GW Hospital, and UHS became the sole owner of the hospital when the University sold its minority stake in 2022. GW and UHS also entered an agreement in 2018 with D.C. to open the Cedar Hill hospital, a $434 million facility staffed by MFA physicians and operated by UHS, which D.C. opened in April. As of early July, UHS and the MFA were still negotiating an agreement over the MFA’s staffing of Cedar Hill after the enterprise requested late last year to renegotiate its contract.

The relationship between UHS and GW Hospital’s nurses and service workers’ unions has been a tangled, ongoing mess. Years of allegations — from discouraging union participation and engaging in bad-faith bargaining to firing and disciplining employees for union activity — have kept tensions high. Even after National Labor Relations Board interventions and a December settlement, the nurses’ union filed five new unfair labor practice charges last spring, showing that disputes continue as bargaining resumes. The ongoing pattern makes it clear that UHS’s labor relations remain deeply troubled, a trend reflected in failed unionization efforts at UHS-owned hospitals in Pennsylvania, California and Nevada in recent years.

GW’s talks with UHS underscore a high-stakes tension as the University faces the urgent need to address the MFA’s persistent financial losses while ensuring the quality of its medical education and maintaining fair treatment for its workforce. The deal may help stabilize GW’s finances, but it also ties the University even more to a company with a documented history of anti-union practices, ongoing labor disputes and a reputation for mistreating staff. As the MFA remains central to training the next generation of physicians, the stakes are far higher than just finances — they also include the quality of education and the wellbeing of employees.

Transparency, acknowledgement and active community engagement are essential as GW moves forward because the consequences of this partnership will be felt by medical students, faculty, physicians and other stakeholders. How GW navigates this deal will define not just its finances but the future of its medical school and the lives of the people who run the medical arm of the University.