Cutting the cord: Doctors pursuing independent status

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by Eric Olson|ret||ret||tab|

SBJ Reporter|ret||ret||tab|

eolson@sbj.net|ret||ret||tab|

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Enticed by the idea of business ownership, physicians are breaking away from large community health systems to operate as independents. This trend appears to be a reversal of the mid-1990s trend, which was a reaction to managed care's entrance into the Springfield area market.|ret||ret||tab|

Greene County Medical Society President Dr. Marsha Taylor calls it a "shake-down" of the 1990s' trend in which physicians flocked to hospitals to take advantage of HMOs and other insurance plans.|ret||ret||tab|

"You have physicians who have an entrepreneurial spirit and want to maintain their own desires to have a larger say in their business life," said Taylor, who is an employed physician at CoxHealth in Nixa. "You see a flux of that."|ret||ret||tab|

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The doctor is out|ret||ret||tab|

Both St. John's and CoxHealth have recently dealt with physician departures.|ret||ret||tab|

A group of seven neurosurgeons, operating as Springfield Neurological and Spine Institute LLC, ceased affiliation with St. John's Health System last fall.|ret||ret||tab|

According to a St. John's news release, the health system accepted the doctors' resignations Oct. 31 over differences regarding emergency trauma center on-call responsibilities, which are required by St. John's Medical Staff bylaws.|ret||ret||tab|

Dr. Mark Crabtree, managing member of the seven-member neurosurgery group, said at the root of the dispute was the quantity of trauma calls required of the neurosurgeons.|ret||ret||tab|

"It was a very big difference in philosophy that caused us to go different ways. We said, basically, we'd stay on staff, but we weren't going to take as (many trauma) calls as they wanted us to," Crabtree said.|ret||ret||tab|

In other words, the independent physicians' group of more than 25 years was not going to act as hospital employees, though they were on St. John's active medical staff.|ret||ret||tab|

"We've always been independent," Crabtree added. "We see advantages to independent physician practices."|ret||ret||tab|

Their St. John's staff positions were officially terminated Dec. 31, and now the neurosurgeons have a primary affiliation with CoxHealth, said Brian Williams, Springfield Neurological and Spine Institute president.|ret||ret||tab|

Numerous phone calls to St. John's seeking administrative comment on this issue were not returned as of press time.|ret||ret||tab|

Williams said CoxHealth administration provides a favorable environment for independent physician groups.|ret||ret||tab|

"Cox has chosen to work with us to continue to build this group," Williams said. "St. John's probably should have, too, for the good of the community. It is a tragedy, and I don't think either one of us have anything to be proud of."|ret||ret||tab|

According to CoxHealth spokesperson Laurie Cunningham, CoxHealth has a proactive model in approaching the trend toward independence.|ret||ret||tab|

"We see a variety of ways to work with physicians, whether they are employed or independent or contracted," Cunningham said. "We see that as having been a positive way to approach our business."|ret||ret||tab|

While Ozarks Area Orthopaedics Associates has discontinued employment at CoxHealth and plans to build its own 45,000-square-foot orthopedic clinic, Cunningham said the group likely will remain affiliated with CoxHealth.|ret||ret||tab|

"For now they have chosen a direction that works best for them, and I believe Cox will continue to work with physicians in the manner in which we have been successful," Cunningham said.|ret||ret||tab|

Ozarks Area Orthopaedics Associates' managing member Dr. Paul Olive could not be reached for comment.|ret||ret||tab|

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Pros, cons|ret||ret||tab|

Doctors say the biggest advantage to practicing as independent physicians is the autonomy it allows, from front-office operations to technology and marketing efforts.|ret||ret||tab|

"You can affect your own outcome without worrying about retaliation, and speak for what you know is right," said Dr. Gil Mobley, who has been on both sides of the fence. Being independent has allowed him to bypass the "red tape and middle management" in corporate medicine.|ret||ret||tab|

Mobley is medical director of Concentra Medical Center; he was an emergency trauma doctor employed by St. John's for about six years. Mobley resigned under fire in 1992, and he still doesn't speak fondly of the physician-hospital relationship.|ret||ret||tab|

"If you've got a mind and a mouth, you are not going to get along with (the administration) at St. John's. They would take it out on individuals that would speak out for legitimate patient advocacy," Mobley said, recalling a specific trauma conference meeting during the hospital's budget crunch of 1989. |ret||ret||tab|

The trauma-care physicians were informed that St. John's administration was planning to terminate or severely cut back the patient-family representatives "whose sole job was to relay compassion to the patients in the emergency department, frequently during a trauma," Mobley said.|ret||ret||tab|

Mobley fought the cutbacks and immediately felt opposition. The family-patient representative position did get reinstated, but Mobley said the confrontation was an early sign of things to come. He later sued St. John's for contract interference, but dropped the suit in 1993.|ret||ret||tab|

Although today he is an employee of Concentra, which bought out his north side occupational medicine practice in 2001, Mobley said he has full control of the Springfield office as medical director. And he has made amends with St. John's administration after a turnover in top personnel. |ret||ret||tab|

On the flip side, hospital employment offers financial security, which is appealing especially for physicians just entering the health force, according to American Medical Association spokesperson Robert Mills.|ret||ret||tab|

For Dr. John Bentley, an employed St. John's physician for eight years of his 35-year affiliation there, extra stress came with the steady paycheck.|ret||ret||tab|

"It was a mixed blessing," Bentley said. "We did end up with financial stability, but the hospital's control of our overhead and their demands on our productivity, the two areas where we got stressed, were, I think, a little greater than we thought."|ret||ret||tab|

But Bentley, now clinical medical director of Jordan Valley Community Health Care Center, said hospital administrations have improved relationships with physicians.|ret||ret||tab|

"They are listening better and they're trying hard to allow physicians some leeway in their productivity," said Bentley, who was among the doctors who sold their practices to St. John's in the early 1990s.|ret||ret||tab|

"The last couple years I was there we were able to sit down and really negotiate," he added. "In the beginning, hospitals said, in a sense, Take it or leave it.' They're not as hard-nosed about it."|ret||ret||tab|

And most doctors that go independent retain some sort of affiliation with the health system, Taylor said.|ret||ret||tab|

"It is very unusual to see someone who is independent who doesn't maintain any contracts with health systems or with a hospital," Taylor said. "For a lot of specialties, it's almost a have to.'"|ret||ret||tab|

What it boils down to is the right business environment for each physician, Taylor added, and that is the Greene County Medical Society's mission.|ret||ret||tab|

"Physicians are making choices based on what best fits their personal and business needs," Taylor said. "I think you're just seeing people move within what options are available for them to do."|ret||ret||tab|

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