Once considered free agents with the power to make their own decisions, doctors are increasingly employed by large hospitals and health care systems.
That trend is evident in a dispute between Christus St. Vincent Regional Medical Center and New Mexico Cancer Care Associates, a private group of cancer specialists that provided hospital care under contract for a decade. The cancer clinic intends to remain independent, its leaders said, despite pleas from Christus St. Vincent to come on board.
American Medical Association statistics increasingly show that doctors are foregoing the right to run their own hospital job security shows. But that’s not something the oncologists at New Mexico Cancer Care Associates want to do.
“It’s a recurring theme in medicine,” said Dr. Scott Herbert, an oncologist at the Santa Fe Cancer Clinic, of doctors gobbled up by hospitals. “And we have the opportunity to do that a bit better here.”
The American Medical Association reported that 2020 was the first year in which less than half of the country’s primary care physicians worked in private, wholly physician-owned practices. Physicians in workplaces owned or partly owned by hospitals, systems and other entities rose to 50.2% in 2020 from 41.8% in 2012, the association said.
Young doctors are more likely to work for someone else, the AMA said. Seventy percent of doctors under 40 are employed by a hospital or similar organization, according to the report.
Dr. Angela Bratton, a Los Alamos ophthalmologist and president of the New Mexico Medical Society, said medical schools teach little about business management and many young doctors are intimidated by the costs and challenges of starting a business. from their own office.
In the 1970s, many doctors came out of medical school considering solo practice, she said, because it was such a common pattern at the time. But spending has increased and regulations have increased.
Bratton is part of Eye Associates of New Mexico, a large company owned almost entirely by its physicians. Eye Associates has more than 50 healthcare providers, she said.
She said the size of her group allows her to have operations managers who take care of contracts, regulations, equipment and other things. She has been practicing medicine in New Mexico for nearly 30 years.
Dr. Barbara McAneny, an oncologist in Albuquerque and head of New Mexico’s Independent Hematology Oncology Consultants, said she and her team had no interest in being employed by a hospital. McAneny is a past president of the American Medical Association.
She said her group of seven medical oncologists and eight nurse practitioners are keeping patients out of hospitals at a much higher rate than the national average.
Hospitals have higher fees than independent providers, she said, and institutions like their doctors employed to make internal referrals for hospital care, imaging, chemotherapy and surgery.
“So it’s following the money,” said McAneny, who said he has friends at New Mexico Cancer Care Associates but has no vested interest in the dispute. “Hospitals really want to acquire doctors.”
She said her clinic can structure the practice the way she and her colleagues prefer and at a lower cost.
Hospital care is expensive, she says, “and we can’t keep doing it. This country cannot afford to do that.
“Independent doctors like to be like Switzerland,” she said. “We would like to remain independent.”
Dr. Jason A. Call, a radiation oncologist employed by Memorial Medical Center in Las Cruces, said the job at the hospital “seemed very well suited to my situation.”
Call, 42, and his wife moved to Las Cruces to be closer to her parents and found working for a hospital suited her needs.
“I just take care of the patients I have, and it works,” he said. “I don’t wake up at night wondering if we’re going to do the bills and if the numbers are going to work.”
He said his hospital treats him well and gives him the tools and equipment he needs. He said his support staff are excellent. Granted, he said, “You don’t have as much control” over the operation, but that also relieves him of some of the headaches of overseeing a business.
Locally, the clash between Christus St. Vincent and Cancer Care Associates involves a variety of issues, including whether the independent team of four full-time oncologists, two part-time oncologists and two nurse practitioners will join Christus as employees.
Christus St. Vincent plans to build his own cancer center in two years on his campus off St. Michael’s Drive, and he has already hired one of the clinic’s oncologists as well as one of its nurse practitioners.
The hospital said in a statement Friday that the clinic, based at 490 W. Zia Road, “informed us months ago of their desire to step away from their exclusive relationship with Christus” and to “form a type different from a group of independent physicians”.
Christus St. Vincent said he “respects their decision to become entrepreneurs in a new venture. We, on the other hand, appreciate that some vendors have chosen to leave the NMCCA to support Christus St. Vincent’s commitment to fully integrated cancer care.
Clinic leaders said late last week that Presbyterian Health Services built a hospital in Santa Fe in 2018 that they wanted the freedom to serve both facilities. Herbert said doctors at the clinic currently do not have practice privileges at Presbyterian and have an exclusive agreement with Christus St. Vincent.
“Our goal is to park in the middle and go to both,” he said. Having two hospitals is “a win for this community”, he said.
Dr. Kat Chan, practice chair at the cancer clinic, said independence gives her operation the flexibility to change quickly for challenges like the coronavirus pandemic, to “set the tone” of the place, modify workflow gaps and hire and train staff. . “And it doesn’t take any approval” from hospital management, she said.
Christus St. Vincent said he would terminate the clinic’s contract at the end of May, seven months before its scheduled end. Clinic leaders say this will leave “thousands” of cancer patients without their oncologists, at least for a while.
“We would like to avoid the courts,” Chan said.
Christus St. Vincent spokesperson Arturo Delgado wrote in a text Friday that the hospital has “three oncology providers currently caring for patients and we will have a 6-7 team by ‘summer”.
The hospital said several independent groups, including those in emergency medicine and cardiac care, have long-term contracts with Christus St. Vincent. The hospital “appreciates these important relationships,” the statement said.
The hospital statement also said: “During this transition, we are working hard to ensure that contractual changes will not affect a patient’s ability to continue to see the provider of their choice, or disrupt care. and treatment.”
Herbert said his patients are worried about what will happen when June arrives and that Cancer Care Associates no longer has a contract with Christus St. Vincent, the largest hospital in the upstate.