On April 1, the Edwards-Elmhurst Hospital Health system will replace fifteen physicians at seven immediate care clinics in the Chicago suburbs with lower-cost nurse practitioners (NPs).
Hospital administrators informed the physicians of their job terminations at a meeting in November, according to one physician who asked not to be named. The physician, who is a member of the organization, Physicians for Patient Protection, said administrators told them the move would save the hospital one million dollars over the next few years.
“We were offered no severance or other positions at the hospital,” the physician said.
The physician said it was not clear whether the hospital would enforce the non-compete clause physicians had to sign as part of their employment contracts. The clause prohibits physicians from working for a competing health care organization for two years after employment within a 30-mile radius, according to the physician.
A letter sent to physicians signed by CEO Mary Lou Mastro, a registered nurse, and Robert Payton, M.D., the hospital’s chief medical officer, stated “patient cost concerns” were the main driver behind the move, according to a November 26, 2019 article in Medpage Today.
“Patients have made it very clear that they want less costly care and convenient access for lower-acuity issues (sore throats, rashes, earaches) which are the vast majority of the cases we treat in our Immediate Cares,” the letter stated.
Health Care News asked hospital spokesperson, Keith Hartenberger if the hospital offered the physicians jobs in other divisions, whether the price at the clinics will be lowered, what physicians will be overseeing the nurse practitioners, whether the hospital will enforce the non-compete clauses, how much of the decision was driven by under-reimbursement by third party payers, and how patients have responded to the move.
Keith Hartenberger, the hospital’s spokesperson, replied with a general statement.
“We continue to assess our care delivery models in the interest of providing cost-effective care to our patients,” Hartenberer said. “We shared with physicians that we have plans to change the model at some outpatient sites and are working with anyone affected to find alternative placement. Any advanced practice clinician working at Edwards-Elmhurst Health only does so under the supervision of a physician.”
Replacing Not Supplementing Care
The physician who spoke to Health Care News said it is an unsettling trend in health care to assume non-physician providers can replace physicians. NPs and physician assistants (PAs) have traditionally served in a collaborative role.
“Many of these NP programs are popping up, some are non-accredited and there are no measures for quality control,” the physician said. “You can become an NP with 500 hours of training and a PA with 3,000 hours. Physicians, on the other hand get 15,000 minimal clinical training over a minimum of seven years of clinical training, medical school and residency.”
One area where the extra clinical training may be critical is in the detection of heart attacks, said the physician. “Heart attacks can present very unusually. Sometimes it’s jaw pain, sometimes pain in the shoulder, or nausea. With extensive training, you learn to think out of the box and expand the differential diagnoses.”
While training is a valid point, NPs and non-physician providers have an important role in health care, says Matt Glans, senior policy analyst at The Heartland Institute, which publishes Health Care News. “Allowing nurse practitioners to administer care under an expanded scope of practice would greatly reduce the growing health care and physician shortage and increase access to care,” says Glans. “Nurse practitioners are not the single answer to improving health care availability, but they can be an important part in solving the problem”.
In a number of states, NPs can write prescriptions and work independently after a certain number of clinical hours. Until that time, NPs must work under the supervision of a physician,
A Quest to Save Money
Edwards-Elmhurst Health is not the only health organization to replace physicians with non-physicians. A Dallas television station reported 27 pediatricians were let go at a chain of clinics in 2018. Atrium Health in 2018 ended a 40-year contract with a 90-member physician group to work with an organization, Scope Anesthesia, which forms partnerships with certified registered nurse anesthetists.
Chad Beste, a partner with BDO Healthcare Advisory Practice told Chicago Business News in a December 6, 2019 article, “a lot of these urgent care facilities, you have to see a high volume of patients to break even with an M.D.”
Deane Waldman, M.D. lobbied for expanding the market for mid-level providers in Texas after he reviewed 120 articles and published studies assessing the quality of their care.
“For the majority of minor illnesses and for triage, [a mid-level provider] is quite adequate, however, they should always have the ready ability to discuss with an experienced physician.,” said Waldman
Mid-level providers can be particularly helpful with triage in hospital and clinic settings and in rural areas where there may not be a physician, says Waldman. “But again, there should be ready access to discuss with a physician by tele-technology.”
Chad Savage, M.D., founder of Your Choice Direct Care and policy advisor to The Heartland Institute says it is surprising that the quest to save money is happening in a country that spends $3.6 trillion a year on health care.
“Brazil will hire Cuban doctors to take care of the poorest of the poor in its country but in the U.S., you can go to the most expensive hospitals and you get an NP,” Savage said.