Physicians who aren't referring patients to Raleigh (N.C.) Community Hospital say they are being told by the hospital's parent company to find office space elsewhere.
Duke University Health Systems, which owns Raleigh Community, won't renew the leases for about 16 physicians who rent the offices, which have 190,000 square feet and are owned by the hospital. Representatives of the health system say it wants to fill the hospital, and one way to do that is to get physicians on campus who will use its services.
"I'm impressed with the myopia on the part of Duke University," says William Ketcham, M.D., a dermatologist with Cardinal Healthcare, a 60-physician medical group, who was told that his lease would not be renewed. Not all of Cardinal's doctors have offices in the RCH buildings.
Duke has extended some of the leases until physicians can find new office space. Some physicians have already moved their offices.
But Michael Israel, Duke's chief executive, says the decision is not about referrals.
"We're not ending leases," Israel says. "We are not renewing leases of people who don't use the hospital. You may use the word 'refer,' but there's a fine line, a big difference in thinking."
There is a shortage of office space on the RCH campus, he says. The offices near the hospital are for physician and patient convenience, Israel says. "The reason they're on campus is to make it more convenient for patients to utilize services in RCH and for physicians who utilize RCH," he says. "This is really not being looked at from a perspective of 'you as a bad doctor, you don't refer, you can't be in my building.' If we had an abundance of space, it would be a different situation."
He says that it doesn't make sense for doctors who aren't using RCH to be next to the hospital. The closest office building is about 15 yards from the hospital, Israel says.
"Having space in the building should not be viewed by anyone to be an inducement to use the hospital," Israel says. "We want physicians in the building who want to be in the building. . . . It's located next to a first-class hospital. They can see their patients in inpatient and outpatient settings by just running across the driveway."
Israel says he is sorry that people are being inconvenienced. "I'm sure that's taken as hollow by the people who have had to pick up and move their offices," he says. "No one is attempting to be mean-spirited. We're attempting to be practical to get the maximum utilization out of the resources that exist to make the health system work the best way it possibly can."
Ketcham, who has until the end of November to move, says he doesn't understand that reasoning, since the orthopedics department of his group refers patients to RCH. He says he is puzzled about why Duke would want to irritate Cardinal.
"I've never heard of this," Ketcham says. "It seems nearsighted. How many friends is Duke going to make? I can't imagine people's memories are that short. . . . There would be more diplomatic ways of dealing with it, I think." Ketcham is looking for office space, and while some providers have found offices close to their old locations, he isn't sure where he will end up.
Hospitals that do this risk invoking the ire of physicians, but they likely won't irritate other physicians who aren't directly affected, says Karen Miller, a partner with the Pace Group, a Dallas-based consulting group. "While (doctors will) collaborate in the halls and gather when the rubber hits the road, (they) will make independent entrepreneurial decisions," she says.
This strategy to increase hospital utilization isn't often seen, Miller says. But it is likely one method of increasing use of a particular hospital and to "participate more fully in the healthcare delivery design," she says.