Year one of Carilion Clinics bid to convert to a physician-led facility has been marked by ongoing opposition from area doctors and an urgent push to launch Virginias fifth medical school.
Since unveiling plans in June 2006 to put doctors at the head of the seven-hospital Roanoke, Va., system, Carilion Clinics architects have met with vocal resistance from independent doctors who work in Carilions hospitals and see the switch as a threat to private practice. But dissent has not stopped Carilion from aggressively recruiting specialists during the past 12 monthsor from expanding an already sweeping, costly five-year initiative to include a proposed five-year medical school.
Edward Murphy, M.D., Carilions president and chief executive officer, acknowledged the opposition from southwest Virginia doctors, but contends critics have not slowed the conversion. He cited the clinics steady physician hiring as evidence of Carilions progress. In the past year, the clinic recruited 77 doctors, nearly double Carilions annual average, he says. Recent recruits include doctors in roughly 50 specialties and subspecialties, such as neurosurgery, pediatric gastroenterology and cardiovascular surgery, according to the clinic. Murphy says recruiting in the clinics second year may keep pace with the first. It wouldnt surprise me if we did, he says.
Six of Carilions clinical chairs were recruited from outside the clinic, he added. Its been very busy, Murphy says. Its gone very well.
Nearly one year ago, Carilion executives said the systems financial survival hinged on a dramatic overhaul of its operations; the system had $1.4 billion in assets as of 2005. Officials announced plans to create a not-for-profit, Carilion Clinic Physicians, to run operations; expand its campus; hire specialists and subspecialists; and start a research joint venture with Virginia Tech University.
The plan grew more ambitiousand more expensivein January when Murphy and Virginia Tech President Charles Steger announced the partners would establish a medical school with an emphasis on research by 2010 at a cost of $30 million to $50 million. To stay on schedule, officials must draft a curriculum and file an accreditation application by April 2008, Murphy says, a task he admits is a big body of work.
Carilions success at adding doctors to its payroll has been shaken by recent high-profile departures.
Since March, two private practice groups have bolted from Carilion to work at rival 521-bed Lewis-Gale Medical Center, an HCA-owned hospital in nearby Salem, Va.
We said No thank you, says Jim Blackwell, M.D., president of Radiology Associates of Roanoke. The 60-year-old doctor is one of more than a dozen from Radiology Associates of Roanoke who jumped to Lewis-Gale in March. Blackwell called Carilions employment and contract offers dictatorial and coercive. We dont owe it to (Carilion) to sell our business or to become an employee.
Vistar Eye Center followed the radiologists in early June. Frank Cotter, M.D., an ophthalmologist with Vistar, in a Roanoke Times editorial called the groups decision to discontinue its emergency call service for Carilion and switch to Lewis-Gale a new future for our companyone that limits Carilions ability to harm us.
A third medical group has successfully applied for privileges at Lewis-Gale, but the internal medicine doctors have not broken ties with Carilion, says Lawrence Monahan, M.D., with Jefferson Internal Medicine in Roanoke.
The departures follow months of organized opposition from area independent doctors. Within months of unveiling Carilions proposed conversion, opponents formed the Coalition for Responsible Healthcare, which launched a Web site and ad campaign. Critics have questioned the clinics price tag and say the clinic threatens to monopolize Roanokes market and alienate independent doctors.
Its a charge Murphy denies.
Its going to remain an open medical staff, he says. If you dont want to have anything to do with the clinic but you still want to work here, thats OK too, he says.
Geoffrey Harter, M.D., a Roanoke ear, nose and throat doctor and coalition spokesman, says independent doctors have met with clinic executives to discuss independent doctors futures and do not trust the clinic to remain open. Regardless of what they say, even if they came out with the sweetest sounding statements in the world, they are disingenuous, Harter says.
James Thweatt Jr., Lewis-Gales CEO, declined to comment, says Mark Foust, an HCA spokesman.
Carilion Clinic also suffered a financial setback in fiscal 2006, which ended Sept. 30. After watching operating income spike roughly 300% to $35.1 million in 2005 from $8.5 million in 2003, the clinic saw its 2006 operating income drop 17% to $29.1 million despite an 11% increase in operating revenue.
Despite rocky relations with private medical groups in Roanoke, Mark Werner, M.D., Carilions executive vice president and chief medical officer, called the clinics inaugural year a success. I think our first year, from my perspective, exceeded my expectations. Carilion overhauled its budget process in April to put doctors in charge, he says. The influx of doctors has strained the clinics space, he says, meanwhile, clinic chairs have been asked to set at least three strategic objectives for the coming year.
Carilion executive and clinic critics say that the radiologists exit from 723-bed Carilion Medical Center in Roanoke disrupted patient care, but disagreed on to what degree. Weve responded as well as anybody could have, Werner says. Radiology Associates of Roanoke gave the hospital a 90-day notice before leaving, he says. To meet demand, Carilion Medical Center has relied on temporary doctors, teleradiology and contracts with a handful of doctors who have departed, he says. Many on the medical staff do understand that some physicians have made hasty or premature decisions, Werner says.
Opposition from Roanokes independent doctors didnt put off Anthony Slonim, M.D. The former executive director of the Center for Clinical Effectiveness at the 188-bed Childrens National Medical Center, a Washington pediatric hospital, successfully inquired about a job with Carilion. He arrived in early April as its vice president of medical affairs.
Slonim, who was also previously vice chairman of pediatrics at George Washington Universitys School of Medicine and Health Sciences, called resistance to Carilions conversion an important consideration, but not one so great that he balked at getting in on the ground floor of what he considers to be an effort to revolutionize healthcare delivery. Anything worth fighting for is worth fighting for, he says.