Christus, cancer clinic battle reflects trend toward employed docs

By Rick Ruggles rruggles@sfnewmexican.com

Apr 16, 2022 Updated Apr 18, 2022

Once viewed as free agents who had the clout to call their own shots, physicians increasingly are employed by large hospitals and larger health care systems.

That trend is evident in a conflict between Christus St. Vincent Regional Medical Center and New Mexico Cancer Care Associates, a private group of cancer specialists that has provided care to the hospital by contract for a decade. The cancer clinic intends to stay independent, its leaders said, despite Christus St. Vincent’s entreaties to come aboard.

Statistics from the American Medical Association show more and more, physicians are giving up the right to run their own shows for the security of hospital employment. But that is not something the oncologists at New Mexico Cancer Care Associates want to do.

“That is a recurrent theme in medicine,” Dr. Scott Herbert, an oncologist at the Santa Fe-based cancer clinic, said of physicians being gobbled up by hospitals. “And we have an opportunity to do it a little better here.”

The American Medical Association reported 2020 was the first year in which fewer than half of the nation’s patient care doctors worked in private practices wholly owned by physicians. Physicians in workplaces owned or partly owned by hospitals, systems and other entities rose to 50.2 percent in 2020 — up from 41.8 percent in 2012, the association said.

Younger doctors are more inclined to work for someone else, the AMA said. Seventy percent of physicians younger than 40 are employed by a hospital or similar organization, the report said.

Dr. Angela Bratton, a Los Alamos ophthalmologist and president of the New Mexico Medical Society, said medical schools teach little about how to run businesses, and many young doctors are daunted by the costs and challenges of setting up their own practices.

In the 1970s, many doctors came out of medical school envisioning a solo practice, she said, because that was such a common model then. But expenses rose and regulations increased.

Bratton is part of Eye Associates of New Mexico, a large business owned almost entirely by its doctors. Eye Associates has more than 50 health care providers, she said.

She said the size of her group enables it to have operations managers who deal with contracts, regulations, equipment and other things. She has been practicing medicine in New Mexico for close to 30 years.

Dr. Barbara McAneny, an Albuquerque oncologist and head of the independent New Mexico Oncology Hematology Consultants, said she and her team have 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 keeps patients out of hospitals at a much higher rate than the national average.

Hospitals have higher fees than independent providers, she said, and the institutions like their employed doctors to make in-house referrals for inpatient care, imaging, chemotherapy and surgery.

“So, it’s follow the money,” said McAneny, who said she has friends in New Mexico Cancer Care Associates but has no direct stake in the conflict. “Hospitals very much want to acquire physicians.”

She said her clinic can structure the practice as she and her colleagues prefer and at lower cost.

Hospital care is expensive, she said, “and we can’t keep doing that. This country can’t afford to do that.”

“Independent physicians 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 hospital employment “seemed to be a very good fit for my situation.”

Call, 42, and his wife moved to Las Cruces to be closer to her parents and found working for a hospital met his needs.

“I just take care of the patients that I have, and that works out,” he said. “I don’t wake up at night wondering if we’re going to make the bills and if the numbers are going to work out.”

He said his hospital treats him well and gives him the tools and equipment he needs. He said his support staff is 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 its own cancer center in two years on its campus off St. Michael’s Drive, and it already has hired away one of the clinic’s oncologists as well as one of its nurse practitioners.

The hospital said Friday in a statement the clinic, based at 490 W. Zia Road, “informed us months ago of their desire to move away from their exclusive relationship with Christus” and “form a different type of independent physician group.”

Christus St. Vincent said it “respected their decision to become entrepreneurs in a new endeavor. We, on the other hand, appreciate that some providers have chosen to leave NMCCA to support Christus St. Vincent’s commitment to fully integrated cancer care.”

Clinic leaders said late last week, with Presbyterian Healthcare Services having built a Santa Fe hospital in 2018, they wanted to be free to serve both facilities. Herbert said the clinic’s doctors currently don’t have practice privileges at Presbyterian and have an exclusive arrangement with Christus St. Vincent.

“Our goal is to park ourselves in the middle and go to both,” he said. Having two hospitals is “a win for this community,” he said.

Dr. Kat Chan, president of practice 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, to tweak workflow deficiencies and to hire and train staffers. “And that doesn’t take any stamp of approval” from hospital leadership, she said.

Christus St. Vincent has said it will terminate the clinic’s contract in late May, seven months before it was expected to 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,” said Chan.

Christus St. Vincent spokesman Arturo Delgado wrote in a text Friday the hospital has “three oncology providers caring for patients currently and we will have a team of 6-7 by the 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 “values these important relationships,” the statement said.

The hospital statement also said: “During this transition, we are working hard to ensure that the contractual changes will not affect a patient’s ability to continue to see the provider of their choice, or otherwise disrupt care and treatment.”

Herbert said his patients are worried about what will happen when June arrives and Cancer Care Associates no longer has a contract with Christus St. Vincent, the largest hospital in the northern part of the state.