When Don Cue developed a bladder an infection final fall, he known as his longtime urologist’s workplace for a urine tradition and antibiotics. It was a well-recognized routine for the two-time prostate most cancers survivor; infections weren’t unusual since he started utilizing a catheter that connects to his bladder by way of an incision in his stomach.
When Cue known as this time, a receptionist instructed him that his doctor, Dr. Mark Kellerman, now not labored on the Iowa Clinic in Des Moines, a big multi-specialty group. She refused to reveal the place he’d gone.
“As a patient, ‘scared’ is too strong a word, but my feeling is, ‘What do I do now?’” stated Cue, 58.
Flummoxed, he solved his instant downside by taking leftover antibiotics he had in his medication cupboard.
It was solely later that he discovered his physician had been fired by the Iowa Clinic and deliberate to begin a urology follow with clinic colleagues. And, below the phrases of their contract with their former employer, the medical doctors have been banned for a 12 months from training inside 35 miles of the clinic and from recruiting former sufferers to observe them.
Contracts with so-called restrictive covenants at the moment are frequent in medication, though some states restrict their use. Noncompete clauses — frequent in lots of industrial sectors — purpose to cease physicians or different well being care professionals from taking sufferers with them in the event that they transfer to a competing follow close by or begin their very own. But what could also be good for enterprise is dangerous for affected person care — and definitely disquieting for these whose medical doctors merely disappear.
One survey of practically 2,000 main care physicians in 5 states discovered that roughly 45 percent have been certain by such clauses.
Continuity of care is vital, medical doctors say, particularly for sufferers with ongoing medical points. Cutting off entry to a physician is totally different from disrupting somebody’s relationship with a favourite hairstylist or cash supervisor, they are saying.
“When doctors want to move from one practice to another, if they’ve got good therapeutic relationships with their patients, you’d think that public policy would want them to continue to treat these patients that trust them,” stated Judy Conti, authorities affairs director on the National Employment Law Project.
Charlie Wittmack, a lawyer at Hartung Schroeder in Des Moines, is representing Kellerman and the 2 different urologists who have been additionally fired in a lawsuit towards the Iowa Clinic. The wrongful termination go well with asks the court docket to declare the physicians’ restrictive covenant provisions unenforceable. Wittmack stated the controversy there was “tragic” for sufferers. “These are people who have prostate cancer or are in extreme pain because of kidney stones or have blood in their urine.”
Ed Brown, the clinic’s CEO, stated the noncompete agreements aren’t nearly enterprise but additionally assist be certain that the Iowa Clinic can present dependable companies.
“Noncompetes are good for the patients because they help to provide stability within a practice and ensure continuity of care,” Brown stated lately in an electronic mail. Further, he added, noncompetes defend physicians by making certain that different physicians within the follow are dedicated to the identical settlement and might’t abandon it with out correct discover.
The urologists “believe they can make more money elsewhere, and they don’t want to be held to any contractual responsibilities,” he stated.
Even when longtime sufferers go sleuthing to search out their medical doctors’ new places of work, they is probably not accepted into these practices. Hospitals and clinics say they’ve little selection however to respect the phrases of enterprise agreements that others have negotiated.
UW Health, the well being care system for the University of Wisconsin-Madison, lately employed three main care medical doctors who had labored throughout city, stated Dr. Sandra Kamnetz, vice chairwoman of medical take care of the Department of Family Medicine and Community Health on the University of Wisconsin’s School of Medicine and Public Health. They are taking nice pains to not deal with any of the brand new medical doctors’ former sufferers as a result of the phrases of the medical doctors’ contracts with their previous employer prohibit them from caring for former sufferers for 2 years.
Staff on the UW clinics ask potential sufferers in the event that they’ve ever been seen by one of many medical doctors. They then verify the affected person’s digital well being file to verify there are not any messages, prescription refills or different latest contact with the brand new UW Health medical doctors and that affected person on the earlier job, stated Kamnetz.
When Don Cue known as his longtime urologist in Des Moines to get an appointment, the receptionist stated the physician now not practiced there and wouldn’t clarify why or the place he had gone.
“Patients get frustrated, but what they may not understand is that this is a legal thing that we have to abide by,” she stated.
Whether noncompete clauses are binding in well being care — particularly when affected person care is disrupted — is some extent authorized students debate. In common, to be enforceable, the agreements have to be cheap and narrowly drawn in order that they defend an employer’s authentic enterprise curiosity however don’t unduly limit a physician’s capability to make a dwelling.
Courts could weigh whether or not imposing a noncompete clause would create a doctor scarcity in a selected area or specialty. The tenet is affected person selection, stated David J. Clark, a companion within the New York workplace of the legislation agency Epstein Becker Green who has analyzed state noncompete statutes in well being care.
“No court is going to deny a patient who wants to go see a doctor of her choice,” Clark stated.
Most disputes are settled earlier than they make it to court docket, nevertheless.
A latest report by the Trump administration evaluating learn how to promote selection and competitors in well being care advisable that states study noncompete agreements for his or her impact on sufferers’ entry to care and the provision of suppliers.
Several states, together with Massachusetts and Colorado, that permit noncompete clauses in employment contracts typically gained’t implement them towards medical doctors, in keeping with Clark’s evaluation.
Other states, equivalent to Texas and Tennessee, place limits on the agreements. In Texas, for instance, a noncompete pact should permit medical doctors to have entry to a listing of their sufferers prior to now 12 months and entry to their medical data, amongst different issues, Clark discovered.
Medical board guidelines take it a step additional. “In Texas, when a physician leaves, the practice is required to cooperate with a physician who wants to put up a notice that says this is where that physician can now be contacted,” stated Kathy Poppitt, a companion within the well being care and authorities and inside investigations practices on the Austin, Texas, workplace of King & Spalding.
The American Medical Association, which represents medical doctors, doesn’t oppose restrictive covenants outright, though its coverage notes they’ll restrict sufferers’ selections. “To the extent that these agreements disrupt continuity of care and disrupt patient choice, this is of great concern to the AMA,” stated Dr. Patrice Harris, the group’s president-elect.
For sufferers in central Iowa, the departures of longtime urologists on the Iowa Clinic is dizzying. After Kellerman and his colleagues left, 5 of the clinic’s remaining seven urologists submitted their resignations. They are additionally topic to noncompete restrictions. They left the follow in mid-February.
Brown, the clinic CEO, stated the urology division has changed 4 of the eight urologists and has 9 nurse practitioners or doctor assistants to deal with sufferers. The clinic is constant to recruit physicians and superior follow suppliers like nurse practitioners.
Susan Murphy, 72, has seen quite a lot of medical doctors within the urology division. Dr. Richard Glowacki, one of many urologists who left with Kellerman, carried out surgical procedure to take away her kidney stones greater than a decade in the past. Another, Dr. Stephanie Pothoven, did surgical procedure to restore her prolapsed uterus a number of years in the past.
Murphy stated she acquired a letter from Pothoven asserting her departure. It didn’t present particulars about the place she can be going.
“I’ve got it etched in my brain to find out where they went,” she stated. She has no plans to return to the Iowa Clinic. “Somehow they lost sight of patient care and were more concerned about the bottom line,” she stated.