Patients may suffer as doctors switch practices, health systems

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A few weeks ago, a staff member at Pittsburgh Medical Associates in Banksville phoned Rose Marie Angelo to tell her an appointment with her longtime family physician had been cancelled.

"They proceeded to tell me he was no longer with Pittsburgh Medical Associates," she recalled recently. "I said, 'Where is he?'

'We don't know.'

'What do you mean you don't know?'"

The office offered to schedule her to see another physician there, but Ms. Angelo would have none of that.

"I have been calling everyone and everywhere to try to find out where he is. This is terrible!"

Ms. Angelo moved to Beaver County last winter but continued to make the trip to town because of her regard for her physician, Tom Bonacorsi. "I've been continuing to see him and I will continue to do so if I can find him," she said.

Her friend, Darlene Taylor, who had recommended the doctor to Ms. Angelo, had a similar reaction when she learned the doctor had left without explanation or information about where he was going. "I'm so hurt right now, and I'm so depressed. They won't tell me anything and I don't even know how to find him," Ms. Taylor said.

In all likelihood, their experience will become more common.

Out of the blue, people will learn their doctor has left a practice with little or no explanation, and without a forwarding address. When a physician effectively disappears, the cause usually is tied to the physician's employment contract, says a local health care attorney.

Michael A. Cassidy, chairman of the health law practice group for the Downtown law firm Tucker Arensberg, represents more than 500 local physicians. He said most physician contracts now contain clauses that prohibit doctors from soliciting patients if they leave a practice.

While it's not always clear what constitutes "solicitation," it generally means departing physicians cannot contact their patients to invite or entice patients to follow them to their new location. They also cannot take their patient list with them, since that is property of the practice.

"I would imagine the doctor wouldn't contact them because he can't, or he doesn't have their address," said Mr. Cassidy.

Contracts also often require that doctors cannot practice medicine within 10 miles of the previous practice office, and sometimes the required distance is even greater. Nor can they give out information about the practice they're leaving. Violating these contract terms could mean a financial penalty, such as loss of severance pay.

Contracts have become more restrictive, but that's not the only reason that more such incidents may occur. The competition between Highmark and UPMC for doctors, and health care overhaul that is steering doctors into larger systems may help make these situations more frequent.

About six weeks ago, Maxine Plotkin learned her family physician had left her Squirrel Hill practice on very short notice. Neither Ms. Plotkin nor other patients she has spoken to have been able to learn where the doctor went.

"It's frustrating, especially if I were ill. If I had a problem, I don't know where I'd go. To start all over is tough. It can be very traumatic," she said.

Ms. Plotkin understands that the medical practice doesn't want to lose patients or revenue to a departing physician -- and she readily admits that's what would happen in her case.

"I would go to Westmoreland County" to continue with her doctor, Ms. Plotkin said. "I was very fond of her and she gave me a lot of time, and seemed to be very conscientious. She was just very compassionate and caring."

For his part, Dr. Bonacorsi has been located. Last week, insurer Highmark Inc. announced that he and two of his former colleagues at Pittsburgh Medical Associates had signed on with the insurer's network.

Reached by phone last week, Dr. Bonacorsi confirmed that he was contractually prohibited from contacting patients from his former practice, but noted that they are welcome to contact him.

"We haven't deserted them. We're still in the area. We will be in our new office in the very, very near future," he said.

In the meantime, though, patients can be left in the dark in the process, unable to find out what's happened to the doctor they've been seeing for years, even if the doctor has cared for them and their family for generations.

"Unfortunately for patients, they're not getting that story and they feel very upset or left out, and we certainly don't want to paint that picture," Dr. Bonacorsi said.

As for his previous practice, he said simply: "They know where we are and they don't want to say." Reached by phone last week, a supervisor at Pittsburgh Medical Associates declined to comment.

Typically, Mr. Cassidy said doctors in these situations "are torn up emotionally and they are torn up financially. Most of them have deals with productivity requirements, so they want to take those patients with them."

And the practice obviously wants to keep those patients, even if it means not sharing information about the departing doctor.

"The health care business is different from the business of health care," Mr. Cassidy said. "It doesn't seem right. There are a lot of things that don't seem right, but because it's about their health, it seems less right."

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Steve Twedt: or 412-263-1963.


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