It's the holidays. Elizabeth Felter is 35 weeks pregnant. That right there is stressful enough.
But imagine discovering, with just a few weeks to go in your pregnancy, that the small obstetrics-gynecology group you've been seeing for years no longer exists -- that it has been poached from UPMC by rival Highmark and its would-be partner, the West Penn Allegheny Health System.
Then imagine the confusion that arises when patients aren't immediately informed of the practice's overnight evaporation. Instead, patients -- including Ms. Felter, of Edgewood -- learn of the departures through a grapevine of friends, colleagues, fellow expectant mothers and toll-free hotlines.
That scenario became reality last week after a practice of five UPMC-affiliated obstetricians and gynecologists informed UPMC and Magee-Womens Hospital of UPMC that it soon would depart the region's No. 1 health system and its Womancare Associates division for the region's No. 2 system. When that happened, UPMC asked the doctors to clean out their desks the next day, revoking their hospital privileges.
"Pregnant women are a vulnerable population, by anybody's standard," said Ms. Felter, 37, who teaches at the University of Pittsburgh's Graduate School of Public Health and is expecting her second child.
"This was very badly handled," she said. "Who's going to deliver my baby? Where am I going to deliver my baby?"
Last week's OB-GYN departure is but the latest volley in the ongoing hostilities between UPMC and WPAHS and its would-be affiliation partner, Highmark Inc. WPAHS and Highmark have hired more than 100 physicians in the last year to work at their under-construction regional health network. Only a few of them have come by way of UPMC.
As such, the recruitment of the five OB-GYNs -- and the repeat patient revenue they can generate -- represents a small coup for Highmark and West Penn Allegheny. The practice, together known as the "teal" division at Magee, was responsible for about 10 percent of the 10,000 live births that occur at that hospital every year.
UPMC, meanwhile, has added nearly 400 doctors of its own over the last year, some from WPAHS.
And when the two health giants wrestle over practices, it's often the patients who end up getting bruised.
"At this point, I'm due in [five] weeks," Ms. Felter said, and "I'm having to track down doctors."
The five doctors who are leaving UPMC and its physician-employer division, UPP, are Kristina D. Bishop, Ganya Alvarado-Reagans, Emily Lebovitz, Pamela L. Kridgen and Amy Yester.
Because of a non-compete clause built into their UPMC contracts, all but one of the doctors, Dr. Kridgen, will have to practice outside of Allegheny County in the next year. That likely means opening new offices in Cranberry or Mars and one in northern Washington County, at least temporarily. Highmark also is working to get the doctors admitting privileges at other hospitals in the region.
The five OB-GYNs told UPMC of their decision Dec. 17, giving six-months' notice, a notification period required by their contracts.
UPMC and the doctors briefly considered an arrangement in which the doctors would be reassigned to work their final six months at UPMC Mercy, but by the next day, that plan was rejected and the five doctors were told they would not be returning to work at Magee or the Womancare clinics.
They are on administrative leave until Monday, their last day of employment at UPMC. They are to begin at Highmark on Jan. 1.
"Paramount to all of this is the continuity of care with patients," said Highmark spokesman Aaron Billger. "We want be able to help women find their doctor." While the physicians themselves are now prohibited from reaching out to former patients, Highmark has set up an informational hotline at 866-844-4431.
In other lines of work, even hyper-competitive professions such as law, departing professionals often are allowed to leave on more relaxed terms. In the legal arena, non-compete clauses are a major no-no, and enforcement of "notice provisions" for departing partners is lax. And while poaching clients certainly isn't encouraged, departing lawyers can use their remaining time at a firm to notify clients in their book of business of their impending departure.
But in the medical world -- and especially when a region is dominated by two major health systems as Pittsburgh is -- the walkout provisions are all the more restrictive. Often they contain non-solicitation provisions, tortious interference clauses (which prevents a doctor from raiding his or her former practice of employees) and surprisingly large geographical non-compete areas.
As for the patients, the lists of their names and their charts are property of the practice, not the departing physician.
For those reasons, notifying patients of a departure can be delicate -- the physicians themselves often are forbidden from communicating with patients once they have been locked out, and the jilted hospital or practice doesn't want patients to follow their departing physicians, so the system doesn't go out of its way to steer patients to their former doctors.
As a result, information can be scarce, especially in the days immediately following a group departure. And while that may not seem like a terrible hardship for a man in his 20s who sees his doctor once every two years, for a woman in her 35th week of a pregnancy, weekly visits to the OB-GYN are the norm.
Last week, Ms. Felter said she was uncertain of her next step. She is considering following her obstetricians, but because she works at Pitt, she has UPMC Health Plan insurance and UPMC Health Plan doesn't include West Penn Hospital on its roster of in-network facilities.
She said she might seek a special waiver to be allowed to deliver at West Penn using UPMC Health Plan insurance, but she was unclear whether that would be permitted. When she contacted UPMC, she said, she was told that they would have plenty of doctors to cover for the suddenly missing ones.
However it shakes out, this was not the type of Christmas surprise she was hoping for.
"No letter, no phone call," Ms. Felter said. "To have the rug pulled out from under you like that, [I] was totally caught off guard."
Bill Toland: email@example.com or 412-263-2625.