Medical sources: Doctors leaving Central Maine Healthcare

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Insiders say physicians are bailing for a host of reasons; officials say necessary cuts, new systems, pay talk have prompted departures of about 1 out of 4, but ‘it’s starting to turn.’

LEWISTON — Central Maine Healthcare staff members say things have been bad within the hospital system for a while.

In recent months, the Sun Journal has spoken to or received emails from about a dozen people affiliated with the hospital system, most of them current or former members of the staff. Nearly all asked to remain anonymous, fearful of losing their jobs or being labeled troublemakers in the close-knit community that is Maine health care.

Their comments come amid public turmoil at Central Maine Healthcare, the corporate parent of Central Maine Medical Center, Bridgton and Rumford hospitals and a collection of medical practices in 15 communities. With about 4,000 workers, Central Maine Healthcare is one of the largest employers in the area.

Central Maine Healthcare CEO Jeff Brickman

Last month, medical staff at all three hospitals issued votes of no confidence in Central Maine Healthcare CEO Jeff Brickman. Last week, the hospital system’s board of directors voted to change its bylaws to give doctors more of a say in how things are run while affirming its support of Brickman, who it had hired two years ago to lead the financially troubled system. The day after that board vote, the president of the Bridgton and Rumford hospitals resigned.

Each person who spoke to the Sun Journal had a different perspective, but a common theme quickly emerged: Doctors are fleeing Central Maine Healthcare.

“Every couple of days there are several more resignations,” said a provider within the hospital system.

Central Maine Healthcare officials acknowledged this week that its most recent physician turnover rate stands at 27.1 percent. That means about 81 of its 300 doctors left this past fiscal year that ended in June.

Average turnover rates for doctors in hospital systems statewide or nationally are hard to come by, but health-care data company SK&A says the annual turnover rate for office-based doctors in the U.S. is 8 percent.

It says the average turnover for all hospital employees — doctors, nurses, support staff and others — in the U.S. is 18.6 percent.

While people who spoke to the Sun Journal say Central Maine Healthcare’s doctor turnover is high and causing problems, particularly for patients, system officials say the turnover rate is actually lower than it was the previous two years.

Further, they say they’re working on boosting recruitment and retention and are taking to heart the medical staff’s concerns.

They say, however, at least some turnover is virtually guaranteed. Not every doctor will fit this new administration.

“Change is hard and they may decide that they aren’t up for the change,” said David Tupponce, executive vice president for the system and president of CMMC.

GETTING ON BOARD

To be clear, current and former staff members say, the former Central Maine Healthcare administration wasn’t great, either.

When Peter Chalke retired in 2016 after 33 years with the system, 14 years as CEO, Central Maine Healthcare was running millions of dollars in the red.

Not long after he was hired to replace Chalke, Brickman spoke publicly about the system’s financial troubles and the need for a “transformational” plan.

He hired consultants from Kaufman Hall to look at Central Maine Healthcare’s performance, quality and finances. He declined at the time to say how much the consulting group would cost, except to say it would be “a lot of money” and “a very significant investment in resources.”

Brickman also soon began reshaping the administration. Outside hires dominated, including a new chief financial officer who had worked with Brickman at his last job in Colorado. Several key officials from the old administration left, including CMMC President Tina Legere and Chief Nursing Officer Sharron Chalke, wife of the former CEO.

In 2017, Brickman dropped Chalke’s plan to move sports medicine, outpatient physical and occupational therapy and weight management programs into Bates Mill No. 5. At the same time, Central Maine Healthcare laid off 28 workers and let the YMCA of Auburn-Lewiston take over operations of the CMMC Fitness and Wellness Center at 12 High St.

Also in 2017, Central Maine Healthcare closed its urgent care center in Auburn. Less than a year later, it decided to open one in Topsham.

Brickman’s mandate was clear: Things were going to change.

That was not unusual for him. In November 2016, just months after he took over at Central Maine Healthcare, Brickman wrote a piece for Harvard Business Review titled “How to Get Health Care Employees Onboard with Change.” In it he talked about his time as group president for Centura Health in Colorado — his last position before moving to Central Maine Healthcare — and his efforts to create a strong executive team in Colorado, fix financial and operational problems there and determine a clear, strategic path for the organization.

“Within a few years, we had dramatically turned around the organization’s finances, performance measures and market share,” he wrote. “Things were looking up on all fronts except one. Our employees weren’t along for the ride.”

Brickman outlined the ways he brought employees on board, including soliciting staff feedback, hiring an organizational change consultant he’d worked with at other hospital systems, and establishing teams of employees to identify problems and solve them.

It worked, Brickman wrote, and the experience changed him.

“The approach we put in place forced us to listen and learn how to support people rather than dictate or direct them,” he wrote.

A year and a half later, separate medical staffs at all three Central Maine Healthcare hospitals said his leadership here is so harmful that they have no confidence in him.

Brickman declined to comment for this story.

FASTER, MORE

Those who spoke to the Sun Journal say Brickman’s management style is anything but the collaborative, cooperative approach he described in Harvard Business Review.

They paint a picture of a leader very concerned about the system’s financial future but less concerned about employees or patient care.

“From my perspective, it seems like the goal of health care has shifted from more of something that’s focused primarily on quality more toward the quality we can afford,” said one former Central Maine Healthcare provider. “Going from, ‘Let’s do this the best way we can,’ to, ‘As long as we can do it good enough, that seems to be OK.'”

He and others say they’ve seen staffing cuts, particularly among support staff. Employees who remain have to take up the responsibilities of those who left.

“Those people already had full-time jobs and now their work is being tripled or quadrupled,” the former provider said. “People then feel like they can’t do a good job because there just aren’t enough hours in the day to do a good job.”

Those who spoke to the Sun Journal say at least some doctors have been required to see patients faster — as quickly as every 15 minutes.

“Faster, so you could see more,” the former provider said.

One person said the new pace increased patient load in one office by about 50 percent.

That pace, those who spoke to the Sun Journal said, makes it impossible for doctors to spend much time with their patients or transcribe notes after each appointment. Doctors began waiting until the end of the day to add information to their patients’ files, a chore that took hours. It didn’t help that a new electronic medical records system added even more time, they said.

One person said a doctor complained and was told not to document so much and that notes didn’t need to be so thorough.

Morale problems persisted, people say. When complaints arose, they got the sense that Brickman, his administration and the consultants hired to change things didn’t want to hear it.

Several people called the atmosphere “toxic.”

“It’s just unconscionable the way people have been treated,” the former provider said. “Treating providers like first-graders that needed to be scolded. Sometimes being brought to tears. And that’s no exaggeration.”

PRO-PHYSICIAN EXECUTIVE RESIGNS

Some staff members said they got the sense their jobs were on the line if they continued to complain. John Berry, a volunteer chaplain, said he was fired.

Berry said he served CMMC for 13 years before being told not to come back last year. He said he was told he was fired because of a Facebook post in which he poked fun at a new Central Maine Healthcare plastic surgery effort, but his termination came a month after he publicly questioned Brickman at a staff meeting.

“I was marked because Brickman was very unhappy with me,” he said. “We had a subsequent conversation that was brief but during which he showed his displeasure. It was palpable.”

Berry wasn’t the only one told to leave. A number of people said they were fired or knew of people who were.

“Part of my trouble with the new administration is there just seems to be not very respectful interaction with the doctors,” said Gregory D’Augustine, a retired  surgeon who worked at both CMMC and St. Mary’s Regional Medical Center under the former administration and still speaks with former colleagues there.

“There’s one doctor in particular that I know of who did great work for CMMC for 15 years or so and was the head of one of the departments there — I don’t want to give his name — he was head of the department until quite recently. Then he had some sort of a bad interaction with the administration and they told him, ‘Today you’re out. Clean out your desk and security is escorting you to the door.’ That’s just kind of unheard of in my era.”

As morale plummeted, people said, doctors started leaving on their own. Some moved up their retirement date by a few years. Others left to work somewhere else.

“We’re lacking more and more doctors,” said a provider within the system.

Several people said at least one Lewiston-area specialty practice lost all three of its doctors and another lost its sole doctor.

“In my time there I’ve never seen anything like it … this systematic and persistent,” the former provider said. “We would get these announcements from administration over email and you just automatically knew, ‘All right, whose the next person who’s leaving?’ And every week it would happen.”

He said he recently heard the system has lost at least 80 medical providers in the past year, a figure that fits with Central Maine Healthcare’s official physician turnover rate.

“I can’t imagine a time where I’ve ever heard of that anywhere, short of a hospital system actually shutting down,” he said.

Earlier this year, the system hired Stacy Goldsholl to serve as chief physician executive. Many believe she was brought on board to improve the relationship between administration and doctors.

“She was very much pro-physician. Extremely pro-physician,” a provider within the system said. “She wanted to improve our working conditions. She wanted to give us all the resources that have been taken away from us and just improve the ability to deliver care that has been jeopardized in the past two years.”

Goldsholl resigned two weeks ago, just before the board voted to keep Brickman.

ENCOURAGED TO VOICE CONCERNS

Those who spoke to the Sun Journal say they worry about what the turmoil means for patients.

“My sense is that there is something very, very wrong going on at CMMC,” said Berry, the volunteer chaplain. “You have trained medical professionals — I’ve had brief conversations with a few, but I’ve had long conversations with five — and their impression, the thing I came away with, is the quality is suffering and will suffer more in the future because of the direction (the hospital system) is going in, and they want no part of it.”

Fewer support staff can mean longer waits on hold over the phone, a more difficult time getting appointments or medical information, a longer wait in the office.

High physician turnover can mean patients must find new doctors, and rely on doctors who haven’t met them and have little time to get to know their medical history. Patients may also have to deal with rescheduled and delayed appointments.

Low morale can mean that doctors will continue to come and go, so patients lose the continuity of care that comes with having the same doctor for years.

“We used to say that we are ‘patient centric,’ meaning that your decisions were all supposed to be answered about what was best for the patient. That’s certainly not what’s going on there anymore,” the former provider said.

The Central Maine Healthcare board chairwoman did not respond to a reqest for comment by deadline, but through a spokeswoman agreed to speak with the Sun Journal at a later date. Tupponce, the system’s executive vice president and president of CMMC, agreed to talk.

Tupponce and spokeswoman Kate Carlisle, both new within Brickman’s administration, made it clear that they disagree with many of the assertions made by the people who spoke to the Sun Journal.

“Significant change has been necessary to ensure the organization’s financial stability,” Carlisle said. “We recognize that change can be difficult and may create a sense of disruption or uncertainty. We encourage our staff to ask questions and raise concerns, and it is certainly not our practice to terminate employees for doing so.”

She said she could not comment on personnel matters, such as Berry’s removal as a volunteer chaplain.

“But I will reiterate that we encourage staff to share their concerns and ask questions; we offer town halls and other forums for that purpose,” Carlisle said.

Asked about the disrespect some doctors perceive from Brickman, his administration and consultants, Carlisle said, “It is our expectation that anyone engaging staff on behalf of the administration behaves in a professional and respectful manner.”

Carlisle and Tupponce said physician firings have dropped over the past three years and doctor turnover, while at 27.1 percent, is lower than it was in either fiscal years 2017 or 2016, which includes the last year of the Chalke administration. Carlisle declined to say how much lower it is.

It is unclear how Central Maine Healthcare’s doctor turnover rate compares to similar hospital systems in Maine. Officials at MaineHealth in Portland, St. Mary’s Regional Health System in Lewiston, MaineGeneral Health in Augusta and Eastern Maine Healthcare headquartered in Brewer said they could not provide the information, either by deadline or at all.

Tupponce acknowledged that stresses have caused some Central Maine Healthcare doctors to leave. The new electronic medical records system, he said, was partly to blame.

“For some of the physicians it was just one more thing that they just didn’t want to go through, the pain of learning a new electronic medical record,” he said. “And so they said, ‘You know what, I’d rather retire,’ or, ‘I’m going to go find somewhere else.’ Honestly, that did drive some of the turmoil.”

‘WE DO HAVE A PLAN’

Carlisle denied that any doctors have been told not to document so much or that their notes didn’t need to be so thorough.

“We would never suggest a provider compromise either patient care or documentation,” she said.

Tupponce said doctors did grow uncomfortable when leaders decided to standardize physician pay and employment contracts to make them more fair.

“That’s been kind of a long, hard process,” Tupponce said. “Any time you kind of start talking about how you’re going to compensate physicians, that’s personal. And so some physicians have been a little worried about that process and whether we would be responsive to the physicians’ needs, which I believe we have. But some of them decided, ‘You know what, this is making me nervous. I’m going to go look somewhere else.’ Some of them have chosen to leave the organization prior to us finalizing that.”

He said system leaders listened and responded when doctors raised concerns over the contracts.

“They’ve been at the table and we’ve really worked to a point where we presented some of the work that we’ve done at the last general medical meeting and it was very well-received,” he said. “I think because of that, that’s helped decrease some of the anxiety in the medical staff and prevent physicians from going and looking at other places.”

Tupponce said the system has struggled a bit to hire new doctors this year because some of its own recruiters left. Central Maine Healthcare hired outside recruiters to help solve the problem.

“That’s been what’s been such a good thing to see — all the great physicians, we’re getting more and more of them. But it feels harder because we lost some of those (internal) recruiters,” he said. “Now it’s starting to turn.”

Tupponce denied there have been cuts in support staff. He said, however, that the system has struggled to find people to fill positions. To address that, Central Maine Healthcare has contracted with recruiters to help fill jobs and has more clearly laid a path for career advancement to help entice new hires.

“I will tell you, I’m not lying to you, that it has improved over the course of the year as far as our ability to recruit and retain those support staff,” he said.

He said the system has also shifted some responsibilities, freeing up people to “work at the top of their license.” That means, for example, nurses can focus more on patients rather than spending all day on the phone dealing with prior authorizations and referrals.

“That’s better for the practice, better for the patients and more fulfilling for the nurses,” Tupponce said.

As part of that, he said, Central Maine Healthcare this summer started an automated call, text and email system to confirm patient appointments.

“When we went live with that, we put 120,000 return phone calls into that system. Can you imagine how much time that gave back?” he said. “That’s just one example. There’s opportunities like this all over the place.”

Asked whether doctors are required to see patients faster, Carlisle didn’t say yes or no, but responded, “We would never request that our providers compromise patient care, or documentation.”

Tupponce acknowledged there have been other changes within Central Maine Healthcare and some of those affect staff and patients — like no longer automatically replacing doctors who leave with a new doctor in the same job.

“We’re taking that as the opportunity to strategically focus on, ‘OK, what does the community need?'” he said. “If we have a physician leave, it may not be one for one.”

An outgoing pediatrician, for example, might be replaced by a family medicine doctor or a pediatric nurse practitioner who can work with the doctors who remain.

He said Central Maine Healthcare is also structuring care differently, sometimes consolidating medical practices, sometimes partnering with outside medical groups — as with the new Topsham center — to provide health care.

He said the system has also strengthened its Massachusetts General Hospital partnership, which first formed under the previous administration. The Boston hospital now helps with recruitment and interviews potential Central Maine Healthcare doctors “to make sure that there’s a good fit in both places.”

While that may raise some eyebrows — it’s unusual for an unrelated hospital to interview another hospital’s potential employees — Tupponce said this is not a sign that Central Maine Healthcare is looking to sell to Mass General.

“The basis of this relationship is really, ‘How do we use the best of what Mass General has to our advantage?'” he said.

Tupponce said Central Maine Healthcare leaders understand the anxiety of staff members, community members and patients — particularly when doctors, the most visible employees in any hospital system, leave.

“We do have a plan,” he said. “We’re going to make sure that we’re providing access to our communities.”

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