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Doctors ‘step off the treadmill’ and detail why they are splitting off from Novant

Two doctors leading the effort of dozens of physicians to split off from Novant Health said they want to use their new-found independence to improve the quality of their own lives and the care they provide patients.

“I wouldn’t say anything negative about our relationship with Novant Health,” one of the doctors, Ehab Sharawy, told the Observer this week. “We spent many years doing things with Novant Health and will continue along that road. But coming into independent practice gives us a little more self-determination to move towards the things that we want to do.”

It’s the first time the doctors have spoken publicly since the announcement in January that they were leaving Charlotte’s second-largest hospital system.

For Charlotte, the breakup is major medical news in a region that for decades has seen hospital systems acquire independent practices — though that trend has been reversing in recent months.

The 42 doctors leaving Novant represent the second wave of physicians in less than a year breaking away from a big hospital system to open an independent practice. Last year, about 92 doctors with Atrium Health’s Mecklenburg Medical Group left to form Tryon Medical Partners.

The Novant physicians — a group of family doctors, obstetricians and gynecologists — are expected to join Tennessee-based Holston Medical Group on March 19.

One aim of the group is to reduce healthcare costs by at least one-third initially, said David Cook, the other physician heading the breakup.

“It is time that physicians have to own the cost of health care,” Cook said.

“If you ignore cost, as a physician, you’re not really doing anything to fix the system,” he said. “You’re part of the problem.”

Winston-Salem-based Novant declined to comment.

Here are some highlights from the wide-ranging interview with the doctors:

Atrium split gave ‘courage’

The departure of the Atrium physicians was not the main reason the Novant doctors decided to leave, Cook said. But it provided motivation for the decision, which had been in the works, he said.

In suing Charlotte-based Atrium last April to get out of non-compete agreements and operate independently, the Atrium doctors claimed the hospital system’s practices were not always in the best interest of patients. Those included requirements that physicians refer patients needing further care to Atrium-owned or managed facilities, the suit said.

The same day of the suit, Charlotte’s dominant hospital system said it would grant the doctors’ request to leave.

“We did look at them and sort of garner some of their courage to do this,” Cook said. “Our decision was long in coming. I’d say 25 years in coming.”

The Novant doctors made their decision to leave last year, Cook said.

The doctors said their split is driven by a desire to focus on an approach with four pillars: improve patient care and satisfaction; enhance the health of the local population; improve the work life of doctors, nurses and other staff; and reduce the per capita cost of care.

“The main reason why we want to break away ... is that we want to be clearly 100 percent focused on the patient in delivering the best care that we can,” Sharawy said.

Lowering costs

In leaving Novant, the doctors say they want to address the growing problem of skyrocketing health care costs.

A big contributor to that increase has been a decades-old model known as fee for service, Cook said. Under that system, health care providers are paid for every service they provide, from tests to office visits.

Cook said that the model doesn’t create incentives for the industry to keep people healthy and out of the hospital.

Also, in Charlotte, the costs for the same service can swing wildly from one provider to the next, Cook said, noting that health care expenses are a large contributor to poverty in the U.S.

Using the example of a knee-replacement surgery, he said the price for the procedure in Charlotte can range from $17,000 at one provider to $50,000 at another, with no difference in quality.

“There’s so many steps you can go through initially to keep that person from having to have surgery that we don’t always go through or do,” Cook said. “A lot of times there’s not a lot of incentives to do that, there’s not a lot of payment in doing that. But we need to do that.”

By going independent, the doctors also said they can focus more attention on sicker patients.

“The ones that need to be seen when they need to be seen,” Cook said, “and provide really efficient menus for the millennials and others who don’t necessarily want to be in the office to have their care delivered to them. What we want to do is sort of step off the treadmill in Charlotte with Tryon (Medical Partners) and others and say, ‘Hey, there’s a different way to do this.’ ”

But lowering costs does not mean sacrificing quality, Cook said.

“It’s not that we’re going to dumb down or cheapen health care,” he said. “Actually, in doing this you’re able to provide more care for more people in a much more efficacious way.”

‘Like they’re widgets’

The fee-for-service model can also make doctors feel like they are on a hamster wheel, the Novant doctors said. That has helped contribute to the problem of physician burnout across the country, they said.

“Sometimes physicians feel like they’re widgets in care,” Sharawy said. “You’re on a treadmill, and the faster you run, the more widgets you take care of, but then you look back and you’re like, ‘Oh, my gosh, I don’t see my family.’ ”

By going independent, the doctors will also be able to quickly make big changes to improve care, which is not always possible when working for a large hospital system, he said.

“If you have an idea or just things that you know is a process you want to do, sometimes you’ve got to go through multiple layers to get there,” Sharawy said. “If you want to create an innovative, new approach to taking care of people ... or we want to create a some type of a diagnostic center or something like that, well, you do it, you can do it within those scenarios, but it’s not as easy.”

More breakups coming?

The Novant doctors and those who left Atrium are likely not the last groups of physicians to go independent in the Charlotte region, Cook said.

“It’s not a blip,” he said.

“Charlotte’s one of the most expensive places in the country to get health care,” he said. “The national trend is that you cannot sustain this expense any longer. Physicians, the burnout is extraordinary. Patient satisfaction is often down as they feel, too, like a widget.”

Other physicians will likely break away from hospital systems as they feel compelled to lower patient costs, he said.

“I think you’ll see in Charlotte others do the same as Tryon and our groups.”

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Deon Roberts has covered Charlotte’s financial services industry for The Charlotte Observer since 2013. His beat includes Bank of America and Wells Fargo. He attended Loyola University in New Orleans and is a native of Lafitte, La.
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