At least 15 physicians have been fired from Edward-Elmhurst Health as the suburban Chicago-based health system moves to cut costs, sources told MedPage Today.

The doctors, who worked across its seven "Immediate Care" or urgent care sites, will be replaced by advanced practice nurses, according to an email sent by hospital leadership that was shared with MedPage Today. The physicians were informed late last week that they would be terminated as of April 1, 2020.

A physician who spoke on the condition of anonymity said the doctors were "broadsided" by the news. While they harbored some concerns that a few of the slower urgent care sites might be turned over to non-physician clinicians, they weren't expecting so many of the sites to be impacted and for such a large number of doctors to be let go.

In their email, hospital system CEO Mary Lou Mastro, MS, RN, and Chief Medical Officers Robert Payton, MD, and Daniel Sullivan, MD, pointed to patient cost concerns as the reason for eliminating the jobs: "Patients have made it very clear that they want less costly care and convenient access for lower-acuity issues (sore throats, rashes, earaches), which are the vast majority of cases we treat in our Immediate Cares."

"Beginning in the spring of 2020, we will move to a delivery model in which care is provided by Advanced Practice Nurses (APNs) at select Immediate Care locations," they wrote.

Leadership also stated in the email that they are "working closely with these physicians to assist them with finding alternative positions within Edward-Elmhurst Health or outside our system," but doctors noted that they face a saturated Chicago healthcare market and they're likely to have to relocate.

When asked to confirm the layoffs, Keith Hartenberger, a spokesperson for Edward-Elmhurst Health, said in a statement: "We continue to assess our care delivery models in the interest of providing cost-effective care to our patients. We shared with physicians that we have plans to change the model next year at some outpatient sites and are working with anyone affected to find alternative placement."

The move is becoming a more familiar one as some health systems try to save money by relying more heavily on non-physician clinicians.

Last year, 27 pediatricians at a chain of clinics in the Dallas area lost their jobs and were replaced by nurse practitioners -- even though the chain subsequently changed its name to MD Kids Pediatrics.

Rebekah Bernard, MD, wrote in Medical Economics that she spoke with three of the pediatricians who were fired: "They told me that they and their physician colleagues were completely shocked by the sudden firing. 'We thought we were going to retire from this place,' one told me."

Also in 2018, Charlotte, North Carolina-based Atrium Health ended a nearly 40-year contract with a 100-member physician group, signing up instead with Scope Anesthesia, which says it's dedicated to forming partnerships with certified registered nurse anesthetists. Atrium said it too was looking to reduce patient costs.

"This trend of shuttering hospital departments and firing physicians to save money is dangerous and short-sighted," Bernard wrote.

Purvi Parikh, MD, of NYU Langone Health in New York City, and a board member of Physicians for Patient Protection, which advocates against other healthcare providers replacing doctors, said that although non-physician clinicians "are vital members of the healthcare team, they are not trained to be substitutes of physicians and as a result diagnoses are missed and improper treatments and tests [are] prescribed."

Parikh said patients "have the right to choose a facility that is physician-only or one with physician-led care. In Chicago, luckily there are other options among competitors."