At least 15 full-time physicians have been fired from Edward-Elmhurst Health in west suburban Chicago, according to one of the physicians fired.

The physician told Medscape Medical News that a group of physicians in the immediate care clinics was told November 19 in a staff meeting that they would be fired and replaced with nurse practitioners (NPs). The physician asked to remain anonymous because of fear it could negatively affect future employment opportunities.

"At first it was disbelief. We felt a little broadsided. We absolutely were not expecting to hear that at our staff meeting," the physician said. "Our next thought was about patient safety."

A memo leaked to the group Physicians for Patient Protection (PPP), a grassroots organization dedicated to physician-led care, came from hospital leadership and confirmed that advanced practice nurses will replace the physicians.

The memo was sent to medical staff and the health system management team by Edward-Elmhurst Health CEO Mary Lou Mastro, MS, RN; Robert Payton, MD, vice president and chief medical officer of Edward Hospital; and Daniel Sullivan, vice president and chief medical officer of Elmhurst Hospital.

It read, "Through a multidisciplinary planning process that included physicians, a decision was made to change the care delivery model at some of our Immediate Care sites.

"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."

The new model is in patients' best interests and reflects emerging national trends, leadership members wrote.

The physician ― who is a member of PPP ― acknowledged that "there definitely is a good share of lower-acuity things, which I think would be fine for a nurse practitioner to see, but we do get a lot of infants and geriatrics. They're missing the scope of probably closer to 50% of the patients."

The physician expressed concern for patients who present with stroke, heart attacks, and other more complex conditions.

"Strategic Decisions"

Keith Hartenberger, spokesman for the health system, said he could not confirm the number of physicians fired.

He told Medscape Medical News 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 physicians were told that their employment would end April 1, 2020, according to the fired physician.

The health system memo added that the NPs will have extensive experience working in urgent and/or emergency care and would work closely with emergency department physicians.

But the physician who spoke with Medscape Medical News noted that in Illinois, as well as in many other states, working closely with the emergency department physicians does not mean the collaborating physicians have to be on site. The physician sees that as suboptimal for patient care.

The physician also added that they were told this move would lower costs but said it remains to be seen whether those cost savings will be passed on to the patients.

Additionally, physicians in immediate care who were fired may need to relocate, because the job market in the area is tight for physicians in that role, the physician told Medscape.

The physician added that the changes may also put the health system at a competitive disadvantage because in nearby hospital systems, physicians lead in providing care in their immediate care clinics.

In its memo, the health system gave a different view on competition.

"As the healthcare industry evolves," the memo said, "it is imperative that we make strategic decisions about changing care delivery models to remain competitive and effectively meet the healthcare needs and expectations of our patients and our community."

Scope of Practice in Illinois

According to the Scope of Practice Policy, a legislative database in Illinois, NPs must have a written collaboration agreement with a supervising physician. The agreement must describe the categories of care and treatment or procedures that may be provided by the NP.

NPs in Illinois may prescribe prescription drugs and schedules III–V controlled substances. They may prescribe schedule II controlled substances if approved by the supervising physician and if certain requirements are met.

In an August 15, 2017 article, the Chicago Tribune reported that the health system planned to cut $50 million in costs, including through layoffs, in response to financial pressures many hospitals face nationally.

The Tribune quoted Mastro then as saying she didn't know how many layoffs would be necessary, but that the system had already starting keeping vacant positions open. She said at that time that 300 positions were unfilled.

Edward-Elmhurst Health lists three hospitals, 11 walk-in clinics, and seven immediate care locations on its website.

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