Changing of the Carilion Guard

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by Hayden Hollingsworth

I remember when Nancy Agee, then Nancy Howell, was a first-year student nurse at the erstwhile Roanoke Memorial School of nursing.  She was a good nurse and went to work on a ward in the long-since demolished south wing of the old hospital.  Soon she was named “Miss Hope” by the American Cancer Society in recognition of her compassionate care.  To say that since those halcyon days Nancy Agee’s rise has been meteoric would be a vast understatement.

Ed Murphy, for reasons that are not readily apparent, is moving on to another pasture, TowerBrook Capital Partners, an investment firm and will serve as chairman of the board of one of their subsidiaries, Sound Physicians.  No one would deny the monumental changes that took place under his decade as Carilion CEO.  He has been regularly recognized as one of the leading healthcare professionals in the county and according to reports is one of the highest paid hospital system executives in the United States.

It remains to be seen how his legacy will play out.  Certainly the formation of the Carilion Clinic is, to date, the most important.  It was created in recognition that the delivery system for healthcare in this county has been on the cusp of major change and Carilion has placed itself in a position to respond to forces that are beyond the control of individual practitioners.

The manner in which this was presented to the professional community left a lot to be desired.  As has been frequently mentioned, physicians who had dedicated their private practices to southwest Virginia health care and the development of Roanoke Memorial Hospital as a regional center felt threatened by the creation of a clinic staffed with Carilion physicians.  This was not a new concept.  Years ago Carilion began buying up primary care practices.  To be sure, there may have been economies of scale in doing this but it wasn’t until the Clinic was launched that many physicians felt they would not be able to sustain themselves in such a competitive climate.  A number moved their practices to Lewis-Gale Hospital; others chose to give up hospital practice and confined themselves to their offices.  Still others moved away.

The Carilion professional staff now numbering in the five to six hundred range  has absorbed most of the large subspecialty groups, including my own, Consultants in Cardiology, of which I was a founding partner 36 years ago.

In the immediate future, I suspect there will be but a handful of individual physicians’ offices in the area.  The reasons for that are many, not the least of which is, younger physicians have different professional goals that those of previous generations.  A more manageable life style is certainly one of the most understandable and that is virtually impossible to maintain in an individual practice, particularly with hospital care.

This has given rise to a new type of physician—the hospitalist.  Such doctors confine themselves to hospital work only and generally do not give follow up care after discharge but refer the patient back to the primary care doctor.  There is now a subspecialty in hospitalists—the “nocturnist,” one who works only at night and soon to be followed, I suspect, by the “weekendist,” and then the “holidayist.”  It is to this professional population that Dr. Murphy will direct himself at Sound Physicians.  For a fee, they will supply hospitalists wherever there is a need.  It would not be reasonable to suspect that their physician employees will have a demographic loyalty to the community to which they are assigned.

One cannot say whether this will be more efficient but I would strongly suggest that continuity of care is already an early casualty.  If you have not had a hospitalization in the last year or so you may be surprised to find that you see a different physician every day during your confinement.  More than once I have asked friends who their doctor was during their stay and the answer has been depressingly the same:  “I have no idea.”

As the Bob Dylan song of my youth said, the times, they are a’changin.  Perhaps the Miss Hope of Nancy Howell Agee is alive and well as all this unfolds.  If she can re-establish a sense of collegiality with the private practice sector, that would be an important step. We shall see.