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Separation one casualty of managed care`s darker side

Tupelo Medical Group: Three IMA Foundation internists go independent

tupelo — Citing the desire to work in a smaller, less restrictive environment, three Tupelo physicians are leaving the safety of one of the oldest and largest internal medicine practices to go it alone.

Paul White, Ricky Parker and Julian Loden, all general internists with Internal Medicine Associates in Tupelo with 14 years combined experience, will open the Tupelo Medical Group May 1 in a 6,000-square foot building on Green Street nearly adjacent to IMA`s current location.

White, a general internist with IMA Foundation for eight years, said the decision to establish an independent practice was not made quickly, particularly in light of the growing climate of managed care. He said general discussions about such a move started nearly a year ago with serious talks beginning six months ago. The doctors gave their three-month notice to NMHS at the end of January, White said.

For a while, White said there were even limited discussions about joining Baptist Health Systems in it`s venture to establish a clinical practice in Tupelo but in the end the decision was made to opt for the less risky and less costly avenue of affiliating themselves with the Baptist preferred provided care plan.

The three physicians will retain hospital privileges with North Mississippi Medical Center, and Tupelo Medical Group will continue to participated in Health Link, NMMC`s managed care plan.

In addition to the three physicians, Tupelo Medical Group will open with a staff of nine, including two nurses, one medical assistant, one lab technician and office personnel. White said he and his colleagues are investing around $250,000 in the venture.

Although many specialities in the Tupelo area have remained independent, such as surgical, ear, nose and throat and others, White said only two physicians in Tupelo have an established internal medicine practice not associated with the area`s dominate health care provider, North Mississippi Health Services, parent company of NMMC.

“In our area (Tupelo), in internal medicine, it`s a big step to break away,” White said, adding that he believed there was strong need for another independent internal medicine practice.

“If they`ve wanted some place else to go they just haven`t had that option,” he said. “Now they will.”

In fact, White said, he believes the area could support some more internists, and that Tupelo Medical Group is optimistic it could add a fourth internist by the summer of 1999. Combined, White said he, Parker and Loden have a patient load of nearly 12,000.

Parker, an internist with IMA for nearly four years, said he was more pessimistic and conservative about the growth of the new practice but agreed that there is a need for additional internists.

“I think there`s plenty to go around for those who want to work,” Parker said, noting that IMA has around 25 internist, including 15 general internist, five gastroenterologists and two rheumatologist.

Fortunately, there is a growing trend for physicians to specialize in general internal medicine, he said, after so many years of physicians moving into the sub-specialities like gastroenterology, rheumatology and cardiology. He said managed care, its related fee payment structure and other administrative issues are lessening the appeal of some sub-specialities that once attracted many internists.

Parker said “IMA is a great group in this part of the state,” but said managed care has dramatically changed the clinical climate and that a small, independent practice would more suit the styles of his three colleagues who have decided to break away.

White was more direct in the reasons for the split, saying since the once independent IMA affiliated with NMMC, the cost control measures have continually made it difficult to serve patients to his satisfaction.

IMA, which affiliated with NMMC nearly four years ago and became the IMA Foundation, has come under criticism from the public in recent months from some patients who voiced frustration with waiting times and the inability to speak with their doctor or respective nurse.

In an open letter to the editor in the Feb. 21 edition of the Northeast Mississippi Daily Journal, IMA Foundation medical director Ken Harvey recognized the concerns of at least one patient who publically complained. Harvey said IMA was taking steps to address the problems, including hiring more support staff, opening a 24-hour system for patients to access their own lab results, hiring a “hospitalist” solely for hospital care and adjusting the office hours of IMA physicians.

“All three are good physicians and they`re going to be busy,” Harvey was quoted as saying in the Daily Journal last week about the departure of White, Loden and Parker. “I expect them to do well.”

An open house is scheduled for May 31, White said.

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