By Dr. M.L.

• React to this article in the Discussion Forum.

First, despite what officials of HealthAmerica have stated, a number of physicians of the former PGMA group in addition to the pediatricians have apparently chosen not to sign contracts with AHERF, the new purchasers of PGMA and HealthAmerica's formerly owned offices. They include:

1) A current head clinical physician taking a previously agreed position with UPMC in the eastern suburbs.

2) 4 internists from one office will be working in a practice and/or supported by West Penn Hospital (I do not know details).

3) 2 family practitioners from an office in the south hills area of the city will also be working with West Penn hospital to set up a practice.

4) A former department head of one of the clinical departments of PGMA is reportedly accepting a teaching position at one of the hospitals in town not affiliated with AGH.

This is quite different from the statement below from the article:

"Eighteen pediatricians were part of the [115 doctor] group, serving nearly 25,000 children. Children’s Hospital of Pittsburgh acquired 15 of those 18 pediatricians. Of the remaining Penn Group doctors, says HealthAmerica’s CEO Robert Mayer, the "vast majority" have signed with AHERF but "a couple haven’t."

Seems like alot more than "a couple" to me. Also, the medical community should be aware that HealthAmerica engineered the layoff of 12 physicians from the PGMA group in early February 1996, due to an announced loss of 2 contracts with major employers: the city of Pittsburgh public school teachers, and UPMC faculty and staff.

In the remaining year, over 12 physicians resigned for other positions in the area; 1 physician, who was the administrative clinical head of one of the 9 offices, resigned in protest to the lay-off.

The group that decided which MDs should be laid off (make no mistake, contractual obligations were upheld, the MDs involved were politely told at the end of a Friday that their "services were no longer required" and that their four month severance pay would be paid out over the next four months) included the physician interviewed in the article, Dr. Brostoff.

As one of the laid off physicians, with over 5 years of service to HealthAmerica, I find it heartening that Dr. Brostoff is willing to now, in a public forum, state that:

"HealthAmerica and Allegheny did this without our consent," says Leon Brostoff, M.D., a Penn-Group pediatrician who did not sign with AHERF. "Our choice was to go along or leave. I was on the executive committee [of Penn Group] and we were aware [the deal] was happening, but we had no substantive input."

He adds, "I’m a human being and shouldn’t be sold like a piece of furniture."

Even though I had decided prior to the lay-off to accept another job offer, I certainly did not appreciate, with my colleagues, being treated "like a piece of furniture" then.

My point to all this, if you've followed me through all this, is that physicians working in groups owned by other entities cannot forget the fundamental fact that a physician is an employed executive, subject to any and all aspects of any and all contracts signed. You may be sold like a piece of furniture. Executives in the business community move all the time.

Please, as fellow physicians, be aware of the impact you may have in an administrative capacity to affect the lives of your colleagues if you are in the position to affect their professional life. You may eventually share in their fate, just as Dr. Brostoff shared in mine.

Dr. Brostoff, I share in your concern that you and your fellow pediatric physicians did not have any power to affect change. Certainly, little of ultimate substance happened at PGMA in my absence—the owner made a decision despite the physician leadership's input. Perhaps the time to make a stand would have been better in February 1996 at the time of the first layoff, not when the final decision was made for you. Indeed, my understanding is that PGMA sought to replace the very physicians that were laid off (in order to take care of future patients); it would have been a better course, in 20-20 hindsight, to have presented a unified front then, rather than later, when you had "no substantive input."

Responses are certainly encouraged, but will be answered selectively. My intent is not to foster an argument, but a dialogue of support for a growing number of salaried physicians who may soon find out that their loss of autonomy and control of workplace issues may not have been worth the price they've been paid.