Dr. James Westhoven recently resigned from Northern Light Eastern Maine Medical Center. Westhoven was a hospitalist, a doctor who provides a wide range of care to admitted patients, at the Bangor hospital for 16 years. Credit: Gabor Degre

At least eight doctors are resigning from Bangor’s Northern Light Eastern Maine Medical Center amid a push by the hospital to reduce their ranks, cut their benefits and have fewer doctors work each day, forcing those on duty to see more patients in a shift.

The resignations also come as doctors from departments across the Bangor hospital have criticized management for sidelining them from recent major decisions. Those doctors recently told managers and board members of the hospital’s parent organization, Northern Light Health, that doctors’ morale is at an “all-time low” and that there could be a “mass exodus” if things don’t improve.

The tensions have emerged as Northern Light leaders make a variety of changes to standardize compensation and operations across the $1.76 billion Northern Light health care system, which has grown in recent years to include nine hospitals stretching from Portland to Presque Isle. Northern Light is poised to grow even more through a merger in the works with Mayo Regional Hospital in Dover-Foxcroft.

The eight who have submitted their resignations since the beginning of March belong to a group of about 45 physicians called hospitalists, who provide a wide range of care to admitted patients.

[Subscribe to our free morning newsletter and get the latest headlines in your inbox]

Their resignations will start to take effect in the middle of the summer and have come as their group has been negotiating a new contract with EMMC’s administrators that would eliminate their paid time off.

But more departures could be coming. A hospitalist who still works at EMMC said at least 12 hospitalists have decided to resign in recent weeks.

A Northern Light Health spokeswoman confirmed the eight departures and attributed them to normal turnover.

But even eight resignations would take away almost a fifth of the hospitalist group and be unprecedented, according to Dr. James Westhoven, a hospitalist who resigned at the end of March and said he can’t remember a time in his 16 years at EMMC when more than about five hospitalists left in short succession.

‘Handed to us as a done deal’

Westhoven and the current hospitalist — who did not want to be identified out of fear that speaking publicly could lead to repercussions from the hospital — both attributed the departures to the changes EMMC leaders have made since late last year.

They’re the reason that Westhoven, 72, decided to resign in March rather than retire at the end of the year, as he had previously been planning to do.

“This was just handed to us as a done deal,” Westhoven said. “I realized I can’t take part in this wholesale dismantling. It’s really hard to work with staff who are demoralized. They just are fed up with the things that have been done to them over the last six months.”

Early this year, the hospitalists were told that they would be reclassified as shift-based workers and lose all of their paid time off, while other types of doctors at EMMC either lost lesser amounts or even gained paid time off. That has meant they must work more weeks each year for no extra pay.

Since last fall, EMMC has also reduced the number of hospitalists who work each day by about four, according to the one who still works there.

Credit: Linda Coan O'Kresik

That has increased their daily workload. A few years ago, hospitalists usually saw about a dozen patients during a 10-hour shift, but the cuts have meant that they now see 15 to 17 in the same length of time, according to the hospitalist.

Northern Light officials said the changes align EMMC hospitalists’ workload with a national guideline from the Society of Hospital Medicine that hospitalists should see 15 patients over a 10-hour shift.

But Westhoven and the current hospitalist said they have forced the hospitalists to devote less attention to individual patients with complex health problems and affected the overall care residents of eastern Maine can expect from the state’s second-largest hospital.

“They’ve dramatically increased the work,” the current hospitalist said. “They’ve made it totally unsafe, and on top of that, they’ve pissed off the entire group.”

Besides reducing daily staffing, EMMC’s leaders have said they plan to reduce the total number of hospitalists to about 40, from a high of 50 in recent years.

The system has also eliminated a four-hour period that hospitalists were paid to work at the end of a weeklong rotation, which Westhoven said was a critical time to discharge patients or share information about patients with doctors just starting a new rotation.

“You hurry yourself,” Westhoven said. “You don’t pay as much attention. A lot of times, I’d see patients two to three times a day, going back to see them after their tests. Now, that second visit doesn’t happen.”

Adding to the cascade of changes, the hospital’s parent group, Northern Light Health, last year signed a controversial contract with a for-profit Tennessee company, TeamHealth, that has been providing behind-the-scenes guidance on the hospitalists’ work. TeamHealth also has become the employer of hospitalists and emergency room doctors in four smaller hospitals in the Northern Light system, which until recently was called Eastern Maine Healthcare Systems.

[Hospital visits for some Maine residents could become more complicated, and costly]

Altogether, Westhoven and the current hospitalist said the changes will make it harder for EMMC to recruit well-trained doctors to the Bangor region and force the hospital to fill openings with temporary traveling doctors, also known as locum tenens physicians, who are more costly to hospitals than employed physicians.

Northern Light officials have described the recent changes as part of a systemwide improvement effort and said that they align EMMC’s practices with national norms and its compensation with similar markets’.

Credit: Gabor Degre

“The clinical leadership at EMMC was really engaged in working through the [benefits packages] that they have introduced,” Michelle Hood, Northern Light’s CEO, said during an interview in April. “I don’t expect that we’re going to see a problem with recruitment. This is a very standard package.”

Northern Light spokeswoman Suzanne Spruce described the departure of eight hospitalists as “all very normal movement.” She said reasons for the resignations included expiring visas, fellowship opportunities at other organizations and out-of-state work opportunities for relatives.

“I can tell you that it is not unusual for a group of this size to have members leave our employment and the state for such reasons,” she said.

‘A break-even’

Northern Light leaders said they’re not pursuing the reduction to the hospitalists’ ranks and the changes to doctors’ compensation packages with a specific savings goal in mind.

“It’s really a break-even,” said Timothy Dentry, the chief operating officer of Northern Light who is now serving as the Bangor hospital’s interim president after last month’s departure of Donna Russell-Cook. “There’s some that lose a little bit; there’s some that gain some.”

Although some of Northern Light’s smaller hospitals have suffered operating losses in recent years and the overall system in 2017 received a low credit rating, its flagship hospital has been operating in the black.

[Moody’s drops Eastern Maine Healthcare’s debt to ‘junk bond’ status]

From 2013 through 2017 — the five most recent years for which financial data are available — EMMC posted positive margins every year that exceeded the state median for hospitals, according to data from the Maine Health Data Organization. Its net operating income has hovered around $28 million in recent years.

The coming resignations could add to some of Northern Light’s costs.

EMMC is now working to recruit physicians to replace the hospitalists who have announced they are resigning this summer, Spruce said, but it may have to hire more costly locum tenens physicians until it can fill the openings.

It also may not fill all the vacancies, she said.

Under a single banner

It’s not unusual for large health care systems to alienate some of their medical staff when they try to unify diverse hospitals under a single banner and institute new standards across previously independent organizations.

Another example of that happening in Maine came just last year, when the staff of three hospitals belonging to Lewiston-based Central Maine Healthcare held votes of no confidence in the system’s CEO, Jeff Brickman, amid a series of physician resignations.

[Maine hospital system board backs CEO despite ‘no-confidence’ vote]

Health care systems need to avoid hiring too many administrators who are disconnected from the actual medical care their hospitals deliver, and they need to be open and attentive to the doctors who are pivotal to their success, said John Morrow, managing director of Franklin Trust Ratings, which specializes in analyzing health care industry data.

“To a great extent, physicians make the hospital or break the hospital,” Morrow said. “When you have systems trying to run health care — which is always local — more as a corporate entity, it can be a struggle. If the people who are contributing to the system’s success by bringing in patients are now not being listened to, it’s a failure of management.”

At Northern Light Health, the cuts to paid time off represented a breaking point for many practicing doctors at EMMC, who thought they had been cut out of important decisions affecting their jobs and the care they deliver to patients, according to documents obtained by the BDN and interviews with doctors and administrators.

In letters on Feb. 7 and Feb. 11, a group of doctors who lead their divisions at EMMC told Northern Light Health board members that “morale is at an all-time low among the employed physicians at our institution” and that the cuts to paid time off were part of a “recurrent pattern” of “disenfranchisement of clinically active physicians.”

During a March 12 meeting, one of them warned board members and administrators that there could be a “mass exodus” of doctors if things didn’t improve, according to official minutes from the meeting.

Even as Northern Light Health tries to standardize operations across its nine hospitals, the system needs to ensure its hospitals can still respond to the unique health care needs of their regions, said Dr. Jonathan Wood, EMMC’s senior lead physician for pediatrics, who has been among the physicians pushing Northern Light leaders to listen to their larger concerns.

“Whether it’s been intended or not, the feeling has been every square peg pounded in a round hole, everyone the same,” said Wood, who was present for the interview with Northern Light CEO Hood at the group’s headquarters in Brewer. “We know that is not the case. Clinically, that’s so not the case.”

During that interview, Hood said that the organization’s leaders have tried to collect physicians’ feedback in various ways over the last two years, including by elevating them into administrative roles and placing them on committees, but that those efforts need to improve.

Wood and another EMMC doctor who was present for the interview, Dr. Michelle Toder, director of surgical and nonsurgical weight loss programs, both said they are cautiously encouraged by Hood’s efforts to respond to their concerns.

But they also said they don’t speak for all of their colleagues. “I can tell you that not everyone in that huge group of people feels that way,” Wood said.