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Pratt Medical Center cut its work force last week in response to declining insurance reimbursements and the departure of 14 more doctors.
Ten employees at the clinic's business office were laid off last Wednesday. Robert E. Alexander, Pratt's chief executive officer, described the support-staff layoffs as painful but necessary.
"A lot of health-care providers are looking for ways to cut costs," he said.
Prior to the layoffs, 50 clerical and administrative employees worked at the clinic's business office on Fall Hill Avenue in Fredericksburg. The workers were invited to apply for existing vacancies, Alexander said.
The downsizing did not affect any of the workers at Pratt's seven satellite offices, Alexander said.
Pratt's roster of doctors has shrunk in recent years as the organization has gone through several changes in corporate structure.
Nineteen doctors resigned last year, and 14 more submitted resignations since this summer. With fewer doctors, fewer workers are needed in the business office, Alexander said.
In addition, the federal Medicare program has decreased its reimbursements in recent years, and Medicaid followed suit this year. Payments from private insurers are often tied to the government reimbursements and have declined as well.
For patients, each physician resignation means that they have to switch to a new doctor or follow their doctor to a new out-of-town office.
Pratt has a noncompete clause in its employment contract that requires a departing doctor to move at least 25 miles for one year if he or she wishes to continue to practice. The doctor can buy out of the provision with the equivalent of one year's salary.
The newest resignations include the entire cardiology department and one of Pratt's busiest pediatricians, Dr. Allen E. Aaronson.
Drs. Thomas E. Martyak and William M. Cicio have already resigned from Pratt's cardiology department. Drs. Robert B. Vranian and Thomas E. Wheeler will resign at the end of the year.
Alexander said the clinic will continue to do cardiology tests and contract with cardiologists in the community to evaluate the tests.
Alexander would not comment on Aaronson's departure, and efforts to reach Aaronson were unsuccessful.
Carolyn W. Jones, whose son Andre has been a patient of Aaronson's for years, said she first heard about Aaronson's departure earlier this month, when a friend called to make an appointment. She said she called the Pratt office yesterday and was told that today is Aaronson's last day. She said she has received no notification from Pratt.
"That's one of the things I was upset about," Jones said.
Aaronson is one of the senior doctors at Pratt and one of its owners. He has cared for thousands of local children in nearly 15 years there. He is also president of the medical staff at Mary Washington Hospital.
"He was good with my son," Jones said. "They had a good relationship."
Aaronson joined five of his colleagues in a lawsuit against Pratt last year. The group challenged the clinic's employment contract. Aaronson eventually withdrew from the suit, and the remaining doctors reached a settlement with the clinic.
It is not clear what will happen to Aaronson--and to his patients--after he leaves Pratt. According to one source, he has reached an agreement with Pratt that will allow him to continue to practice in the Fredericksburg area.
Jones said she was told yesterday by the Pratt office that he will open a new practice on Princess Anne Street in Fredericksburg in mid-October.
The other physician departures include a variety of primary-care and specialty doctors. To Alexander, these resignations are neither surprising nor alarming.
"The turnover of physicians is common in health care," he said. "I think if you look around, you will see physicians leaving everywhere."
Pratt has already added two pediatricians, Drs. Resa E. Davis and Sharon R. Strickland, and an occupational health specialist, Dr. Michael Neylon.
The clinic also has hired an endocrinologist and an internist who will join the staff on Oct. 1. A second endocrinologist will arrive early next year. Endocrinologists treat diabetes and other gland and hormonal problems.
Founded in 1937, Pratt is the largest clinic in the region, with 36 doctors and offices in three localities. Construction of a new MRI/CT center on State Route 3 in Spotsylvania County will begin soon.
Because of developments such as these, Alexander said he is optimistic about the future.
"Pratt's here to stay," he said. "Making the types of decisions we're making is really an indicator of our commitment."
To reach JIM HALL 540/374-5433 jhall@freelancestar.com