University Times

Patient-physician rela- tionships could be at risk under one of the proposed contracts that would govern the new University of Pittsburgh Physicians (UPP) practice plan, according to a committee of Pitt medical professors studying the documents.

UPP is being formed through a merger of Pitt's 18 previously distinct clinical practice plans. It will be a nonprofit corporate subsidiary of UPMC Health System.

Pitt medical faculty member Nick Bircher, a member of the ad hoc oversight committee elected by medical professors to represent their interests, reported at the Sept. 14 Senate Council meeting on physicians' concerns with UPP draft documents.

One of those concerns is apparently contradictory language concerning physicians' rights to refer patients outside the UPMC Health System.

UPP's proposed bylaws say there will be no interference in the patient-physician relationship, Bircher noted.

But the contract governing newly hired UPP employees indicates doctors will violate the contract if they refer patients outside the health system, he said. Such referrals would require approval of the UPP president — a "special papal dispensation," Bircher called it, which could prove unwieldy in an emergency.

"The bylaws say UPP won't disrupt the physician-patient relationship. However, the employment contract states explicitly that all patients belong to UPP and not to the physicians," Bircher told Senate Council.

Chancellor Mark Nordenberg replied, "I am familiar with the draft bylaws and have heard the views of physicians most directly involved in their development. I have never heard any expression of a desire or a willingness to relinquish or interfere with the physician-patient relationship." But Nordenberg said he was unfamiliar with provisions of the proposed employee contract, adding that "it would be of concern to me, too" if the contract interfered with doctor-patient relationships.

Council member Herbert Chesler, interim chairperson of economics, said the UPP employee contract frightened him as a health care consumer. "I fear that we as consumers will be potentially vulnerable to all kinds of institutional imperatives that have nothing to do with our care," Chesler said. He pledged his support as an "ally" of Bircher's committee.

At a Sept. 9 special meeting, medical faculty approved a resolution calling UPP, as currently proposed, "unacceptable" and instructing the ad hoc oversight committee to spend another 30 days working out an acceptable UPP agreement in collaboration with practice plan officials. See box on this page.

— Bruce Steele