Dr Brittain was a general surgeon in the Mountain Physician Med Group, a managed care organization. He developed a large clientele of referring physicians. After about two years, Mountain Physician’s gave Dr Brittain an ultimatum–either resign or you will be fired. If we fire you, we will be obligated to report you to the Physician National Data Bank.

The National Data Bank was formed by congress to force hospitals and others involved in quality of care to report physician discipline, loss of hospital privileges and loss of licensure, so doctors couldn’t go to another state to practice. To be reported would essentially eliminate all future practice by that doctor. Therefore, attorney Galie has termed the National Data Bank a tomb for physicians. An ignominious end to a professional career.

Although managed care organizations may be formed as an Independent Practice Association, or a medical group, they are in the financial arena to reduce costs. In Mountain, California, Mountain Physicians Medical Group had eliminated 200 doctors one year, 20 doctors the next year, and everyone was waiting for the ax to fall the third year. However, they are being very selective.

The ultimatum given, RESIGN or BE FIRED, trades on an important issue. This shows that a managed care organization is using a quality of care issue, when there is none, to eliminate a doctor. You see, if they fired a doctor, he has recourse to the administrative remedies, the courts and all sorts of retribution. Most, however, lose, are reported to the National Data Bank and never seen or heard from again. However, a physician who resigns has done just that–resigned. Hence, he can no longer change his mind. He loses his practice, but he avoids the risk of the National Data Bank. And it all looks voluntary, even if done under the threat of losing one’s professional career and future.