I have indirect info on this, but I can't 100% verify. There were several things going on here. I think number one is Providence is bleeding money. All health systems especially out west are screwed by travel nurse cost and procedure volumes have not resumed post COVID like everyone was hoping. Plus, Providence had neurosurgeons in Walla Walla, WA doing unnecessary surgeries. Lookup the news articles on it and it's very bad. Something like the doctors were taking 9x as many people in for spine surgeries than the average neurosurgeon. Basically numbers that would be easy to track and an administrator was either somewhat complicit because of the revenue or incompetent. But regardless, Providence has a multi million dollar payout to the government for fraud and I don't think this includes any of the likely dozens or more medmal lawsuits that could be coming for unnecessary surgery. So not a good financial time at Providence.
There are two parallel employed psychiatrist groups. One doing inpatient only with little if any teaching, all MDs. The other are residency faculty which cover a small portion of inpatient but mostly run the oupatient clinic. I heard they have too many residency docs (which I don't know how that's possible, but maybe the clinic volume doesn't justify it), and there was pressure to let some of them go, but instead the residency agreed to takeover inpatient to avoid losing faculty jobs.
The Spokane inpatient non-residency group was was completely run by psychiatrists with no np's, which on it's own may be motivation for admin to force a change to save money. But also, the adult service was pure RVU and very high volume, with 1 doc doing the work of 2-3 average docs, with commensurate salary, which has bad optics from a regulatory standpoint if a psychiatrist is making $750K even if volume justifies it. This is not fraud but could invite investigation and looks bad especially with the recent neurosurgeon debacle. I also heard the group was asking for increased RVU rates which may have been justified based on median salary survey numbers, but again if you're making $750K on a below median rate, I can see how admin would not be happy getting pressed to pay even more.
Also, this inpatient group (not all the same doctors at the time) resigned en masse about 7 years ago to force a salary renegotiation which may have rubbed admin the wrong way and memories of the past may be coloring the current decision. You can probably still find news articles about this resignation, it wasn't a quiet thing, it made the papers and probably embarrased admin. It may be a "you played hardball with us now we'll play hardball with you" situation. Basically, we have enough doctors to shift from residency plus some np's that we can takeover your job, and there's enough going on we don't like, that we would rather risk problems in the transition than continue the current setup.
I think the lesson here is everyone is replaceable. Not always easily. 7 years ago they weren't easily replaceable and renogotiated a favorable contract. Currently, there's a residency program with extra docs willing to work with np's...so that shifts the power balance.
My understanding is the current docs can apply for residency faculty jobs at more typical median salaries, and also lower work load for adult docs. But it goes from a 7 on 7 off job to a 5 days a week. And the units are covered with closer to 1:1 MD to np instead of all MD.
I think that even in independent practice states for np's Medicare still requires a physician in some capacity that care can be escalated to, even if not officially supervising. I think there was some legislation trying to change this last year, but it's likely the lynch pin at some hospitals keeping MDs employed, though I've never heard an administrator say this explicitly.
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