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Mission Hospital faces an exodus of urologists, and five physicians from a local urology group refuse to practice at the HCA Healthcare-owned hospital, potentially reducing the number of specialists in the system to two by summer.
One Mission urology physician left in October 2023, another was terminated in January, and one plans to leave by July 4, according to documents and emails obtained by Asheville Watchdog.
Urologists from Asheville Urological Associates — located across the street from the Mission campus but owned by GenesisCare — decided to relinquish their own practice privileges at the hospital and began doing so in 2022, said Jeremy Cloninger, the group’s practice administrator. Relinquishing privileges means doctors decided not to provide care there.
The urologists’ departures follow a larger pattern of employee exits over the past five years, as The Watchdog has reported. The medical oncology group at Mission’s cancer center dwindled to nothing last year, numerous hospitalists fled after the HCA purchase in 2019, and others continue to bow out, all part of a growing exodus of more than 200 physicians. Additionally, hundreds of nurses have departed between 2022 and late 2023, two years marked by federally chronicled patient death and endangerment.
As recently as two years ago, Mission had 10 urologists on call, former Mission Urology physician Dr. Brian Cohen told The Watchdog.
Asheville Urological Associates’ urologists now have practice privileges at AdventHealth Hospital and UNC Health Pardee, both in Hendersonville, according to Cloninger and the Asheville Urological Associates website. The group’s newest doctor, who joined in September 2023, relinquished his Mission privileges in early 2024, Cloninger said.
The Watchdog asked Mission Health spokesperson Nancy Lindell several questions about the departure of Mission Urology doctors, including whether the hospital was recruiting urologists, and the decision by Asheville Urological Associates physicians to relinquish their privileges. Lindell did not directly answer the questions.
“As with any job, there are various reasons why people leave,” Lindell said. “ Out of respect for our current and former employees, we do not discuss personnel matters publicly. Mission Hospital has urologists on its medical staff and, with its affiliates, continues to recruit for any open positions.”
As of this week there was one posting for a Mission urologist on HCA’s career portal.
According to a description of Mission Urology’s services on the hospital system’s website, doctors there “bring state-of-the-art care to our patients, including robotic surgery, urologic cancer care, kidney-stone treatment, female incontinence and pelvic surgery, men’s health including erectile dysfunction and penile implants plus a variety of other urologic conditions.”
Cloninger noted many surgical procedures “could in some form require urology services.”
The staff and physicians listed as associated with Mission Health’s urology services serve all six regional Mission Health hospitals in an 18-county area of more than 950,000 people. Lindell did not answer a question about why members of Asheville Urological Associates were still listed on Mission Health’s website as associated with the hospital system. Cloninger also did not know why the doctors remained on the Mission website.
Most urologists The Watchdog reached did not want to discuss their reasons for leaving or halting practice at Mission or did not return requests for comment.
Dr. Quinton Cancel, the physician planning to depart Mission Urology by July 4, declined to comment. Mission recently sent letters to his patients, notifying them of his plans.
On March 21, Cancel sent an email titled “Resignation” to Mission Health CEO Chad Patrick and copied HCA North Carolina Division President Greg Lowe. Cancel thanked Patrick and Mission Urology for hiring him four years earlier but referenced challenges at Mission.
“While I have enjoyed working with my partners and our awesome staff, the current and future state of Urology at Mission is incompatible with my personal and professional priorities at this point in my life and career,” Cancel wrote. “Although this will mark the end of my current contractual relationship with Mission, I am open to working with Mission, in perhaps a different capacity in the future, to help meet the needs of the community.”
One of Cancel’s patients spoke with The Watchdog on the condition of anonymity because he didn’t want to reveal personal medical information. Cancel’s letter was the second one he received in less than a year from a departing Mission physician. The first was from Dr. Michael Burke, a medical oncologist who left in November 2023.
“The awkward part is you really don’t know what the situation is,” the patient said, noting he had moved to the Asheville area because of its reputation for good health care. “You don’t know if it was just a personal choice, or if it’s related somehow to the Mission practice.”
Though the patient said he’s received appropriate and high-quality treatment at Mission, the departures have left him considering whether he should continue getting care there.
“It sort of places a marker in your mind, you know,” he said of Cancel’s departure. “What’s the next thing that’s going to happen?”
Dr. Matthew Young is another urologist who left Mission Urology, departing at the end of October 2023.
“I want to assure you that Mission Urology Asheville is committed to providing the highest quality of care to our patients and to serving the needs of our community,” Young said in his departure letter to patients. The Watchdog reached out to Young for comment, but did not receive a response.
A return of privileges at some point?
Dr. Brian Cohen, who formerly worked at Mission Urology for more than a decade, told The Watchdog that urologists there were having to take on heavier workloads after some Asheville Urological Associates decided to not practice at Mission.
Cohen was terminated without cause in January, meaning he wasn’t given a specific reason.
“I’m pretty sure they just got rid of me because they got sick and tired of hearing me voice my frustrations and voice my complaints,” Cohen said. “I’m not a compliant person. I’m certainly not built for corporate medicine, I can assure you of that.”
More broadly, Cohen said, the situation across departments at Mission was “deteriorating”: There were departures because of pay, issues in the operating room, a heavy reliance on traveling nurses, and especially issues with how HCA was managing the hospital. He expressed concerns to hospital administration, he said, but nothing came of it.
“I would get increasingly frustrated with the situation of, you know, not feeling supported from the… administrative side of things,” Cohen said.
Cohen now works as a locum tenens physician, filling in for absent doctors. He routinely works in Michigan, he said, though he continues to live in Western North Carolina.
The Watchdog contacted most current Asheville Urological Association doctors regarding their decision to relinquish privileges at Mission. Only one responded.
“Out of courtesy for physician colleagues within the Mission system I would prefer to step aside of any direct dialogue related to the decision of providers within our group to suspend active privileges at Mission Hospital,” Dr. James Brien said in an email.
Cloninger would not speak directly to the reasons behind Asheville Urological Association doctors’ decision, but noted there were a “host of reasons,” and said “the consensus was just expectations for when they’re on call for the hospital and coverage of multiple hospitals while on call.”
Cloninger said “it was a personal decision for all of them,” adding that the doctors may pursue practice privileges at Mission again, depending on what happens there in the coming months and years.
“Our doctors may get privileges again one day at the hospital system,” Cloninger said. “They didn’t step away with the intention of never coming back. But there has to be some… larger scale changes made to allow them to make that independent decision.”
In February, the U.S. Centers for Medicare & Medicaid Services found Mission to be in immediate jeopardy, the most severe sanction a hospital can face. CMS removed the finding less than a month later, but the hospital still faces the potential loss of federal funding due to numerous deficiencies outlined in a 384-page report.
That report came after a CMS and North Carolina Department of Health and Human Services investigation in November 2023, which found 18 people were harmed or died at the hospital from 2022 to 2023 due to conditions that violated federal care standards.
Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email arjones@avlwatchdog.org. The Watchdog’s reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/donate.
Thumbs up to the urological physicians who have taken a more professional choice in where to practice. Note their names, where they can be reached, and patronize them in support of their responsible decisions.