Pallav Mehta, M.D., Medical Director for Reimagine Care
Non-Compete Clause & Healthcare
Recent data suggests that ~ 20-40% of all U.S. workers have employment contracts that contain a non-compete clause (NCC) which restricts the person’s ability to work within a specific distance from their current employer for a certain amount of time should they leave their job. While NCC’s are seen at all wage levels and industries, they are more common with higher wage employees and in the field of healthcare, so it’s not surprising to see a large percentage of physicians reporting an NCC in their contract. A 2019 study revealed ~45% of physicians’ contracts contained a NCC (K Lavetti, C Simon, W White. J of Hum Res. Feb, 2019) while a 2024 Doximity poll regarding views on NCC’s found that ~62% of physicians surveyed were under a NCC. In this same poll, there was near unanimous support from the ~5,000 physicians on banning these clauses.
The NCC Ruling
This leads us to the recent final rule on the matter of non-compete agreements issued on April 23rd from the Federal Trade Commission (FTC). After several months of careful review of the empirical research and >26,000 public comments (with >95% opposed to NCC’s), the Commission voted to adopt a comprehensive ban on all new and most existing NCC’s declaring them an unfair method of competition. “Non-Compete clauses keep wages low, suppress new ideas, and rob the American economy of dynamism…” said FTC Chair Lina Khan. The FTC estimates that banning NCC’s will result in $75 – $195 billion in reduced healthcare spend, the addition of 8500 additional new business being created annually, an average of 17,000 – 29,000 new patents annually for the next decade, and $488 billion in increased wages for workers over the next decade.
If the ruling survives the legal challenges that were immediately brought against it (the US. Chamber of Commerce with 3 other groups has brought a lawsuit against the FTC), it would go into effect 120 days later. While non-profit entities are technically exempt, the FTC made clear that being designated as a non-profit simply under the IRS tax code does not necessarily exclude an organization from this ban. “If you claim non-profit tax status but are really organized for the profit of your members, you are within our jurisdiction and covered by the rule,” FTC commissioner Rebecca Slaughter said. Clearly, hospitals and health systems are in the FTC’s line of sight with this decision.
Ban of the NCC & the World of Oncology
For oncology professionals, this change may be a welcome relief, offering bargaining power and unprecedented freedom to move between jobs. But empowering healthcare workers in this way can pose a significant and unique challenge for cancer centers: retaining their top talent. It is in this environment that Reimagine Care emerges as a crucial ally to cancer centers, providing a tech-enabled, human-led platform designed to enhance job satisfaction and reduce burnout, thereby bolstering staff retention.
Oncologist Burnout
Oncologists and nurses face immense pressures daily. The demands of managing patient care, particularly in oncology, involve constant interruptions from acute patient needs, coupled with extensive administrative responsibilities like unnecessarily detailed EMR documentation. These interruptions can disrupt the flow of a clinic and significantly extend work hours, encroaching on personal time and contributing to professional burnout.
The toll on personal life is substantial, with many oncologists and nurses experiencing decreased job satisfaction. The recent 2024 Physician Depression and Burnout survey found that 90% of all physicians are clinically or colloquially depressed and oncologists are now tied for #2 in Burnout rates among 25 medical specialties (Just 10 yrs before, oncologists were #19 out of 25). The problem also extends to oncology nurses. A 2023 AMN Healthcare survey found 85% of nurses planned to leave their current place of employment in the next year and 75% of nurses were considering leaving clinical practice altogether in the next 5 yrs. These trends are not just unsustainable for cancer care but could be cataclysmic for the future of healthcare if they continue in this direction. Provider dissatisfaction is exacerbated by the administrative burdens and the emotional strain of providing constant high-stakes care. As a result, turnover is not just a matter of replacing a staff member; it involves losing a highly trained and invaluable part of the cancer care ecosystem.
Economic Implications of High Staff Turnover
Along with the disruption to patient care and dissatisfaction that comes with a team member leaving, the economic implications of high staff turnover are significant. The cost of recruiting and training new oncologists and nurses can be exorbitant, often ranging from one-half to two times the employee’s annual salary. To put this in perspective, the national average salary for a medical oncologist is $516,000 (MGMA DataDrive provider compensation) an oncology nurse practitioner is $130,000 and an oncology nurse is ~$85,000. So turnover costs for losing a single one of each in a year can be ~$1.5 million.
Reimagine Care Serves as a Virtual Extension of the Cancer Center
Reimagine Care serves as a virtual extension of the cancer center introducing a proactive, human-led, tech-enabled platform that fundamentally changes how symptom management and patient interaction are handled in oncology. An AI-powered NLP virtual assistant named Remi is the digital front door that interacts proactively and reactively with patients via simple SMS text, offering 24/7 accessibility without the need for cumbersome apps, passwords, and portals.
Remi’s technology is designed to analyze and respond to symptoms based on proprietary acuity models and alerting thresholds which underlie RC’s ability to drive the kinds of nurse-to-patient efficiencies that are simply not possible in a pure bricks and mortar cancer center. Whether a patient responds with “I’m nauseated” or “I’m throwing up” or simply an emoji that illustrates the problem, Remi can recognize what the patient is saying and these responses trigger a dialogue based on numerous pathways developed by RC using validated national oncology guidelines. All of this allows patients to report and manage symptoms effectively from home. Remi can determine if a situation is more complicated and automatically escalates to our team of oncology RNs and APPs, who can respond back to patients via text, phone calls, initiating telehealth visits that in some cases may require RC’s unique ability to deploy in-home urgent care for interventions like fluid administration, labs or medication adjustments.
Reimagine Care is there for Patients 24/7
The last few years has seen an emergence of what I call “cancer treatment-adjacent” startups that are clearly attempting to help patients with cancer but avoiding the significant operational and clinical challenges that are inherent during active cancer treatment. Reimagine Care, on the other hand, is willing to go precisely where others won’t, “Once more into the breach” repeatedly standing shoulder to shoulder with the patient and their caregivers during the most frightening of days, be it 2pm on a Tuesday or 2am on a Saturday night. Instead of partnering only with entities that are peripherally involved in the patient’s cancer care, RC partners directly with oncologists and their team take over the care of their patients on active cancer therapy like chemotherapy, radiation, oral cancer medications, etc.
RC’s seamless integration also extends to documentation. All patient interactions are recorded directly into the EMR of the partnering cancer center, ensuring no additional administrative burden falls on their clinical staff.
We find that it’s precisely in these more laborious aspects of cancer care that providers feel the greatest strain as individuals and as the collective team. While serving as Medical Director of Reimagine Care, I am fortunate enough to still maintain a thriving clinical practice as a breast Medical Oncologist where I currently evaluate and manage 30-40 pts every week. While a some have completed treatment and are now on surveillance, many more have an advanced diagnosis and/or are on active treatment. Most of my clinical time every week is spent in the multitude of texts, EHR messages, emails, and other conversations between me and my RN, APN, Nurse navigators, infusion nurses, pharmacists, and others for patients getting treatment. It is not at all unusual that patients have symptoms requiring an urgent next day office visit trying to fit into a schedule that is already completely full.
Implementing Reimagine Care Leads to Reduction in Provider Turnover
By reducing the frequency of interruptions and the administrative load, Reimagine Care allows oncologists and nurses to focus more on direct patient care and less on the bureaucracy of medicine. This allows these invaluable clinicians to rediscover the joy that led them to this wonderful calling in the first place, reducing the epidemic of burnout.
Reimagine Care is in a unique position to help cancer centers retain their staff. If our platform reduces turnover by even 10%, the savings on turnover costs alone provide a substantial return on investment (ROI). This calculation does not even factor in the improved patient outcomes and satisfaction scores that often accompany better continuity of care, which can also contribute to a cancer center’s financial and reputational standing.
Our partnerships with multiple cancer centers have already shown promising results. Oncologists reported a more manageable workload and greater job satisfaction, citing fewer interruptions and a more focused clinical environment.
Testimonials from our clinical staff reinforce these statistics. One seasoned APP oncologist at a community practice mentioned, “Reimagine Care has helped reduce the number of acute care visits during the day, reducing schedule interruptions and allowing providers to see more patients. It has also provided our patients comfort and reassurance that they can have their questions and needs addressed in a timely manner.”
Investing in Solutions
As cancer centers navigate the implications of the FTC’s ruling on non-compete clauses, it’s more important than ever to invest in solutions that not only enhance patient care but also improve the work environment for oncologists and nurses. Reimagine Care stands out as a strategic tool in this regard, offering a dual benefit: it streamlines patient management and significantly enhances staff retention. By addressing both these areas, Reimagine Care not only supports cancer centers in maintaining a stable, satisfied workforce but also ensures that patients receive the best possible care.
In an era where job mobility is at an all-time high, investing in employee satisfaction is not just good practice—it’s essential for survival and success in the competitive healthcare landscape.