Scripps Shows Renegade Doctors the Door : Health: The Rancho Bernardo clinic says the firings are merely fair play in a battle to retain patients.

The Scripps Clinic in Rancho Bernardo played hardball this week and abruptly fired 19 doctors who planned to leave to start their own clinic 2 miles away.

Citing a need for greater autonomy, the doctors last week gave Scripps six months notice of their intention to set up the rival clinic.

But Scripps officials Monday delivered letters to the doctors giving them two days notice, asking them to move out of the clinic by 5 p.m. Wednesday.

“It’s like any divorce--it started out amicably,” said Robert Erra, Scripps’ senior vice president and chief operating officer.

In San Diego, which has a higher doctor-patient ratio than the national average, the dispute centers on the patients. Several doctors predict that the two clinics will duke it out for a patient population that is probably not large enough to support both.

“We’ve got too many doctors as it is,” said Dr. Robert Reid, president of the San Diego County Medical Society. “It’s going to be cutthroat competition. There’s not enough patients to go around.”

The renegade group of doctors hopes to lure 70% of their Scripps patients to the new facility, said Dr. Paul Mills, former medical director of the Scripps Clinic in Rancho Bernardo and new director of the rival clinic.

But Scripps officials are equally determined to hang on to those patients. No patient appointments will be canceled, and the clinic will be staffed by the usual number of doctors, Erra vowed.

Moving quickly, Scripps hired three new doctors to start work today and lined up doctors from four neighboring Scripps facilities to work at the clinic until a full-time permanent staff is in place in three months.

The clinic is manned by 50 doctors, 35 of whom worked there full-time. The defection of 19 doctors was considered a blow. Yet Scripps officials are determined to make up for the loss.

Erra likened Scripps’ action to that of a law firm battling back after having several partners resign to start a new firm. It would be self-destructive to let the splinter group siphon off business, he said.

“Clearly, we have to preserve the patient-clinic relationship,” Erra said. “To allow the group of physicians to work within the clinic and develop new relations with new patients would be to aid them in building their new business that they could bring to the new clinic.”

But the renegade doctors counter that Scripps’ surprise move threatens patient care.

“Obviously, all of us would have preferred a smoother transition for the patients’ sake. This is disruptive,” Mills said.

Acting with equal speed and urgency, Mills and the newly formed Centre for Health Care Medical Associates found temporary offices to set up shop--an endeavor they didn’t plan on until several months from now. Beginning today, the group will start scheduling appointments for patients, whom doctors are prepared to see beginning Monday.

The new group, which has entered a 50-50 partnership with Dallas-based Republic Health Corp., will build its own $9-million primary-care office complex in the 17000 block of Bernardo Center Drive. That facility will open next spring, said Margareta Norton, vice president of the San Diego Region Republic Health Corp.

During the first two years, most of the 21 physicians who joined the new group will probably earn the same salaries they made at Scripps, Norton said. After that, they may earn about 10% more, but it’s a “little riskier,” she said.

However, the move to set up their own clinic, Mills said, had nothing to do with money. And the new group, he said, will be more attuned to the needs of the community.

Although under the auspices of Scripps, doctors sometimes had to send patients to Scripps facilities elsewhere in the county. At the new clinic, every effort will be made to keep those patients in the Rancho Bernardo area, Mills said.

“I view it as a normal maturation,” he said. “It’s important for a physician to feel he has control and input into the multiple factors that affect patient care. . . . We wanted more control and say. I’m sure we’ll make some of the same decisions that Scripps did, but the thing is, we’ll make those decisions.”