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Buffalo Cardiology & Pulmonary Associates to close May 20 after 40 years

Buffalo Cardiology & Pulmonary Associates, which has 16 doctors at its Amherst location, is closing after 40 years, as industry trends drive more doctors to choose to practice in large, multispecialty groups or as employees of hospitals.

The group began mailing letters to its 25,000 patients Friday, informing them that the practice would close May 20. About half of the doctors will join Buffalo Medical Group, and the rest will join Kaleida Health, Erie County Medical Center, CCS Healthcare and other practices, said Dr. Robert P. Gatewood Jr., the practice’s president.

“This is all about moving to larger networks,” Gatewood, a cardiologist who joined the practice 36 years ago, said in an interview.

Buffalo Cardiology & Pulmonary Associates once had as many as 26 doctors. Today, the cost of running a practice has grown, and doctors in private practice face increasing regulatory burdens and shrinking payments for the procedures they perform. That’s why many smaller and solo practices are closing, and doctors choose to work for someone else, veteran physicians said.

“This is, I’m sure, cataclysmic to patients, but it’s a sign of what’s happening. We’re going to see more of that. We’re going to see more affiliations, more mergers, more acquisitions – just as you’re seeing between hospitals,” said Dr. Nancy H. Nielsen, senior associate dean for health policy at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences, who has practiced medicine in a small private practice and with Buffalo Medical Group.

Dr. William J. Breen founded what became Buffalo Cardiology & Pulmonary Associates in 1975. It started with three doctors and expanded to six when Gatewood joined.

“He was quite a visionary,” Gatewood said of Breen, who had the idea to put comprehensive heart and lung care in one building. He died in 1992.

The practice offered cardiac rehabilitation services almost from the beginning, started a cholesterol clinic in the early 1980s and in recent years began providing telemedicine. The practice moved into its current location on Main Street in Amherst in the early 2000s and opened its BCPA Fitness, with medically oriented fitness, expanded cardiac rehab, physical therapy and a wellness and prevention program about three years ago, Gatewood said.

“We’ve tried to be as progressive as possible,” he said.

However, a 16-physician practice is no longer large enough in today’s health care environment, he said, where the trend is for bigger and bigger practices such as Buffalo Medical Group, the various UBMD practice plans and Western New York Urology Associates.

“You need size, you need scale, you need connection with a referral base, which is increasingly being controlled by primary care in a way that it has not been. And that’s because the reimbursement systems are changing to focus on primary care,” said Nielsen, a former president of the American Medical Association, the largest group representing the nation’s doctors. She also has closed a practice, in the mid-2000s, after finding herself tied up too much with her university commitments and with travel out of town on AMA business.

In the last three decades, the number of physicians practicing medicine in groups with 10 or fewer doctors in Western New York and across the nation has declined sharply, while the number in the largest practices has soared, according to the latest data from the AMA.

Between 1983 and 2014, the share of physicians in solo practice fell to 19 percent, from 44 percent, and the share working in practices with 10 or fewer doctors fell to 61 percent, from 80 percent, over that time, the AMA reported in July. Meanwhile, the share practicing in groups with 25 or more physicians quadrupled over that period, from 5 percent in 1983 to 20 percent in 2014.

Buffalo Cardiology & Pulmonary Associates leaders have considered their options for a number of years. Gatewood said they approached Kaleida Health about five years ago about becoming part of the hospital system, but nothing came of that.

About 1½ years ago, the group began discussing a possible merger with several larger practices, including negotiations for more than a year with Buffalo Medical Group, but that also didn’t lead to an agreement, Gatewood said.

In the end, the group’s physicians were left to dissolve the practice and to decide where to practice on their own, with the largest number, seven of them, opting to join Buffalo Medical Group. The rest are going on their own, or with one other physician, to other practices and hospitals.

The doctors are hoping to bring as many of their 83 physician assistants, office workers and other employees with them from 6460 Main St. to their new practice locations, Gatewood said. He said they also hope their patients follow them.

“We realize that change is sometimes unnerving, but all the doctors remain committed to your present and future care,” the Buffalo Cardiology & Pulmonary Associates letter to the practice’s patients stated.