Dr. Seth Baker was in a great mood on the first day of his new solo cardiology practice that opened in Vero Beach last week.

The veteran cardiologist spent the past decade of his 25-year career employed by what is now Cleveland Clinic Indian River Hospital. Last week, he took the final step in breaking free of that arrangement, opening a concierge practice in a freshly renovated space just west of the hospital.

“Oh my gosh, I feel like I’ve been let out of a cage,” said Baker, a few hours into his first day, as he reveled in the independence of having his own practice again.

“It’s come full circle,” said Baker.

For some patients, though, the cardiology department at Indian River has seemed more like a revolving door. By summer’s end, five of the hospital’s eight cardiologists who were employed prior to the Cleveland Clinic takeover will have left in less than a year.

Baker appears to have left more willingly than some, having given a long notice prior to an “amicable parting.”

“I go there every day,” said Baker, who retains privileges at the hospital and visits his patients there. “My colleagues are a well-trained, diverse group of medical professionals that I look forward to working with.”

Baker regards the hospital highly – it is where he and his family would go to be treated, he said.

He championed the choice of Cleveland Clinic to take over the hospital in January 2019, and said he understands the health system’s need to standardize practices throughout its hospitals.

The new management made few changes in its first year. But in 2020, Baker found himself depleted by time and paperwork constraints that he felt short-changed his patients and chipped away at his off-hours. Approaching 59, he still enjoyed his specialty and felt far from retirement, but after two years of the “corporate template” of Cleveland Clinic, as he put it, his heart wasn’t in it.

“It became very depersonalized, and I didn’t like that,” Baker said. “We became much less efficient with more hurdles to go through. I think I was actually working 30 percent more hours and seeing 20 percent less patients than when I was in private practice.”

Now Baker is looking forward to seeing 90 percent fewer patients by going to a concierge model, ultimately reducing his practice from 4,000 to 350. And they are not all affluent.  Despite a $3,000 annual fee, two public school teachers are among those who have signed up.

The new practice is not without challenges for Baker.  Concierge members get his cellphone number and are told they can call 24/7. There’s also the promise of day-of or next-day appointments, almost certain to mean long hours for staff on days those requests come back-to-back. Telehealth visits are an option, too, and so are house calls when necessary.

Baker, who before med school, played football for Johns Hopkins University, dreams of his practice including people who have not yet had a heart attack, hoping to educate them on the importance of a regimen of more exercise, healthier food and fewer drinks to limit heart disease.

But teaching takes time, and at Cleveland Clinic – like most health systems, and private practices for that matter – patient time is limited.

Ironically, the cardiologists departing Cleveland Clinic Indian River had a lot to do with building the hospital’s Welsh Heart Center, a so-called “center of excellence” like the Scully-Welsh Cancer Center that attracted Cleveland Clinic to Vero in the first place.

The advanced care offered at those centers was rare for a small community hospital and is frequently credited for bringing a world-renowned system like Cleveland Clinic here.

Heart center doctors including Baker were among the biggest cheerleaders for Cleveland Clinic as the choice of a takeover partner narrowed to four finalist health systems in the fall of 2018.

Baker felt that with the Cleveland hospital’s longstanding national ranking of No. 1 in heart care, the already strong heart program at Indian River would get even better.

“I was at the front of the parade, banging the drums” to get Cleveland Clinic here “for the community,” Baker said.

It turned out, for him, the health system “just wasn’t a good fit.” With five cardiologists leaving, he apparently wasn’t alone.

Cleveland Clinic would not comment directly on the doctors’ departures. But the hospital repeated Monday what its president, Dr. Greg Rosencrance, said in late March – that the hospital is actively recruiting cardiologists. So far, Dr. Nazar Sharak is the only one hired.

First to leave last fall was Dr. Tudor Scridon, who came in 2008 when Indian River was just ramping up its then Duke-affiliated heart center. After initially joining Dr. Arley Peter at the Treasure Coast Cardiovascular Institute, Scridon has opened his own practice and anticipates being joined by his cardiologist wife, Dr. Cristiana Scridon, when her resignation from the hospital takes effect in August.

By then, Dr. Charles Celano will have left the hospital and opened his own new concierge cardiology practice, slated to be up and running July 1. Celano has been practicing in Vero since the early 1990s and joined the hospital as the Heart Center was taking shape.

Prior to joining the hospital, Baker had been in private practice in the area since 1996; his wife Dr. Mary Baker, practiced obstetrics and gynecology in the suite next door. Around 2010, Baker decided to merge his practice with the hospital cardiology group.

He was joined by his partner, Dr. Richard Moore, another well-respected, long-time cardiologist who left the hospital in April. Moore has decided to retire, Baker said; the two remain close friends. They, along with the Scridons, all practiced in the same office prior to moving into the hospital’s Wellness Center in late 2016.

Life for hospital-employed cardiologists was different under the former management of Indian River Medical Center. “They basically left us alone,” said Baker.

Cleveland Clinic, which prides itself on monitoring for systemwide consistency in protocols and policy, added a new layer of bureaucracy.

“It wasn’t the way I wanted to practice,” Baker said. “What we lost was a very different feel, a different culture, a different vibe.”

That “vibe” is what Baker says he is trying to restore at his new practice. “Getting back to the basic patient-doctor relationship where when people call, they’re greeted by a personal voice.”

Phone system foul-ups at Cleveland Clinic Indian River dating back to December left its physicians apologizing frequently to patients irate over being unable to reach the office.

“And we had nothing to do with it,” Baker said. “I was apologizing for something I had no control over.”

When complete, the five departures will leave only four cardiologists employed by the hospital. In addition to newcomer Sharak, there are three doctors who’ve been with the hospital since 2015 or 2016: Dr. Vik Gongidi, Dr. Dan Wubneh and Dr. Alan Rosenbaum.

Those remaining doctors are listed as options for the thousands of patients who got letters from Cleveland Clinic informing them their doctor had left the hospital.

The letters did not include ongoing contact information for the departed doctors, saying only that the patient’s cardiologist is no longer with the hospital-owned practice, and that messaging the doctor “is unavailable” through the hospital’s MyChart portal.

Cleveland Clinic declined to comment on the policy of not informing patients about the departing doctor’s plans, and whether they would be practicing locally.

Left in the dark about the whereabouts of their heart doctors, some patients resorted to Facebook or frantic phone calls to try to find out if they were practicing elsewhere, or even if they were OK. “I didn’t know if he’d dropped dead,” said one patient, who was stunned to find his doctor unavailable.

Patient records remain with the hospital, the letter said; a form was enclosed for patients to have them transferred.

Baker is now one of 13 independent cardiologists in the county; there will be 15 when Celano and Cristiana Tudor leave their hospital posts this summer. Nearly all will retain their privileges at the hospital, meaning their patients can be admitted and seen there.

According to an analysis by Global Healthcare Advisors, the percentage of cardiologists employed by a hospital or heart clinic as opposed to private practice was 84 percent in 2018.  The increase over the past decade has been “staggering,” the report said, attributed in part to the pressure on private practice physicians with diminished insurance reimbursement rates and rising costs.

In fact, hospital-owned physician practices are not standard throughout the Cleveland Clinic system. The heart center at Martin Health North, the Stuart hospital acquired by Cleveland Clinic at the same time as Indian River, uses mostly independent physicians, apart from two cardiac surgeons installed when Cleveland Clinic affiliated with the heart center just prior to the takeover.

At Weston, though, the standard is the opposite – most physicians are employed by Cleveland Clinic. The same is true at Cleveland Clinic’s main campus in Ohio.

As for concierge cardiology, it is a growing niche, according to a 2018 article in Cardiovascular Business. Most of the estimated 5,000 concierge practices nationwide were primary care, with only “hints of emerging interest in concierge practice in cardiology.”

Baker’s decision makes him the second concierge cardiologist in town; Dr. Nancy Cho has had a concierge cardiology practice for years. And soon, there will be three, when Dr. Celano opens his concierge practice in July.

For Vero to have 20 percent of its private cardiology practices go concierge may speak to the town’s care-seeking demographic, which may be better able to afford the up-front fee.

For Baker, the reduced risk of physician burn-out is worth the trade-off of deferring retirement as he builds his new practice under the concierge format.

“This is going to add years to my career and happiness in my life,” said Baker.