It has been eight years since a group of five doctors at the Dartmouth-Hitchcock Concord clinic left their salaried positions to form their own medical practice. According to one of those doctors, Dr. Frank Betchart, they left because they were frustrated with the way the hospital micromanaged their medical care.

This month, stymied by the tough economic realities of primary care, they have come under the wing of a different hospital.

Concord Hospital purchased Pleasant Street Family Medicine in early October and now runs the practice.

Patients of the group should see little change, according to Betchart and Concord Hospital president Mike Green, but the sale underscores the difficulties facing independent primary care practices in the region, eight of which have come under Concord Hospital's ownership in recent years.

"The bottom line is it's about money," Betchard said. "The expenses and costs of doing business were going up and the revenue was flat, and there wasn't anything we could do to counter that except seeing more patients, which didn't make sense."

Betchard said doctors at the practice had been cutting their salaries to stay solvent and would have needed a loan to replace obsolete billing software.

Primary care wasn't a big part of Concord Hospital's original business plan, but the hospital has been asked to bail out a number of practices in recent years, Green said. Doing so fits into the hospital's overall mission, he added. The Pleasant Street practice is the second the hospital has bought this year.

"Our mission is, as a charitable organization, to provide health care services to individuals in the communities we serve," Green said. "And providing health care services begins with primary care."

Primary care doctors remain in short supply locally, and few in Concord are taking new patients.

Green said the hospital hopes to recruit four to eight new physicians this summer to help fill the gaps.

Green said doctors and staff at Pleasant Street will run the practice much as they had, although the hospital will help them with billing and other areas where their technology had fallen behind.

The practice will become a department of the hospital, and doctors will become salaried employees.

Four of the five doctors who founded the practice will continue to work together. One chose to leave when the deal closed. Dr. Mark Bardo left the practice to take a position at Frisbie Memorial Hospital in Rochester.

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By MARGOT SANGER-KATZ

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