Southwest Virginia's largest cardiology practice has decided to join with Carilion Clinic, the area's largest health care provider.

Consultants in Cardiology, located on McClanahan Street in Southwest Roanoke, has been an independent physician practice for 35 years but signed a letter of intent Friday to become part of Carilion.

Carilion announced the partnership in an e-mail to its employees noon Monday.

Consultants in Cardiology, which employs about 100 staff members including 14 physicians, announced the agreement to its staff during a meeting Friday morning.

One cardiologist, Dr. William Rutherford, will not make the move because he is retiring in September.

The move will take effect Jan. 1. Individual contracts with the physicians will be hammered out during the fall, and Carilion will purchase the assets of Consultants in Cardiology. Neither Carilion nor Consultants in Cardiology would disclose the purchase price.

The deal also outlines new cardiology ventures to be pursued by Carilion, including developing a congestive heart failure clinic and other specialized cardiovascular treatment programs.

Consultants in Cardiology also has offices in Salem and Radford. While the Salem office is part of the deal with Carilion, the Radford office is not. The Radford office is incorporated separately and doesn't have plans to join Carilion.

The announcement comes two years into Carilion's conversion from a traditional hospital system to a physician-led clinic model and is among the largest merger agreements Carilion has made with a local practice.

In a traditional hospital system, most physicians are independently employed and have privileges to work at the hospital. In a clinic setting, the physicians are employed by the clinic.

As part of the clinic conversion, Carilion had signaled a need to develop a strong cardiology department, and has held ongoing conversations with Consultants in Cardiology. Talk of the two merging began in earnest near the end of 2007.

"Like any wise person, we didn't want to jump on the bandwagon, so to speak, without seeing a proven track record that this is a viable business plan," Dr. Jeffrey Todd, one of the cardiologists and the president of Consultants in Cardiology, said of Carilion's transformation to a clinic.

While the outpatient office will not move, the name will change to Carilion Clinic Cardiology. Todd emphasized that patients will continue to get "the same personal care."

Several factors, including minimizing competition, contributed to the practice's decision to join Carilion, Todd said.

"Eventually, we would have been a competing practice with Carilion [cardiologists]," Todd said.

The news comes as the local medical community has continued to debate the impact that Carilion's clinic plan has had on independent physician practices.

Carilion maintains that employing doctors puts the local health care system and patient care directly in the hands of physicians -- instead of hospital administrators -- and improves the quality and cost of health care.

Critics, such as the locally formed Coalition for Responsible Healthcare, say the clinic is slowly eliminating independent practices, which reduces patient choices, increases the cost of care and can lower the quality of medicine.

Friday's agreement gives physicians at Consultants in Cardiology a say in some of the upcoming medical education aspects that Carilion has already announced. Those include a plan to start a cardiology fellowship by 2010 to train doctors in the specialty.

"To remain independent inherently gave us less influence over the practice of cardiology within the health system," Todd said. "We felt we were better off sitting at the table."

Carilion also has approached another of Roanoke's private cardiology practices, Cardiology Associates of Virginia, about joining the clinic, said Dr. Ralph Whatley, chairman of medicine for Carilion.

"We've kept that door open," Whatley said, adding that the agreement with Consultants in Cardiology does not take the offer off the table.

Cardiology Associates, which employes about 20 people and has five physicians, has no plans to join Carilion, said Kristin Stathers, the practice's administrator.

"We enjoy being an independent practice and treating our patients in that manner," Stathers said.

While keeping the door open to the other practice, Whatley said Carilion is hoping to bring other cardiologists on board soon because of a shortage of cardiologists in the region.

Recognizing the need to recruit more cardiologists to the area was another reason Consultants in Cardiology decided to join, said Todd, echoing Carilion's analysis showing that a minimum of six additional cardiologists are needed.

Cardiology Associates has also seen a need for additional cardiologists and has been trying to recruit one to its practice for about six months, Stathers said.