Robert Coward, a long-time company executive picked in December to lead the integration of Envision’s physician-staffing business with merger-partner Amsurg’s staffing division, is leaving to pursue other opportunities.

Envision had not signaled specific problems with the business during several recent earnings calls and analyst conference presentations, said Richard Close, analyst with Cannacord Genuity.

Additionally, Envision did not affirm earnings guidance that was lowered after the first quarter in the face of softening of hospital volumes, Close said.

That only adds to investor uncertainty about what might be behind Coward’s departure, he said.

“Bottom line, we view the news as concerning,” said Mizuho Securities analyst Ann Hynes in a note to investors Tuesday.

Envision’s shares were down about 9% at 3 p.m. Eastern time Tuesday after announcing Monday the departure of Coward and retirement of Chief Financial Officer Claire Gulmi.

An Envision spokesman did not return requests for comment.

But Envision’s statement released Monday said Coward’s decision was “not the result of a disagreement with the company on any matter relating to the Company’s operation, policies or practices.”

Coward will remain on board for two months to help with the transition.

At a Baird healthcare conference this month, Envision CEO Chris Holden said the integration between merger partners Envision and Amsurg is proceeding on schedule.

Envision merged with Nashville-based Amsurg in December to create the nation’s largest physician-staffing company with annual revenue of about $8.5 billion.

Since then, Envision has agreed to divest its ambulance business to a subsidiary of KKR to focus on its physician-staffing and its other major business line, ambulatory surgery centers.

Holden reiterated to Baird analysts that he believed physician staffing revenue would grow organically by 3% to 5% annually, with new contracts chipping in 1% to 3% of that growth.

Envision contracts with hospitals to provide physician staffing in emergency rooms and provide hospitalists, anesthesiologists and radiologists to hospitals and post-acute facilities.

Holden told Baird that Envision generates about 3.5% of its revenue in Houston, where hospitals were affected by Hurricane Harvey. About 30% of the company’s revenue is in Florida, which was awaiting the arrival of Hurricane Irma as Holden spoke at the conference.

Holden said Envision, like the entire industry, has seen some softening in emergency room visits over the past few quarters. But he said it was too early to say whether that’s a long-term trend or something cyclical.

Close said declining healthcare stock prices overall show investors are responding to that trend.

Add to that the revived efforts to replace Obamacare, and Envision’s management changes are magnified, Close said.

He added that new blood could build a strong bench at Envision. But the uncertainty generally is not good for investors looking for signs of future growth.

“Is it foreshadowing something?” Close asked.