Dealing With Physician Departures at Your Practice

For gastroenterologist Timothy Orphanides, leaving the Philadelphia-area group practice he was with for more than two decades was no small decision. He enjoyed his work and his patients, but the time finally came when it simply didn't make sense to stay. "The overhead was high, the reimbursement was low, [and] there was no negotiating with the insurance companies. Even though I was working hard, I wasn't getting ahead financially," says Orphanides.

Although he'd seen the handwriting on the wall several years before he took the plunge and relocated to Martinsburg, W. Va., where he practices today, Orphanides waited until his children were pretty much grown before making the move. "You have to have everyone in the family onboard," he says. "You can't make these decisions on your own."

Once he secured his position at University Healthcare Physicians in West Virginia, Orphanides gave 90-days' notice. The group's business manager oversaw details such as making sure patients and insurance companies were notified, and scheduling was adjusted so that Orphanides stopped taking new patients and had time for final visits with established ones.

Naturally, patients wanted a recommendation about who to see for continuing care, and Orphanides took care to match each patient with the doctor in his group he felt they'd be most compatible with. "They're all very qualified, but I tried to tailor my recommendation to the individual patient," he says. "I wanted everyone to feel comfortable staying with the group."

Tying up loose ends

Orphanides' story makes the process of leaving a practice sound relatively stress free, but make no mistake, there are a great many details to tend to if you want to make a smooth transition. Whether you are permanently closing the doors to a practice or leaving a group that will carry on after you relocate or retire, you'll probably want to work with your practice management consultant, accountant, and attorney to make sure every "i" is dotted and every "t" is crossed.

Professional help aside, educate yourself on the ins and outs of wrapping up a practice, starting with a call to your state and/or county medical society. These organizations have information available to members about how to exit a practice. Checklists include giving proper notice to patients and referring physicians, notifying licensing and regulatory agencies as well as third-party payers, terminating lease agreements, and so forth.

Assuming you've maintained occurrence-based liability insurance (as opposed to claims made) you won't need to purchase tail malpractice coverage. If it turns out that you need tail insurance, be prepared for this lump-sum premium to cost about twice the amount of your most recent annual premium, and maybe even more.

If you are leaving a group, patient records will likely be maintained by the practice so that continuing care can be provided by the colleagues you leave behind. That said, you should still personally confirm that patients are properly notified of your plans to move on, that they're informed about their options for ongoing care, and that they know how to obtain copies of their medical records or how to have them transferred to another healthcare provider. If you are closing the doors to your practice permanently, you are responsible for taking these steps in accordance with what your state mandates so that there is no question of patient abandonment. Find out, also, what is required in terms of how long you must store medical records. The rules for adult and pediatric records are different and the details should be spelled out in the information you obtain from your local medical society.

Possible pitfalls

All the planning in the world doesn't guarantee there won't be bumps in the road. Santa Rosa, Ca.-based practice management consultant Keith Borglum has helped physicians navigate many unexpected obstacles related to transitioning out of a practice. One such bump involves non-compete agreements. Although they are not always enforced (or enforceable, depending on the state and situation), non-compete clauses are common in physician employment and partnership agreements. One physician Borglum worked with honored this portion of his contract and moved his practice 30 miles away when he left a group. "He thought his patients would follow, but they didn't. I have him going back to the group in which he worked to negotiate a buyout of the non-compete so he can move back closer to his original location," says Borglum.

Another of Borglum's clients came face-to-face with the realities of how important the Internet has become. "She left a large group and they kept all of her information on their site so that when someone searched for her by name they'd find her previous employer's website," says Borglum. This caused the doctor months of trouble and she eventually had to hire an attorney to get the group to remove her from their website.

How physicians speak to patients and referral sources about the departure of a member of the group should be thought out ahead of time. "This often doesn't make the list, but it's important for the reputation of the group and the individual who's leaving," says Borglum. "I try to get doctors to come up with a prepared statement that's 20 words or fewer and neutral such as, 'We have different ideas about the direction of the practice.'"

Practice pointers

Borglum also advises practices on how to handle a physician's departure. "When a doctor gives notice [the practice] should quickly move to prepare for switching patients to another physician in the group," he says. "If the practice doesn't have the capacity to spread the volume to others they might need to bring in a locum tenens to bridge the gap while they recruit."

Whether to replace a provider who is leaving - and with whom - is a question that should be thought through carefully. "Consider replacing a doctor with a physician extender," says Borglum. "I worked with an ophthalmology group who had two doctors retiring out and I explained the trend of hiring optometrists and opticians. They can do routine eye exams and keep the ophthalmologists in surgery." Another option for specialists, says Borglum, is to hire a family physician instead of nurse practitioner or physician assistant to replace a doctor who is leaving. Doing so makes supervision less of an issue, patients get a higher level of service, and reimbursement is not reduced because "incident-to" billing rules don't apply.

As far as logistics such as notifying patients, the state licensing board, the DEA, third-party payers, and the malpractice carrier, Borglum says that while the individual doctor may do some of this legwork, it's ultimately the practice's responsibility to make sure it all gets done. "All liability goes back to the employer," says Borglum.

Change is good. It's also a lot of work. If you're contemplating retiring or relocating, plan ahead, make lists, be methodical in your process, and engage professional help where you need it. By managing the transition step by step and paying attention to detail, tying up loose ends when you're ready to step into a new chapter of your life should not be an overly daunting process.

Karen Childress is a former practice management consultant and physician career coach who now works full-time as a freelance healthcare writer. She lives in Cortez, Colo. Karen can be reached at editor@physicianspractice.com.

This article originally appeared in the November/December 2013 issue of Physicians Practice.