When a Physician Leaves Your Practice

It's an arduous process to select a physician to join your practice and when it doesn't work out it's difficult to face. After all, your intentions were right. You were methodical in the recruiting and selection process and went through appropriate due diligence to choose the right physician, but he has not lived up to your expectations and is disenchanted with the choice he made, as well. The one-year employment contract is coming to an end and you might both recognize it's time to say goodbye; but how can you do it without creating collateral damage that could cause ill feelings from staff, patients, or the medical community?

This column will talk about how to end the relationship respectfully and ensure a smooth transition. It is not intended to replace the need to seek legal counsel in order to protect the interest of both parties. The practical side of making a break with as little angst as possible for everyone is a three step process.

Step one - Who's responsible?

The first step is examining what responsibilities each party must fulfill to meet the terms of the existing contract and ensure patient care is not compromised. It is important to have an open and honorable discussion. If emotions or conflicts are likely to emerge during such a discussion you may need a mediator to facilitate this process, such as the practice's management consultant or legal adviser. The goal of this meeting is to agree that the termination is inevitable and to clarify everyone's intent to fulfill the obligations defined in the employment agreement with a cooperative attitude.

Step two - Develop negotiation strategies

The second step is to establish an effective negotiation and departure process. Obviously, the practice and the departing physician will see things from a different perspective and may not agree on what is the fairest outcome. Effective negotiation strategies include creating a list of the most important things each of you want to achieve - what feels reasonable and fair. Once the list is complete, review it and think about where you are willing to be flexible.

For example, you may want your departing physician's patients to stay with your practice, but in reality patients do have a choice. You can remind the physician that she cannot openly solicit patients who belong to the practice, but be reasonable, and not resentful, if many patients choose to follow the physician. On the other hand, if the departing physician wants to write a letter to all her patients and you would rather she didn't, perhaps you can compromise on this as long as you have the right to review it and ensure the wording is acceptable, not solicitous, and respectful.

Another physician may want to stay until the end of the contract, but you'd rather buy out the contract and have him leave a little earlier. If the physician's nurse wants to join him when he sets up his own office across town you might as well give it the green light, or you will have an unhappy employee who ends up leaving the practice just the same. Besides, if it appears you are holding a staff member hostage it will leave a bad impression with your other employees and affect morale. Being amicable isn't always easy, but it is in your best interest when it's time to say goodbye.

Step three - Don't burn your bridges

The third and final step is easing the path into the future. The best way to ensure a smooth transition is to keep things positive. This means leaving any bad feelings or disappointments in the past. It is important that the practice stakeholders not say anything negative about the departing physician to anyone in or outside the office. Keep the communication open with staff and have a "from this day forward" meeting. Provide staff with positive scripts on what to say to patients, referring physicians, and other people in the community. A physician departure is not the end of the world - it is the beginning of a change in your practice mix and the practice dynamics. It's up to you to make it positive so your practice's good reputation and culture will endure.

Judy Capko is a healthcare consultant and author of the popular books “Secrets of the Best Run Practices,”2nd edition, and “Take Back Time."Based in Thousand Oaks, Calif., she is a national speaker on healthcare topics. She can be reached at judy@capko.com.