In this installment of Lessons from the Disciplinary Committee, we delve into the topic of licensee departures from medical practices. When these relationships end, they can be every bit as difficult as the end of a marriage.
Case Study
Weary of the business side of medical practice, including negotiating with health insurers and other financial responsibilities, MD sells his solo gastroenterology practice to a large group practice that is interested in expanding into the area. MD stipulates that his existing staff be hired as part of the deal, and MD’s nurse and two administrative staff are hired along with MD as employees of the group practice.
Eight months into the new arrangement, MD is extremely frustrated with his status as an employed physician. He has been advised repeatedly to follow practice clinical protocols instead of independently determining how to manage his patients and is generally resistant to complying with employment policies, such as the expectation to work a set schedule and arrange for time off in advance.
MD speaks privately with his former nurse and administrative staff, indicating that he is planning to quit and re-establish in solo practice. MD’s former staff express willingness to leave their new employer to accompany MD to his new practice. MD resigns and is advised of his contractual obligation to provide 30 days of notice.
MD continues to report to work during the wind-down period, during which he was asked to transition patients to other providers in the group practice. Instead, MD aggressively lobbies patients, many of whom had been with him for years in his former solo practice, to follow him to his new practice. MD directs his former employees to proactively call patients, during work hours, to advise of his departure from the group practice and ask if they would like to have their records transferred to MD’s new solo practice.
MD’s employer learns of MD’s efforts and demands that he desist actively “recruiting” patients. The practice administrator advises MD that he has posted a letter at the front desk noting that MD is leaving and advising them of the option to transfer to another provider in the practice. The letter, which will also be mailed to all patients who have been seen at the practice by MD, does not specify how patients can get in touch with MD if they prefer to remain with him. Front desk staff are not provided with MD’s contact information and are directed to say, “I don’t know” if asked how to contact MD.
Discussion
NCMB generally cannot get involved in employment or contract disputes, which fall outside of its jurisdiction. That said, NCMB recognizes that departures from or dissolutions of medical practices can be contentious and complicated. It is important that licensees proceed carefully to ensure they do not needlessly disrupt patient care or, worse, abandon a patient who needs ongoing treatment.
When issues related to licensee departures come to the Board’s attention, NCMB’s primary concern is ensuring that all licensees involved meet their professional obligations to patients. The Board has two position statements that are relevant to the scenario presented: “
Departures from and Closures of Medical Practices” and “
The Licensee-Patient Relationship.” The first statement, as the title indicates, specifically addresses the unique obligations that arise when the licensee-patient relationship ends due to the licensee leaving practice, whatever the reason. Obligations to patients apply even if the reason for the licensee’s departure is a disciplinary action (such as a suspension) by the Board. The
Licensee-Patient Relationship is more of a universal statement that urges licensees to ensure that their actions support patient continuity to the greatest extent possible and put patient welfare above all other considerations, including financial interests. Some of the key principles discussed in these position statements are noted below. It is recommended that licensees read the full statements online for additional guidance.
Meeting your obligations
When a licensee is leaving practice the Board expects at least the following steps to be followed:
• Patients are notified sufficiently far in advance to arrange to receive care from a different medical provider. NCMB considers 30 days to be the minimum notice period. The Board recommends notifying all active patients seen by the departing clinician. Although there is no formal definition for what constitutes an “active patient” notifying patients seen within the last one to two years is reasonable. The Board does not have specific rules for how patients are notified and there are many options. Possible options include letters to patients, posting notice in public areas of the practice, front desk flyers and website notices. In some communities, an announcement in the local newspaper may be useful. Using multiple methods of notifying patients can help reach more patients.
• It is clearly communicated that patients have the right to decide who to receive medical care from. Both the departing licensee and licensees remaining with the employer or practice are responsible for ensuring patients are aware of their right to choose. If other medical professionals in the practice are willing to care for the departing physician’s patients, it is appropriate to make patients aware of this. If the departing physician will continue to practice, it is the Board’s view that withholding information about the new practice location Is unethical. The patient’s rights should rise above any acrimony or business interests.
• Patients are advised both of the process for transferring to a different provider within the same practice and, if requested, provided with contact information for the departing clinician. Whatever the patient’s choice, licensees involved should ensure that patients know how to request transfer of their medical records and promptly facilitate this process.
Avoiding messy practice breakups
The Board recommends that medical practices of all sizes prepare for departures, including those due to retirements, deaths, terminations or loss of authority to practice due to regulatory action, as well as voluntary separations. The best way to do this is to develop policies and procedures that outline exactly how the practice and departing licensee will meet the obligations stated in this article and discussed in the Board’s position statements referenced.
Written policies should be shared with patients as well as with licensees providing patient care in the practice. Having a clear and thorough plan for handling notice to patients, including how information about patient choice will be addressed, will go a long way toward avoiding disputes that put patients in the middle.
In addition to its position statements, NCMB also provides a guide on practice closures that includes information relevant to any situation where a licensee is leaving practice.
Find it online here. NCMB cannot provide legal or business advice to licensees, but staff are happy to answer questions and explain NCMB’s guidance.
With planning and care, tension and disruption can be minimized or even avoided altogether.
Send feedback to forum@ncmedboard.org
