What Should be in a Physician Closing Practice Letter

Hi, I’m attorney Renee Osipov with Chelle Law in Scottsdale, Arizona. We draft employment agreements, policies, and patient letters for physicians within their practice. If you’re watching this video, you’re likely a solo practitioner or a multi-physician practice which has decided to close their practice. 

Sending a Letter Part of Patient Notification Requirements

The best way to communicate this information to your patients would be via letter. You should forward the letter, giving your patients significant time to find alternate healthcare. The letter itself may state the reason for the closure, whether that’s retirement, death, illness, et cetera. This is an option. You don’t have to include this in the letter. You’ll want to let them know when you will stop providing them healthcare services. Recommend that they find alternative healthcare. You can also state that if they’re having trouble finding alternative healthcare. They can look on their state’s medical board website, which has a directory where they can choose a physician.

You’ll also want to let them know how they can obtain their medical records from your office directly. You can also include a medical records release form within the letter itself. And then lastly, it’s nice to include thanking them for their continued support of your practice and wishing them the best in the future. It’s also an option to add contact information for the physicians at your office, which is now closing. But again, that’s optional. Every situation is unique, and if you want further information on this topic, please visit our website at Chellelaw.com, C H E L L E. law.com. Our contact information is also on our website. If you would like to set up a consultation with us, we would be happy to speak with you and address any of your unique needs for your practice. Thank you.

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What Should Be in a Physician Leaving the Practice Letter  | Physician Leaving Practice

We draft employment agreements, policies, and patient letters for physicians within their medical practice. If you’re reading this article, you are likely a multi-physician practice. One of those physicians has decided to retire or depart from the geographical area. 

Patient Notification Requirements

The best way to communicate this information is via an official letter to your patients. You should send this out at least 30 days before the physician leaves, and not sooner. That is to give plenty of time to patients to consider continuing care at your facility or seeking care elsewhere. The letter should include notification of the change and reassure them that they will remain to have quality healthcare within your medical practice. You can also include their medical practice records that you can request, or you can even include a medical practice release form.

And then, depending on this situation, you can also include the physician’s contact information that’s leaving. But that’s optional, especially considering why they’re leaving your practice. And then, finally, you’ll want to include just a brief apology and reassurance again that they will receive quality care. We know that every situation is unique. For more information, check out our Chelle Law, C H E L L E law.com website. We have more information on there as well as our contact information. We’d be happy to set up a consultation with you. And address your unique needs for your medical practice in a similar situation. Thank you.

What Is the Proper Way for a Physician to Terminate a Patient?

How does a physician properly terminate a patient from their practice? There are several considerations for terminating patient relationships. There are generally three main things that the physician must do. So they can’t get accused of either patient abandonment or some other kind of ethical lapse. 

First, the physician needs to provide written notice. I would suggest sending a certified letter to the address on file of the patient. I would also send them an email. That way, the patient can’t state that they never received any notice. You also need to provide a reasonable amount of time for the patient to find a substitute provider. 

Now, this is specialty-dependent. It’s easier for some patients to find a replacement than others. But unless there’s an egregious act on the part of the patient, you can’t just terminate the patient on a Monday and say, I’m over on providing any care for you, move on. So, you need to find a reasonable amount of time to allow them to find a new provider. You could even assist in that, but ultimately, in that scenario, it would depend on why you’re terminating the patient. 

Usual Reasons to Terminate Physician-Patient Relationship

Now, there are several factors in terminating a physician-patient relationship. Maybe the physician is retiring and not transitioning to practice with someone else, taking a new position out of town, and moving. I mean, those are normal things that can happen. If a behavioral concern on the patient’s side complicates things, maybe they become verbally abusive to staff or the physician. Perhaps they have mental health issues, and it’s just making the care impossible. Maybe like in pain management, they signed a pain contract with the physician and violated it. The physician obviously could then terminate them from the practice. 

The reason you’re going to terminate the physician-patient relationship with the patient will also kind of dictate. I would think of the assistance that you provide to them. One, written notice, two, give them time to find a replacement, and then three, provide bridge scripts. Once again, depending upon specialty. Suppose the patient is on psych meds or some life-saving medication. Then the physician needs to provide at least a reasonable bridge script, allowing them time to find a substitute physician. 

Patient Care Work Ethics: Providing Medical Records ASAP

And then lastly, you need to provide information on how the patient can retrieve the medical record. Every state board has kind of details as far as what a physician must do in providing the patient’s medical record. And then also what a patient must do to request it. I mean, for most states, the patient has to request it in writing. Then some states allow a reasonable fee to get a copy of the med record. Then they have to state it has to be reasonably available within a short period. 

Many clients have gotten in trouble for not promptly providing the patient’s medical records. Sometimes, the physician has no idea this is going on, and maybe an office manager had some clashes with the patient. They decide to terminate them, and then they mess around with quickly providing the record for whatever reason. Well, ultimately, that can fall on the shoulders of the physician. So, I want to ensure that the patient gets the medical record quickly. 

Summary

To summarize, it needs to be in writing. It would be best if you gave them time to find a new physician with services similar to your specialty or practice. You need to provide bridge scripts if possible or necessary. Then you need to give them access to the patient’s medical record. There are patients whom you can satisfy, and no matter what, it will likely end up in a board complaint. Suppose you’re covering what you’re required to do and acting ethically in terminating the patient. In that case, there should be no issues regarding a board complaint. Just sticking your head in the sand and not dealing with the patient is a bad idea.

There are some obligations when you’re providing medical care to someone. And even though you may want absolutely nothing to do with them just because of how they’re acting, or maybe they’re disruptive. You still must go through the steps to ensure that you’re giving a good transition to a new provider. Continuity of care is essential, and that’s why these general guidelines are in place. That is to ensure that even if someone is disruptive, they’ll still get the care they need so that it doesn’t become a huge issue.

What Happens if You Are Fired as a Physician? | Doctors

What happens if you are a physician and you get fired? There are apparent ramifications that come with that. The situation is probably not as bad as most people think. Still, the most important thing is maybe the reason behind the firing. Defining firing is undoubtedly important. In any physician contract, there are two main ways to terminate a contract: with-cause or without-cause. In the case of cause termination, it simply means one of the parties breached the contract. Then the other party decided to exercise their rights to terminate the agreement. Usually, immediately if a breach didn’t get fixed. If there is a breach of contract, let’s take this from the employer’s perspective since this video is about what happens if a physician gets fired.

Let’s say the physician is refusing to take a call, and it was in the contract that they’d take one in five calls or something like that. Well, the employer would send a letter to the physician stating you’re in breach of contract. And then there’ll be a cure period. A cure period usually means somewhere between 15 to 30 days. The physician can fix the breach and cure it. And then, at that point, the employer would no longer be able to fire them for-cause termination. The only difference between for-cause and without-cause is that for-cause can usually terminate the contract immediately without any notice. Whereas without-cause termination, either party can terminate the agreement at any time, for any reason, with a certain amount of notice, and as I said before, usually 60 to 90 days.

What If a Physician Was Fired for Cause Termination?

Let’s say a physician got fired for-cause. What do they have to think about? Well, depending upon where they are in the contract, maybe within the initial one or two years, there may be repayment obligations. Regarding the signing bonus, relocation assistance, credentialing fees or licensing. The employer can recoup some of that money. Suppose you get fired for-cause. It probably depends on what it is. Most of the time, none of that gets reported to the medical board. The only real employment consideration if you get fired for-cause is when you try to find a new job. They will certainly want to know what happened at your old job. And if you got fired for-cause, then it’s probably going to talk about what led to that. 

And it could cause some difficulty in finding a new position. However, I find physicians are in high demand. Suppose the reason behind a termination didn’t involve peer review, clinical issue, or some primary behavioral concern. In that case, it’s usually just a personality clash, and most new employers aren’t honestly that concerned about that. When they get terminated, they must repay a signing bonus, relocation assistance, or whatever to consider. 

What If a Physician Was Fired for Without Cause Termination?

Now, suppose you get terminated without-cause. In that case, as I said before, either party can terminate it for any reason at any time with a certain amount of notice. The physician can do this as well. They can give notice to the employer and leave. I don’t think, in that case, you’re not firing the employer. I don’t see it as a physician getting fired if the employer uses without-cause termination.

Several reasons an employer could terminate a physician without-cause are not negative at all. Maybe they’re just simply closing a location. They could be bad at business or marketing, and the volume isn’t there to support another physician. 

Maybe they’ve sold the practice to a new organization, which is restructuring. Or also, if a new organization comes in, they almost always require that the physician sign a new agreement. If the physician is unhappy with the terms of the new agreement, the employer usually will terminate the contract. 

So, just because the contract gets terminated without-cause doesn’t mean the physician did anything wrong. It means that the employer no longer needs the physician for whatever reason. Some negative things may be that the physician didn’t breach the contract. Still, I guess the most likely situation would be if their physician has very low productivity or if they see patients very slowly. They’re not even close to reaching the volume expectations of the employer. That would be one reason the employer would terminate them without-cause, but they’re not in breach of contract; they’re just not meeting the expectations.

Just Fired: Medical Doctors’ Considerations About Patient Care

When you get fired for-cause, the biggest things to think about are the ones that could happen immediately. So, the transition in patient care is something to keep in mind. Continuity of care is important. And if you are in a specialty like psychiatrists or people with mental health issues, make certain there are bridge scripts so that they can find new providers. That is something the physician wants to think about. Now, the patients are always the patients of the employer, even though they are the patients of the physician. 

So, if a physician gets terminated for-cause, they’re not necessarily responsible for the patients anymore. It’s the employer’s responsibility to take care of them, although continuity of care is essential. And indeed, if you want to avoid board complaints. Board complaints are often failed because the patient will say, oh, my doctor abandoned me, or they abruptly left. Many times, it’s not the physician’s fault at all. 

Summary 

So, in summary, if you got fired, think about what you may have to repay. And maybe you have to pay tail insurance, think about the restrictive covenants that would apply, the non-compete, the non-solicit, and then think about the continuity of care issues. Look, things happen in employment. Just because you get terminated doesn’t mean you necessarily do anything wrong. This is just business; things happen.