Jarrod Shapiro, DPM Practice Perfect Editor Mountain View Medical & Surgical Associates, Madras, Oregon

Ending a Practice

I’ve read a lot of articles in our various podiatry magazines and journals about starting practice, whether it’s the associate-boss relationship or starting a new office from scratch.  One topic I haven’t found in my reading is what to do when terminating a position or closing a practice.  This is understandable, considering more doctors are starting out in practice than leaving.  However, it’s become quite common for young podiatrists (and even some experienced ones) to move to new locations.  In fact, I’d say it is more likely than not , that sometime during your career, you will leave a practice and ecnounter the issues associated with it.  With this in mind, let’s talk about ending a practice.

First, let me say after experiencing two changes in practice location and the corresponding termination of my practice in two locations, that this is a difficult and emotional process for not only the doctor but also the staff and community.  As a physician, you are automatically a leader in your community, and that community will be affected by your leaving.  My last day in the office was a tearful affair.  I became quite close with my office staff specifically, and the hospital staff as a whole. Leaving was more difficult than I had expected. 

How do You Terminate Your Care of Patients?

The next difficult step was terminating patient care.  This may sound easy on the surface.  Just stop right?  Wrong.  There are several important questions to answer.  When do you stop doing surgery?  What do you do with patients that require follow-up?  What about emergent patients?  When and how do you announce you’re leaving?  What about boards cases?  These are just a few of the issues surrounding leaving a practice.

Let’s be a bit analytical about this.  Instead of recommending how to prepare to leave a practice (what I might normally do), I’m going to discuss mistakes I made leading up to my leaving.  Hopefully mistakes I made can act as examples for those who follow.

My Mistakes - Let's Learn from Them

Surgery.  I announced I would stop doing elective surgery two months prior to my last day.  As the only podiatrist at my hospital, and as an employee of the hospital, I felt compelled to continue doing emergent cases until about one month before leaving.  My plans were totally in vain.  I actually did my last procedure in Oregon eleven days before leaving.  This was an emergent transmetatarsal amputation in an uninsured patient with worsening prognosis who had been admitted to my hospital.  It’s not easy to transfer an already admitted uninsured patient to another hospital for the obvious reasons.  As such, I agreed to do his surgery.  Things went well, and he was discharged without event, but I had to do a lot of legwork to set up his follow-up appointments.  I did three elective cases one month before I left.  In each case, I counseled the patients about my leaving and offered to set them up with another physician, but in each case the patients asked me to do the procedure. 

Mistake: I didn’t set a solid enough date to stop doing any cases and didn’t stick to it.  My life would have been much easier if I had been more firm on the dates.  Three months would have been better, but wasn’t realistic in my situation.  This is much easier if you have someone to refer these cases to.

Patients that require follow-up.  For these patients I set up referrals to other podiatrists in nearby towns.  Against my wishes, my practice manager sent out a letter to my patients about three weeks before my leaving.  The letter contained four other physicians who would be capable of following up.  We waited to send this letter out until three weeks before I left due to negotiations with someone to take over my practice.  We sent letters out to those I had seen within the past six months.

Mistake: I should not have left this announcement up to my manager.  Letting your patients know you’re leaving should be initiated and organized by you, the doctor.  I would recommend a one month notice at the shortest.  The idea is to provide appropriate notice and prevent patients from feeling they’ve been abandoned.  I would also suggest sending the notice out to those from the past year at least.  Some of your patients may have longer than six month follow-ups.

Boards Cases.  I’m not yet board certified, mostly because of the poor job I did at organizing myself during my first two years in practice.  Because I failed to copy certain surgical charts from the various hospitals and clinics I worked, I lost quite a few cases.  I almost made this mistake a second time.  My staff started copying charts two months before I left.  The hospital medical records department copied my charts one month before the end.  Due to the digital radiography system my hospital used, I was forced to make copies of individual images onto my computer.  This turned out to be a last minute endeavor.

Mistake: Don’t wait for the last minute to copy charts.  Copy patient charts, x-rays, etc. as often as possible.  Plan to be board certified as soon as you start practice, gathering your information as you go instead of putting your folders together at the last minute.

To the Future, and Beyond

Stopping practice is more complicated than I would have thought, one fraught with potential mistakes.  If I could give any advice, it would be two-fold.  First, give yourself as much extra time as possible.  It takes effort to end a practice, while at the same time working to start a new one.  Second, if that job you’ve always wanted finally arrives, don’t hesitate to chase that dream!  Best wishes.

Keep writing in with your thoughts and comments. Better yet, post them in the eTalk forum, where you can get in on the discussion or start one of your own. Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

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