Practice life's been good to
you. You're respected by your patients and your staff
and are considered an upstanding member of the community.
It hasn't been all skittles and beer, of course. The hours
are long and the frustrations many. It's been hard to
watch the deterioration in the quality of healthcare and
the endless bureaucratic meddling, but on the whole you're
happy with your career in medicine. All good things come
to an end, and you've decided to get out of active practice.
Whether you're retiring or pulling up stakes and moving
away, for the solo practitioner, closing a practice isn't
as simple as posting a sign that reads "Last one
to leave, turn out the lights."
Here's a checklist of some of the things to consider before
shutting the door for good.
SELL, PHASE OUT OR
CLOSE UP
Your best option by far, say practice consultants and
your colleagues who've gone through it, is to sell.
The reason has everything to do with your patient records.
By selling your practice outright, they become someone
else's responsibility, failing that you have to make
provisions for them yourself and that can be a headache
(see Patient records in the next section).
There's a financial incentive as well. Provided you
can find a willing buyer, you might expect between 50%
and 100% of your annual gross. (For more on evaluating
your practice, see How much could you get for your
practice coming in our July 30 issue). Many physicians
consider gradually phasing out. Not a good idea and
an option only if you have the time -- two to three
years -- and can gradually transfer patients to other
physicians, otherwise, you could half your work hours
and double your hassles with patients. Closing up and
walking away may look attractive on the surface -- but
what about those pesky medical records?
PATIENT
RECORDS
These represent your biggest challenge. Those that aren't
transferred to another physician will have to be stored
for up to 10 years. Patients will have to be offered
copies of their records and advised where they are stored
and how they can be accessed. You'll be the one responsible
for filling requests. Incidentally, never turn over
records without first receiving authorization from the
patient and then only provide copies, never the originals.
If you can 'sell' the records to another physician,
even for a few thousand dollars, do it -- at least you'll
be free of them. You might even consider giving them
to a colleague. The reason he or she might be willing
to take on the task is that history shows that patients
tend to stick with the physician who becomes custodian
of practice records. This may appeal to new doctors
and to other who want to build up their practices.
TELLING
YOUR PATIENTS
About three months before your departure, send a letter
to all patients who you've seen in the previous two
years. If you're selling, include the name of the MD
taking over, if not, suggest names of physicians in
the area who are taking on new patients. Include details
on how to obtain records and include a form to be signed
by the patient authorizing their release.
STAFF
Do everything you can to help staff either keep their
jobs with the physician taking over the practice in
the case of
a sale or by providing leads and letters of recommendation
to other doctors. Longtime employees deserve a bonus
of, say, a week's pay for every year of service as a
minimum.
WHO
TO ADVISE
The provincial college; the provincial health plan;
affiliated hospitals; third-party payers; your practice
insurer; the Medical Protective Association; your provincial
association and the CMA, if you're a member; make arrangements
to have mail and phone calls forwarded. In small centres
you might want to put an announcement in the local paper
thanking your patients and giving closing details.
That done, turn off the lights and close the door.
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