Fam Pract Manag. 1998 Jan;5(1):13.

Leaving a solo practice


I will be leaving my rural, solo practice in about six months. I'm afraid I may not be able to find a replacement. What are the most important considerations when closing a practice?


Before you assume that the practice will have to close, look hard at the viability of the business. The solution of choice is to find a replacement physician, but if that's not possible, an alternative might be to sell it to a hospital looking for rural referral sources. If you are retiring, and the practice is in a rural, medically underserved area, consider recruiting a midlevel provider you could supervise under a rural health clinic provider agreement with Medicare.

If you do close, the primary consideration is the well-being of your patients. With every patient, the family physician accepts general responsibility to care for any known health problems. To fulfill this responsibility, write to your patients at least 90 days in advance of closing. Tell them when your practice will close and urge them to find another physician. You may wish to give your patients the names and numbers of physicians whom you suggest they consider seeing. Also, include information about how your patients can obtain their medical records from you. Consider enclosing a release of information form that would allow you to send the entire record to the selected physician. Hold on to returned releases so the records you send to other physicians can be traced.

Any records remaining in your possession should be stored for at least six to eight years after the last date of service. Records related to the birth and development of infants should be held until the patients reach majority. Check your state laws to find out exactly how long medical records must be kept.

Once you've fulfilled your obligations to your patients, you can turn your attention to closing the business. Focus on collecting your accounts receivable and on disposing of your real assets. Institute a vigorous collection process at the time of service and by telephone. Next, shop for a good collection agency if you don't already have one. As the date for closing your practice nears, send account holders a statement and a letter politely informing them that, after the practice closes, all of your accounts will go to a collection agency.

Used equipment typically brings 10 to 50 cents on the dollar depending on age and condition. Ask your sales representative to recommend someone who deals in used medical equipment or simply check the yellow pages.

Do not cancel premises insurance when you move out; wait until you are no longer the legal tenant. If you own your building, find out from your real estate agent whether remodeling will make it more marketable. If so, the cost will probably be preferable to winding up permanent owner of a building nobody wants.

Dismissing a patient for nonpayment of medical bills


I have an uninsured patient who owes me close to $1,000 in unpaid medical care. Can I legally dismiss this patient from my practice for this reason?


A physician is required to provide services to a patient only if a contract requires the physician to do so, the patient is in an emergency condition requiring immediate treatment or a patient-physician relationship requires ongoing care such that termination of treatment would constitute abandonment.

You should review any contracts, including payer contracts, that are applicable to the patient in question to determine what contractual obligations you have undertaken. If the patient is not currently receiving ongoing treatment, consider sending the patient a letter indicating that you will no longer see him or her because of the outstanding balance and suggest a few alternative sources of medical care. It is better to send such a letter now than to wait until the patient needs health care.

*Denotes Charter Members of the Academy's Network of Consultants.


Copyright © 1998 by the American Academy of Family Physicians.
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