I know my patients will be in good hands, but it’s hard to accept they’ll no longer be “my” patients.
Fam Pract Manag. 2025;32(5):36
Author disclosure: no relevant financial relationships.
I sat across from Evelyn as she told me about being admitted to the hospital and resisting the medication changes the inpatient team wanted to make.
“Dr. Schrager manages my medications,” she had told them.
But that was no longer the case. I took a deep breath and said, “I have something difficult to tell you. I will be leaving my practice soon.”
Delivering this message to patients has been one of the greatest challenges of my career. Evelyn was among the first people I got to know when I started practicing medicine. We cried together, and she thanked me for 28 years of care.
A DIFFICULT DECISION
After working at the same clinic for nearly three decades, my career evolved in an exciting way, and I made the difficult decision to transition away from practice and to take on more research and administrative roles. While I knew that many excellent family physicians at my clinic could care for my patients after I left, I felt conflicted when I heard my patients’ responses to the news:
“You delivered my children,”
“I started seeing you at 17,”
“You were always willing to squeeze me in when I needed it,”
“Your message after my cancer diagnosis made me feel less alone,”
“I remember when you were pregnant with your son” (now 25).
I kept telling myself this was the logical move for my career and personal life, but it didn’t make the decision easier. For almost three decades, I have defined myself as a primary care physician who spends time discovering and addressing my patients’ health and social needs. I had been part of their lives, sharing joys and sorrows, listening to them, giving advice, and reassuring them. Now I had to say goodbye.
LEAVING WELL
I tried to make my exit from practice as patient centered as possible. I sent every patient a personalized letter informing them that I would be leaving. During each “last visit,” my patients and I reminisced about how long we had known each other, talked about my new roles, and said goodbye. There were often tears, but people were happy for me and understood my decision.
My patients’ gracious reactions reminded me of a 2007 study in which researchers analyzed patient letters to a family physician who was retiring after 42 years in practice.1 The themes in those letters reflect what patients value in their primary care physician: “being there,” caring, medical expertise, personal characteristics, filling multiple roles, being a family doctor, and continuity. I have tried to embody these characteristics, and that’s what makes leaving so difficult. As one patient said to me, “You were a part of my family, and I felt like I could tell you anything.”
I’m excited about the next chapter in my career, but I will always value and remember these relationships as the most meaningful aspect of my professional life.
TIPS FOR TRANSITIONING OUT OF PRACTICE
If possible, determine who should be the new primary care physician for each patient on your panel. If that’s not doable, focus on those who are high-risk, vulnerable, or have been with you for a long time. Make personal hand-offs where needed.
Work with your organization to personalize a transition letter informing patients you are leaving and reassuring them they will have a new primary care clinician. This letter should be sent at least two months before your last day.
Attempt to say goodbye in person or by patient portal to as many people as possible.
Designate several patient care sessions as “transition” visits to give longtime patients an opportunity to say goodbye in person.
Expect these last visits to take longer. You and your patients will need some time for closure.
