By Jay A. Shorr, BA, MBM-C, CAC I-VIII
As your practice grows, you will need to hire additional surgeons to take on the additional caseload, or maybe even to provide different yet complementary procedures.
This is a good thing (or at least it should be).
But what happens when he or she moves on to bigger and better things and drops or poaches some of your patients in the process? Think this won’t happen to you? You’re wrong.
There are so many ways this type of breakup gets messy. For example, a surgeon may leave your practice and:
• take only those patients they personally treated;
• take or solicit all of the patients who may have come in for consults with them;
• refuse to treat a patient who was still under their care as of the date of their departure; or
• refuse to treat a patient previously under their care, but now has complications from a prior procedure.
The key question is, who really owns the patient once a physician/patient relationship is established? Often, there is a legal answer and a moral answer, and they don’t necessarily overlap.
The best way to prevent a mess is to address these potential road bumps up front and in advance. Many employment agreements do contain a restrictive covenant that states that if the employee physician chooses to leave, he/she cannot practice within XX miles for XX years after the separation from the practice and/or actively solicit patients. However, these provisions are not always enforceable.
Still, patient responsibilities and ownership should be agreed upon prior to entering into a contractual agreement with an employee. This should include treatment up to and including discharge, and resolution for any potential complications afterward. Always have cross coverage from a specialist who can perform procedures you can’t, don’t or won’t to protect your patients.
If these issues are not addressed properly, and well in advance, there will be a legal battle, and no one ever wins with that tactic—especially your patients.
Jay A. Shorr, BA, MBM-C, CAC I-VIII, is the founder and managing partner of The Best Medical Business Solutions, based in Fort Lauderdale and Orlando, Fla. His column, “The Shorr Thing,” appears in every issue of Plastic Surgery Practice. He can be reached via [email protected].
I read with interest Jay Schorr’s article “Holding Your Own” in the January 2016 edition of Plastic Surgery Practice. Mr. Shorr’s article is extremely relevant and points to an often overlooked issue. But perhaps a different perspective is also relevant, especially for physicians just finishing their training and signing contracts when entering their first practice. During this time most physicians are coming from an academic teaching setting where teachings of ethics, patient first-business second, and the Hippocratic Oath are measures to strive for in their future practices.
Unfortunately, and perhaps more so in the aesthetic industry, this altruistic philosophy often runs contrary to “the ways of doing business” in many medical practices. Hence, the cringing awkwardness of the statement in Mr. Shorr’s subtitle, “Who really owns the patient when an associate leaves?” Does this not sound unusual and misplaced? Should it not be the patient themselves?
Many states, such as California, require physicians (and all physicians associated with the practice) to inform patients that he or she will be leaving and to inform them of their new location, to prevent a diverse spectrum of patient abandonment issues. Equally, many states have ruled (and rightfully so) that the patient-physician relationship is different from a business-customer relationship, and the patient has a right to continue (or not) their physician-patient relationship, but with a mind-set of “ownership” how can a patient be provided this option?
As a result, Mr. Shorr’s recommendations for these issues to be addressed properly, and well in advance, is well taken and will serve both parties, especially when the “ways of doing business” may not be aligned.
Timothy R. Miller, M.D.