Closing Your Practice
There are several reasons why a medical practice may be closed. They range from retirement to relocation, from a change in personal circumstances to a change in career path, but except when death or sudden severe illness necessitate quick decisions, it can take several months to a few years to tie all the loose ends together. There will also be some differences in closing a practice, depending on whether you are in solo or group practice.
Closing a practice can be an emotional time, not just for the physician, but for partners, employees and patients as well. This article aims to help the physician close his/her practice as painlessly and professionally as possible.
Closing date
It is never too early to start thinking about retirement or departure from your practice and planning ahead. Regardless of whether you are going to close the doors completely or hand over the keys to another physician, the first step you must take is to decide on a closing date. The sooner you decide on a date, the better. Once you have made the decision to close your practice, you may be fortunate enough to find a buyer for it. However, in today's economy and medical environment, this may not be possible. If your lease permits, then plan on closing at the end of your lease to save on the penalty fees.
Start recording any questions, ideas and thoughts as they arise. Develop lists by area of practice (i.e. informing patients, transferring of records, selling office equipment, etc.) and meet with colleagues who have closed or left a practice to get some answers to your questions. Physicians who have gone through the process will be the most valuable source of information to you. They can point out the pitfalls and help you steer clear of errors, and may be able to guide you through a smooth transition.
If you are in a group practice, give plenty of notice to your partners/associates and try to arrange to leave at the end of the current lease if your name is on the lease. This gives them time to decide what they want to do at that time.
Contact professionals
Meet with your lawyer and accountant to inform them of your decisions and to start the legal and financial procedures of closing your practice. Set time lines with their assistance for what you need to do and what information you must provide them with so that you can close your practice as easily as possible.
Informing your staff
Especially if you are in solo practice, discuss with your lawyer your legal obligations towards your staff with the closing of your practice. Also, make some decisions to cover any moral obligations you may feel towards your staff. This may be offering them some tangible help in finding other employment by talking with your colleagues, offering testimonial letters or even providing them with a financial bonus for their efforts on your behalf during their employment with you.
Inform your staff at least three months before your closing date. However, keeping news as momentous as this from employees is difficult, and staff will likely pick up on rumours, overheard conversations or simply put two and two together, so you may need to tell them even earlier.
Giving your staff advance notice provides them with the time they need to make plans of their own. If you are selling your practice, it's possible that the doctor taking over will want to start with his or her own staff, and this is something you will have to discuss with the buyer. Your own staff may not want to remain in the practice with a new doctor, but they will need to know if this is an option.
If you are in a group practice and no one is taking over your practice, your partners may want to reduce staff hours. This will have to be done with the same legal considerations and obligations towards staff as if you were in solo practice to reduce the risk of any legal actions.
It is in your best interest not to lose your staff to other jobs before your final day, so keep them informed every step of the way. Depending on the job market, it's likely your staff will start looking for another position fairly quickly, so you may need to provide at least one of your staff members with some incentive to stay with you until the end and possibly longer after the practice is closed (60-90 days after close).
Notifying Your Patients
Informing your patients that you are closing or selling your practice is probably the most emotionally difficult step you'll be taking in this process. You will most likely have developed a great deal of patient loyalty, and many patients may feel that you are abandoning them or will worry about the future of their medical care. You will need to plan very carefully the way in which your patients will be informed of your decision to reduce the emotional upheaval on both you and them, and also to ensure continuity of care.
If you are not selling your practice, you must spend time researching the availability of other physicians in the area who will be able to take over some of your patients. Even if you are selling your practice, not all patients will want to stay with the new physician, and will need to know of other physicians in the area taking new patients.
Get the guidelines from the College of Physicians and Surgeons of Ontario (CPSO) regarding the continued care of your patients.
Develop a letter to your patients informing them of your plans and their choices for their continued health care, based on the CPSO's guidelines. Patient letters should be prepared and sent to all active patients at least three months in advance and/or to those seen within the last 36 months. Your letter must provide the date you plan to close your practice. If you are selling it, provide as much information as possible about the physician taking over, his/her credentials, and the fact that you are confident leaving your practice in his/her hands.
Also, provide patients with names and telephone numbers of local medical society personnel and hospitals who may be able to help them find another physician in the area.
Your letter must also mention what your legal responsibilities are with regard to the patient records, and how the patient can have them transferred. With regard to the enclosed authorization form, mention that it must be signed by the patient and returned to you. Provide a self-addressed envelope or label for the return of this form which will give you permission to release their records to the physician of their choice.
Provide the names of any physicians who have agreed to take over your patients, and to whom you will transfer copies of any records. The office should keep a list of all the files that were transferred. Call the CPSO for current guidelines on transferring patient records and the OMA's Economics department for current fees.
Be prepared for an influx of telephone calls and appointments from patients once they receive the letter, as many of them will want to come in to discuss their health concerns, or just to say goodbye. This will be an emotional time for many of them, so schedule your last weeks to reflect the additional time, many appointments will take.
Help your staff develop responses to anticipated questions from patients. Decide how much, if any, personal information you want your staff to give out (for instance, many patients will ask what your future plans are). Keep a copy of the letter that was sent to your patients, the mailing list and all returned (or undelivered) envelopes.
Medical records
Whether you are selling your practice, or closing its doors for good, you have strict legal obligations towards your patients' medical records. Visit the CPSO's website for more information.
If you are interested in storing your medical records, you may contact the Practice Advisory Services for names of storage companies.
Notifying professional and business associations
Notify the people with whom you work or do business of the pending change. Provide them with your old and new address, as well as the new telephone and fax numbers (if applicable) and the effective date. Some of the associations or memberships require a minimum of six to eight weeks' notification to ensure no interruption in you mail. If you move or practice closure also necessitates a change in banking institution or accounts, be sure to include this information when speaking with the Ministry of Health. Some of these include:
Notifying other organizations
You may have been involved in other organizations or personnel and these should be taken into consideration:
Selling equipment and furniture
Inventory all your equipment and furniture, stating the year purchased, any upgrades made, original cost, etc.
Contact your medical equipment supplier and ask him/her to provide you with a reasonable estimate of what your equipment would be worth. If your equipment is in good repair, and you don't have a buyer for your practice that wants to purchase the equipment as well, your suppliers may purchase it from you. Alternatively, you may want to advertise it in medical publications (e.g. OMR) or on hospital notice boards. Also, inform your colleagues what you have available. They may be interested in some of it, or know of other physicians who may want to look at it.
If you are in a group practice, you may be able to sell any portion of equipment for which you are part owner to the group or to any new physician coming into the group.
You may also be interested in selling your computer hardware and software. Get an estimate from your computer vendor and written consent if you plan on transferring their software onto the new physician.
Plan to move all remaining equipment, furniture and supplies, such as letterhead, business and/or appointment cards and prescription pads. Book a moving van.
Financial
Inform financial institutions and insurance companies of your practice closure. You may want to cancel your business credit cards and accounts. Inform insurance companies that you want all relevant insurance policies cancelled on the last day of practice.
If you are owed money by patients, insurance companies or lawyers for medical services rendered, make sure that you collect as much as possible before your last day in the office. If you do not want to undertake the collection yourself, hire a casual billing clerk to do it for you.
Cancellation of utility services
Contact your telephone service and set a date for cutting off your phone lines.
You may need to keep one line open for up to three months with a message notifying patients that you have closed your practice and providing them with choices for finding another physician. If you have a website address, you will need to contact your provider with your change of address.
Notify your answering service how to respond to any of your patients who want to speak to you once your doors are closed.
Contact your utility companies and let them know when you want services terminated.
Complete mail forwarding processes at the post office so that any mail that is addressed to your practice is forwarded to your home address. Cancel all magazine subscriptions or have them redirected to your home address.
Last day
Take down your office sign. Turn out the light. Lock the door. Hand your keys to the landlord!
Sample Letters & Advertisements to Patients
Closing a medical practice with no one taking over
Dear Patients,
With mixed emotions, I wish to inform you that I will be retiring from the practice of medicine on (insert date).
For your convenience, I have enclosed an authorization form for the transfer of your medical records to a physician of your choice. After (insert date), all my medical records will be transferred and stored at Records Save, located at 234 Charles Street in Lake Port.
If you would like to obtain a copy of your medical records after the closure date, Records Save can be contacted at telephone 517-587-4920 or fax 517-587-4921, for a fee.
If you would like information about other physicians in the area, you can contact the College of Physicians and Surgeons at (416) 967-2600.
I will miss my patients and friends, and wish you all the best.
Sincerely,
Allan Jones, MD
Advanced notice for closure of a medical practice with another physician taking over:
Dear Patient:
To begin, I would like to thank you for the trust you have given me over the years as your primary care physician. Taking care of you and your family has been an honor for my staff and me. Your wellness and health are priorities for us.
I'm writing today to inform you that I am making plans to retire, and to ask that you schedule an appointment with us in the coming year so that you can meet Dr. Charles Jones, the physician taking over the care of my patients. Dr. Jones is a well known physician here in the Bigtown metropolitan area. He has been practicing medicine since 1990. Dr. Jones has worked and studied at Small Lake Women's Hospital in the Bigwater Medical Center, Lansing General, and with me here at St. John Hospital in Grosse Rain.
Rest assured that I'm not leaving quickly. Over the next 18 months, Dr. Jones will be in our office here at St. John. All of your medical records will be kept unchanged to ensure a smooth transition. In fact, my staffers Susan and Beth will remain with Dr. Jones.
Please call and talk with us about any of your concerns. We will remind you again about my retirement in six to eight months. Thank you again for allowing me to serve as your physician. I'm confident you will feel comfortable and secure with Dr. Jones.
Sincerely,
David Smith, MD
Closing a medical practice with another physician taking over
Dear Patient,
With mixed emotions, I wish to inform you that I will be retiring from my practice of medicine on (insert date).
I feel very fortunate in finding Dr. Carol Smith to take over my practice. Dr. Smith received her training at Provincial University and completed her family practice residency in 1987. For the past eight years she has been in private practice in Bigtown and will be relocating here with her husband and two young children.
It is very gratifying to have found such a caring and competent doctor to take my place. Dr. Smith will begin working with me on (insert date). If you should have occasion to visit the office before I leave, I will be pleased to introduce you to her.
Your medical records will automatically remain with Dr. Smith unless I receive written authorization from you to transfer them to another physician. If you want more information about other physicians in the area, you can contact the College of Physicians and Surgeons at (416) 967-2600.
I will miss my patients and friends, and wish you all the best.
Sincerely,
Allan Jones, MD
Sample Newspaper Advertisements
Dr. Allan Jones, family physician, will be opening a new practice in Bigtown starting (insert date) and will be taking new patients.
To book an appointment with Dr. Allan Jones, please call (416) 123-456 between the hours of 8:00 am and 4:00 pm. This telephone line will be answered only on Mondays, Wednesdays and Fridays.
After 35 years of practicing family medicine, the office of Dr. Allan Jones, located at 184 Calm Water Street, Bigwater will be closing effective (insert date).
Should you need to contact his office, please call (416) 123-456 between the hours of 8:00 am and 4:00 pm.
Please join us in welcoming Dr. Allan Jones, family physician, to the Bigtown Family Health Group. Dr. Jones will be starting on (insert date) and will be taking on new patients.
To book an appointment with Dr. Allan Jones, please call the office at (416) 123-456 between the hours of 8:00 am and 4:00 pm.
Dr. Allan Jones, family physician, of the Bigtown Family Health Group is currently accepting new patients.
To book an appointment, please call his office at (416) 123-456.