It was a great ride for a while. Dr Gray welcomed you as a partner to the practice, although you both kept separate families of patients. Your contract stipulates that in the event of death or disability of either party, the remaining partner would assume the responsibility of providing patient care. Gray initially appeared to be a good mentor—especially in practice management. He kept a keen eye on accounts and was a strong advocate for encouraging patients to pay their entire fee when treatment began. “Better in my pocket than theirs,” he’d always say. He owned the building independent of the partnership. However, recently he seemed to have become a bit disconnected with the practice, as his relationship with his wife has become challenged.
He shows up at the office one evening just as you are about to leave, and announces that he has decided that he had enough of clinical practice–especially in light of the recent complications in his life. Not only does he want you to treat the entire patient pool, but he also wants you to buy half of the practice and the building simultaneously. You tell him you’ll need to mull it over after seeking your wife’s input.
After some thought, you decide that the opportunity might be too good to pass up. The referring dentists and patients know you well, and their transition toward trusting you should be seamless. So you try to contact Gray by phone and text but have no luck.
A few days later, one of your patients holds up a note with the practice letterhead on it. It’s a form letter signed by Dr Gray. The note says he is transferring his patients to you immediately because his lease was just terminated—yet you know he owns the building. The notice also stipulates that you would complete any remaining patient care. But you’ve not yet had the opportunity to agree on the terms of the transfer of the practice. And you have no interest in owning the office space.
It’s not until he finally contacts you that you realize a serious loophole in your contract, as it does not address the issue at hand. In a manner atypical of his usual demeanor, he tells you that he will promptly leave the practice because of family issues. When you ask him if he will reimburse you for his active patients who prepaid their entire treatment fee, he flatly declines. When you request some form of consideration for those patients who might need revised treatment plans, he curtly replies negatively. You feel an ethical responsibility to complete these cases or possibly invite litigation from discontented patients. Not only were the patients in the practice misled, but you feel trapped by your predicament. This is not the same man you knew—and you object to his new demeanor.
Change at all levels can be difficult, but internal practice transitions carry significant ethical and legal ramifications because they involve a balance of patient trust and economic concerns. The salient issues in an internal practice transfer involve continuity of care, availing a patient’s access to diagnostic records should they wish to transfer elsewhere, and avoiding abandonment. It’s all about keeping the patient’s welfare first. It’s easy to violate a patient’s trust in a storm of haste and the distraction of a deteriorated relationship. That aside, the ethical orthodontist should inform his patients well before his intended departure, produce appropriate transfer records for any patients who need them, and determine each patient’s remaining treatment time in collaboration with his successor. This will facilitate the determination of a cumulative value for the transfer of care from the departing doctor to the remaining doctor. Patients should bear no additional fees if their care is transferred within the same practice, especially if prepaid for professional services.
Patients deserve the opportunity to achieve the best possible result regardless of the internal politics within an office. As always, the patient’s welfare reigns supreme.
1. Koocher G.P.: Ethical and legal issues in professional practice transitions. Prof Psychol Res Pract 2003; 34: pp. 383-387.