Abandonment?

[forchinet121]

Hypothetical: you’re working a telepsych gig for a clinic. You have a full patient load. Your contract does not specify giving notice for quitting. You then wake up one day and decide to quit for whatever reason. You then just never show up virtually to that clinic anymore and let them know you are quitting. Are you liable for abandonment and responsible for those 300 patients on your caseload?

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[PikminOC]

Hypothetical: you’re working a telepsych gig for a clinic. You have a full patient load. Your contract does not specify giving notice for quitting. You then wake up one day and decide to quit for whatever reason. You then just never show up virtually to that clinic anymore and let them know you are quitting. Are you liable for abandonment and responsible for those 300 patients on your caseload?

Check your contract

 

[TexasPhysician]

Hypothetical: you’re working a telepsych gig for a clinic. You have a full patient load. Your contract does not specify giving notice for quitting. You then wake up one day and decide to quit for whatever reason. You then just never show up virtually to that clinic anymore and let them know you are quitting. Are you liable for abandonment and responsible for those 300 patients on your caseload?

Unlikely depending on the contract. Usually the patients are patients of the clinic. The clinic should just move them to a different psychiatrist.

 

[forchinet121]

Unlikely depending on the contract. Usually the patients are patients of the clinic. The clinic should just move them to a different psychiatrist.

What if you’re the only psychiatrist there?

 

[littlefred]

I am not a lawyer, so check with one or check your local laws.

Abandonment applies mostly for when you have your own outpatient private practice.

Good practices will tell you to give your job and patients a good timeframe and notice, but techically if your contract had no exit clause (you can quit or they can fire you without any timing clause) then you can leave and they should have to cover their patients (they are not technically yours).

 

[littlefred]

What if you’re the only psychiatrist there?

Then your company is screwed for coverage. They are making a lot of profit off of your license/expertise right now, so don't feel bad if you bounce.

 

[forchinet121]

Then your company is screwed for coverage. They are making a lot of profit off of your license/expertise right now, so don't feel bad if you bounce.

I appreciate the insight, Does this differ if you are 1099 vs w2?

 

[nexus73]

I’d want to talk to an attorney before suddenly quitting without notice. Most states 30 day notice is technically all that’s needed. For peace of mind I’d probably do that. To minimize risk of lawsuits and board complaints. Theoretically you don’t need to work for the 30 days just be available for urgent needs, which could be refills, or if someone is in crisis direct them to the ED. But to just completely bail sounds dicey.

 

[TexasPhysician]

What if you’re the only psychiatrist there?

Need more details. In my state, it is illegal to hire physicians as a non-physician. There are legal loopholes, but I’ve never seen a small company do this for 1 physician. Why are you the only one? If not done correctly, it could be argued that it was actually your practice that you left.

Typically it is the employer’s responsibility to hire locums to fill the role until a replacement is found or just distribute patients to other staff.

This is different if the contract states that they are assisting you to grow a pp that is yours. The larger entity could state that you are paid 80% off all collections and that 20% is kept for providing administrative and executive support. With no non-compete, etc as it is designed to be your practice, you’d have to go through all necessary closure steps.

 

[forchinet121]

Need more details. In my state, it is illegal to hire physicians as a non-physician. There are legal loopholes, but I’ve never seen a small company do this for 1 physician. Why are you the only one? If not done correctly, it could be argued that it was actually your practice that you left.

Typically it is the employer’s responsibility to hire locums to fill the role until a replacement is found or just distribute patients to other staff.

This is different if the contract states that they are assisting you to grow a pp that is yours. The larger entity could state that you are paid 80% off all collections and that 20% is kept for providing administrative and executive support. With no non-compete, etc as it is designed to be your practice, you’d have to go through all necessary closure steps.

For example it could be a therapists clinic and they have contracted you to do medication management. So you’re the only psychiatrist there.

 

[TexasPhysician]

For example it could be a therapists clinic and they have contracted you to do medication management. So you’re the only psychiatrist there.

Usually these contracts would make it clear that it is the psychiatrist’s practice. It is essentially the psychiatrist’s practice, but they collect a percentage for admin support. This would be abandonment in my eyes to just walk away.

 

[calvnandhobbs68]

Usually these contracts would make it clear that it is the psychiatrist’s practice. It is essentially the psychiatrist’s practice, but they collect a percentage for admin support. This would be abandonment in my eyes to just walk away.

Yeah I'm in this exact situation in terms of practice setup. I highly suspect it would be considered abandonment by the medical board to just walk away from a setup like this without giving patients at least 30-60 days notice.

In most of these cases you're also not "hired" by the therapists. You're often 1099 with these setups, which means in technical terms that you have your own business (your psychiatric services) that you're contracting out to the therapy group. This also supports the notion that these are actually your patients that you are responsible for giving reasonable notice for discharge/ending services to avoid abandonment issues.

 

[forchinet121]

Yeah I'm in this exact situation in terms of practice setup. I highly suspect it would be considered abandonment by the medical board to just walk away from a setup like this without giving patients at least 30-60 days notice.

In most of these cases you're also not "hired" by the therapists. You're often 1099 with these setups, which means in technical terms that you have your own business (your psychiatric services) that you're contracting out to the therapy group. This also supports the notion that these are actually your patients that you are responsible for giving reasonable notice for discharge/ending services to avoid abandonment issues.

Yes it would be 1099, so that would mean we can just quit but be available prn for refills and urgent questions regarding side effects etc but we don’t have to schedule any regular patient encounters and can move on to a new job?

 

[TexasPhysician]

Yes it would be 1099, so that would mean we can just quit but be available prn for refills and urgent questions regarding side effects etc but we don’t have to schedule any regular patient encounters and can move on to a new job?

You’ll need to review your state board rules. Last I looked, my state required a notice in a newspaper (who reads those?), advanced notices, and period of availability.

1099 means you have your own business. If yours was the only business providing psychiatric services, you likely are considered opening a private practice.

 

[Candidate2017]

Why is this even a hypothetical question? Absent emergent circumstances, a physician shouldn't wake up one day and decide to no-show their patients that day.

Check your contract

Abandonment is a legal/malpractice issue related to doctor-patient relationship, which is governed by state laws. Abandonment is not a contractual labor issue between doctor and owner/clinic. That said, the abandonment issue is likely bypassed in a clinic where there are other psychiatrists to whom the clinic will transfer patients (because money).

But OP is the sole psychiatrist. So abandonment comes into play. OP, what did your training program do regarding termination of doctor-patient relationship?

 

[whopper]

Based on the small amount of information it is possible this is abandonment, but like was said above there's fine print in the contract and state laws. We really can't answer.

This doesn't answer the question, but if you're quitting knowing the organization can't accommodate patients AND-there's nothing significant that makes you want to leave (e.g. an emergency, you have to get out of the area for whatever reason, the employer is being inappropriate on some level where your continued work there enables it, etc), whether or not this is illegal it is unethical by a Hippocratic Oath standpoint because you have a doctor-patient relationship with these patients. Whether or not that matters to you is up to you, but we're not in a profession where we are supposed to act as mercenaries. This is why Abandonment is an issue in medicine and why several states and specific laws on what constitutes abandonment, because in our profession we can't just get up and leave at a moment's notice. We're not burger flippers. We're doctors.

Now if the employer is being unfair or you have significant reasons why you want out that are exceptional that's different(e.g. you need to move cause you found out your father living on the other side of the country had early stage dementia, or you found out the employer is doing something illegal), but if it's cause of something like you just don't feel like it, it may be legal, it may not be-again that's where the legal fine print answers, but this is not ethical and if it were that type of situation-I would not want to work with you in my own practice. If I ever found out a colleague abandoned patients there's no way in hell I'd want to work with this person. Also it's not like there's a million psychiatrists in a locality. You flake out people in the area will likely find out as many doctors and other providers in a town know each other.

If the organization can't accommodate patients and you want out, then you should terminate your doctor patient relationship and then get the hell out of there by offering prescriptions to give patients time to find a new doctor and referrals. Some areas you need to give a legally defined warning such as 1 month or even more. Many institutions demand 3 months. I used to live in Ohio-it required a newspaper add, or a sign on the office waiting room. Many states have laws that even after you're gone for up to a certain amount of years you are responsible to still provide medical records upon request.