Guidelines for leaving a psychiatry practice.

[deleted1100659]

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It looks my state does not have any explicit rules on this, digging deeper it seems like the patients are a part of the practice itself. Since im leaving the practice and the practice is a community health setting with other providers, im assuming I do not have to try to call every patient ive ever seen before? On top of this its impossible to even know who is technically my patient, as patients are generally shuffled around between providers. Any thoughts? Thanks!

 

[calvnandhobbs68]

Ugh what a mess, I don't know if anyone besides malpractice will have hard/fast answers on this. You'll probably want to ask them since they'll be the ones covering your ass if you get accused of patient abandonment or something. Whenever ive seen this play out before, they usually send a letter to all your active patients 1-2 months ahead of time informing them that you'll be leaving the practice and either giving them the opportunity to followup with another person or referral options, so that way you officially terminate with all your patients.
Even if patients get "shuffled around", if you're the last one who saw them, technically you're on the hook for them unless you were clearly covering for someone else.

 

[deleted1100659]

Ugh what a mess, I don't know if anyone besides malpractice will have hard/fast answers on this. You'll probably want to ask them since they'll be the ones covering your ass if you get accused of patient abandonment or something. Whenever ive seen this play out before, they usually send a letter to all your active patients 1-2 months ahead of time informing them that you'll be leaving the practice and either giving them the opportunity to followup with another person or referral options, so that way you officially terminate with all your patients.
Even if patients get "shuffled around", if you're the last one who saw them, technically you're on the hook for them unless you were clearly covering for someone else.

Calling malpractice carrier was a good idea, just called them. Good news is I know for sure I dont need tail coverage due to having an occurence based policy here.

Being as its a CSC im working for in my state, if anything the duty would fall upon the practice and practice is tasked with finding appropriate coverage, especially since I did give them nearly 2.5 months of notice.

He basically stated there was nothing for me in particular to do so that works. Im assuming this would be more an issue if I had started a practice and closed it down.

 

[Sushirolls]

Yep.

 

[Merovinge]

This is a big advantage to employed health care system job. You can leave with notice as outlined in the contract and that should give them plenty of time to send out letters and avoid any patient abandonment.

 

[Candidate2017]

This is a big advantage to employed health care system job. You can leave with notice as outlined in the contract and that should give them plenty of time to send out letters and avoid any patient abandonment.

Nah, having a coworker take over patients to avoid abandonment when you leave isn't really a selling point to being employed.

If you have your "own" patients, all you need is whatever is required by state law. Usually a certified letter plus supply of scripts, referrals, etc. It's fairly easy.

Most relationships come to an end. So I begin with the end in mind. To me, this means no enabling patients: no enabling borderlines, no enabling anxiety patients with long term daily benzos, no enabling substance users with stimulants, no enabling patients who don't care about their health (patients must get a PCP to manage their medical care and refills if they can't get into a new psych clinic). These are where the abandonment problems are found. Practically speaking, don't practice bad psychiatry, and you'll have less headaches.

Even so, abandonment fears are overblown. I've had a family member who was ghosted by their psychiatrist. They were pretty mad but just went to their PCP for refills. I've also heard of a psychiatrist who retired with nary an announcement. They disconnected their office phone and left the state with no repercussions, as far as I know

 

[smalltownpsych]

Whenever I have left an agency, I usually just focus on the couple of patients that will need extra support or planning just of because where they are at in the treatment process and level of risk/acuity. Each active patient and how I tell them is a clinical decision obviously, but for most of them it’s not very complex or imminently risky. I document that I told them and the plan and then start counting down the days till I can get out of there. Just the fact that you are asking the question and want to have a process puts you ahead of the curve from what I have seen and experienced.