Resigning and patient abandonment

[gibits]

So I have just given my boss my notice today. I don't think he was shocked as I am just the latest of people who quit his practice. The problem I'm having is that my contract requires I give a 90 day notice, I have requested that he let me go earlier.
Now the strange thing is that he wants me to keep my resignation a sercret from everyone and wants me to keep accepting new patients. Both of those confuse me as I would figure it would be time to make arrangements to transfer all my existing patients to the other psychiatrists and taking in more patients would just complicate the matter.
If I see the new patient once and then leave would that be abandonment? I plan on telling all my older patients I may not be around next month but what should I do with new ones?

Also, how do I leave this practice early but still on good terms? My boss is going on vacation next week and I told him I would stay until he got back so the other two psychiatrists aren't over burdened but after that I wished to leave. What should I do? Should I tell the office to stop giving me new patients and just leave when I feel like it? Or should I do as he says and stay silent about the whole thing? Thanks in advance.

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[whopper]

The bottom line is no one can answer your questions until you tell us what state your in, but hey, I'm in Ohio and I don't feel like reading the laws of other states when you can do that yourself. The details in termination differ per state. For example, in some states you have to provide 3 referrals to other providers, others-no. It all depends.

But I can tell you this, in general.

Most states have specifics on how to terminate your doctor patient relationship. In the case of working in a practice or any other organization made of multiple providers, when you leave the practice, the patients are simply referred to other providers in the practice and your doctor-patient relationship ends when you leave the practice and you don't have to do anything other than leave the practice ---> IN MOST STATES. READ UP THE LAWS IN YOUR STATE TO FIND OUT IF YOU CAN DO THIS.

Now is this the case in your state? You'll have to read the fine print.

If you go earlier than the 90 day notice, I'd recommend you get this in writing from your employer that he let you go, otherwise he could sue you for violating the contract even though he verbally told you otherwise and you'd have no way to prove what really happened, and then you could also be accused of abandoning the practice and the patients becuase they can argue they didn't have time to re-arrange the patients to new providers within the practice.

When I did private practice, I told the practice I was leaving and I was the only psychiatrist, so I interpreted this as me having to inform the patients and follow the termination of doctor/patient relationships guidelines because they had no other psychiatrists to take over. Guess what? The guy running the practice still wanted me to take in new patients so they could make more money without regard to the legal aspects of this, and of course the ethical. That was just more reinforcement I was doing the right thing in terms of leaving the practice.

I didn't take the new patients. It was one of a series of things the guy heading the practice wanted me to do where it was apparent he was willing to make a buck by having me do things that were unethical, and possibly even dangerous.

 

[gibits]

Whooper, I am practicing in CA. I feel the same way as you, I should not be receiving anymore new patients as that would make things tougher to distribute my caseload once I leave. Oh and I hate lying to my patients.

I'm not sure I can get him to consent to letting me go earlier, much less get it in writing. This may have to be unilateral on my part. I guess a follow up questions is what can he really do? One paragraph states the if the contract is terminated he would still need to pay what I earned. Would that be different if the contract was breeched? Also, how should I go about leaving without his approval? Cede my earnings?

I honestly want to just stop now as I am already receiving a salary from new job. I am only staying on to help out the remaining psychiatrists since they will be severely short handed while he is away. But if he is going to be uncivil about it I really don't feel like being considerate.

 

[TexasPhysician]

Depending on the state/contract, violating the contract could result in you paying the practice the equivalent of all loss of income for the remainder of 90 days, the added costs of finding an urgent replacement, etc. You basically would owe every penny that it would cost to make equal which is likely tens of thousands of dollars.

Of course you could owe nothing if you get a release in writing.

I would hope the practice has a way to get your patients to other providers so that they aren't abandoned.

 

[billypilgrim37]

Leaving your contract without fulfilling its terms leaves you open to all kinds of badness. Especially given the way you've described your boss, he might be happy to skullfrak you. And honestly, he'd be in the right, despite the fact that your job sounds crappy. Don't bail out early unless with his blessing unless you want to get hit hard.

 

[gibits]

The only real defense i have is that the schedule I am working under is not what I agreed to. I agreed to work one weekend every month and instead I have been working three. That's the main reason I want to quit in the first place. Alas, I don't have an agreed upon schedule in writing but there is ample proof that I have worked 21 days straight.

http://www.mbc.ca.gov/licensee/terminate.html

Those are the rules for terminating patient-physician relationship.

So am I SOL then? No way am I staying here, if I have to buy myself out then that's what I'll do. My overhead for each month is 30%, I'll try to negotiate so they take 90% of my earning currently in collections and call it even (90% being 3x30). I'm not pulling in a lot of income right now due to a small case load. But if they really are going to take almost all my income why should I even work at all?

PS he doesn't want me to hand in a resignation letter or let anyone know I'm leaving. Is this normal? I always thought you should let people know so they can phase you out. Am I looking too much into this?

 

[Fenster]

I don't have much to add here except to say that if you feel something is off, it probably is. Trust your gut whenever you can and try to be extra safe.

 

[whopper]

Again, get the employer's permission to leave in writing.

Read up on the Caifornia Laws. More effective for you to do it than for me to do it for you eh? (I'm not from Canada, just seemed like the perfect time to use the word "eh".)

Oh and I hate lying to my patients.

You are not allowed to lie to patients. This is considered unethical, unprofessional, and possibly even worthy of action against you.

Like I said, in most states, you leaving shouldn't cause anything to happen (again read up on your own state) because the patients are simply transferred to other providers within the same organization. It's like being in a hospital and quitting. The last day doing inpatient, you can still take in new patients, the following day they'll just give them to someone else.

But also like I said, if you're not following the contract, you could lose that protection. If your employer is not following it either, it doesn't grant you immunity. You cannot tell your patients you will continue to be there if you will not be.

Without knowing more about your specific situation, if I were in your shoes, I'd just stay there for the three months because there's a heck of a lot of legal fallout that can happen to you, and could still happen even after you leave because the the statue of limitations is a few years. Anyday up until the statute ends, someone could take action against you. I'd rather just do the 3 months and be able to psychologically move forward from this job with a clear head.

PS he doesn't want me to hand in a resignation letter or let anyone know I'm leaving.

Employers could ask peple that are leaving to keep it hush-hush though I don't know the specific technicals of this.

 

[heyjack70]

I think you should set a limit on the weekends you are working because it sounds like that bothers you (and it's a lot of work). Get everything in writing in regards to your resignation to prove you've given 90 days notice. There must be some type of lawyer who could give you good legal advice about what documents you would want to have in the case of your boss agreeing to let you leave prior to 90 days. Something to prove he let you out of the 90 day requirement in the original contract.


Does he want you to keep your leaving a secret from patients or other psychiatrists? You want to be setting your patient's expectations for you leaving, so you cannot leave them out of the loop.

I agree with whopper's statement about taking on new patients. As long as there are other providers in the group that will absorb your caseload, there is no reason you cannot take new patients. Just be clear to them and your other patients when you will be leaving. If the clinic is as busy as you say, I bet most patients would be happy with an explanation that seeing you (even though you're leaving soon) got them into a doctor sooner. When you have your final appointment with a patient, make sure you get them scheduled with another doctor in the group so there is not a loose end, and document who they will follow up with in your note.

 

[michaelrack]

If I was in your situation, I would immediately give 90 day written notice, and immediately let everyone (including patients) know that I was leaving. I would also not work a single weekend or do anything else that was not specifically in my contract. I would talk to a lawyer before doing any of this.

 

[gibits]

Thank all of you for not saying its all my fault for not reading the fine print. I messed up by not taking it into account. I didn't go into this job thinking I was going to quit it so fast, nor did I expect getting another job so fast.

I can't wait for 90 days. I guess I am at the mercy of my employer at the moment. Thing is, my new employer is expecting me to start work in 2 weeks and is paying me salary while I tidy things up.

 

[michaelrack]

. Thing is, my new employer is expecting me to start work in 2 weeks and is paying me salary while I tidy things up.

YOu need to get a lawyer immediately to negotiate the terms of you leaving

 

[TexasPhysician]

YOu need to get a lawyer immediately to negotiate the terms of you leaving

This. Breaking contracts happens, but you need an attorney to negotiate this effectively.

 

[whopper]

Just going to say this. You can't get a new job before you finish up your responsibilities to your old one. The truth of the matter is I've seen a lot of doctors not follow things to the letter and nothing happened, but if something did happen and it became legal-and you didn't follow up with what you were supposed to do, you could get screwed.

Doctors violating contracts if taken to the fullest legal extent can be very serious. One could be accused of civil if not criminal negligence. It could be reported to your state medical board and put into permanent record that you violated your obligation to treat patients. A doctor simply cannot leave one's duties because they do not like their employer.

Just to give you an idea of what goes through my head whenever I pick up a new job is the fine print on how to get out of it before I sign anything. Further, I've never been in a job where I've decided to be there permanently cause there's just too many good opportunities out there. I already know what I have to do to get out of my current job if I wanted to, and I get calls all the time for other stuff that I do find interesting.

It's normal for new attendings to not know these things. I've seen employers try to exploit new attendings. Doctors in general don't know much about business.

The good news I can give you is most people usually don't want to go to the extreme in going after a doctor that wants to get out of contract cause they don't want a long and embittered war. They don't want to start a rep for screwing with doctors that leave cause then no one will want to work for them either, but I will say in the chess of this situation, you didn't play this out well. I'm not saying this cause I want you to feel bad but just to point out that you shouldn't make this mistake in the future.

But on the other end, while full legal action might not be taken against you, you could develop a rep as a contract breaker in your area. Psychiatrists are in a small world. I could name pretty much close to all of them within a few counties, and know the reps on them. It's not a good way to build your rep as the guy that broke contracts.

When I left private practice, I told them about 6 months ahead of time. I didn't want to do it cause I knew the guy heading the practice was going to give me crap over it and beg me to stay to the point of annoyance, but I had to do it to keep in the legal clear. During those 6 months, the guy was trying to figure out legal backstab methods to keep me there but couldn't figure one because I was doing everything by the letter. On more than 5 occasions, as I was packing to leave, the guy kept arguing with me to stay to the degree where I got home about 1.5 hours later than I wanted. It got real freaking annoying.

When I left my state job, I made it out to the state hospital that I had a passion for teaching, gave them about 9 months of warning, and I did get some flack but it was on the positive end such as remarks that they were sorry to see me go because they liked me.

The only case I know of where someone wanted to sue me for malpractice (I terminated her and she was ticked off), I did it by the letter of the law. Her attorney demanded I give all the records and I even documented expecting to get sued because she was that litigious and antagonistic. I happily gave the records to him knowing I didn't do anything wrong. I never heard from the former patient or the lawyer again, cause I knew this lawyer had to tell the patient they had nothing on me and he wouldn't be able to do anything. I followed everything, I mean everything to the letter.

(And I could imagine this lady screaming at him after he likely charged her a few thousand to research the case only to say he couldn't do anything to me cause he could find nothing wrong. I bet the lawyer thought to himself "no wonder why that doc terminated her.")

 

[gibits]

Thanks for all your input. It looks like I won't have to worry about abandonment issues since there are 3 other psychiatrists to take over. So that's a relief.
I am not currently in any real dispute with my current boss, I think he suspected I would resign because he didn't even make a counter offer, just said that he working on finding a replacement and for me to stall with my new place for as long as possible. He did just interview another psychiatrist this weekend (I ran into them while I was doing call).

I have not given an official start date for my new place but have offered to put in hours as a contractor for 4 hours a week since they fired all their moonlighters to make budget space for me (they are a non profit organization). I think I may offer to work 5 days a week for the first few months to make up some lost ground as well, but I hope it doesn't come to that since I was looking forward to 3 day weekends. I doubt they will sacrifice so much just because they don't feel like waiting a month or two.

So now I'm stuck between two masters, I know I have to consider my reputation and I can only hope this stop gate measure will somewhat satisfy both of them until I am completely free. I just hope my current boss will remain civil and not ask me to continue with SNF patients during the times I'm doing part time work for my new employer.

 

[whopper]

Most employers, if they're smart, will want you to leave on good terms cause they don't want to sour their own reputation. Remember, psychiatry is a small world. This works for and against you in many cases. I already mentioned how this could be bad for you above, but in working for you--an employer doesn't want to develop a rep as a guy that gets real angry and bitter when people leave.

Only an idiot that let's a psychiatrist go on bad terms won't figure out that this psychiatrist will say less than nice things about his employment experience, and given how rare we are in most communities, this could have devastating effects on a practice.

But don't take that info to mean that you (not directed personally at you gibits, this is for everyone) are ever safe and in the clear if you leave a place. Doctors are a strange sort. We are supposed to be for our fellow man but we know full well that some of the biggest narcissists and people simply after money go into the field of medicine. Some of the biggest A-holes I know are docs and I sometimes have more respect for the criminal that just upfront says he'll kill someone for the heck of it than some doc that does real bad work on a patient while charging them top dollar. In some cases the latter is actually worse.

I personally hope you get out of this unscathed with a good learning experience. Like I said, this is something a lot of new attendings go through because they don't teach you about this in residency or medschool.