Moving on.....need advice

[Iladelphia]

Hello fellow SDNers,

As I'm sure is the case for many of you, the past two years have caused me to rethink a lot of things. For a variety of reasons (both personal and professional) I have decided to uproot my life and family and move to a different state to continue my practice. A new job is secured and I'm slated to begin at the end of 2022. Surprisingly, I have found very little transition advice on the network after searching previous threads. Although not a partner, I have been a well-regarded and respected employee of a small group practice for several years. I think my current practice will be taken by surprise when I inform them. That being said, how much time is a reasonable amount of notice to inform them of my intentions? My goals are to not burn any bridges, provide a stable period for my current patients until a replacement ophthalmologist is secured, and continue to work until relatively close to my start date for this new opportunity. In other words, I do not intend to take too much time off between my old and new job. Surprisingly my current contract does not contain language of a required amount of notice.

All the best to my wonderful colleagues and thanks for your advice!

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[mjohnsonets]

I have always thought it professional to provide as much notice as possible. The average I see in contracts is 3 months' notice. Ophthalmologist recruitment is not easy and there has been a particular crunch this cycle. If you are well respected in the group, they are unlikely to ask you to leave early. I would think your practice would immediately start recruiting your replacement. If they find that person before you intended to leave and they can start before you intended to leave, the practice would likely ask you to leave after a transition period between you two or just before their start date. Your practice could start decreasing your patient base and pushing them to other docs if there is availability. This would cause you a reduction in income if you're production-based.

I have no idea where you are currently working but even if it's in a highly desirable area, I would say minimum, one month to find someone then they give 3 months' notice. You leave around May-June and that would be if they got on it today. Flights are a bear right now due to cancellations so that is extending recruitment timelines too.

 

[Iladelphia]

Hi Matt,

Thanks very much for your replay. I was expecting to give 4-6 months of notice, so that seems to fit nicely with what you are saying. I didn't know ophthalmology recruitment was so tight at the moment. Why do you think this is so? More doctors opting out and retiring?

Thanks again

 

[dantt]

Many people have been burned in the past being asked to leave early or otherwise having your referrals and consequently production/compensation cut, vacations cancelled, etc so I'd caution on giving too much notice. That's never happened to me as I've always left on great terms practices that needed/wanted me to be there and was willing to pay for it but it's been known to happen there as well.

If you don't mind me asking, was it a partner track position? Typically after several years partnership is offered and if it's not accepted, usually it's a sign to the partners that you're leaving. If it's not offered or deferred, that's also a sign that you're not going to be in it long term.

 

[mjohnsonets]

Hi Matt,

Thanks very much for your replay. I was expecting to give 4-6 months of notice, so that seems to fit nicely with what you are saying. I didn't know ophthalmology recruitment was so tight at the moment. Why do you think this is so? More doctors opting out and retiring?

Thanks again

There are more positions open than people looking for positions. It has been that way for awhile.

In 2020 and 2021 there were a lot of retirements, more than usual. Patient volume came back strong and has grown in almost all of my client practices to more than pre-pandemic levels. This drives a need for more surgeons as well. There has just been a couple of compounding factors in the last two years on top of the first point I made.

 

[i-doctor]

There are more positions open than people looking for positions. It has been that way for awhile.

In 2020 and 2021 there were a lot of retirements, more than usual. Patient volume came back strong and has grown in almost all of my client practices to more than pre-pandemic levels. This drives a need for more surgeons as well. There has just been a couple of compounding factors in the last two years on top of the first point I made.

Part of the reason for retirements are a ton of Private Equity deals have been done over the last 3 years. A number of those who got a lot of upfront cash called it quits, especially when Covid hit. Many of them in their 50’s and 60’s, who otherwise may have worked longer

 

[MstaKing10]

Part of the reason for retirements are a ton of Private Equity deals have been done over the last 3 years. A number of those who got a lot of upfront cash called it quits, especially when Covid hit. Many of them in their 50’s and 60’s, who otherwise may have worked longer

Is this a fact? Most PE deals don't allow doctors to leave without significant penalties. Yes they get their upfront cash but the PE firms investment is worthless if all the doctors up and leave. Most (if not all) PE deals that I am familiar with not just locally but around the country are set up to discourage such behavior.

 

[sushichopstickz]

Hello fellow SDNers,

As I'm sure is the case for many of you, the past two years have caused me to rethink a lot of things. For a variety of reasons (both personal and professional) I have decided to uproot my life and family and move to a different state to continue my practice. A new job is secured and I'm slated to begin at the end of 2022. Surprisingly, I have found very little transition advice on the network after searching previous threads. Although not a partner, I have been a well-regarded and respected employee of a small group practice for several years. I think my current practice will be taken by surprise when I inform them. That being said, how much time is a reasonable amount of notice to inform them of my intentions? My goals are to not burn any bridges, provide a stable period for my current patients until a replacement ophthalmologist is secured, and continue to work until relatively close to my start date for this new opportunity. In other words, I do not intend to take too much time off between my old and new job. Surprisingly my current contract does not contain language of a required amount of notice.

All the best to my wonderful colleagues and thanks for your advice!

Congratulations on taking the next step for you both professionally and personally. I am also going through a similar situation. My question is what is the best and legal way to tackle the topic of providing continuity of care for patients in the practice you're leaving? For context, I am in a region where a non-compete clause is not applicable and is not in written in the contract. Without direct solicitation or jotting down patient demographics (which I believe may fall under practice "trade secret"... please correct me if I am wrong), how do you or the new practice communicate to current patients where I will be going and how patients can setup an appointment should they want to transfer care? Similarly, how do you let the patients know you're leaving and when they ask, "Where are you going?" Do you answer generically by saying, "I will be going to said practice. I am happy to transition your care to another provider in the current practice if you would like to keep your care local?" Again, the question is how to delicately handle the transition period without stepping on someone's toes or put oneself in legal exposure for direct solicitation?

 

[MstaKing10]

Congratulations on taking the next step for you both professionally and personally. I am also going through a similar situation. My question is what is the best and legal way to tackle the topic of providing continuity of care for patients in the practice you're leaving? For context, I am in a region where a non-compete clause is not applicable and is not in written in the contract. Without direct solicitation or jotting down patient demographics (which I believe may fall under practice "trade secret"... please correct me if I am wrong), how do you or the new practice communicate to current patients where I will be going and how patients can setup an appointment should they want to transfer care? Similarly, how do you let the patients know you're leaving and when they ask, "Where are you going?" Do you answer generically by saying, "I will be going to said practice. I am happy to transition your care to another provider in the current practice if you would like to keep your care local?" Again, the question is how to delicately handle the transition period without stepping on someone's toes or put oneself in legal exposure for direct solicitation?

I've heard of some pretty aggressive legal battles related to solicitation. You should consult a healthcare attorney to make sure the language in your contract is clear regarding what you can and can't do. The practice has an obligation to alert patients and insurance carriers that you are terminating your relationship with them in the form of direct communications and/or publications. I think this varies by state in terms of how it needs to be done. If your specialty will be covered in the practice then there is less of a problem. But if you are a sub-specialist and they will need to replace you when you leave then everyone is in a bit of a pickle. I worry about abandonment issues in that circumstance.

 

[Iladelphia]

Wow thanks so much to everyone for the responses. I think the issues at play here (transitioning to a new practice, either locally or more distant) are important. I don't really feel like there is a perfect way to do this, as there is ample opportunity for fractured professional and patient oriented relationships. That being said doctors should not feel guilty if they decide the next move professionally involves a change of scene.

That being said, I can't comment on the issues regarding patient solicitation. This can get very dicey and a healthcare attorney seems imperative. I do have a non-compete cause as I practice in a pretty protected area and it's reasonable for the practice to, in my opinion at least, protect their turf. Thankfully I'm moving several hundred miles away so the non-compete is a nonstarter for me.

Regarding the question above about partnership track - the answer for me personally is quite complex. Had I wanted it, partnership would have been an option. But for a variety of reasons I decided several years ago that I did not want to make this investment in this particular practice. My next practice has a clear avenue for this, and it's also one I would be very interested in pursuing. This is one of the major reasons I wanted to leave.

All the best and I'm still curious about what other people decided to do when confronted with a similar scenario. Thanks again

 

[mjohnsonets]

Is this a fact? Most PE deals don't allow doctors to leave without significant penalties. Yes they get their upfront cash but the PE firms investment is worthless if all the doctors up and leave. Most (if not all) PE deals that I am familiar with not just locally but around the country are set up to discourage such behavior.

3 years after a sale to realize your full gains from the original sale seems fairly standard but I'm sure there are different and unique clauses depending on the practice and PE group buying them. I know there are different benefits and payouts they could miss out on that are incentives to stay as well.

 

[schistosomiasis]

No way would I not wait until the very last moment specified in the contract to notify your group you’re leaving. If it’s 90 days so be it. They can treat you real funny (unfair) once you’ve given notice. The nicest people can turn into a fury when this happens.

It’s the old practice’s responsibility to ensure continuity of care for “their” patients.

If you have a strong nonsolicit then tell your old practice patients “I’m not allowed to say anything but My new location will be on the internet”. The day you leave, make sure new website up/ google maps and other websites changed.

 

[Iladelphia]

Just wanted to give an update:

I informed my practice approximately 4.5 months prior to my anticipated departure.They were very thankful that I provided them with such advanced notice. So far there have been no hurt feelings/animosity. As of now they want me to continue seeing patients up the departure date I offered as my last day of work.

I think there is very little advice on this very difficult transition, not only for ophthalmologists but physicians in general. I will update this thread periodically with my experience: informing a practice, navigating transition of patient care, recruiting a replacement, malpractice coverage, etc.

All the best everyone! So glad this part is behind me.