Exit etiquette: Whose patient is it, anyway?

When a physician leaves a group, a tension begins over whether that doctor's patients can follow to the new practice. Experts say each side can find ways to protect itself without putting patients in the middle.

By Larry Stevens, AMNews correspondent. Oct. 17, 2005.

Just as the end of a marriage is stressful, the departure of a doctor creates a tremendous amount of dislocation in group practices. The situation can be even more contentious when the departing doctor sets up shop within the same market area as the group. Suddenly, doctors who had been cooperating in building the group practice find themselves in a competitive struggle to attract patients.

A major part of that competition centers on the departing doctor's patients -- the ones he or she acquired while at the group practice. The departing physician wants them -- and so does the group.

"There is definitely a lot of tension between the group's wish to maintain its patients and the departing doctor's wish to take as many patients with him or her as possible," says Daniel M. Bernick, an attorney with Health Care Law Associates in Plymouth Meeting, Pa.

One Midwestern pulmonologist has experience on both sides.

He left a group with which the employment contract, signed when the doctor was just starting out, included a "restrictive covenant," a clause that prohibited him from setting up a practice in the local geographical area. Feeling pressure to leave his group but not wanting to dislocate his family by moving out of town, the doctor ignored the agreement and set up a local practice. The group took legal action, and the sides settled out of court for an undisclosed amount of money.

A few years later, the pulmonologist was fighting a similar battle, but on the other side of the issue. A doctor who left the pulmonologist's group decided to ignore a noncompetition clause. Again, the situation had to be negotiated.