Patients and families will need to be notified of the practice's closure. One helpful resource is the State Medical Board. Typically, it provides requirements on the duty to notify "patients." Even so, sometimes that guidance is lacking on details about exactly who those patients are and how to contact them.
- Every patient he or she has ever seen?
- Is it sufficient to provide notice only to those patients treated within the past year? 3 years? 5 years? 10 years?
- Are there different standards for different treatment options – for example, patients at an urgent care center compared to a clinic or practice?
- Can a pediatrician or practice notify more recent patients directly, and put others on constructive notice by placing an advertisement in a local newspaper or on the practice's website?
These are all important questions to ask the State Medical Board. Unfortunately, there are no black and white answers. In general, the expectation is that a departing pediatrician will make a reasonable effort, given the current situation, to notify patients so that they are not put in a situation where their care is interrupted. That's the overall goal. However, States may have more stringent requirements.
Additionally, medical malpractice insurers may provide some guidance on this matter. Legal advice is the best option. The AAP does not offer legal consultations to its members.
Reasonable advance notice to patients is critical to providing continuity of care. The State Medical Board may define what is meant by "reasonable." Often it is at least thirty days. Contracts with payers may address this, as well. Beyond that, continuity of care and the amount of advance notice may depend upon the type of medical care provided.
If diagnostic tests or reports from consultants are pending and will not be completed before the practice closes, these situations should also be addressed in advance. Appropriate follow up should be arranged. None of these changes should come as a surprise to the patients.
For pediatric patients in emergent or high risk situations, such as nephrology or hematology-oncology, it is prudent to notify patients via telephone and mail. Some medical malpractice insurers recommend sending high risk patients notice by certified mail, return receipt requested. Again, sufficient time should be provided so that the patient may receive continuous treatment.
To effectuate patient choice, the pediatrician closing his or her practice needs to provide adequate communication to patients that they may obtain their medical records or have them transferred as they choose. They may be told how to contact a departing practitioner, if that person will continue to practice elsewhere, at least upon the patient's request.