Advertising Disclaimer

Decreasing Responsibilities and Options

-A   +A

​Decreasing Responsibilities and Options

Closing a Practice Handbook

​​Cold Turkey Versus Step-down
When facing the need to step away from your practice, several factors come to bear. How soon do you need to be out of the practice? Do you need to quickly turn over because of new job or health issues, or can you take a more gradual approach? What is your practice setting—solo with night call coverage, partnership, a large pediatric group, or a university teaching setting? What are your financial needs—would you be better off trying to sell your practice to a young pediatrician or larger group? Are there opportunities to assume different responsibilities or no longer provide clinical duties but do research or administrative functions? Are your partners or department chair willing to consider a gradual withdrawal and if so, what financial arrangements need to be agreed on?

Advertising Disclaimer

Step Down
If you are in a group practice and your partners are agreeable to a gradual withdrawal, this is the most attractive approach for someone who is ready to slow down but not discontinue patient care. Much of the actual details will depend on your practice and community demographics and your practice legal arrangement (eg, partnership agreement). If many of your patients are teens and you have limited newborns, you can have a natural attrition of patients and work just by discontinuing taking new patients and families. If you are in a partnership, bringing in a new pediatrician to pick up those families who are referred to you can be a win-win for the practice and the new pediatrician. Sharing your families with this new pediatrician is another approach, especially if your availability in the office is limited. This allows the families to become familiar and begin to bond with a new pediatrician. Being forthright with your families about the arrangements is critical. The approach allows for working less in the office, perhaps in a graduated manner over 3 to 5 years, and also for taking more extended vacations and time away from the office. In university settings, you might be able to limit your clinical time or switch to a more teaching, research, or administrative function. Some medical schools and universities offer part-time positions for teaching and clinical coverage to retired pediatricians.

One University's Program: The Senior Associates Program
The University of Rochester offers a program to allow a transition for its senior tenure faculty. Beginning at age 62 years, and with the approval of the chair of the department and dean, a senior faculty member can discontinue her usual responsibilities and is able to continue to do whatever academic responsibilities she chooses while still receiving half pay and benefits. Faculty members may not earn more than they did before through extra activities. This allows a medical faculty member to drop clinical responsibilities or limit severely his responsibilities but enables him to pursue other avenues such as research, administrative, or teaching functions. The university benefits because the program ends at age 70 rather than the indefinite tenure for faculty.

Night Call
For many pediatricians, night and weekend call are the onerous tasks that push one toward retirement. If you are in a group practice and your partners agree, you may be able to make an arrangement to not take call in return for less income or taking on other responsibilities like evening hours or more hospital rounding. If your practice pays separately for night call, you may actually be more profitable to the practice if all your time is spent in productive time in the office. 

Niche Practice
If you are in a larger pediatric group, another option for cutting back is to limit your practice scope to a particular interest. For example, behavioral health, adolescent medicine, hospitalist, or other specialty area may allow you to cut back but have an interesting practice life.

Practicing After Practice
There are many volunteer and even paid positions available to the semiretired pediatrician. With the large number of uninsured children, there is an opportunity to help the community through medical clinics serving the uninsured. In many cases, these clinics are able to obtain malpractice coverage for you at no cost except for your time in service. Other options include teaching medical students and residents at a children’s hospital or medical school, serving as a physician for a school or group home, or switching from a partner to an employee. 

Selling Your Practice
If you need to leave practice in a short time frame (1 year or less) or if you prefer to “cut the cord” quickly, selling your practice​ is an option. Finding a buyer will be the biggest obstacle, but checking with the local hospital systems or other pediatric practices in your area is a good first step. ​

No Waffling
If you have decided to cut your hours, limit new patients, or transfer patients to a new associate, it is important to be certain that this is what you want. In today’s economic environment, you will most likely need to live with your decision to limit or leave your practice. It is not fair to new associates if you don’t uphold your end of the bargain.

Income and Practice Expenses
If you are in solo or small group practice, the cost of maintaining an office and staff in addition to professional expenses such as malpractice insurance may complicate the timing of retiring versus slowing down. If you are in a larger pediatric practice with the option for new pediatricians to join the practice, perhaps even initially part-time, you have much more flexibility. If you work 1 less day a week and take 4 weeks’ more vacation, will you be able to cover your expenses and still have a take-home income. If you are in a larger practice, recognize that your professional expenses will be a larger percentage of your practice income and that your take-home pay will be need to be reduced appropriately. Malpractice insurance is very expensive and the cost does not drop significantly until less than 20 hours a week, in total, are worked.

Maintaining Licenses and Certification
If you are interested in some practice as you approach or enter retirement, it will be important to maintain your license, malpractice insurance, and other certifications. Check with your local medical society to find out what the requirements are in your locality.

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. This content is for informational purposes only. It is not intended to constitute financial or legal advice. A financial advisor or attorney should be consulted if financial or legal advice is desired.​
            print           email           share