Changing practices – planning your exit well

There are many important considerations to bear in mind when leaving a practice, to ensure a smooth handover of patients, and deal with possible difficulties that may arise after you’ve left.

At Dental Protection, we are regularly asked for advice when disagreements arise between colleagues – especially between principals and associates. This can be particularly challenging when the parties have parted on less than amicable terms. Some of the resultant issues and disputes could have been mitigated if there were more clearly defined and thought-through parameters in place from the beginning.

Your contract
Before entering into a new agreement, it is important to carefully review any contract. You may wish to consider whether you want to agree to a certain notice period to be given by either party to terminate the contract. Are there any restrictive covenants after departing the practice, e.g., preclusion from working within a specified geographical radius? What are the financial arrangements for outstanding patient bad debts when you leave?
Dentists are provided with very little training in this area prior to graduation, and we do see instances of disputes between parties that can rapidly escalate. Dental Protection would encourage anyone starting in a new role to have their contract reviewed by a suitably qualified legal professional.

Dental Council guidance
In the Dental Council’s Code of Practice relating to Professional Behaviour and Ethical Conduct (2012) it states that “you must arrange to look after your patients if you leave your dental practice”, and that “if you accept a patient for treatment, you must complete the agreed course of treatment safely and to a satisfactory standard”.
There are important considerations to bear in mind when leaving a practice. Are all outstanding treatment plans completed? If not, what are the arrangements for continuity of clinical care? If you had a specific clinical interest, e.g., short-term orthodontics, will your successor or the practice itself be able to provide follow-up care?
The simplest way of overcoming the difficulties thrown up by continuity of patient care is to plan your exit from a practice well in advance. By doing so, you can notify your patients ahead of time and this will help you avoid any surprises. This approach may also allow you to refer complex treatment plans to colleagues, to avoid the patient having to change clinician mid treatment.

Record keeping
Robust record keeping is one of the central pillars in clinical risk management. Ensure that your clinical records are of an adequate standard – that is, your records should facilitate another practitioner who replaces you. A helpful exercise would be to review some records from a few months back and consider whether you can easily understand what discussions you had with the patients, what treatment options were explored, what risks and benefits were considered, and the final agreed treatment plan. If this basic information is missing, then it would be harder for any dentists taking over the patient’s care.

Complaints
Before you move to another practice, it is important to discuss what process is in place for any patient issues or complaints once you have moved on. Consider posing the following questions:

How will you be informed and asked for your comments?
Will you be notified of all patient complaints or just the ones the practice considers to be significant?
Who will respond to the patient – yourself or the practice?
If remedial treatment is required, what financial arrangements are in place (especially regarding retained sums)?
What if you disagree with the approach to the complaint?

Dental Protection regularly sees difficult situations arising out of disagreements on handling complaints, particularly after the treating clinician has left the practice. Ordinarily, it is preferable for the practice to inform the treating dentist of any complaints made by patients, so that they may then provide a response to the patient having had an opportunity to review the clinical records.
The risk of the practice attempting to handle the complaint is twofold. It is very challenging (and ordinarily inappropriate) for an individual not responsible for the treatment to comment on the clinical issues. Perhaps more significantly, the complaint may not be handled as the treating dentist would like, and can occasionally cause unnecessary escalation of the complaint. It is unfortunately not uncommon for an outgoing dentist to first become aware of a complaint when it has escalated to a point where the opportunity for a simple intervention to nip it in the bud has been lost.

Patients who want to be treated at your new practice
Upon leaving a practice, some patients may wish to continue being treated by you, particularly if you continue working locally. Patients may request the details of your new practice. Find out the practice policy about divulging your new practice, whether patient records can be transferred to the new practice, and whether there is a reference to ownership of records in your original associate contract.
In the Dental Council’s 2012 Code of Practice, it states: “You must not canvass for patients or try to persuade patients to leave another dentist or practice. This is particularly important when a dentist is leaving a practice”.
You do not want to be seen as obstructive or evasive when asked by patients about where you are moving to. A simple discussion with the practice principal to agree on what you can say, when asked, will avoid any unnecessary conflict. You may, for instance, wish to reach an agreement for patients undergoing treatments, such as orthodontics or implants, where it may be preferable for you to continue the treatment and avoid the patient having to switch dentist midway through care.

Moving forward
Communication is the key to early resolution and avoidance of any unnecessary escalation. The value in parting on good terms cannot be overstated. It is important to keep in touch with your former practice – updating them if your contact details change and, particularly in the early days and months after your departure, perhaps reaching out to them every now and then to check in on how former patients are doing.
Hopefully by following some of these basic principles, changing practices can be easily managed with minimal stress. As always, Dental Protection’s team of dento-legal experts remain on hand to answer any specific concerns that may arise before, during, or long after you have moved on to new pastures.

For more information, visit dentalprotection.org.

Dr George Wright
Deputy Dental Director,
Dental Protection