Jump to content
Sign in to follow this  
Colorado

Transfer of patients when someone retires

Recommended Posts

How have others dealt with the transfer of care of patients from a provider who is leaving/retiring?

Warning, there is a bit of a rant in this:

There is a provider at my clinic who is retiring next month and is feebly transferring patients to myself and another full time provider. The retiring provider has been at the clinic for almost 30 years and has a HUGE panel. Nearly half are on chronic narcotics. Granted, she has worked most of them down over the years to </= 50 MDE but some are still around the low 100's MDE. Additionally, many are in their 50s-70s and many are also prescribed benzos and/or stimulants. When I have inquired in the past about these med combinations, esp in older patients, she replies something along the lines of "well, they're doing well on them/they work". Or, if an outside provider prescribes the benzo or stimulant, she claims the "head in the sand" excuse of "Well, I"M  not the one writing those prescriptions". This aggravates me to no end. Okay.... so you may not have written them, but you wrote your Rx for their narcotics with the full knowledge that the patient is taking other potentially dangerous medications. 

I mentioned her feeble attempts to transition patients because she is continuing to see many of her patients for follow-up of routine care despite telling them that she's leaving and that they need to transfer care to another provider. Some of this may be the patient's preference, but its frustrating because they tend to be complex patients that require more chart review prior to my first meeting with them. I simply don't know them as well because they've been her exclusive patient for 30 years. I feel that she should be transferring more of these patients over to us other providers prior to her final day. When I asked her about this, she happily gives me some of the patients from her schedule, but typically keeps the above-mentioned type patients to herself for now. I have met with some of those former patients of hers, but after having a discussion about the potential dangers of their med regimens, they often return to see her and plan to until the very end. I foresee a metric shitstorm coming my way come next month when she finally leaves. Not to mention, a lot of initial visits with those patients are going to be difficult as we discuss their med regimens. They get quite upset when I talk about reviewing and considering changing their controlled substances.

 

Thoughts on how to make these transitions smoother? I feel that for one, starting to transition patients earlier is ideal. I am also curious because I myself may be voluntarily departing this position in the near future as well.

 

(again, sorry for the rant. I am genuinely curious on how others have dealt with transfers of care when providers leave)

Share this post


Link to post
Share on other sites

This is a big problem and I feel your pain. While I've never been in this situation, I've had to bear the outcome of it many times. In my cases, the older-narcotic-happy doctor retires and the new provider says "Hell no I'm not prescribing oxycodone for your headaches I don't care if 'old doctor' has done it for 30 years. So, I'm sending you to the headache clinic and they will do it."

Then I have the break the bad news that I might help taper them off ASAP,  help them get dependency treatment, but I will not rx them for chronic use. Then they are pissed.

Share this post


Link to post
Share on other sites

I have been on the receiving end several times and what I found is that word spreads quickly through the community.  Granted, I'm in a small, rural community so may be different if you are in a larger town.  But, I have found it's really only a headache for the first 1-2 months and then everything settles down, or maybe I just get used to it.

I also view it as: this is not a discussion, it's unsafe and bad medicine, I will NOT prescribe this dangerous combination of meds...end.of.story.

I know some on here don't like that approach, but I am done fighting with patients.  It is the same as antibiotics,  the patient came to see me for my professional opinion, whether they view it that way or not.  If they don't like my approach to medicine then drive two doors down.

  • Upvote 1

Share this post


Link to post
Share on other sites
39 minutes ago, mgriffiths said:

I have been on the receiving end several times and what I found is that word spreads quickly through the community.  Granted, I'm in a small, rural community so may be different if you are in a larger town.  But, I have found it's really only a headache for the first 1-2 months and then everything settles down, or maybe I just get used to it.

I also view it as: this is not a discussion, it's unsafe and bad medicine, I will NOT prescribe this dangerous combination of meds...end.of.story.

I know some on here don't like that approach, but I am done fighting with patients.  It is the same as antibiotics,  the patient came to see me for my professional opinion, whether they view it that way or not.  If they don't like my approach to medicine then drive two doors down.

I too am in a small rural community. There is one other small primary care office in town. Other than that, patients will need to drive about 45min to 1 hour to the next clinic. The other clinic has recently cut down on these prescriptions and now we, as the community health clinic, are seeing patients looking to transfer care. Luckily, the organization I work for is very explicit in not allowing ANY new chronic narcotic patients to receive Rx's through us. We can see them for their other care though and work to get them resources (pain management, MAT program, behavioral health, addiction recovery, or specialty referral if warranted) for their pain. I do my best not to kick the can too much by getting fed up and referring them out if I can avoid it, but I also know my limitations.

Funny enough, the more of these conversations I have with patients, the less chronic pain patients I see. And my pediatric and Gyn patient panel is on the rise!! So maybe it will all settle out after a couple months. I'll try to keep ya'll updated.

Share this post


Link to post
Share on other sites
3 hours ago, mgriffiths said:

If they don't like my approach to medicine then drive two doors down.

I want to clarify that this is not kicking the can, I don't just ignore them, but I am not going to fight with them.  I only discharge patients for violating their controlled substance contract.  It is their choice to continue with me or go elsewhere, but it's very simple - chronic narcotics are not the right answer and should never be treated as a "right."

 

2 hours ago, Colorado said:

Funny enough, the more of these conversations I have with patients, the less chronic pain patients I see.

But this is 100% true

  • Upvote 1

Share this post


Link to post
Share on other sites

I've been in this situation and I tell patients bluntly "I don't prescribe those medications.  I'm more than happy to refer you to pain management (or other appropriate specialty) and they can prescribe them for you, but I don't do it here".

I don't leave any wiggle room on the table.  I haven't gotten much push back on it because I don't say that I'll only prescribe it for xyz or that "I won't prescribe it", I say I don't prescribe it.  If they push I just stand my ground and say I don't prescribe those medications. 

It is a bear picking up another providers pt's, especially when notes consist of "pt here for f/u, doing well, no complaints".  I don't have any great words of wisdom for a smoother transition, they're going to come to you eventually and it sounds like your doc isn't being helpful or considerate.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Sign in to follow this  

×

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More