Closing Your Practice

In this episode of PodMD, Director of RWS (Rooms with Style), Caroline Chaplin will be discussing the topic of closing your practice. We discuss the factors to consider, clinical responsibilities for doctors and more!

• Transcript
  Please note this is a machine generated transcription and may contain some errors.
  *As always, all in this PodMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.

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  Today I’d like to welcome to the Pod MD studio, the director of RWS, Caroline Chaplin. Today we’ll be discussing the topic of closing your practice. Caroline, thank you so much for taking the time to talk with us on Pod MD today.

  Caroline: You’re really welcome. I’m looking forward to the chat.

  Question 1
  Caroline, could you give me a little bit of an insight into this topic for our listeners?

  Caroline: So when we say closing the practice, what it means is that doctors, for various reasons might decide that it’s just time for them to wind up their private practice. Now the reasons can be varied, as I said. Over the course of time, I’ve assisted doctors who had to close their practice for health related reasons, whether it’s for themself or a family member. Sometimes it’s just personal reasons and personal choice like lifestyle, hey I want to play more golf or whatever it is you might want to do and good on you if that’s the case. Sometimes it’s just age and they’re finding that they’re just not able to do exactly the amount of surgery or hours and winding down in their particular specialty doesn’t quite work for them. Mostly what I am saying is doctors are wanting to move into something different. Have an opportunity to do something different, which might be a choice or it might be a little bit forced on them. Either way you need to pull your finger out and really plan for this because there’s a lot to it.

  Question 2
  Caroline, you mentioned that there’s a lot of factors that go into this, what would some of those be and how does this come up?

  Caroline: Well, everybody’s different and obviously their specialty is different. Their setup is different. Their financial set up is also different. So for example, some doctors just want to close the business. They’re interested in trying to sell it, they’re not interested in trying to get another doctor to take over and so forth. Other people are just wanting to wind back graduall, and I guess the first thing is thinking about what your what your reasoning for needing to close. So for example working with a gentleman at the moment and he’s moving to a different role, but he also felt, I’m just a bit sick of operating, I’ve done this for many years. So because of that, he’s already in the other role. So because he’s already in the other role, he’s utilising my team a lot because he has no time to do it. So we’re going through all the things that he needs to do, but he’s an example of someone that we didn’t need to talk about selling the business because he wasn’t particularly interested in someone coming along and taking it over. Whereas other doctors would say to me it’s really important for legacy reasons that someone takes this over and takes this over well. So a lot of closing your practice is about having that mentoring meeting with me and discussing well, what do you need from this, and we can go through a checklist and so forth and I’ll cover off on a few areas today, but it’s got to be pertinent to you. This is very generic of course, because I might talk to you about selling a practice and you’ve got nothing to sell or there’s no sort of goodwill particularly with your with your practice. One area can be selling your practice, as I’ve said. And how do we manage that and how do we measure the goodwill or the worth of your practice? Typically we might work with your accountants in this for this step of the process as well, but really it’s looking at measuring, and we have a bit of an algorithm for that – how we measure that goodwill. The other thing that is helpful is to hear what others have done, and obviously privacy is a massive concern. We talk in generic terms, but roughly what do other people sell their practices for and what sort of patient input do they have? Are they physicians or are they surgeons so I find the benchmarking is quite helpful, even just to give confidence to a doctor in relation to that, not all practices will be able to be sold. Not all practices will have that goodwill element about them and that can be hard for doctors to understand or you might have a few people because you’re not just selling the practice and the goodwill of the practice. You might be selling the physical rooms as well. We see that quite a lot too where it’s to do with the physical rooms, the equipment, and potentially handing over of the staff as well could be part of that saleable asset if you like. So it’s case by case, but that’s certainly one area that that we look at for doctors and discuss how you might like to move forward.

  Question 3
  Caroline, clinical responsibilities for doctors in regards to their patients referrers it’s really important ins’t it, so how do doctors go about this and navigate this area?

  Caroline: Yeah you just don’t realise when you close a practice how much there is to do and so what we do is we sit with you and we look at all the bodies. So the governing bodies for you, it might be RACS, everybody is AHRPA, it might be the AMA as well. A lawyer needs to be involved, particularly as the sale of a practice and those sorts of things. So we look at what’s being said out there. What are you being told to do, and what you’ll find is when you start looking into it, it’s kind of a bit vague. Some things are specific, keep your patient records for this amount of time, that’s clear. Other things are a little bit nebulous so what we like to do is to make sure you’re doing plenty in relation to communicating with your patients and your referrers that you’re closing because then you’ve ticked the box multiple times. We’re in the process at the moment of winding up a particular practice and what we’re doing is we’re sending letters out by medical objects or Argus, or whatever else you’re using, to let the referrers know that the practice is closing and that the surgeon will be able to release medical records or whatever your situation might be. The particular doctor that we’re working with at the moment has 30,000 plus patients. So it’s not always possible to let everyone know. Someone may slip through the net, people no longer using e-mail addresses. We look for a different way or a few different ways I should say, on how can we communicate effectively to patients and referrers and sometimes part of that too is making your indemnity insurer work for you. We’re often writing letters to medical indemnities on behalf of the doctors. Saying this is our intention do you support this. Sometimes I think there’s kind of laziness there, you get a generic list back, but at least you’ve shown due diligence that you’re trying to put things forward and make sure you tick off the box in many areas many times as well. For example, we might say to you, let’s put a notification on your website, but what if the patient doesn’t have the Internet and doesn’t see that. So looking at different ways so that we can try and cover your bases, how to wind up your phone as well, and the phone number. So there’s that practicality of that. Which can be quite involved and can be something that happens over a period of time. For example, one of the practices that we’ve been winding up just recently, the practice is still open 2 mornings a week where the phone calls are attended to. Now that’s not going to go on forever. There’s a plan in place for that to eventually stop, but that doctor wanted to see all his follow up patients for the next 12 months and be able to at least advise them that he’s no longer working again and again so that they definitely have got that follow up getting to their GPS and so forth. So there’s kind of a host of things. The important thing is sitting with you and looking at your individual circumstances. How you run your practice. What can we do here. What’s the best way of communicating the clinical responsibilities and that means as I said, to patients and referrers.

  Question 4
  Caroline if there was a new doctor coming on board that was taking over the practice how do you go about this?

  Caroline: Well, there often is a new doctor that’s in the wings and interested in either just taking over or contributing to a payment for the doctor to take over. So we see all different types of things. That handover process you’ve got to think when you hand over what are you actually handing over. It’s not just the physical rooms necessarily and the admin and so forth, but the handover process might involve staff and if it does, then there’s certain Fair Work requirements that we need to take the box on. In relation to what those staff are going to be engaged by you, or is the doctor fully going from the practice. Sometimes the doctors will be there once a month, so the staff are still engaged under their authority. Sometimes with the staff it’s very much about letting them know, and you have an obligation to let them know what’s happening and how the practice is changing – a change impact statement and so forth. We help you with all of that. Also, in relation to the handover, you might be thinking, these referrers mean a lot to me. I want to make sure that they’re told. It’s not just a case of, Dear Doctor I’m closing the practice and being all formal. It might be that you want to spend some time and go and visit the best referrers and say hello. Press the flesh. Say thanks so much for a long career together and tell them what you’re going on to. Introducing a new doctor, everybody’s different. Some people say I just want to do a letter and I’ll introduce, ‘Doctor Matt Smith is going to be coming to the practice’, others want to do this in a far more personable manner, and it’s really up to. So my job is to go through all the variables and the ideas and things that you could do, making sure we tick the box from a risk management point of view, just making sure that you’re doing all the right things. Obviously there’s only so much you can control, once the practice becomes the entity of the new doctor, then it’s up to them. That’s why I think people are quite careful about who they will consider to take over their practice because it is a lot about legacy and not just about finance.

  Question 5
  Caroline about those doctors who are wanting to actually cease their surgery or their practice as a whole, how would they navigate that and what goes into that kind of process?

  Caroline: Well again that’s very popular. Often, unless they’re going on to another role, they won’t cut and dry the practice and then off to the other role, they will wind back that gradually and obviously that can be just reducing the number of surgical lists and reducing the number of consulting sessions. A lot of that is about planning in relation to your accounting and bookkeeping and how much money do you still want to earn and so forth. We talk to you about that and what it will be looking like and also really need to get to thinking about how we’re going to talk to referrers about that because people can presume very quickly, that person’s retired when you’ve actually just wound down. So writing some good letters, and I always recommend making a phone call or going out to see your best referrers so there can be no miscommunication in relation to that space. So reducing and ceasing your surgery list, sometimes people can be doing more medico legal. A younger doctor might be coming in and doing the actual surgery, and you’re just doing the consulting. So it’s just about planning really, sitting there and looking at it. Let’s get back to the pyramid we talked about in the other podcast that we made on self-care and retiring. Whar are the points of your pyramid in relation to this. If you’re going to reduce, what income do you need to have? What lifestyle do you want to have. I’ve had an obstetrician recently who has reduced a lot of her surgical commitments, and she said I still find them too busy. So now we’re looking at, what else can we do to reduce. She’s not getting that free time that she thought she would. Is that just in habits of always answering the phone, always saying yes. Is it a timetable thing. That’s where the coaching comes into it. Where we can sort of sit and do that bit of mentoring and planning in relation to that. So how people cease and reduce their surgical commitments is really case by case scenario and depends on the individual.

  Question 6
  Caroline, we spoke a little bit about staffing and how to navigate this kind of area, is there anything more that doctors need to take into consideration during these processes about their current staff that are at the practice?

  Caroline: I think it’s just a word of warning to say it is important to do it by the book here, and you’ll get yourself into hot water with Fair Work if you haven’t done the right thing. You can’t just simply walk in and say, staff out you go now, someone new is coming. There’s a process that needs to be followed. For the new Doctor coming in, there’s a word of warning too, because people will say, the staff is rolling over to me. Okay, if they’re rolling over to you, then they’re also rolling over their entitlements. What’s the new position description. Basically, what’s the change that’s occurring at the practice, and how will this impact staff, and what are we trying to put in place so that we can try to keep people in a job and so forth. So we need to tick the box on that. We take everything very seriously, but particularly staff. I see doctors getting into a lot of hot water and they come to us after they’ve already decided things with staff and it’s all a bit of a mess. Just remember that whilst a lawyer and an accountant are really, really valuable, they don’t necessarily know exactly how a doctor works, so it’s kind of better we talk to them with you in tandem so that they understand the nuances of your business and how and why staff might not be appropriate now for the new role. So all of those sorts of nuances we need to talk through.

  Question 7
  Caroline, you mentioned a little bit about personal mentoring and things like that and I know in the other podcasts of the self-care for retiring doctors it was a prevalent point as well, how do you go about this and what does the process kind of look like?

  Caroline: Good question again it’s pretty straightforward. It’s just about booking in some sessions with me and we talk about your needs. So working out who you are as an individual, again Portia has talked about the self-care podcast where I go through that in a lot more detail. So have a listen to that and what are you going to do because you’ve gotta cope with the changes that are happening. It can be very difficult to go from a bustling career where you hardly get any sleep at night and you’re hardly home to suddenly – Oh, God, what do I do? Or even the challenges of a new role, because it’s different, may not tick all the boxes. It might tick the financial box, but for the rest of the boxes you’re thinking I hate this, this isn’t what I want and it can be difficult to show that weakness and show that vulnerability. So we talk about it to begin with and then we can work through it just as I said before, the lady who’s struggling to get free time, even though she’s wound back a bit, well why is that happening. Can we look at that and say, what are some of the things? So just getting that coaching and mentoring to me, it’s the most valuable thing of all because if your mind’s not right about what you’re doing then nothing else falls into place.

  Question 8
  Now Caroline, we’ve touched on a lot of different sectors and factors that go into this long process for retiring doctors. Were there any other key takeaways points that you could let everyone know about what goes into this process and what’s really important?

  Caroline: Well look we’ve gone through a lot of big ones, but there are some that we haven’t had time to to do in more detail today. Obviously your software and how you’re closing your software. So that’s something that we work through with you. The role of the medical indemnity insurer that you’re with and what your obligations are there and what their obligations are to you. You’re paying a lot of money and how much do you pay now that you’re closing your practice, where’s the risk still. Your physical asset management might come into play like selling your goods for you and helping you with that. Knowing what sorts of things you need to destroy and how to destroy them. CPD obligations can sometimes keep going as well. Probably the last one that’s just popped into my mind is often doctors want to talk about what are alternative income streams to surgery. What else can I do. What do others do. So benchmarking is a is a big thing with this. People like to come to us and say. Doctors don’t seem to talk about these things. What do others do, how can I do it well and how can I tick the box again. If you look at that pyramid, one is the fear of compliance, making sure I get that right and tick that box. One is personal headspace, how am I going to cope with that. One is the timing. So all these points of the pyramid are all involved with the planning and whatever to make sure that your retirement goes smoothly or your change of role goes smoothly or the handover goes smoothly as well, so that you end up knowing from the onset what you want to get out of it, and it might just be finances and that’s fine too. What is it that you need to take the box on for you before you start closing your practice so let’s get a plan in place.

  Thank you so much for your time today. It’s a really important topic to touch on and I think it’s something that a lot of people don’t consider until they’re faced with the issue at hand. So I think it’s really important to have this information in practice and the ability to speak with you with that mentoring especially, it’s really really valuable for doctors who may not understand the whole process, and it’s something that you wouldn’t understand until you’re faced with it. I think it’s really valuable and thank you so much for your time today.
  

  Caroline: No worries Portia. I’ve enjoyed it too, and I really just wanted to reiterate we enjoyed helping doctors start up their practice that gives us a buzz. It also gives us a buzz to wind up properly for them too, so that they finish their career on a high. Thanks again.