2: Partnership Approach
“I’ll do it for you if you’ll do it for me.” The Partnership Approach
to Professional Wills, Wonts and Won’ts.
A. Steven Frankel, Ph.D., J.D.i
Welcome to the second article on ways to address the problem of how to prepare for unanticipated disruptions or terminations of practice due to death or disability. In this article, I address a way of approaching the problem that has been around the longest in our fields – the professional partnership model.
Where to start:
The partnership approach requires that two colleagues make an agreement to “be there” in the event of a disruption in one of their practices.ii The modal strategy is to form a relationship with a colleague who practices in your geographic area, with the specific agenda of assisting each other with a practice transition in the even of an “event.” The typical approach is to work with a fellow senior colleague, as practice seniority is associated with a good working knowledge of how practices work, the ways in which records are kept and managed, a familiarity with other psychiatrists who practice in the community, their specialties and other indicia of relevance to being good choices for referrals
of one’s patients, etc.
The standards of care for psychiatric practice require that patients be provided with informed consent to treatment, which typically includes: 1) diagnosis, 2) proposed treatment plan (with nature, purpose, risks/benefits), 3) alternative treatment plans (with nature, purpose, risks/benefits), and 4) likely
consequences of no treatment.iii In addition, informed consent includes information about how the practice operates – limits to confidentiality, fees and payments (including insurance), accessibility, emergency procedures and access to records.
When a partnership between colleagues is created, the informed consent discussion and documentation should include an identification of who the partner is (“if I do not respond to phone calls, letters, etc., please call ……..”), that the partner has agreed to manage the transition of the practice, and that, by signing the informed consent document, patients authorize the partner to view charts and make direct contact with the patients for the purpose of practice transition. The only foreseeable problem with this part of the plan is that, especially in “small” communities, there may be a patient who, at one time, has received services from the colleague, and refuses to sign a release for that reason. For such patients, an alternative means of providing a referral and transmitting records must be found.
In the event of an “event,” the following tasks must be addressed by the surviving colleague: 1. Notification of patients: The surviving colleague’s job begins with the notification of patients that an event has occurred. This process is best done by the colleague rather than an office staff member, as
psychiatrists are familiar with the grieving process and are best qualified to assist patients with the transition of care during that grieving process.
2. Making referrals: The surviving colleague’s responsibilities include referring the patients to a new treater. Ideally, the issue of what will happen in case of an “event” has already been discussed with each
patient, with an eye toward who might be the best colleague for each patient to see in the future. These discussions are typically quite beneficial to patients, who appreciate being thought of in protective ways, such that they already know who they will be seeing for future care.
3. Transfer of records: The surviving colleague’s responsibilities include ensuring that patient records are forwarded to the new treater, or provided to the patients who request them consistent with the laws of the jurisdiction of the practice.
4. Office rental: the surviving colleague’s partnership arrangements should already have been explained to landlords of office buildings, such that provisions for payment of rent, disposal of equipment and
furnishings and associated tasks can be completed smoothly. 5. Family: the families of colleagues going through life transitions will be grieving, and the partnering colleague’s responsibilities include reassuring families that preparations for transitions have been made and are being implemented properly. 6. Estate-planning attorney (wills/trusts): the partner should be aware of the identity of the estate-planning attorney, who, in turn, should have permission to discuss the estate plan and to provide funds for handling practice transitions, as there will be expenses associated with practice transitions.
7. Accounts payable and receivable: an important part of the transition partnership should include information as to billing and payment processes/procedures, such that the surviving colleague is able to
ensure that bills are paid and collections are received. The partners’ names should be known to the banks, such that checks may be written and deposits made.
8. Telephone: colleagues should contact the relevant phone company and arrange to forward calls to the surviving colleague’s telephone number.
9 Notices: the surviving colleague will place a notice in the local newspaper for two weeks, indicating that the practice is in transition and how to contact the surviving colleague. Further, notice should be provided to licensing boards, insurance companies and professional societies.
10. Computer access: surviving colleagues should be fully knowledgeable as to computer passwords and computer access to information.
11. Insurance: It is strongly recommended that partners take out term life insurance policies of $10k-$20k (which, at this time in history, are quite inexpensive), to support the partner during the transition
period, as the amount of time that colleagues will be putting in to assist with the transition can be compensated in this way.
12. Personal “good-bye” letters: It is a matter of grace and kindness for professionals to leave letters in the charts of all patients – which can then be mailed to each patient, with a simple statement of
farewell, of appreciation for having had the opportunity to provide care, and wishes for future benefits from the care provided.
13. Access to offices: keys, pass-codes, access to files, awareness of staff and their availability – all of these must be known to the surviving colleague.
14. For colleagues who utilize EMR for record-keeping, releases need to be signed by patients to provide access by the surviving colleague.
Down-sides of the “partnership” approach:
If you are still reading this article, you may be coming to realize that the partnership approach has two significant downsides. First, it is exhausting. The amount of time and the degree of detail involved can be overwhelming, and it is this degree of apprehension that has led to such a slow development of
acceptance and implementation of these types of partnerships. Second, a major downside of the partnership model is that one of the partners will most certainly pre-decease the other, such that the surviving partner will have to find another colleague to join with for the future. Thus, the enormity of the tasks and the awareness that more than one of these experiences awaits colleagues who wish to be helpful, add to the general denial and avoidance that keeps us from developing needed plans.
The next article in this series will present a related model, involving a group of colleagues rather than a partnership of two colleagues. Such a model makes some of the overwhelming qualities of the partnership model less foreboding, but has problems of its own. The fourth paper in the series will discuss a quasi-insurance model that has been developed to deal with these issues and problems in ways that are far less intimidating to colleagues. i i If you are interested in a closer look at the issues and support systems, you’re welcome to contact me via www.practice-legacy.com ii Frankel, A.S. (2013). Practice continuity, Nevada Psychiatric Association Convention and Frankel, A.S., & Alban, A. (2010). Professional wills: protecting patients, families and colleagues. California Psychiatrist, February, 2010. pp.4-6. –iii See, e.g., Simon, R.I. (1992). Clinical psychiatry and the law, 2nd Ed. Washington, DC: American Psychiatric Press, p. 128.