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Old 06-13-2019, 10:52 AM
Fotheringay-Phipps is offline
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Dr retires; recommends Dr so-and-so


I'm wondering what's the typical implication in this common situation. Suppose a long term doctor sends letters to all his patients, announcing his imminent retirement and recommending that everyone transfer to his esteemed colleague Dr so-and-so. What's typically the primary driver here?

Can this generally be assumed to be a pure and unbiased opinion, based on his experience with Dr so-and-so, in whom he has a lot of confidence and whom he thinks is the best option for his patients? Or can there be assumed to be some financial angle involved, in which Dr so-and-so has paid the retiring doctor for this recommendation? (Understood that if you trust the first guy you might think that he wouldn't make this type of arrangement with a guy he didn't trust etc. etc., but nonetheless there's no doubt that you would and should put more weight on the recommendation if it did not involve any money changing hands.)

Question is how these things typically work with doctors retiring and closing their practices.

Last edited by Fotheringay-Phipps; 06-13-2019 at 10:53 AM.
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Old 06-13-2019, 10:58 AM
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It's such a money driven industry that I wouldn't just assume a benign motivation on the part of the retiring doctor. I would certainly research his recommendation, but I would shop around on my own as well.
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Old 06-13-2019, 11:03 AM
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I would assume the Dr. sold their practice and Dr. So-and-So would be working out of the same building and have pretty much the same staff.
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Old 06-13-2019, 11:07 AM
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Obviously there is zero obligation to see the new doctor, and patients can request their medical records be sent to the physician(s) of their choice (an M.D. who bought the practice does not "own" the medical records of the previous doc's patients).

https://www.aafp.org/practice-manage...-practice.html
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Old 06-13-2019, 11:09 AM
Andy L is online now
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Quote:
Originally Posted by Fotheringay-Phipps View Post
I'm wondering what's the typical implication in this common situation. Suppose a long term doctor sends letters to all his patients, announcing his imminent retirement and recommending that everyone transfer to his esteemed colleague Dr so-and-so. What's typically the primary driver here?

Can this generally be assumed to be a pure and unbiased opinion, based on his experience with Dr so-and-so, in whom he has a lot of confidence and whom he thinks is the best option for his patients? Or can there be assumed to be some financial angle involved, in which Dr so-and-so has paid the retiring doctor for this recommendation? (Understood that if you trust the first guy you might think that he wouldn't make this type of arrangement with a guy he didn't trust etc. etc., but nonetheless there's no doubt that you would and should put more weight on the recommendation if it did not involve any money changing hands.)

Question is how these things typically work with doctors retiring and closing their practices.
It is possible that retiring doctor simply wanted to let his patients know of another doctor in the area (a rural area may have relatively few doctors, and patients might have trouble finding a new one without the recommendation). On the other hand, a retiring doctor's list of patients is a valuable commodity - so some money may have changed hands (it's related to the concept of "goodwill" - the part of a business that is intangible, related to the good feelings that a long-standing firm has earned over time (and can pass on to a successor business owner)).
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Old 06-13-2019, 11:15 AM
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My former dentist was a churchy sort of guy. So he recommended for referrals other dentist/orthodontist types he knew via the church connections.

These were not great people. Either in terms of skills or personality.

So when he was setting up to retire, he joined his business with another similar type. The patient files were merged, etc. He slacked off to a couple days a week and then retired completely.

The new guy? No. Teeth cleaning and such okay. Anything more serious crops up I'm looking for a new dentist.

So it wasn't for money or anything, but for religious compatibility. An even worse criteria.
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Old 06-13-2019, 05:18 PM
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I would presume that the new doctor bought the patient list of the old doctor. If he had sold the entire practice, it probably would have been structured differently so as to make better use of the goodwill of the old practice. My childhood dentist retired after a few years of working with a younger guy on the same site, and I continue to go to that new dentist now over a decade later. He clearly bought the practice and was making use of the goodwill and habits of people of going to the particular building the practice was run out of. If I had just gotten a notice that he was retiring and recommending someone somewhere else, it would be a disruption to me regardless of what I did, and so I would have more reason to try somewhere else.

I wouldn't say it's entirely a raw deal to get your name sold to someone else as a potential client when your old provider of that service is retiring. In some fields, it can be difficult to find nearby providers who are accepting new patients. When someone buys up a client list like this, it's because (s)he has the time to accept all the new business, and they are making an investment in that list and have good reason to want to wring as much as they can out of the list and so should be providing quality service.

Sure, it's *possible* that the doctor is simply recommending a colleague he knows, but the most important asset of an individual's professional practice is the client list and goodwill, and he's leaving a lot of money on the table by retiring and not at least selling the client list.
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Old 06-13-2019, 05:58 PM
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I'm only 8 years out of medical school, so I can't comment on the details of how things worked when the vast majority of doctors were solo private practitioners. But I have never heard of one doctor paying another to send his patients to him when the former retires, nor of one doctor buying a list of patients from another doctor. (What good would a list of patients do a doctor anyway? Most doctors aren't hurting for patients. Doctors aren't salesmen who cold-call prospective patients trying to entice them to come in for an appointment.)

I would wager the OP's scenario is the result of social schmoozing, as with ftg's dentist: they go to the same church, their kids go to school together, they're tennis buddies, something like that.
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Old 06-14-2019, 12:39 PM
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Don't doctors fill up their patient rolls to capacity and then stop taking new patients until such time as older patients move away or die? It's probably just a matter of your doctor finding the closest doctor who still has the capacity to take on nearly an entire practice's worth of patients.

When the local pharmacy closed, they transferred all their prescriptions to Walgreens. I said "screw that" and took my business to another small family pharmacy farther away. But I think the retiring pharmacist just transferred his patients to the closest pharmacy he knew had the capacity to handle them all. Without knowing better, I'd assume the same of a retiring doctor's recommendation.
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Old 06-14-2019, 02:53 PM
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Thanks for the responses.

Would people's assessment change if 1) the guy getting the referral is Associate Director of the relevant specialty at a major NY teaching hospital, 2) the retiring doctor is also affiliated with that hospital, and 3) both of these guys are the type with numerous published studies to their credit listed on PubMed etc.? Points being that these are not a couple of struggling guys, and that they have some connection to each other.
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Old 06-14-2019, 04:28 PM
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Originally Posted by Fotheringay-Phipps View Post
Thanks for the responses.

Would people's assessment change if 1) the guy getting the referral is Associate Director of the relevant specialty at a major NY teaching hospital, 2) the retiring doctor is also affiliated with that hospital, and 3) both of these guys are the type with numerous published studies to their credit listed on PubMed etc.? Points being that these are not a couple of struggling guys, and that they have some connection to each other.
Large hospitals and healthcare organizations generally have a policy of trying to keep business in the system, naturally. However, the guy getting the referrals does not stand to gain financially from getting these referrals. It's not like a doctor is a store owner who's going to make more money if more customers come to his store. He has a fixed schedule, and I guarantee his schedule is already full every day. If new patients don't come from one source, they're going to come from another. Also, working in an academic institution, he's more likely to be straight salary-based as opposed to productivity-based, so he may not even have any financial incentive to see more patients.
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Old 06-14-2019, 04:34 PM
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The doctor has simply transferred his or her records to this other doctor. You can go to him or her if you wish, and if not, have them transferred to whoever you wish to see.
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Old 06-14-2019, 05:24 PM
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My dentist retired at the end of 2018, and was pretty transparent about it. He sold his practice to another dentist who was looking to strike out on her own. The "sale" included the building, equipment, staff, and patient records. My dentist then retired to Colorado.

From a patient's standpoint, it was simple. The only thing that changed was the name of the dentist's office, and the person who worked on our teeth. We even kept our old dental hygienists, who had all been assigned to individual patients, rather than just working on the next case to walk through the door.

Obviously there will be changes down the road, but at the moment it's kind of like your old dry cleaner, hardware store, or hair stylist selling their business, and now there's a new business doing the same thing, in the same place, with pretty much the same staff.
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Old 06-15-2019, 06:49 AM
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The "sale" included the building, equipment, staff, and patient records.
The sale included the staff????
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Old 06-15-2019, 10:43 AM
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I was working for a psychiatrist when he retired. His practice concentrated on children with autism (rare at that time, maybe not now.) He didn't sell his patient list or recommend any particular doctor, but as a service to his patients he compiled a list of EVERY psychiatrist in Massachusetts/New Hampshire/Connecticut/Rhode Island with a practice that emphasized children AND was accepting new patients, with their names, practice addresses and phone numbers.

The entire list fitted on a single sheet of paper.
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Old 06-15-2019, 12:13 PM
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When my "first" doctor (that I had as an adult) retired, he was part of a practice, and I kept going to that practice for a while (convenience, laziness, no particular health issues). Over the next four years I saw four different doctors there for my annual physical, none of them lasted. I finally got tired of that, asked someone I trusted for a referral, and went to my current doctor. At that time he was in practice by himself. Now he's 64, and has joined a practice with a couple of other doctors. I suspect he's going to go part-time pretty soon, and then retire altogether, at which time I suppose I'll try one or both of his co-practicants (is that a word?). I hope one of them works out, I'm not looking forward to finding another doctor at my age (70) but I guess that's just one of life's little things we have to put up with.
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Old 06-15-2019, 12:42 PM
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Patients rely on their physicians for prescriptions, in addition to seeing them in the office. If specialists are involved there is even more need for patients to find a suitable replacement. Referring your patients to a suitable replacement doctor seems to me to be a bare minimum requirement for responsibly closing your practice.
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Old 06-15-2019, 07:54 PM
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The sale included the staff????
The sale included a promise to retain the existing staff for, I guess, some minimum specified period.

Feel better now?
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Old 06-16-2019, 02:30 PM
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Quote:
Originally Posted by Fotheringay-Phipps View Post
Would people's assessment change if 1) the guy getting the referral is Associate Director of the relevant specialty at a major NY teaching hospital, 2) the retiring doctor is also affiliated with that hospital, and 3) both of these guys are the type with numerous published studies to their credit listed on PubMed etc.? Points being that these are not a couple of struggling guys, and that they have some connection to each other.
A plus that they may be known to each other (major teaching hospitals though have lots of docs on staff and it doesn't necessarily follow that physician A knows physician B well.

It wouldn't necessarily impress me that a potential new physician is aan associate director of a specialty at a teaching hospital and has numerous published studies. It depends of course on what you would be seeing the new M.D. for, but I personally would want someone who's concentrated heavily on day-to-day care of patients as opposed to an individual largely devoted to teaching and research (as important as those activities are).
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Old 06-16-2019, 03:25 PM
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My pulmonologist retired after I saw him for 31 years. He had long been one of maybe ten doctors in a pulmonology practice. He recommended three different doctors in the same practice.

He said "#1 is very good, they're all very good, and #2, well, she's a girl doctor, she's good also, and there's #3, he's good, all of them are very good. So that was #1, #2, that was the girl doctor, I don't know if that'd be any problem, and #3." I was pretty sure he wasn't referring an old man to see a gynecologist, so #2 was apparently a doctor that also happened to be a woman. Progressive soul that I am, I thought, well, I pretty much HAVE to pick #2. But then I thought no need to be hasty, let me look them up online to see how they compare. Online, #2 looked best -- more papers, more accolades, more involvements in professional societies, etc etc. I've been with her for maybe 4 years now, and think she's just excellent.

My dentist was getting older, and added a second dentist to his practice, somebody young and fresh out of school. A little while later, the older dentist wasn't around, and I heard the following story: he pretty suddenly announced he was going on vacation for a week, rescheduling all his appointments. Then several days after he left, the office got a call. It seems he had advanced metastatic pancreatic cancer and had gone to Scandinavia for a treatment unavailable here, but had died there. Nobody in the practice had the slightest clue. The new dentist was suddenly in charge of an existing practice with perhaps a staff of a dozen, and here she was just out of school. They decided to try to survive, and they did quite well. They've been thriving like that for maybe ten years now.

Aaaaanyhoooo, I'm going to bet that doctors recommend replacements pretty much on a benevolent basis judging that their recommended doctor can absorb all the patients pretty seamlessly as well as with professional skill. I'm getting pretty close to retirement myself (though not in medicine), and I'm more motivated to do right by people than to scheme and rake in extra bucks in the process. Other people of like age seem to mostly say the same kind of thing.
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Old 06-17-2019, 11:47 AM
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When my dentist retired he recommended that his patients go another doctor that took up his practice and staff. One of the incentives to go was a guarantee of previous work performed by the retiring dentist. It's been about three years now and I've had a crown replaced for 1/3 of the cost. I have bridge that cost me $7000, the new dentist told me if it broke he would replace for half of that (depending on the failure mode).
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