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Transitioning from an Existing Practice

Quick Summary: Whether you're leaving an employed position or converting a traditional practice to DPC, thoughtful transition planning protects your patients, your reputation, and your legal standing. Plan 3-6 months ahead when possible.

Table of Contents

Transition Scenarios

Scenario 1: Leaving Employment to Start DPC

You're employed by a hospital, health system, or group practice and want to start an independent DPC practice.

Key challenges: - Non-compete agreements - Patient notification restrictions - Timing and notice requirements - Credentialing and insurance panel logistics

Scenario 2: Converting Your Practice to DPC

You own or co-own a traditional fee-for-service or insurance-based practice and want to convert to DPC.

Key challenges: - Patient attrition expectations - Insurance panel resignation - Staff transitions - Revenue gap during conversion

Scenario 3: Hybrid Transition

You maintain some traditional practice (or part-time employment) while building DPC on the side.

Key challenges: - Time management - Potential conflicts of interest - Clear boundaries between practice models

Leaving an Employed Position

Review Your Employment Contract

Before making any moves, carefully review:

Non-Compete Clauses: - Geographic radius (miles from current practice) - Time duration (typically 1-2 years) - Scope (primary care, all medicine, specific services)

[!CAUTION] Non-compete enforceability varies dramatically by state. Some states (California, Oklahoma, North Dakota) largely prohibit them. Others enforce them strictly. Consult an employment attorney in your state before assuming yours is or isn't enforceable.

Non-Solicitation Clauses: - Can you contact former patients? - Can you contact former colleagues/staff? - What constitutes "solicitation"?

Notice Requirements: - How much notice must you give? (typically 60-90 days) - What happens if you leave early?

Tail Coverage: - Does your employer provide tail malpractice coverage? - If not, what will it cost?

Negotiating Your Exit

What to ask for: - Release from or modification of non-compete - Tail coverage included - Ability to notify patients of your departure - Access to your patient list (for notification only) - Reference letter

Leverage points: - Long tenure - Good relationships - Willingness to help with transition - Flexibility on timing

If You Can't Negotiate

If your employer won't modify restrictive covenants:

  • Wait it out: Honor the non-compete period, then start DPC
  • Relocate: Start outside the geographic restriction
  • Challenge enforceability: Consult an attorney (expensive and uncertain)
  • Accept the risk: Some physicians proceed despite non-competes (consult an attorney first)

Patient Notification

What employers typically allow: - General announcement that you're leaving - Your last day - No forwarding information

What employers typically prohibit: - Telling patients where you're going - Providing contact information for your new practice - Taking patient lists

What you can do: - Update your personal social media (not soliciting patients, just announcing your new practice) - Patients who independently find you can choose to follow - Word of mouth from friends and family is not solicitation

Converting Your Own Practice to DPC

Setting Expectations

Realistic patient retention: - 5-20% of existing patients typically convert to DPC - Higher conversion with strong relationships and advance preparation - Some patients will be upset regardless of how well you communicate

Timeline: - 3-6 months advance planning recommended - 2-3 months of patient communication before conversion - Expect 6-12 months to reach sustainable panel size

Insurance Panel Resignation

Process: 1. Review each contract for termination requirements (typically 60-90 days notice) 2. Send written termination letters via certified mail 3. Keep copies of everything 4. Follow up to confirm receipt

Important: - You may need to continue seeing patients already in treatment for a period after termination - Confirm you've completed all pending claims/billing before panels close - Keep panel termination letters for your records

Medicare Opt-Out

If you're opting out of Medicare, this is a separate process from private insurance. See Medicare Opt-Out Guide for detailed instructions.

Staff Considerations

Conversations to have: - Will their role exist in the new model? - Will compensation change? - Will hours change? - Timeline for transition

Reality: - DPC practices often need less staff (no billing department) - Some staff may not want to make the change - Be honest and give appropriate notice

Patient Communication

Messaging Framework

What patients need to understand: 1. What is changing (your practice model) 2. Why you're making this change (better care, more time) 3. What it means for them (options, costs, benefits) 4. What happens next (timeline, decisions they need to make)

Sample Communication Timeline

3 months before conversion: - Send letter explaining upcoming change - Offer FAQ sheet - Announce town hall/information sessions

2 months before: - Follow-up letter with specific details - Individual conversations with complex patients - Begin accepting DPC memberships

1 month before: - Final reminder letter - List of alternative physicians for those not converting - Records transfer information

Conversion date: - Transition to DPC operations - Continue communicating with patients who haven't decided

Sample Language

Initial Announcement:

Dear Patients,

After [X] years of practicing medicine, I've made a decision to change how I deliver care. Starting [date], my practice will transition to a Direct Primary Care (DPC) model.

Why this change? Simply put, I want to practice medicine the way I always envisioned—with enough time for each patient, without the constraints of insurance-driven care.

What does this mean for you? You'll have several options, which I'll explain in detail at upcoming information sessions and in follow-up communications.

I'm excited about this change and hope you'll consider joining me in this new model of care.

For Patients Not Converting:

I understand that DPC isn't the right fit for everyone. Your health and continuity of care are important to me. Here are physicians in the area accepting new patients: [list]

I'm happy to transfer your medical records to your new physician. Please complete the enclosed authorization form.

Patients with Complex Conditions

Give extra attention to patients with: - Chronic conditions requiring frequent visits - Mental health conditions - Patients with limited alternatives in your area

Have individual conversations. Don't let them learn about the change from a form letter.

Medical Records

Your Obligations

  • Patients have a right to their medical records
  • You must provide records or transfer them upon request
  • You may charge a reasonable fee for copying (varies by state)
  • You must retain records for the period required by your state (typically 7-10 years for adults, longer for minors)

Records Retention

If closing the insurance-based practice entirely: - Notify patients in writing of records disposition - Offer to transfer records to new physicians - Arrange secure storage for retained records - Know your state's retention requirements

Electronic Records

  • Ensure you have continued access to your EHR data
  • Export/archive patient records
  • If changing EMR systems, plan data migration

Abandonment

Patient abandonment is a serious concern. To avoid abandonment claims:

  • Provide adequate notice (typically 30 days minimum)
  • Offer to continue emergency care during transition
  • Provide referrals to other physicians
  • Transfer records promptly
  • Continue care for patients in active treatment until stable transfer is possible

EMTALA

If you currently have hospital call obligations, ensure proper transition of those responsibilities.

Malpractice Tail Coverage

  • Ensure continuous coverage during and after transition
  • "Claims-made" policies require tail coverage when leaving
  • "Occurrence" policies cover incidents during employment regardless of when claims are filed

Timeline and Checklist

6 Months Before

  • Review employment contract (if employed)
  • Consult attorney re: non-compete, exit terms
  • Decide on practice model and location
  • Begin business formation

4 Months Before

  • Give notice to employer (per contract requirements)
  • Begin insurance panel resignation process
  • Secure malpractice coverage
  • Finalize practice location

3 Months Before

  • Send initial patient communication
  • Schedule information sessions
  • File Medicare opt-out affidavit (if applicable)
  • Prepare staff for transition

2 Months Before

  • Follow-up patient communication
  • Begin accepting DPC memberships
  • Individual conversations with complex patients
  • Finalize EMR and operations

1 Month Before

  • Final patient notification
  • Transfer records as requested
  • Confirm all panels terminated
  • Complete employer offboarding

Launch Week

  • Begin DPC operations
  • Continue patient outreach
  • Handle remaining transitions

Transitioning to DPC is both a business decision and an emotional journey. Plan carefully, communicate openly, and focus on the better care you'll be able to provide.