No sooner appointments available.

[PecanPie]

Hello,

I am a neurologist in a northeast hospital based practice. 2 other neurologists recently left this practice and I am the only neurologist currently. Patients of these 2 neurologists are now clogging up my schedule. The next available apt for new patients( and my own follow-up patients is in March 2022).

I frequently get requests from patients, PCPs, ER discharges, hospital discharges to be seen quickly. I am unable to accommodate these requests due to lack of open slots for appointments.

These requests are routed via the EPIC medical records system and become part of the patient chart.

1. Am I liable for not being able to accommodate these new patients? My understanding is that there is no doctor patient relationship yet- so I shouldn't be liable, but I am not really sure.
These requests come via the EPIC patient record and I do have access to these new patient records. Not sure If I become liable once I review their medical records and then , am unable to see them sooner.

2. Am I liable for being unable to see sooner, the follow-up patients of these 2 neurologists who left ( they are technically patients of the practice, but I have no doctor patient relationship with them as I have never seen them.)

I thought of reaching out the risk management at the hospital-- but then , they really represent the hospital and don't necessarily represent my best interests.

Any tips/suggestions would be appreciated.

Thanks

[White.Beard.Doc]

If you do have a doctor patient relationship, say for a patient you have seen in the hospital as a consultant, then you would have responsibility for seeing the patient in follow up in a timely fashion. In your situation, I would be sure to set up a system for timely follow up of patients when needed. Perhaps you need to notify your office manager whenever there is a patient who needs timely follow up.

Yours is a high risk practice setting. Do you have a plan to fix this problem going forward? Have you notified the hospital, in writing, of the risk that this represents to your patients? Have you suggested solutions to the hospital management? Have you asked the hospital to fix this problem? Have you reached out to the director of risk management at the hospital? In your shoes, I would do all of those things, and I would document it. You as the physician are also responsible for patient safety. You should set up a system, in concert with your hospital administrative management, to assure timely and safe patient follow up?

[jfoxcpacfp]

If you’re that worried about it (I don’t know enough to know if you’re causing yourself unnecessary grief), then talk to a medical attorney. However, as an aside, i would never allow “strangers” to push our current loyal clients (“patients”) back that far. Can’t your scheduler give priority to your own patients? If I see a client has had to schedule way out because I’m booked, we’ll reach out to offer the client a sooner appt (I’ll email or ask the OM), but most know they can just email and ask. Of course, your system is different in that you’ve already gotten clogged with all of the other doctor’s pts and doctors don’t tend to leave pockets of time available, which seems unfortunate for really busy practices and may not be allowed by the hospital, don’t know. I know this is possible, bc a client with a new practice that is now getting really busy told me his scheduler does the same.

[CordMcNally]

You have no responsibility for patients whom you’ve never seen. Hopefully the hospital is working on becoming properly staffed. I’m surprised they don’t keep appointments open for more urgent follow ups. Also, from an outsider’s perspective, you’ve got quite the negotiation advantage if there’s anything you’ve been wanting.

[Tim]

The solution is actually on the hospital. That is why they hire locums physicians. Not a legal answer to your situation, but that is the staffing solution until they can staff properly. WBD's suggestion is to put the responsibility firmly back on them. Wise advice.

[MPMD]

remember not to send long, discursive emails as you navigate this complex situation.

limit yourself to 2 line emails, one is better.

"tough situation, let's hop on phone."
"sorry we are doing what we can"
"thanks for thoughts, let's continue to look for solutions."

get on phone when possible, let them hear your tone which is overwhelmed and looking for solutions.

[PecanPie]

Thank you all.

Yes, we have had numerous virtual meetings--with no concrete solutions yet. Multiple back n forth emails with no real solutions. They are trying to hire. One of their solutions was to "overbook" ..LOL.

My solution was to create open slots. The problem is that-------to create open/urgent slots, we have to move out/reschedule some existing followup appointments. Doing so, might invite more liability.

They don't give preference to my patients as they don't differentiate between my patients and the prior neurologist patients. Apparently they are "practice's patients", which is technically true i guess.

For the time being, I am just going to keep blocking the new ones and put the burden on management to find them timely appointments.

The major question that I'm trying to find an answer to is that -- am i legally responsible to see the prior neurologist's followup patients sooner if they call for a sooner apt? (Technically they are patients of the same practice, but I have no doctor patient relationship with them). If a patient has only seen one doctor in the practice,, does that patient have an implied doctor patient relationship with ALL the doctors in that practice.

[MPMD]

The major question that I'm trying to find an answer to is that -- am i legally responsible to see the prior neurologist's followup patients sooner if they call for a sooner apt? (Technically they are patients of the same practice, but I have no doctor patient relationship with them). If a patient has only seen one doctor in the practice,, does that patient have an implied doctor patient relationship with ALL the doctors in that practice.

i cannot see how you'd be legally on the hook for this.

[CordMcNally]

Sounds like there is demand for a private practice neurologist to be very successful. If you're the entrepreneurial type I'd take a real hard look at your non-compete.

[CM]

I'm not a lawyer, but if you have any liability here, the system is broken. Your schedule is full. You are doing all you can do. What if 50 patients want to be seen tomorrow. Are you liable if you don't see all 50? That's ridiculous.

Send emergencies to the emergency room. Some things could be handled by the PCP. Because you will be unable to handle the patient volume for an indefinite period, you should recommend that the overflow patients establish care with other neurologists.

I was overwhelmed 20 years ago and thought I had to accommodate everyone. Instead, I burned out and quit medicine for 13 years. Don't do that. Set boundaries.

[Lordosis]

I seem to be going through something similar in the primary care world. I don't have any answers for you but I offer my empathy. Our local neurology group recently had a few retirees and they are booking into next year. I wonder if that's just coincidence?

[wideopenspaces]

No you are not liable for other doctor's patients. How could you be? I'd bump out other people's patients to see my own because I DO have a responsibility to those folks. I would definitely refuse to take on ANY new patients until you are able to see all of your own, and the transfer patients, on a consistent schedule. Only you know what that is. For me, if I can't see a return pt within 4-6 weeks, I start shutting down new intakes(but I'ma psychiatrist). But it's not your problem to solve how to get new people in. That's admins job.

[hebel]

Hello,

I am a neurologist in a northeast hospital based practice. 2 other neurologists recently left this practice and I am the only neurologist currently. Patients of these 2 neurologists are now clogging up my schedule. The next available apt for new patients( and my own follow-up patients is in March 2022).

I frequently get requests from patients, PCPs, ER discharges, hospital discharges to be seen quickly. I am unable to accommodate these requests due to lack of open slots for appointments.

These requests are routed via the EPIC medical records system and become part of the patient chart.

1. Am I liable for not being able to accommodate these new patients? My understanding is that there is no doctor patient relationship yet- so I shouldn't be liable, but I am not really sure.
These requests come via the EPIC patient record and I do have access to these new patient records. Not sure If I become liable once I review their medical records and then , am unable to see them sooner.

2. Am I liable for being unable to see sooner, the follow-up patients of these 2 neurologists who left ( they are technically patients of the practice, but I have no doctor patient relationship with them as I have never seen them.)

I thought of reaching out the risk management at the hospital-- but then , they really represent the hospital and don't necessarily represent my best interests.

Any tips/suggestions would be appreciated.

Thanks

In my opinion, the responsibility was ultimately on the employer and neurologists who left to have a plan for those patients once they left. If you were full, that should have involved letters in advance of their leaving to their patients informing them of the situation with options in the community to find care elsewhere.

As for the requests, you could simply respond in Epic to those requests informing them that you cannot see the patient due to no openings in your practice schedule, and for them to make other arrangements. You could even make it a slick smart phrase.

[StarTrekDoc]

The practice maybe on the hook for availability. You as the physician are not if not ever seen by YOU. If you own part of the practice, you can be exposed in that manner; but this sounds like the hospital or some entity runs the clinic.

In that case, you, as an employee of the clinic, have a responsibility legally to your own patients that you've seen. You can have a contract issue with your employer and that should be handled in that way.

Like cord said -- from the contract standpoint, maybe really worthy to look at your contract -- question why the other two docs left the practice.

Definitely consult a legal attorney (not Risk management) on your physician exposure and stand fast on access to those patients primary and secondary to cover the other neurologists that left -- that's the PRACTICE's responsibility, not the individual physician with no established relationship. -- but verify this with independent party

[Sundance]

If you do have a doctor patient relationship, say for a patient you have seen in the hospital as a consultant, then you would have responsibility for seeing the patient in follow up in a timely fashion. In your situation, I would be sure to set up a system for timely follow up of patients when needed. Perhaps you need to notify your office manager whenever there is a patient who needs timely follow up.

Yours is a high risk practice setting. Do you have a plan to fix this problem going forward? Have you notified the hospital, in writing, of the risk that this represents to your patients? Have you suggested solutions to the hospital management? Have you asked the hospital to fix this problem? Have you reached out to the director of risk management at the hospital? In your shoes, I would do all of those things, and I would document it. You as the physician are also responsible for patient safety. You should set up a system, in concert with your hospital administrative management, to assure timely and safe patient follow up?

You do that at my hospital and you’re next up on chopping block… haha. Doesn’t work that way (at least at the hospital employed positions I’ve had).