At our yearly Christmas medical staff dinner this last year, our chief of staff asked all the doctors present who had been working at our hospital for five or more years to stand up. Quite a few of us rose. He then asked those who had been there 10 years or more to remain standing. After half of us sat down, he upped the ante to 15 years, then to 20. By the time he got to 30, everyone was seated but me. I remained standing at 40, so he finally told his audience that I was at my 50th year, for which I got a round of applause and a statuette. My wife then whispered to me, “Don’t you think it is time to retire?”

It is not that I have an arduous schedule. I only work four mornings a week in my office and have no hospital responsibilities. When I arrived here in 1976, I did in-patient and emergency room medicine, delivered babies, assisted at surgeries, and ran an office. I had privileges in all departments. Nowadays I am on affiliate staff, can’t admit or care for hospital patients or serve on hospital committees (thank God), and am restricted to seeing patients in my office where I am happily ensconced.

When a patient is sick enough to need more of a workup than I can do there or be admitted to the hospital, I simply punt them to the ED, with a heads-up call of course, and wait for them to follow their discharge instructions and call their doctor for follow-up. Easy peasy. No stress. Professional life is good. So why does my wife want me to retire?

“You are almost 80 years old! I hate telling people that you are still working. Besides, it is not that easy to close an office, and what if you die? I haven’t the foggiest idea of what to do.”

Actually, neither did I. I had thought maybe just sending my patients a letter and arranging for medical records to be sent on request would suffice. But would it? Now I wasn’t so sure, especially after talking with my daughter who is also a family physician and doesn’t really have the time to clean up the mess that I might leave. “Dad,” she said, “it is more complicated than that. Perhaps you should get some professional advice.”

Seeking professional guidance

Now that was a good idea. But who could I ask? After pondering for a while, I realized the obvious resource was one of my medical malpractice insurer’s risk managers. I have gone to them in the past when dicey things have come up, like how to fire a patient. It is a great service my insurer offers, and although I had never run them up a bill in legal fees, over the years I have used them for medicolegal advice quite often. This time I got a moonlighting retired lawyer on the line who was quite helpful and seemingly delighted to be dealing with a doctor who wasn’t being sued for malpractice.

Mary Ann told me that it was complicated and requirements varied state to state. My insurer had a generic checklist for how to close a practice, but she suggested I also see what my state’s medical association had to say about it.

Her checklist was formidable enough: “Notify employees of office closure at a staff meeting” (I only have one employee and we don’t have staff meetings); “Keep all employee, personnel and training records for as long as you keep patient medical records” (10 years? Good thing I don’t have more employees!); “Announce the office practice closing on the practice’s website” (No problem, no website).

But the patient requirements were more onerous: “Notifying patients about the closing date either by regular or certified mail with a copy in their medical record, documenting attempts to phone them if the letters come back, getting their medical records to them within 30 days of their request, looking for outstanding tests or referrals and notifying patients of their need for follow-up, continuing the practice’s phone service for several months with automated announcements about the office closure date, instructions for obtaining alternate care and how to obtain copies of their medical records.”

Then there was the question of which medical records to send. All of them or just the problem or medication list, list of allergies, immunization records, most recent history and physical, lab and/or X-ray results, consultation reports, or “other,” leaving it all up to the patient to decide? This was going to be a monumental task since I never had an electronic medical record (EMR), being a solo practitioner and rarely sharing my records with any other doctor unless requested, and some of my paper charts were so big and multiple that lifting them constituted aerobic exercise. Plus, legibility might also be an issue. Maybe, as my daughter suggested tongue-in-cheek, it might be easier just to burn down my building and be done with it.

The regulatory maze

The other link that Mary Ann sent me was to the California Medical Association’s Guide to Closing a Practice. The booklet was 33 pages long online and went beyond the requirements listed in my malpractice insurer’s guide. Under “Who Do I Need to Notify” were listed office staff, patients, my professional liability carrier, colleagues and ancillary services, payers, the Medical Board of California, and the DEA.

Under how long to retain medical records, the recommendation was indefinitely, but 10 years would do in most cases, because it might be impractical for physicians to retain records indefinitely, and three at the minimum. Ten years, they said, should cover 99 percent of possible litigation, but “this recommendation is based on two primary considerations: patient protection and physician protection. Scientific advances make it impossible for a physician to predict what information will be desirable or necessary to aid in a patient’s future treatment. Nor can physicians determine when the statute of limitations will bar a suit for professional negligence.”

Other records needing saving included drug prescribing and dispensing, insurance policies, patient notices, and documents compliant with HIPAA privacy rules. Now I really wished I had had an EMR all these years so that all my patients’ records could have been stored on a thumb drive instead of in a storage locker somewhere.

Thoughtfully, the CMA also included sample letters that I could use to notify patients about my upcoming retirement as well as an authorization form for the transfer of medical records. There was also a 16-document checklist specific to the death of a physician in case a doc committed suicide rather than deal with all this paperwork.

Accompanying my wife to her doctor’s appointment recently, I asked her physician if she ever thought about what closing her practice might entail.

“Never, I can just walk away from it,” she said. That was because she works in a large group and other doctors can pick up her load and assure patient continuity and care.

“Well,” I said, realizing that finding someone to take over my practice would be easier than closing it, “if you ever hear of someone wanting to work independently in an old-timey medical practice on the Mendocino Coast, let me know. I can give them a deal.”

Sandy Brown is a family medicine physician based in Fort Bragg, California, where he is in independent practice. He earned his medical degree from the Medical College of Wisconsin in 1973 and completed a transitional year internship at Alameda Health System Highland Hospital from 1973 to 1974. He has maintained an active California state medical license since 1974.

Over the course of his career, Dr. Brown has written extensively on person-focused care, physician-patient communication, practice management, and the relational foundations of primary care. His articles, published in Family Practice Management and American Family Physician, address topics such as closing the communication loop, delivering difficult news, health care reform, and sustaining the core values of family medicine. His peer-reviewed work is indexed on PubMed.

Additional professional information is available on LinkedIn and through his public profile on Doximity.