A neurosurgeon based in a large metro area in California used to be part of a large group. For a variety of reasons, he’s in solo practice now. He’s still busy. Doctors refer to him. Patients seek him out. He has a strong online presence. And he’s escaped petty intra-group politics.
One problem, though.
He occasionally needs a break. A vacation. Who doesn’t?
His former colleagues will not cross cover for him when he wants to leave town. And other neurosurgeons in the community are not stepping up to help, even if the favor would be reciprocated. He’s a perceived competitor.
Here’s what he does: This surgeon gives his patients advance warning whenever he plans to take a holiday. He also explains he will be available by phone, speak to the patient, and have access to records. He says if there is a medical emergency, they should either go to the closest emergency department or call 911. There are many talented neurosurgeons in the community who could step in to address any such emergency. In other words, he has a reasonable plan for his patients.
I posed this question to an attorney who understands medico-legal matters and how various Boards of Medicine operate. I was curious as to whether this plan sidesteps any concerns for patient abandonment. On the one hand, this neurosurgeon has not arranged a local presence for his patients. He has not subcontracted with locum tenens to serve as a substitute while he is on the beach.
The answer was that this should not matter. The question being posed is whether his patients have access to contiguous treatment without having to locate a new doctor. Here, the community has many hospitals with an established emergency department call schedule. Each department has a neurosurgeon on call who can take care of emergencies. Such on-call neurosurgeons do not have the luxury of refusing to see a competitor’s patient just because he is, well, a competitor. This assumes that the neurosurgeon is not performing esoteric procedures that only he is uniquely qualified in the community to perform.
Further, the neurosurgeon is candid, open, honest, and transparent with his patients. He explains upfront what to do if there’s a problem. The patients have his mobile number. Most complaints to the Board are complaint driven. If the patient’s expectations are properly managed in advance of a problem, the likelihood of a complaint being submitted goes down.
Note: this set of circumstances is different than if the neurosurgeon traveled once a week to a small community several hours away to perform itinerant surgery, where there was no one in the local hospital roster available to take care of a complication. There, a complaint to the Board would trigger a different analysis. The Board might conclude the main motivation for traveling to a remote community was financial. There’s no problem with that. But, if the patient has no reasonable local option to deal with a complication, and this potential forseeable challenge takes place every week, the Board might have a strong opinion.
The only thing that this neurosurgeon might want to ensure is that he “slows down” his surgical schedule a few days before he leaves town. The likelihood of there being a problem is highest in the 24-72 hours after surgery. By being available in person during that window, he would increase the likelihood that most problems that do occur would be handled by him personally.
While it’s always best for colleagues to behave collegially, that’s not how the real world always plays out. Fortunately, for those is solo practice, there are options that serve the patient and decrease the likelihood of concerns with the Board of Medicine.