The devil is in the details, and there are numerous details physicians must manage before their departure.

By Bonnie Darves, a freelance health care writer

Some physicians land on the ideal practice opportunity early in their careers and find it gratifying enough to stay there for their entire careers, but that’s pretty rare these days. In the real world, physicians change jobs a lot. A recent survey by CHG Healthcare found that 62% of physicians surveyed changed jobs or job types between 2022 and 2024, up from 43% in CHG’s 2022 survey. And early-career physicians appear to have few qualms about moving on — statistics show that more than half of physicians will change jobs within five years of leaving training, eyeing better work-life balance, better compensation, or just a better overall fit.

Although it’s become perfectly acceptable for physicians to change jobs for any reason, physicians making their first career move to a new practice opportunity may find that changing jobs, even from one employed position to another, is more complicated and time-consuming than expected. Even if physicians are successful in choosing their next job in a matter of weeks, making the transition in an orderly manner may take several months. That’s because of the myriad issues involved. Those issues range from employment-contract provisions, advance-notification requirements, patient responsibilities, and financial considerations at the current job to malpractice coverage both at the new job and between one job and the next.

Proper and prudent departure planning: where to start

The most important considerations in making a move are ensuring, through due diligence, that the next practice opportunity is truly an improvement over the current one and that there are no impediments to leaving the job on the physician’s preferred timetable. That means that the first order of business is reviewing the current employment contract — closely, and in its entirety. Ideally, physicians should review the contract before launching a job search but absolutely before committing to a start date. Many employment contracts, even those that include “without-cause” clauses that permit physicians to leave at will, require that ample notice be provided. A sixty-day notice is common, but some contracts may require that physicians provide 90 or even 120 days’ notice. And any violation of a notice period could result in financial cost to the physician if the physician is found in breach of the contract.

The following are other employment contract provisions that physicians should pay special attention to and have an experienced health care attorney review early on when they’re planning a move:

Restrictive covenants. Such clauses may dictate where departing physicians may (or may not) be allowed to practice, from either a geographical-radius or competitive standpoint, and should be considered enforceable unless the state outlaws them. The clause may prevent physicians from practicing within 60 miles, for example, of the current employer’s location, or from joining certain nearby organizations considered competitors.

Deferred-compensation considerations. As some physicians have found out, sometimes the hard way, receiving compensation due to them after they’ve left a job can become problematic. Some deferred compensation may be linked to the notice period, and if that period is inordinately long, physicians may have difficulty getting funds they’re due, according to Jim Wall, a health care attorney at Wall, Babcock & Bailey in Winston-Salem, North Carolina. “Some practices may require an extraordinarily long notice period, a year, for example, before the physician can qualify for deferred-compensation payments,” he said.

At the other end of the spectrum, physicians who have contracts in which they’re paid based on work relative value units (w-RVUs) may be liable to pay back some of their compensation if they have been overpaid because they didn’t meet productivity targets. “This is definitely a provision to look for,” Mr. Wall said.

Dawn Plested, a consultant with the Medical Group Management Association, which publishes a leading annual physician compensation survey, urges physicians considering a move to determine how their departure might affect some newer types of compensation, such as value-based care payouts and prospective bonuses based on quality measures. “Ideally, physicians should log in at least quarterly to find out where they stand with such payments,” she said, and how their departure date might affect payouts.

Retirement plans. It’s important to ensure that the physician’s intended departure date doesn’t conflict with the current employer’s calendar-year requirements or vesting schedule. If, for example, the current employer requires physicians to work an entire calendar year before receiving that year’s retirement benefits, leaving early could mean leaving money on the table.

Patient-nonsolicitation clauses. This can be a tricky issue to navigate for departing physicians, depending on the contract. An overly broad definition of nonsolicitation may prevent physicians from directly telling patients or even fellow staff members who they hope might follow them that they’re planning to move to a new practice and identifying that practice. “Nonsoliciation and ‘non-hire’ clauses vary considerably, and the language matters. Physicians should be very careful about such clauses,” said William Mandell, co-managing partner of the health law firm Pierce & Mandell PC in Boston.

For example, while a physician may be in violation of the contract if they direct message patients or staff members about their plans, the contract might not prevent them from announcing their move on social media or LinkedIn. When in doubt, Mr. Wall advises departing physicians to broach the subject explicitly with their current employers. And Mr. Mandell reminds physicians that an overly broad nonsolicitation clause might be waivable or alterable, with an attorney’s intervention. In any event, physicians should update their social media profiles as soon as possible or as permitted to enable patients to find them.

Creating a timeline for handling important matters

After physicians have done the requisite contract and policy review to ensure that they won’t run afoul of their obligations to the current practice, it’s time to start planning for an orderly and risk-mitigating exit plan. In a perfect world, physicians should expect that it will take several months (three to six, usually) to wind down their current job and make the many required notifications. These include regulatory entities such as the Center for Medicare & Medicaid Services and Drug Enforcement Agency, licensing and specialty boards, state medical boards, the state health department, contracted health plans, malpractice carriers, and, of course, patients. Most state medical and specialty societies provide a recommended timeline for notifying patients, and some even have related policies. In the case of psychiatric patients, that recommended notice period may be several months, for example.

Physicians also need to notify hospitals, affiliated clinics, and active and referring colleagues. This should be done in a timely manner to help ensure care continuity.

First and foremost, Mr. Mandell advised, physicians should be both careful and discreet about both their job search and their departure activities, to the extent feasible, until they are ready to formally announce their departure date.

“It’s very important for physicians to avoid giving employers notice until they have a signed employment contract in hand.”

— William Mandell, Pierce & Mandell PC, Boston

In other words, don’t count on either an enthusiastic verbal offer or a quickly and loosely crafted letter of intent before notifying the current employer. Both Mr. Mandell and Mr. Wall urge physicians to have an attorney review the new employment before they sign it, because it’s a lot easier to modify a contract in progress than it is to alter one that’s been signed.

When the word is out, physicians can move forward with their other notification duties, keeping the following best practices in mind:

Ensure physician access to patients’ records in the future. Even if the current employer purports to “own” the patient records, departing physicians should ensure that they have a mechanism for accessing those records as long as might be needed — to protect patients and to protect themselves against adverse actions. State medical boards provide guidance on how long records should be kept. To avoid risk, physicians should ensure they retain patient records for at least the statute-of-limitations period but ideally up to 10 years.

Patient notification. In today’s practice environment, when the majority of physicians are employed, their employing organizations are likely to have standard procedures in place, including templated letters, for notifying patients. That doesn’t mean that the departing physician should simply rely on the employer to ensure that this all-important matter is handled appropriately. If physicians don’t like the tone of the employer-provided patient letter, or don’t consider it complete, sources advise physicians to request reasonable modifications. A jointly crafted and approved letter is the gold standard. The final letter should be very specific about the following issues, for both proper patient care and physician-liability reasons:

“I tell physicians that when they’re changing practices, patient welfare should always be their North Star.”

— Jim Wall, Wall, Babcock & Bailey, Winston-Salem, North Carolina

• Who will be available to take over the patient’s care and how patients can move forward to receive care in the departing physician’s absence. Physicians should make every effort to ensure that patients aren’t abandoned or don’t perceive that they’ve been abandoned.  He added that patients who are medically complex or who may require near-term ongoing care or long-term follow-up care may require special handling to help them navigate a transition. “It’s important to keep in mind that patients’ relationships are generally with their physicians, not with their physicians’ employer,” Ms. Plested said, so physicians should ensure that patients are taken care of in a manner that respects that relationship. She recommends that departing physicians try to schedule a visit with as many active patients as possible, with a focus on vulnerable patients. Biary Bissan, practice solutions outreach manager for the Massachusetts Medical Society, suggests that physicians create a list of those acute patients and intervene proactively to ensure that another physician will take on their care. Ms. Bissan added that physicians might find it helpful to identify “champions” within the practice they’re leaving to assist with this communication task.

• How patient records will be handled and how patients can obtain their records. Again, this aspect of the letter should be extremely specific about both the process patients must follow to get their records and how long those records will be available. The letter should also stress to patients the importance of receiving ongoing care. It’s also a good idea for physicians to publish a public notice in a general-circulation newspaper providing details on when the physician is leaving the current practice and the address where patients can write to obtain their records. Some states may require such public notice, and many set requirements on how far in advance of the physician’s departure (30 days is typical) the notification must be provided and how many times the notice must be published.

Ensuring adequate tail coverage is vitally important

When physicians join a new practice and malpractice coverage is provided at no cost to them, they might not pay sufficient attention to how tail coverage, which is lifetime coverage, will be handled. Because tail coverage is both crucial to protecting the physician and expensive — the general cost range is 1.2 to 1.5 times the amount of the annual premium — the policy must be in place before the physician leaves the practice, and physicians should know who is responsible for arranging the coverage.

“Physicians are changing their practice environment far more frequently than in the past. And the more movement, the more opportunity there is to drop malpractice tail coverage inadvertently,” said Richard E. Anderson, MD, chairman and CEO of The Doctors Company, a leading malpractice coverage insurer.

“When physicians plan to move to a new practice, they must be 100% clear on who will be responsible for the tail coverage.”

— Richard E. Anderson, MD, chairman and CEO, The Doctors Company

The physician’s existing employment contract should contain such details and specify the type of coverage provided, whether that is claims-made (the most comprehensive) or claims occurrence.

Tail coverage is complicated business, and misconceptions about it abound, according to Thomas Bryant, president of Physicians Insurance Agency of Massachusetts, a subsidiary of the Massachusetts Medical Society. “There are three common misconceptions I see among physicians — that tail coverage is part of all policies, that it’s free, and that it’s always for a fixed period of time,” Mr. Bryant said. The truth is that tail policies can vary considerably in the marketplace, Mr. Bryant observed, and that some policies are too skimpy to provide adequate protection.

The first step in ensuring continuing liability coverage is to notify the existing malpractice carrier at least 30 days ahead of the physician’s departure or the expiration of the existing policy and to then determine what actions are needed. If there will be a coverage gap between when the old policy ends and the new one begins, physicians must ensure that tail coverage is in place and avoid “going bare” for even a few weeks. A malpractice claim filed during any gap period could have financially disastrous consequences for physicians and their families. “This is an important life consideration, and it’s not something to be left to chance, because a claim can be catastrophic,” Dr. Anderson said.