Practice Strategies

Transitioning: What Will You Do Next?

Old doctors don’t die…they just transition.

It’s no joke. Whether you call it transitioning, phasing out or just winding down, there are plenty of reasons why a physician might want to slow down — but not quit working.

Some truly love clinical practice (but not the intensity and administrative headaches of full-time practice). Others would be happy simply dropping weekend calls. Still others are willing to be busy, but want substantially more time off (maybe 12 weeks a year). Health problems (or the demands of caring for a parent or spouse) make full-time practice a challenge for some. Others have “lost the fire” and are no longer finding rewards in their professional lives.

A Smart Step Toward Retirement?

Transitioning can also be a smart step toward retirement. The process of transitioning from traditional, full-time medicine provides an enforced opportunity to evaluate your finances, establish post-retirement goals (personal and professional) and initiate a time of “try-before-you-buy” exploration.

Even if retirement is not on your immediate horizon, it’s wise to have at least thought through some of the issues you’ll face in the event you are forced to shoulder a lighter load at some point in the future.

Options Abound For The Resourceful

Whatever the reason for the change, there are plenty of rewarding options for physicians who want to utilize their experience and training in other than a full-time clinical setting.

Go “loco”. A great way to dip your toe in the transition waters is to go locum tenens. It could be a wonderful opportunity to see the country (how about serving as a bush doctor in Alaska) or the world. You could also go seasonal, working in a resort area during the busy season.

Start out by agreeing to a one- or two-week assignment nearby. And remember this important truth: Locums placement companies work for the practice to meet the practice's needs — not yours. For a long-term assignment, involve your attorney to make sure t he contract clearly addresses payment terms, expenses, appropriate lodging and malpractice insurance. Consider adding an out clause if there isn’t one already.

Become a medical missionary. If your goal is to remain active in medicine, and income is less important, volunteering may be an attractive option. In particular, medical missionary work has strong appeal for physicians who want to focus more on what got them into medicine in the first place: helping patients. For a listing of opportunities and organizations, visit the Medical Missions Directory at www.missionfinder.org/medical.htm

Partner. Consider partnering with a doctor who has similar desires. A new physician torn between needing to start a practice and wanting to start a family may be a good candidate. Likewise, in specialties with a surgical component, consider an arrangement where you take over the nonsurgical care, keeping the patients flowing and the exam rooms full, while the full-time doctor handles the procedures.

Cover. In a large practice, it might be possible to arrange to fill in for the other doctors taking summer vacations in exchange for blocks of time in the winter, for example.

Freelance. You may be able to do nursing home work, or work for a hospital run by the Veterans Health Administration. Working at a hospital, part-time physicians are most often hired as independent contractors and offered an income guarantee with some benefits.

Etc. There are also any number of freelance opportunities for the resourceful physician. You could do Social Security disability evaluations, serve as an expert witness, work as a clinical researcher or teach part time. Switching focus, you could also join a pharmaceutical company or become an administrator (e.g., for an HMO, hospital, organized medicine, medical school or other organization).

The Basics of Winding Down

Although transitioning gradually may be the best way to adjust to retirement, it has to be carefully planned. You’ll probably need to start planning three to five years out. Here are some steps to consider:

Lighten your patient load. One way is to temporarily close your patient panel to new patients. The panel size should then gradually dwindle as people move, switch insurance companies or leave for other reasons, making it manageable for part-time work.

Look inside the practice. You may very well be able to find the flexibility you’re looking for in your own group practice. This could include eliminating on-call responsibilities, working a percentage of a full-time schedule, dropping surgery, working only in the office or taking substantially more vacation. Another option is to take on increased managerial responsibilities (i.e., become a Managing Partner) with lessened clinical time demands.

Work out compensation. The basic trade-off for the part-time physician is less money for more free time. But t here are plenty of ways to skin the cat here.

Your salary could be based on days worked (per diem) or your productivity level. A lthough some practices will pay all of a part-time physician’s malpractice insurance costs (which are often less than a full-time physician's costs), many will leave some or all of these costs to the part-time physician. The good news here is that a number of professional liability companies offer reduced premiums to part-time physicians.

Evaluate your feelings. Making a transition can be hard emotionally, too. Spend some time thinking about your goals before taking the plunge. Sit down with paper and pencil and chart out how many hours in a typical week you are currently spending on personal activities (e.g., time with your family, volunteer work, exercise, hobbies and spiritual growth) versus how much time you would like to dedicate to these activities in the ideal situation. This eye-opening exercise should give you some concrete goals to work toward.

For more information about our services to the healthcare industry, Contact:
Maxine Lawyer, Director of Healthcare Services at 972.448.6905.

The articles in this newsletter are general in nature and are not a substitute for accounting, legal, or other professional services. We assume no liability for the reader's reliance on this information. Before implementing any of the ideas contained in this publication, consult a professional advisor to determine whether they apply to your unique circumstances.
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