By Gina M. Wesley, OD, MS, FAAO 
SYNOPSIS
The loss of an associate can be disruptive. Plan ahead to avert a practice crisis.
ACTION POINTS
MINIMIZE DISRUPTION TO PATIENTS. Doctor may have to work an additional day, or longer days, to see departed associate’s patients.
BE OPEN WITH PATIENTS. If they ask, let patients know that your associate left the practice and that you are now happy to assume care for her patients.
ANALYZE WORK LOAD. Calculate hours of work per week to warrant hiringa new associate.
The departure of an associate can cause a major disruption to your practice operations–unless you prepare well. I found this out firsthand earlier this year when my associate, who had beenworking two days a week and filling in asneeded, left to work at a LASIK center. She left on very good terms, and as a mom, I respect her decision, as sad as it made me. This departure, although stressful, forced me put into place efficiencies I had been thinking about for a long time.
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Minimize Interruption to Patient Service
The first thing I did was start thinking about how we were going to cover her patient time. I had to cover about 32 patient slots per week. I had been doing two days per week myself and my associate two days, as well. I took on an additional day (accounting for about 16 patient visits), and then extended my patient hours on two of the days to cover the remaining 16, in addition to compressing comprehensive patient exams at “peak” times from 30 to 20 minutes. This actually opened up more slots than what we were losing by taking back a doctor day, so it was able to account for, and help, patient growth.
Once I started to have a few ideas of how I would do this (because I knew initially I was going to be the one doing so), my associate and I told the rest of the staff within a matter of days and I started open discussions with the staff about how we were going to adapt. We are a team, and I value their input because they often have great ideas about patient flow and demand, as they are the ones scheduling the appointments. I took their feedback into account when managing my final scheduling decisions for doctor time.
Practice Owner Adjusts Schedule As Needed
My associate was very professional in giving her notice, and gave me a full two months to prepare for her departure. So, no need for my schedule to change immediately. However, the new schedule has changed to allow me to see the same number of patients we used to see in four days in three longer days. I sacrificed some administrative time to do this, but I still wanted to have two days per week to spend with my children. We also, in those three days, made sure we built in room for patient growth as our move to a new building last year has made my practice grow quite a bit.
Make Necessary Support Staff Adjustments
My staff now has to work longer patient days, but fewer patient days per week. Some staff members work four 10-hour days, and some work just part days with no breaks (for example, 1-7 pm) to be able to handle our busiest times. Essentially, I have scheduled my staff to be there fully when I’m seeing patients, and very minimally (only two or three staffers in the office) on non-doctor days.
Plan Contingencies
Do an employment contract: Insist on a non-compete, typically for three years and within a three-mile radius
Have subs in mind: Many ODs are looking to work part-time and could fill in in a pinch. —ROB Editors
Be Open If Fielding Patient Questions
I discussed with staff what to say in response to patient questions. We are telling patients, only if they ask, that my associate has reduced her hours and that they will be seen by me instead. According to my staff, most patients haven’t asked, and if they do, they are fine with seeing me. There is the possibility that my now-former associate may someday fill in, or return, so we want to leave that option open.
Reassure Patients
I establish trust with the patient by recognizing the transition and asking them if they have any concerns or questions before starting the exam. I recognize that the patient had seen my associate previously, and tell the patient I’m happy to be assuming their care. I reassure them that my associate did a great job with medical record keeping, so I have a very good handle on their individual ocular health, and visual needs, to be able to assume care.
Have Non-Compete Clause in Associate Contract
Since my associate has moved to a LASIK-only facility, I’m not concerned about patient loss, as this would only involve a small portion of my patient population, and only for that procedure. However, this is why I have a non-compete clause in her contract. It protects my practice’s patients.
Decide If/When to Hire New Associate
I am looking for a new associate, but have evaluated the practice’s position and my own, and have decided to fully take over patient care until our growth determines we could offer at least three days per week to another doctor. I’m anticipating this may happen within a year or so. With my previous associate, I gave up one of my patient days in the hopes of tying her to my practice a bit more, and making her feel a part of that. Life, however, has a way of making us change our professional roles, and I very much respect her decision to leave. So, as much as I want to “make” someone more of a long-term fit, all we can do is attempt to outline our hopes and expectation at the beginning with a new associate, and take life as it comes along and as the practice changes.
Gina M. Wesley, OD, MS, FAAO, is the owner of Complete Eye Care of Medina in Medina, Minn. To contact her: drwesley@cecofmedina.com.
