With the changes to Alberta’s economy witnessed over the past 12-18 months, times are tough. With unemployment rising, more patients are without extended health benefits and others are hesitant to take on extra expenses, even necessary ones, due to job uncertainty. Simply put, health-care providers are feeling the pinch, and this leads to a variety of challenges in the practice environment. Physiotherapist turnover is one of them.
Sometimes, leaving a practice can become like a messy, petty divorce. People get angry, and it becomes a game of he said/she said, with both parties claiming the other is trying to wrong them. When physiotherapists choose to leave a practice, whether to move to a new location, a new community, or to open their own practice, there are some basic expectations that both physiotherapists and their employers are expected to meet. These are the subject of the Leaving a Practice Guideline1, which builds upon the Client-Centered Service, Record Keeping & Management, and Records: Clinical, financial and Equipment Standards of Practice.2
1. Serve the patient’s interests
Along the way, it sometimes seems that the parties involved forget that their first job is to serve the best interests of the patient. This requirement is included in our Code of Ethics3 and in the Client-Centered Service Standard of Practice.2 Members are reminded that this is also the fundamental purpose of our daily work and nothing, least of all personal financial interests, should take priority over this objective.
2. No one owns the patient
The Client-Centered Service Standard of Practice4 requires that physiotherapists support “client participation and choice about physiotherapy services offered, including (the) decision to refuse service or revoke consent.” The patient has the absolute right to choose their health-care provider. They therefore, have the right to follow their provider or to remain with the clinic or organization where services were previously delivered. It is not reasonable to infer anything from a patient’s choice to go or stay, as patients may consider many things when deciding including ease of access to the facility, other services available, proximity to home or work or provider preference.
3. The patient’s decision must be identified to facilitate ongoing care
Physiotherapists have a responsibility to facilitate ongoing care for their patients.1 When patients choose to remain at the clinic rather than following their provider elsewhere, the original physiotherapist must provide adequate information to facilitate ongoing care by the physiotherapist taking over the patient’s care.2 In addition, it is appropriate for the physiotherapist to identify other practitioners who have similar skills or who treat in a similar manner or treatment approach that the original physiotherapist has been using.
4. Records management
As the Guideline Leaving a Practice Guideline1 identifies, it is preferable if some questions are addressed at the time of hire. For example, who will maintain responsibility for the retention, security, access to and appropriate destruction of patient records? How will the departing physiotherapist gain access to patient records for the purpose of completing medical-legal reports? If these issues haven’t been addressed during contract negotiations or at the time of hire, it is both parties’ responsibility to discuss how patient records will be protected and secured when the physiotherapist departs.
It should be noted that if the patient wishes to have a copy of his/her record transferred with them to a new clinic, the original clinic is required to provide a copy, but is able to charge a fee for the preparation and copying of the record. The appropriate fees for chart copies are established in the relevant privacy legislation.5,6 It is up to the patient to request a copy of their chart, the departing physiotherapist does not have the right to request a chart copy independent of the patient.
5. Communication about the physiotherapist’s departure
Another issue that is best discussed at the time of hire is how information of the physiotherapist’s departure or pending departure will be communicated with the patient. The Leaving a Practice Guideline provides a sample letter to share with current patients about the physiotherapist’s pending departure. Again, to support patient choice and foster patient-centered care it is imperative that the patient be made aware of their options. Information regarding where the treating physiotherapist is moving to and options for continued similar treatment at the current clinic location need to be shared in an open and transparent manner. Obscuring this information in the interest of preventing a business loss is inappropriate.
What if the patient isn’t booked for a follow-up appointment, but has not been discharged from physiotherapy either?
When the patient calls the clinic to book his/her next appointment, they need to be made aware of the physiotherapist’s new location and of his/her treatment options. It is not acceptable for a patient to arrive at the clinic expecting to see their previous physiotherapist only to find that they have been booked with someone else.
Can the clinic or the departing physiotherapist use the patient’s contact information to solicit the patient for their continued business?
Physiotherapy Albert’s position is that it is inappropriate for either party to use patient personal information (including telephone numbers and email addresses) to contact the patient to notify them of the physiotherapist’s relocation, to solicit their business, or to pressure the patient to rebook with either party. This type of behavior appears unprofessional and tends to harm the standing of the profession in the public’s eyes.
It’s also important to keep in mind that privacy law indicates that patient personal information can only be used for the purposes for which it was collected. Using patient contact information for solicitation could be interpreted as a breach of the legislation.
6. Professionalism and communication after the physiotherapist’s departure
Remember that the Code of Ethics requires that physiotherapists “conduct themselves so as to maintain public confidence in the integrity and dignity of the profession.” And “conduct themselves in such a manner as to reflect the highest standard of professional integrity and responsibility.”
While it is never fun to relocate, nor is it pleasant to have a valued employee leave your practice, all parties need to act in a manner that maintains the public’s trust and respect. When parties engage in smear campaigns, refuse to communicate or otherwise conduct themselves in undignified ways it harms the standing of the profession in the public’s eyes, and ultimately harms us all.
What can you do to avoid trouble when relocating your practice?
Address the issues in advance, long before you’re contemplating leaving
Preferably at the time of hire the physiotherapist and the business owner should discuss and agree upon how patient notification of a pending move, record retention and ongoing access to patient records will be managed when/if the physiotherapist chooses to relocate in the future.
Get legal advice
When writing contracts, signing contracts and considering breaking a contract, you need to seek legal counsel about what the contract terms mean and what you can and cannot do when you plan to leave. Physiotherapists are reminded that before they agree to a contract they should seek counsel so that they fully understand the future implications of signing. If an employer presents a contract that is overly restrictive to your future ability to work in a community or to inform your patients of an impending relocation, our advice is to not sign the contract-negotiate for better terms instead.
Avoid knee-jerk reactions.
This works both ways. The departing physiotherapist should provide reasonable notice of their plans to move. The business owner should take some time to reflect on how to manage the situation.
Both parties should consider and openly discuss how to make the departure as seamless as possible for the patient and should act to serve the patient’s interests first.
Physiotherapy Alberta — College + Association. Practice Guideline: Leaving a Practice/Re-locating to Another Practice. 2014. Available at: https://www.physiotherapyalberta.ca/files/practice_guideline_leaving_or_relocating.pdf
Physiotherapy Alberta — College + Association. Standards of Practice. Standards of Practice. 2012. Available at: https://www.physiotherapyalberta.ca/files/practice_standards_all_2012_revised.pdf
Physiotherapy Alberta — College + Association. Code of Ethics. Available at: https://www.physiotherapyalberta.ca/files/code_of_ethics.pdf
Physiotherapy Alberta — College + Association. Standard of Practice: Client Centered Services. 2012. Available at: https://www.physiotherapyalberta.ca/files/practice_standard_client_centered_service.pdf
Office of the Information and Privacy Commissioner. Personal Information Protection Act (PIPA): PIPA advisory #5 Access requests under PIPA: Fees. 2005. Available at: http://www.assembly.ab.ca/lao/library/egovdocs/2005/alipc/151962.pdf
Province of Alberta. Health Information Act: Health Information Regulation. 2014. Edmonton: Alberta Queen’s Printer. Available at http://www.qp.alberta.ca/documents/Regs/2001_070.pdf