Patients' attitudes toward the closing of a medical practice

Journal of Family Practice, May, 1989 by Keith Sinusas

Although the effect of termination of medical care has been studied previously, [1-8] the termination of the physician-patient relationship has been principally evaluated in relation to the turnover of resident physicians in a general internal medicine residency program. [2,3,5,6] A study by Toms [8] in 1977 was the first to examine the effect of the closure of a private family practice. His study was a retrospective interview of patients who had just lost their family physician to retirement. The current study is the first to use a questionnaire to evaluate the attitudes of patients in response to learning that their family physician will be leaving. Particular attention was directed to gaining more insight into the physician-patient relationship.

METHODS

This study took place in a small town (population 12,000) in rural Vermont. The author was closing his practice after 8 years in the community to assume a faculty position at a family practice residency program in another state. The practice was part of a group practice manned by three family physicians who were sharing expenses. No definite replacement physician had been identified, but the author's partners were willing to offer acute care to his patients until a new physician was in place. Those patients who would have required routine follow-up care for health maintenance and for chronic illnesses would have to locate a new physician. The author knew of his departure 6 months in advance and personally informed his patients during the final 4 months of his practice. An announcement was placed in the local newspaper on two occasions in the 2 weeks prior to the closing date.

A two-page, 17-item questionnaire was given to 200 consecutive patients during the last month of the practice. Patients were given the questionnaires at the end of their office visits and were encouraged to complete them before leaving the office. Stamped, addressed envelopes were provided to those who were unable to complete the form that day.

Of the 200 questionnaires administered, 178 were returned and sufficiently completed for analysis (89% response rate). The data obtained from the questionnaires were sorted and analyzed using a commercially available database program on a personal computer.

Patient Demographics

Information was obtained regarding the patient seen for that day's office visit and, for those in the pediatric age group, for the individual completing the form. It was assumed that the patients seen during the 2 weeks of the study constituted a representative sample of the author's practice.

The ages of the patients seen were relatively evenly distributed throughout all age groups. Since the author included obstetric care in his practice, a broad base of patients was permitted, which avoided skewing the practice toward a more adult population, as has been previously reported. [9] The patients were 58% female, and their average age was 38.8 years. The informants were primarily female (67.1 percent) and had an average age of 44.8 years.

An inquiry was also made as to the payee for the office visit. The distribution was as follows: Blue Cross/Blue Shield 27.0%, health maintenance organization members 8.0%, other private insurance 22.4%, Medicare (with or without supplement) 21.3%, Medicaid 8.1 %, workers' compensation 3.4%, self-paying 9.2%, and no response 0.6%.

RESULTS

A number of factors were examined by means of the questionnaire. The first was an inquiry into how the patients learned that the physician was leaving his practice. The largest number heard by word of mouth from either a family member (22.5%) or a friend (39.8%). A remarkable number first heard directly from the physician (30.3%). The physician's staff was responsible for informing 6.2% of patients. One patient remarked that she first learned about the closing of the practice from her insurer, a health maintenance organization.

Patients were asked who they thought should be responsible for finding them another physician. Of the 170 respondents to this question, the majority (65.3%) felt that they themselves were responsible for locating a new physician. Some believed that the physician was responsible (10.0%), or that the physician's staff was responsible (14.1%), while other patients felt that the responsibility for finding a new physician should be shared by some combination of the physician, his staff, and the patient (10.6%). Those who felt it was their own responsibility tended to be younger (average age 40.6 years) and better educated (average education beyond high school). Those who believed the physician was responsible were older (average age 58.3 years) and less well educated (average education less than 12 years).

When asked whether they had tried to find a new physician by the time of the questionnaire, 76.6% responded that they had not yet tried. There were 41 patients (23.4%) who had made an attempt to locate a new physician. Of these, only 12 (6.8%) replied that they had found one easily, 13 (7.4%) had found one with difficulty, and 16 (9.1%) had had no success in securing a new physician. Difficulty in finding a new physician may have resulted from the limited number of physicians in the area who were accepting new patients. Nevertheless, over three quarters of the patients had made no attempt to find a physician.