{"id":5838,"date":"2017-02-17T01:40:51","date_gmt":"2017-02-17T06:40:51","guid":{"rendered":"\/about\/blog\/for-doctors\/new-patients\/"},"modified":"2023-10-30T13:47:43","modified_gmt":"2023-10-30T18:47:43","slug":"closing-practice-to-new-patients","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/resources\/blog\/article\/closing-practice-to-new-patients\/","title":{"rendered":"Why I Won’t Close My Practice to New Patients"},"content":{"rendered":"

Closing a medical practice to new patients is like cutting off the very top of a tree. It\u2019s the beginning of the end.<\/p>\n

The top of the tree, the crown, is where the newest leaves are. It\u2019s also the part that continues growing ever upward, at least until it reaches its maximal genetic height, depending on environmental factors like the availability of water and sunlight (both of which also depend on how many other trees are competing for them nearby).<\/p>\n

When you cut the top off a tree, the tree will die. Not right away. Sometimes not for many years. But its death is now inevitable.<\/p>\n

I don\u2019t believe in a \u201cclosed panel\u201d of patients. (I don\u2019t even really know what that is.) Patient populations ebb and flow. No matter how good I try to be, there are a certain number of patients who, due to circumstances beyond my control (and often beyond theirs), leave the practice. Whether moving away, transferring for work, switching insurance plans, getting pissed angry with\u00a0me, or even, yes, dying, there is always going to be attrition. New patients are the lifeblood that keeps those numbers up. Active patients generate the office visits, which produce the billings that bring in the money.<\/p>\n

I know some people with a subscription-type practice model who have a \u201cfull practice\u201d and a \u201cwaiting list.\u201d Frankly, managing those kinds of lists feels like so much more trouble than it\u2019s worth. If someone calls for an appointment, I\u2019d rather just give it to them instead of trying to figure out if they\u2019re \u201con the list.\u201d<\/p>\n

Some people think that closing to new patients can be a temporary thing. They\u2019ll just close for a while until the list shrinks a bit, then open up again. Most of them learn the hard way that once word gets out that you\u2019re \u201cclosed\u201d it\u2019s not that easy to open the spigot again. Besides \u2013 what if you do, and patients come flooding back, and you\u2019re stuck closing again? Most practices have a variety of referral sources, and it can be really hard both to keep up with them all, and for them to keep up with whether you\u2019re open or closed this month.<\/p>\n

There\u2019s also the question of how \u201cclosed\u201d is closed?<\/p>\n

\u201cDoc, my mother-in-law is in town for the week and she forgot her blood pressure pills. I know you\u2019re not supposed to prescribe without seeing her, so can we just bring her in for an appointment? I know you\u2019re \u2018closed\u2019 to new patients, but she\u2019s family.\u201d<\/p>\n

Hard not to make the exception without seeming like a jerk. But then there\u2019s this:<\/p>\n

\u201cDoc, my mother-in-law is coming to live with us. I know you\u2019re \u2018closed,\u2019 but she\u2019s family, and we\u2019ve been your patients for twenty years. How about it?\u201d<\/p>\n

I\u2019ve seen practices describe their status as, \u201copen to families of existing patients only.\u201d What about dear family friends? Will you make that exception too? Doesn\u2019t that mean you\u2019re basically open to anyone referred by current patients? How are you going to work that? When a new patient calls for an appointment, do they need to give the name of your current patient who referred them? What if it\u2019s someone who\u2019s moved away and isn\u2019t technically a \u201ccurrent patient\u201d? What if it\u2019s someone you may not have seen for a while and the person answering the phone doesn\u2019t recognize the name? Can\u2019t someone who really wants to become your patient lie about being referred? How are you going to police that? Like the waiting lists, it all seems so much more trouble than it\u2019s worth.<\/p>\n

Another solo physician in my town recently retired, and I\u2019m enjoying a nice little uptick in new patient calls as her former patients try to find a new doctor. Obamacare has also produced a nice little pool of the newly insured who are lighting up my appointment book.<\/p>\n

I have no problem \u201cclosing\u201d to certain insurances. Been there; done that; may do it again. In fact, if your hidden agenda is to prune your populations, that may be a pretty good way to go. Just don\u2019t say you\u2019re \u201cclosed to new patients\u201d unless you\u2019re looking to retire. Because closing to new patients is the best way to slowly kill a practice. Which is why I have no intention of doing it.<\/p>\n

Lucy Hornstein has been in solo practice for 26 years in suburban Philadelphia, and she still loves it. She’s been blogging<\/span> at Musings of a Dinosaur<\/a>\u00a0since 2009. In her spare time she enjoys reading, writing, eating chocolate, and playing the piano. Dr. Hornstein is married and has four grown children, one dog, and two cats (subject to change).<\/em>\"\"<\/p>\n","protected":false},"excerpt":{"rendered":"

Closing a medical practice to new patients is like cutting off the very top of a tree. It\u2019s the beginning of the end.<\/p>\n

The top of the tree, the crown, is where the newest leaves are. It\u2019s also the part that continues growing ever upward, at least until it reaches its maximal genetic height, depending on environmental factors like the availability of water and sunlight (both of which also depend on how many other trees are competing for them nearby). Read more…<\/a><\/strong><\/p>\n","protected":false},"author":2,"featured_media":17201,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[110],"tags":[9,23,73],"class_list":["post-5838","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-business-insights","tag-awareness","tag-early","tag-referral-programs"],"acf":[],"yoast_head":"\nWhy I Won't Close My Practice to New Patients<\/title>\n<meta name=\"description\" content=\"Closing a medical practice to new patients is like cutting off the very top of a tree. 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