In certain circumstances, a physician or medical practice may decide to end the professional relationship with a patient. This is sometimes referred to as patient dismissal or termination of the physician-patient relationship. Because continuity of medical care is important, such a decision should be handled carefully, professionally, and in accordance with applicable laws, ethical requirements, contractual obligations, and practice policies.
There are various reasons why a physician-patient relationship may need to end. Depending on the circumstances and applicable requirements, these may include:
- Repeated missed appointments without appropriate notice
- Threatening, violent, or seriously disruptive behavior
- Persistent non-payment of bills, where termination is permitted
- Repeated failure to follow essential practice policies
- Breakdown of the physician-patient relationship that prevents effective care
- The physician retiring, relocating, or closing the practice
- Changes in insurance participation or other practice arrangements
Not every disagreement, missed appointment, unpaid bill, or instance of non-adherence justifies immediate dismissal. Each situation should be evaluated individually, particularly when interruption of care could place the patient at risk.
Provide Appropriate Notice
When ending the physician-patient relationship, the patient should generally receive appropriate written notice and sufficient time to arrange care with another healthcare provider, except where different procedures are justified or required.
The letter should clearly state the effective date on which the physician or practice will stop providing routine care. Where appropriate, it should also explain what care will be available during the transition period and what the patient should do in an emergency.
The appropriate notice period and procedures can vary depending on applicable law, professional guidance, contractual requirements, the patient’s condition, and the circumstances surrounding the dismissal.
Explain the Reason Professionally
Where a reason is provided, it should be stated objectively and professionally. Avoid insulting, emotional, or judgmental language.
For example, instead of describing a patient as “troublesome” or “uncooperative,” the letter can refer to specific documented incidents, such as repeated missed appointments, threatening behavior, or failure to follow an agreed practice policy.
Maintain Proper Documentation
The medical practice should maintain appropriate records concerning significant incidents, previous communications, warnings, and the termination notice. Documentation should be factual and relevant.
Patient medical records should be handled according to applicable privacy, access, retention, and transfer requirements. Requests for records and outstanding financial balances should also be managed according to applicable policies and requirements rather than assuming that records can always be withheld until a bill is paid.
Help with Continuity of Care
Where appropriate, the patient should be given reasonable information about how to obtain continued medical care. The practice may provide instructions for transferring medical records to a new healthcare provider upon receiving the necessary authorization.
The following sample letters illustrate different situations in which a medical practice may need to terminate a physician-patient relationship. They should be adapted to the circumstances and applicable requirements before use.
Sample #1 – Repeated Missed Appointments
Subject: Notice Regarding Your Care at [Practice Name]
Dear [Patient Name],
We are writing regarding your history of missed appointments at [Practice Name]. Our records indicate that several scheduled appointments have been missed without sufficient notice despite previous reminders regarding our appointment policy.
Regular attendance is important for maintaining continuity of care and allowing us to manage your treatment appropriately. Unfortunately, the repeated missed appointments have made it difficult for us to continue providing your care effectively.
For this reason, we have decided to end our physician-patient relationship effective [date].
During the applicable transition period, please arrange care with another qualified healthcare provider. Upon receiving appropriate authorization, we will assist with transferring copies of your medical records to your new provider.
If you have questions regarding this notice or the transfer of your records, please contact our office at [phone number].
Sincerely,
[Physician/Practice Name]
Sample #2 – Inappropriate Behavior Toward Staff
Subject: Notice of Termination of Physician-Patient Relationship
Dear [Patient Name],
We are writing regarding several documented incidents involving inappropriate behavior toward members of our staff.
Our practice is committed to maintaining a safe and respectful environment for patients, employees, and visitors. We have previously communicated our concerns regarding this behavior. Unfortunately, the incidents have continued, and we have determined that we can no longer maintain an effective physician-patient relationship.
Accordingly, our practice will discontinue routine care for you effective [date].
We encourage you to arrange continued medical care with another qualified healthcare provider. Upon receiving the required authorization, we can transfer your medical records to your new provider in accordance with applicable procedures.
Please contact [phone number] if you have questions regarding the transition of your care.
Sincerely,
[Physician/Practice Name]
Sample #3 – Outstanding Account Balance
Subject: Notice Regarding Your Account and Continued Care
Dear [Patient Name],
We are writing regarding the outstanding balance on your account with XYZ Clinic. Our records indicate that payment has remained outstanding since March 20XX, despite previous statements and reminders.
We encourage you to contact our billing department at [phone number] as soon as possible to discuss your account and determine whether an appropriate payment arrangement can be made.
If the matter cannot be resolved, the practice may end the physician-patient relationship in accordance with applicable policies and requirements. If termination becomes necessary, you will receive appropriate notice and information regarding the transition of your care.
Please contact our office if you believe there is an error in your account or if you would like to discuss available payment arrangements.
Sincerely,
[Name]
[Practice Name]
Sample #4 – Concerns About Treatment and Conduct
Subject: Important Notice Regarding Continued Care
Dear [Patient Name],
We are writing regarding ongoing concerns about your treatment at [Healthcare Facility].
Your healthcare team has previously discussed the importance of following the agreed treatment plan, including recommendations concerning [briefly state relevant treatment requirement]. We have also documented concerns regarding interactions with members of our staff during treatment sessions.
We would like to meet with you to discuss these concerns and determine whether an appropriate plan can be established to continue your care safely and effectively.
If the difficulties cannot be resolved and the physician-patient relationship must be terminated, we will provide appropriate notice and information to assist with the transition of your care, subject to applicable requirements.
Please contact [Name/Department] at [phone number] to arrange a discussion.
Sincerely,
[Physician/Authorized Representative]
[Healthcare Facility]
Sample #5 – Aggressive or Threatening Behavior
Subject: Notice Regarding Physician-Patient Relationship
Dear [Patient Name],
We are writing regarding the incident that occurred at our healthcare facility on June 12, 20XX.
During the incident, behavior occurred that raised serious concerns regarding the safety of our staff, patients, and visitors. Our practice is committed to maintaining a safe environment for everyone receiving or providing care at our facility.
Following a review of the incident and in accordance with our applicable policies, we have decided to end the physician-patient relationship effective [date].
Please arrange continued medical care with another qualified healthcare provider. Information regarding the transfer of your medical records can be obtained by contacting [department/phone number].
If you experience a medical emergency, seek appropriate emergency medical assistance rather than waiting for a routine appointment.
Sincerely,
[Physician/Practice Name]
Sample #6 – Breakdown of the Physician-Patient Relationship
Subject: Notice of Termination of Physician-Patient Relationship
Dear [Patient Name],
This letter is to inform you that, effective [date], I will no longer be able to serve as your physician.
Over time, there have been repeated difficulties in your interactions with members of our clinical staff. We have previously discussed these concerns, but unfortunately, the problems have continued. After careful consideration, I have concluded that we are no longer able to maintain an effective physician-patient relationship.
To allow you time to establish care with another healthcare provider, our practice will provide appropriate transitional care for [applicable period], subject to the circumstances and our practice policies.
I encourage you to begin looking for another qualified physician as soon as possible. Upon receiving the necessary authorization, we will arrange for copies of your medical records to be transferred to your new healthcare provider.
If you have questions regarding the transition process or transfer of your medical records, please contact our office at [phone number].
I wish you the best with your future healthcare.
Sincerely,
[Physician Name]
[Practice Name]
Letter File: 48 KB
