A physician may withdraw from a physician-patient relationship provided that the relationship is terminated in the proper manner, unless circumstances do not permit termination of the relationship. Abandonment is grounds for discipline under the Medical Practice Act of 1987. Once a relationship is created it may be ended in one of five ways without liability: (1) when medical care is no longer needed, (2) when the patient specifically withdraws from the relationship, (3) when the care of the patient is transferred to another physician, (4) when the physician who is withdrawing from treating the patient gives ample notice to the patient, or (5) when the physician is unable to provide care based upon lack of training, experience, illness or incapacity (any such illness or incapacity must be of a significant nature to disable the physician from being able to provide care).

When giving the patient notice of your withdrawal from their care, inform the patient in writing. You are not obligated to give a reason, however you may wish to do so. References to unpaid bills should be omitted. Clearly set a date of termination to allow the patient to find alternative care. Thirty days from the date the letter is mailed is often given for this purpose, hence the term "30-day letter." While ISMIE recommends 30-days' notice, be aware that 30 days may not be considered a reasonable time period in every case. Send the letter by certified or registered mail (with return receipt requested) and retain a copy in the patient's medical record. If the patient does not accept receipt of the letter, which is not uncommon, note this in the record, attempt to follow-up with a telephone call, and document the follow-up attempt in the record.

Your withdrawal-of-services letter should also advise the patient to seek alternative care. It is recommended that you either (1) offer to assist the patient in finding alternative care, (2) suggest that the patient contact the county medical society and/or a local physician referral service for referrals, or (3) identify a physician who has agreed, in advance, to accept the individual as a patient. For sample withdrawal of services letters, call the ISMIE Risk Management Division at 800-782-4767, ext. 3300, or send an e-mail message to riskmanagement@ismie.com