If a Hospital Decides to Force a Physician to Leave, How Can The Physician Protect Him/Herself?

It all usually starts with a sudden demand that you, the physician, show up at an emergency meeting with either Human Resources or the chair of the department.  There you are met with a very, very unpleasant discussion about your practice, with the upshot being that you have to resign from the hospital.  The people talking to you will come armed with a bushel full of facts, all of which discredit you and some of which might border on being criminal in nature.  You are shocked, not having seen this coming at all, and you had no time to prepare to answer the issues at hand.  Often the doctor will be presented a document to sign, which will end his/her affiliation with the hospital and will also waive any right the physician might have against the hospital. The whole picture is painted in a way that wants you to think that you have no way out except to resign, and by doing that you will at least exit the hospital without a criminal case being filed against you and you will have your license intact. This article will discuss some of the reasons this situation comes into being and it also will tell you some of the arrows that might be in your quiver that can be used to fight back against the hospital.

So, what are some of the reasons I have seen that cause the hospital administration to want to get you off the staff?  One reason is that the politics at the hospital have changed and you are now in the outside group.  This can happen when a new chief is brought into the picture and suddenly the people in high places who you knew very well have been replaced.  This change at the top can come about because the head of the department retired, took another position or was him/herself forced out.  The new powers that be want their own people to work with them, and maybe your slot has to be opened up to provide a position for these new people.

Another situation is when it is decided that you have been at the institution too long and that you are making too much money.  You have to go.  So, the administration starts an intensive review of your activities.  This will include the time you spend with patients, the number of patients you actually see, the billing codes you use, how you go about interacting with residents and/or fellows and all other aspects of your practice.  Remember, the computer tracks your every move and the information it contains can be used against you in a very objectiveappearing manner.

Then there are the tried and true personal reasons which can cause you to be expendable.  These include professional jealousy which often happens when a younger physician is brought onto the staff and does a type of procedure that the chairman and other older physicians are not capable of doing.  This procure often involves robotics or another type of computer-assisted surgery.  The younger surgeon quickly increases his/her practice and gets the lion’s share of the publicity.  This does not go down well with the establishment and often ends with the old guard finding reasons to get rid of the surgeon that are very damaging to the surgeon’s reputation and can put permanent roadblocks in his/her career.

Additionally,  there can be a  romantic relationship between someone in power and another physician, which can make you the odd doctor out.  The other and usually younger physician in the relationship can be set up to move into your position after you are ousted from the staff.  If you think this cannot possibly happen, believe me, you are wrong.  The “other” physician can be someone who is already on the staff and will be moved up the chain of command into your position or someone who is affiliated with another institution who will be “recruited” as your replacement.

So, what can you do if this situation comes your way and you find yourself defending against claims of incompetence, fraud, negligence or some other type time of unprofessional conduct?  The first thing to do is to put a cap on the understandable desire to panic.  You will be confronted with a wellthoughtout plan which aims to cause you to give up immediately.  There might be notsoveiled threats of criminal charges and/or loss of your medical license.  These claims are surfaced to make you want to get out of the line of fire regardless of the longterm consequences.  You are told to give up, resign quietly, and the whole thing will go away.

But what if you have really not done anything wrong?  In that case, you want to listen quietly as the spokesperson for the hospital lays out the claims.  If the accusations against you are sexual in nature or involve what is said to described as fraud, you should deny them unequivocally and then say that you are leaving and will discuss the matter at another time.  In any event, do not sign anything and to not allow yourself to be intimidated.  You may be told that if you do not sign a resignation document you will make matters worse for yourself.  But if you really are not guilty of the claims, simply walk out of the meeting.  This will give you time to plan your defense and to obtain legal advice.

You then have time to understand why this has happened and to review your employment contract if you have one.  What rights do you have in that contract?  Also, is it possible that you are being discriminated against because of your age, your race, your gender, etc.?  If you feel that you are being forced out due to political or personal reasons, then the administration of the hospital might well want to agree to a monetary payout to you in exchange for your departure from the hospital.  You should know that hospitals are relatively allergic to bad publicity, so if you can make a convincing case that this whole situation is a sham and brought about solely to get you to leave the hospital under false allegations, you might very well force the hospital to negotiate with you.

This can result in a settlement agreement that provides for payment to you over a lengthy period of time while you go about obtaining another position at another institution.  This agreement has to be carefully drafted to prevent the hospital from filing a report against you with the National Practitioners Data Bank or the New York State Department Of Health, Office of Professional Medical Conduct, (OPMC) there should also be a non-disparagement clause to prevent members of the hospital from destroying your reputation as you go about applying for staff privileges at another hospital.

Obviously, any agreement of this nature has to take into account the individual issues that apply to your situation.  Suffice it to say, your professional life depends upon looking at this matter with a clear head.  Do not allow yourself to be forced into something you will regret.  Take your time to understand exactly what your options are and how to best present those options.  By doing this, you give yourself the best opportunity to have the best possible outcome from this very unpleasant set of facts.