Determine a realistic timeline for you, your family, and your practice.

This can be a moving target but envisioning an actual end date will help you plan how to get there. Consider staff notification requirements, lease and technology termination dates, and personal financial planning.

Decide how you want to transition.

Explore options and develop a plan to make that happen. Do you want to slowly transition out of practice, or would you like to practise full time until your end date?

Find a new physician to take over your practice.

In some cases, it may be possible to find a physician who wants to take over your practice. This is the best situation for both the retiring physician and patients, as it ensures peace of mind and continuity of care. However, this requires a practice be optimized for takeover to appeal to a new generation of family physician practice styles. (See Finding a replacement to work in your practice below.)

Share your practice or move to a group practice.

If you want to begin decreasing your workdays per week, you can try to find a physician who wants to slowly transition into practising full time. Over the course of a year or two, you can wind down how much you work as another physician begins taking over your practice and patient roster. This option is available to anyone but is particularly attractive to younger physicians who are starting families. They may not have the time to commit to a full practice right away but may have interest in sharing a practice until they are ready to take it over in a full-time capacity. Choosing such a strategy for a gradual takeover process allows for a transition period of mentorship and support.

Transition your patients.

If it is not possible to get someone to share your practice or take it over, you can try to transition some of your patients to other physicians in the area. While this takes some effort and work to coordinate, it ensures continuity of care for your patients, especially high-needs patients who may suffer without access to a family physician.

Close your clinic.

If you are unable to find someone to take over your practice or move to a group, you will have to close your clinic. Try to give as much notice as possible to your patients as it will provide them a longer runway to seek out other care themselves.

Active Patients

You are responsible for ensuring that all your patients are active in your practice. For specialists, active patients mean those currently undergoing treatment. For family physicians, there is no concrete definition.  You need to advise every patient who may reasonably need to know. Patients that have not seen you in several years can be considered inactive. If you have a physician replacing you, you are still required to create and distribute a notice for all active patients.

How to Notify Active Patients:

• Display a public notice in the office. Place the notice in your office at least three months prior to practice closure.
• Send a letter to all active patients as a notification of closure.
• Record a message on the practice answering machine notifying patients about the office closure and keep the voicemail active for at least three months after the practice has closed.
• Keep records about how patients were notified about the practice closure.

What to Include on Your Notice of Closure:

• Anticipated time of final appointments.
• How patients may obtain a copy of their medical records.
• How to transfer medical records to a new physician.
• How to access the Patient Connect list. To learn more, click here.

Resources

• Sample notification for patients when a replacement has been appointed
• Sample notification for patients when a replacement has NOT been appointed

New physicians tend to explore practice opportunities differently than their counterparts did in the past. Many want to spend their first few years locuming at various clinics before they commit to starting their own practice. They want to have varied experience before they settle down, and they are wary of committing to an opportunity that may not be a good fit for them. Although every physician is different, many young physicians are looking for similar opportunities.

The following considerations are important to prioritize when finding a replacement:

Group Clinics 

The collegiality of a group practice (three or more family physicians) is favoured by most who are new to practice. Group clinics also alleviate the pressure of running a business while starting to practice. A Family Medicine New Brunswick group is one option to practise collaboratively.

Electronic Medical Records (EMR)

Many new physicians have never used paper charts and are not comfortable practising without an EMR. The lack of EMR is a significant impediment to attracting a physician because all newly graduated physicians have been trained using only an EMR.

Financial Considerations

Compensation is a significant consideration for new graduates as they enter the workforce and face the realities of repaying their student loans and operating a business.

Work-life Balance

Physician wellness is a priority for new-to-practice physicians who are more conscious of managing their time. This results in a desire for shared or minimal on-call responsibilities.

Mentorship

New-to-practice physicians consistently identify a desire to be in a supportive work environment with the opportunity for mentorship as they transition into practice.

Vacation coverage

Groups are preferable as they allow for coverage within the clinic during time off.

Variety

Many new physicians seek variety in practice, including hospital work, youth clinics, rural locums, or obstetrics. If you can appeal to those interests with flexibility and options, you make your practice more attractive.

For most salaried physicians, the regional health authority (RHA) is responsible for keeping medical records. The RHA is the employer of administrative support and it owns the medical equipment.

Some salaried physicians may have a contract that states that they are responsible for their administration staff.

To enquire about any specific requirements in your contract, contact your Medical Staff Office.

Retirement Intent Notification

When you have made the decision to retire, you should:

• Notify your Department Chief
• Send a letter to your department colleagues.
• Send a letter to the RHA Human Resource Office notifying them of your retirement and last date of work. When speaking to human resources, you should also discuss items such as:
  • Vacation time;
  • patient notification;
  • pension benefits;
  • sick time (if relevant);
  • notice time required; and
  • last working day.
• Notify:
  • College of Physicians and Surgeons of New Brunswick 
  • New Brunswick Medical Society
  • Canadian Medical Protective Association
  • Referring and consulting physicians and surgeons

Fee-for-service physicians have well defined professional and legal responsibilities when planning for retirement. Additionally, they must rely on their own personal financial planning.

Retirement Intent Notification

When you have made the decision to retire, you should notify:

• College of Physicians and Surgeons of New Brunswick
• New Brunswick Medical Society
• Canadian Medical Protective Association
• Medical Director of the Medical Zone where you practise
• Government of New Brunswick
• Medicare
• Regional Health Authorities
• Hospital(s) where you have privileges
• Colleagues
• Department Chief and Members
• On-call group
• Referring and consulting physicians and surgeons

Ensuring Continuity of Care

Physicians have both legal and professional obligations to use reasonable efforts to arrange appropriate transfer of records for patients who are in critical need to continue treatment.

Identify patients that require continuing care such as:

• urgent referrals;
• patients waiting for test results;
• chronic pain patients;
• patients on medications that require frequent on-going monitoring;
• obstetrical patients;
• patients who require on-going care (in hospital, care homes, or other care facilities); and
• post-operative follow up.

Medical Records

Fee-for-service physicians are responsible for keeping the medical records of the patients who do not have an appointed physician before the practice closes. Currently there are no provincial or federal privacy laws indicating the specific timeline for retention of medical records. The Federal Personal Information Protection and Electronic Document Act only states that minimum and maximum retention periods need to be developed.

According to Canadian Medical Protective Association best practices and the College of Physicians and Surgeons of New Brunswick, physicians must safeguard and protect medical records by:

• having a written policy outlining the retention and destruction of medical records;
• retaining medical records for 10 years for adults and 10 years from the point a minor reaches the age of majority;
• properly destroying medical records once the retention has expired;
• ensuring the proper storage of medical records;
• ensuring patients’ access to their medical records; and
• paying any fees related to medical records storage.

You are still responsible for the proper storage of patients’ medical records even if you have hired a company to take over this responsibility.

Office Staff Obligations

One of your first obligations is to inform your staff about your retirement and keep them informed every step of the way. According to the New Brunswick Employment Standards Act, you are required to provide notifications or pay in lieu to employees depending on their length of employment.

• Less than six months: No notice required
• More than six months, less than five years: Two weeks’ notice in writing or two weeks’ pay
• Five years or more: Four weeks’ notice in writing or four weeks pay

Business Notifications

In addition to notifying patients and other medical related parties, you should make sure that you have notified the following parties:

• Professional services providers such as accounting firms, lawyers, financial advisors, payroll companies, and insurance agents;
• municipal tax office;
• Canada Revenue Agency (for employee payroll and HST account) http://www.cra-arc.gc.ca;
• service providers such as telephone, internet, electricity;
• Canada Post canadapost.ca; and
• EMR vendor (if applicable).

Disposal of Drug Samples

Ensure that the disposal of health products does not contaminate the environment, including the local water and ground systems and ensure compliance with the Controlled Drugs and Substances Act for the disposal of controlled substances.

Fee-for-service Retention Fund

The Fee-for-Service Retention Fund was created to increase physician retention and provide a financial contribution toward fee-for-service physicians’ retirement since they do not have access to a pension.

The program works by setting aside a sum of money each year for each fee-for-service physician based on their full-time estimates, location, and length of practice.

The program is designed for physicians participating in a fee-for-service or alternative funding compensation model. It does not apply to salaried physicians and locums.

Accessing Your Payment

You can access your fund after a minimum of 15 years of service in New Brunswick. The 15 years does not have to be continued service; you can stop practising medicine in New Brunswick for a period of up to three years and resume your contributions at previous levels upon your return.

Processing time can be eight to 12 months, depending on Medicare data availability. The payment will be made as a lump sum and it is considered income by Revenue Canada.

Physicians are required to work for 15 years before accessing payment except:

• If a qualifying physician develops a permanent disability that prevents them from practising medicine, payment can be made to this physician regardless of years of service upon request;
• in the event of a qualifying physician’s death, payment will be made to their estate regardless of years of service.

For more information on the Fee-for-Service Retention Fund, please visit: www.nbms.nb.ca/retention-fund