AMA Journal of Ethics^®

Case 

Dr. Sally Young, one of two primary care physicians in a small town, is tired of apologizing to her patients for the hours they spend in her waiting room and the constant rush to move on to the next patient. The 20-minute time slots Dr. Young's scheduler allots do not permit her to have a personal conversation with patients or allow them time to express all of their health concerns.

After some serious thinking and conversations with a colleague and an old friend of hers in Florida, Dr. Young has decided that she will transform her current practice into a retainer practice. She has worked out the finances and realized that she doesn't have to take a pay cut if she has fewer patients and charges them an annual fee in addition to the cost of the individual services she provides. She believes this arrangement will be more satisfying for the patients, and more fulfilling for her.

Dr. Young has sent each of her current patients a letter explaining that she will be changing her practice and that they will be charged a flat annual fee of about $3000 to continue to see her. The letter explains that, under the new practice set-up, Dr. Young will have fewer patients and will offer same-day appointments with more time for each. Dr. Young will also start making house calls and carrying a cell phone so her patients can reach her 24 hours a day. She tells her patients that she will continue to keep appointments as scheduled for the next 6 months but will not schedule any new non-urgent visits for patients who do not wish to participate in the new practice. The other primary care physician in town has told Dr. Young that her practice is full and cannot take a large influx of new patients. So each letter Dr. Young sends contains a list of other physicians in nearby towns, complete with the types of insurance each physician accepts.

Since the letters were sent out, Dr. Young's office has been flooded with phone calls from her patients. Mrs. Liles, a 73-year-old patient, has called 4 times since she received her letter. She insists to the staff that an exception be made for her. The closest primary care physician who is accepting new patients is a 30-minute drive away. Mrs. Liles lives down the street from Dr. Young's office and does not drive. There is no public transportation to the suggested physician's office, and Mrs. Liles cannot afford the roundtrip cab fare.

What should Dr. Young do about Mrs. Liles? (select an option)

A. Tell staff to reinforce the new arrangements of paying the retainer or transferring to another doctor.

B. Ask the other primary care physician in town to make an exception for Mrs. Liles since she is not able to travel to the physicians in nearby towns.

C. Tell Mrs. Liles that she will continue to see her as a patient but that Mrs. Liles will not receive the extra services that are covered by the retainer fee.