AMA Journal of Ethics^®

The Principles of Medical Ethics affirm the right of physicians to choose the environment in which to provide medical care and, except in emergencies, whom to serve. This right however, is not absolute. Loyalty to the interests of patients is essential and is a foundation on which the patient-physician relationship is based. This standard of putting patients' needs first imposes on physicians the "obligation not to abandon a patient who continues to require medical care."

Unlike large urban areas which have many medical care options, including transportation to and from medical offices and facilities, small towns and rural areas often have a limited array of choices. Retainer practices may be difficult to incorporate in small towns and rural areas because no other physicians are available or access to other physicians is compromised. Moreover, the creation of a retainer practice does not exempt a physician from the obligation to provide urgent care to those who cannot pay or to seek opportunities to provide non-urgent care to the needy.