Transitioning your HIV Practice to a new Doctor

The AIDS epidemic raged around me like a wildfire in the late 80s and early 90s while I trained in medicine in San Francisco. In that storm, I began working with people living with HIV. In 1995, ready to start a primary medical practice, I landed at a community clinic in Berkeley, California, overseeing an emerging Ryan White HIV/AIDS Program site. Now 22 years later, I have retired. 
The transition has unfolded according to plan. My organization hired a successor who I am confident will take expert and compassionate care of my former patients. An AETC colleague asked me to share my transition story with other HIV providers planning this milestone and other HIV programs losing long-time staff members. I replied, "What's to tell? I was lucky," to which she answered, "no, you planned it." Both are true. A smooth transition requires planning and luck. 
The earlier you notify the people who will be affected by your departure, the easier it is for them to prepare for the impact it will have, and the easier it is for them to help you. I notified my chief medical officer (CMO) first – about 2 years in advance. When patients, noting the passage of time, asked if I was thinking about retiring, I would answer "not for the next couple of years." I care deeply about keeping my patients in treatment and undetectable. It had at times took a sustained effort to gain the trust of those with mental illness including those with substance use disorders, so the decision of how and when to inform them of my plans was strategic and measured.  One year after alerting my organization and a year before my retirement date, I began telling my patients of my impending departure. I reassured them that I was responsible for choosing a new provider, and that I would leave them only in the most capable hands. At the same time, I informed my colleagues and asked them to be on the lookout for a potential successor.
I re-energized my practice of seeing my chart notes through the eyes of the person who would take over the care of my patients. This meant cleaning up problem lists that had gone from ICD-9 to ICD-10 and from paper to electronic. It meant finding a way to convey some of what I had learned about patients’ unique circumstances, over the course of twenty years. I took inventory of projects I wanted to see completed or at a minimum, organized enough to hand off. 
It is in the best interest of your patients and colleagues that you have a voice in selecting your successor. I was fortunate to have solid backing from my organization's leaders. But all managers have a responsibility to balance the books. Some may be under greater pressure to cut costs in the short run. You may need to advocate for the long-term strategy of investing in finding and orienting a provider who will keep your patients from leaving for another practice and who will remain with the practice for many years.
Next, I began to collaborate with HR about my job description. We posted the opening six months prior to my year-end departure. We solicited CVs, interviewed applicants, and made an offer which, with my CMO’s support, included a 3-month orientation/overlap to provide enough time for my successor and I to see patients and conduct team meetings together. 
No one wants to receive a "Dear Jane" change of provider letter, especially after a long doctor-patient relationship. I began the process of composing a letter to my patients once my replacement was confirmed, announcing the name and start date of their new doctor, assuring them that their new doctor had my unequivocal, highest endorsement. I reaffirmed their importance to me and said goodbye in my own words. 
It bears noting that a complete and accurate patient list needs careful review for accuracy. In particular, the names and addresses of the deceased somehow tend to reappear on various lists. No surviving partners or other family members should receive a notice implying that the death of a loved one was overlooked or forgotten by their medical provider.
In summary, in planning your retirement from clinical practice, I'd suggest:
1. Begin with an honest assessment of your personal health, your family's needs, and your financial needs.
2. Take charge to the extent possible well in advance. two years was ideal for me.
3. Involve the leadership of the organization as soon as possible. 
4. Review and update the medical records, especially the problem lists and medication lists of the most complicated patients.
5. Take responsibility for approving the wording of the job announcement.
6. Utilize word of mouth.
7. Select your successor.
8. Be gracious to applicants who do not get the job.
9. Help your successor get a good orientation. Working together as a pair is expensive in the short run, but it is an optimal practice and an excellent long-term investment.
10. Introduce the new provider to patients and colleagues in person whenever possible.
11. Be the one to warn your patients that you will be leaving. Begin the process one year out.
12. Compose the letter announcing your departure in your own voice.
13. Go over the distribution list carefully.
14. Expect the unexpected. It is inevitable.
15. Say goodbye to your patients and colleagues confident that you are doing right by them!

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