Malpractice Consult

Lee J. Johnson, JD

Answers to your questions

Coverage for part-time practice

Q: I'm selling my practice and plan to semi-retire. If I still want to cover for colleagues, can I get malpractice coverage as a part-time physician, or must I have full-time coverage?

A: Discounts for part-time practice are available in some areas, but they're rapidly disappearing from the insurance scene. Some insurers actually consider part-time practice to be riskier than full-time, depending on the specialty or the services provided. So there's no guarantee that you'll get a break on your premium.

Still, it's worth shopping around for a discount. Such a policy is typically worded like this: "50 percent premium discount is available to qualifying physicians who practice an average of 20 hours or less per week. A 65 percent discount is available to qualifying physicians who practice 10 hours or less per week."

The hour limit must be taken seriously. If there is a claim and it becomes evident that you've been working more than the required limit, coverage can be denied or compromised.

If you currently have claims-made coverage, verify that part-time status won't affect free tail coverage when you fully retire.

If you plan to fill in for a doctor who'll be away for a fairly long period of time, look into locum tenens insurance. This may be provided by the other physician's insurer and will be contingent on his not practicing while the locum tenens coverage is in effect.

Make sure your responsibility is clearly spelled out in a written agreement and in the medical records of the patients you see for your colleague. Insist on a "heads up" on problematic or severely ill patients and access to necessary medical records.

Restricting the scope of your practice

Q: I don't feel comfortable treating certain conditions in my solo family practice. For example, I would treat a patient's hypertension but I'd refer her to a specialist for her fibromyalgia. Can I restrict my practice to only certain conditions? Can I decide to treat only men?

A: The agreement to treat is a contract that both physician and patient must accept. As a private physician, you aren't required to treat every patient who wants your services, as long as you don't engage in illegal discrimination.

Whenever you're not confident of your training and knowledge in an area, the best advice is to refer the patient to a specialist. The decision must be evenhanded and nondiscriminatory. Physicians' offices are considered places of public accommodation, so you cannot automatically refuse to see patients with a disability protected by the Americans with Disabilities Act. You also cannot refuse service to other classes of people protected by law.

A decision to treat only men sounds discriminatory unless there's a medical reason to justify it. If you decide to limit your practice on a wholesale basis (seeing only men, for instance, or only hypertensive patients), provide the patients you'll be excluding with adequate notice—a month should be sufficient—and help in finding another physician. During that month, you must treat them for any emergencies that arise.

The author, who can be contacted at 2402 Regent Drive, Mount Kisco, NY 10549, or at lj@bestweb.net, is a health care attorney who specializes in risk management issues. This department answers common professional-liability questions. It isn't intended to provide specific legal advice. If you have a question, please submit it to Malpractice Consult, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742. You may also fax your question to 201-722-2688 or send it via e-mail to memalp@medec.com.

Lee Johnson. Malpractice Consult.

Medical Economics

2002;4:103.