Shutting down a practice

Psychologist Alice Reinig, PhD, decided to retire from her San Diego private practice after more than 25 years because she wanted to do more traveling.

"It was a big decision because I really liked what I was doing," she says. "But I really liked to travel a lot too. I learned in the 1970s that you can't leave your patients for very long; they don't like it--I was gone once for over a month and I swore I'd never be away for that length of time again while maintaining a practice!"

Reinig began her retirement process slowly by cutting her work hours. "I started out by taking Fridays off. Then I eventually took Mondays off," she explains. And on July 1, 2000, she closed the door for good.

But she didn't do that without a lot of planning for ethical issues such as patient termination, legal issues such as where to store records and her own emotional issues about leaving something she loved doing.

Legal and ethical issues

Good planning is key to closing a practice, no matter what the situation, according to Billie Hinnefeld, PhD, JD, senior director for legal and regulatory affairs in APA's Practice Directorate. "Though APA has not created guidelines that relate specifically to closing a practice," she adds. But there are some legal and practical issues that are relevant when closing a practice:

• Practitioners should give adequate notice of their retirement or decision to relocate geographically. "Not every case will be the same," says Hinnefeld. For instance, Reinig told some of her most serious, long-term patients about six months in advance of her retirement. And Tom McGee, PhD, another San Diego psychologist who plans to retire from a part-time practice in June, recommends giving "more serious" clients at least three or four months notice.

• Patients who will need continued care should be given appropriate referrals. Abandonment issues can become legal issues, Hinnefeld says, noting that state laws can dictate what constitutes a case of abandonment. Standard 3.12 of APA's 2002 Ethics Code, which takes effect June 1, mandates that psychologists should make "reasonable efforts to plan for facilitating services" in the event of their illness, death, relocation or retirement. And Standard 10.10 states that psychologists should provide "pretermination counseling and suggest alternative service providers as appropriate."

• Make sure your records are still accessible. "In retirement, you still have responsibility as the custodian of patient records," says McGee. "Records still must be kept for the state-dictated amount of time," adds Hinnefeld. Current and even former clients may need access to these records, so issues of where to store them and how to let old clients know of plans for retirement are important.

• Tackle informed-consent issues. On a related note, if a patient's records are transferred to another psychologist for continuation of care, the patient must provide written informed consent. Reinig says that about five weeks before she retired, she gave each of her patients three referrals and had them sign a form giving her permission to transfer their records to the therapist they chose--upon receiving written authorization via that new therapist.

• Review malpractice insurance. An ethical complaint might be filed after retirement, as might a malpractice suit, warn Barton Bernstein and Thomas Hartsell in their book, "The Portable Ethicist for Mental Health Professionals" (Wiley, 2000). Practitioners should review their malpractice policies to "ensure that acts of commission or omission covered during practice continue to be covered after retirement," they write.

The emotional issues

In addition to the paperwork and the legal issues, practitioners have to handle the task of telling their patients their closing plans--and that can weigh heavily on some patients.

"Therapist loss can be perceived as the ultimate loss for psychological clients," says McGee. "Termination is almost always painful. Work it through and give patients time to talk it through with you. It's less traumatic that way."

Reinig says she spent about five weeks in the termination process with her patients. In addition to discussing termination with them in therapy and providing them with written notification of how they could access their records and other issues, such as where the records would be stored in the event of her death, she handed patients personal letters at the end of their last appointments.

"I talked about my choice to start a new 'semester' in my life," she says. The letter also told patients how honored she had been to work with them and conveyed warm wishes. "For some it became a transitional object," says Reinig. "For others it was closure. I felt good about that. It was a gentle way of closing, and that was my style."

The termination process isn't just painful for some patients. Psychologists who are leaving a practice--especially for retirement--have to face their own emotions.

"I love my work, and I'll miss it. But [leaving] is like jumping into cold water--there's the shock, but then you get used to it," says McGee, who is retiring to spend more time with his family.

Reinig expresses a similar view: "Making the transition wasn't totally easy. On one side, I was really excited. On the other side, there was a sadness of giving up something I really enjoyed doing and got a lot of satisfaction out of."

A month after retiring, she started her life's next "semester" of travel--she took a cruise to the Caribbean and then went to the south of France for five weeks. She has traveled consistently since then--to China, Tibet and Spain to name a few. Her next trip is to New Zealand and Australia.