Can I pay a patient to leave my practice?

Dr. Goldberg

Dr. Derm’s patient has seen him for body exams, eczematous dermatitis and acneiform eruptions for more than a decade. No matter what he does, she is not happy. She has expressed her discontent to his staff and to him. On numerous occasions, she has refused to pay insurance co-pays and deductibles. He has written off thousands of dollars over the course of three years. Finally, he sends her a letter discharging her from the practice.

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She responds by saying she will “destroy him” on social media if he does not allow her to see him. Dr. Derm responds by offering her $1,000 to never come back to the practice. She files a complaint with the state Board of Medical Examiners over the ethics of such a practice. Is he in trouble? 

In reality, most patients do like their dermatologists. Unfortunately, that is not the case with all patients.

Dr. Derm treated his patient within the standard of care. His treatment, by all means, was good. Yet, this patient became disrespectful to the doctor and his staff. He felt it was worth paying her $1,000 to go away. He had nothing else to offer her medically, and he wanted to be left in peace and tend to his other patients who valued his time.

In “real life” people are paid for doing something: for an action or activity or labor. But in medicine (dermatology), not always.

At times, the government paid farmers to not grow crops. Why? To balance supply and demand in the marketplace; to achieve a policy objective.

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Zappos, the shoe retailer, pays new employees to quit. That program, called Pay to Quit, extended the offer to its newest employees within the first few weeks post-hiring. Employees had to first be hired – so they were eminently qualified. Zappos would pay the new hires $1,000 to quit. Very few took the company up on its offer. Amazon, which purchased Zappos in 2008, came up with a similar type of program.

The company annually makes an offer to pay fulfillment center associates up to $5,000 to leave. The offer starts at $2,000 for employees who have been at the company for one year, and it increases by $1,000 for each year of employment. However, those who accept the offer can never work at Amazon again, according to CNBC.

“We want people working at Amazon who want to be here,” Amazon spokesperson Melanie Etches told CNBC Make It. “In the long-term, staying somewhere you don’t want to be isn’t healthy for our employees or for the company.” 

Amazon tells CNBC that they don’t want employees to accept the offer. In fact, the memo is headlined: “Please Don’t Take This Offer,” founder and CEO Je Bezos tells the news outlet.

But, monetary payments can enhance employee engagement and may be cost-effective in the long run, says Michael Burchell, workplace culture expert and author of the book “The Great Workplace: How to Build It, How to Keep It and Why It Matters.”

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Employee engagement tends to be about commitment to stay and discretionary effort. While Pay to Quit may not necessarily push employees to work harder, he tells CNBC, it does address the issue of commitment to stay.

Disengaged employees cost their company about 34% of their salary, according to a Gallup poll. A disengaged employee making $50k/ year costs his company $17k in lost productivity. So, there’s a strong business rationale for paying disengaged workers to leave. (Of course, one can always fire that employee. But, the pay-to-quit option “smokes out” those employees who may never have reached the threshold of being noticed for their detrimental effect.) So, it’s a short-term cost with hope of a long-term benefit.

Does this principal apply to the management of a disgruntled patient who is loud, aggressive, disrespectful and angry (assuming there is nothing medically different that can be done for him/her)? This is always hard to evaluate. If nothing else, there is a“psychic cost,” if not an actual economic cost to Dr. Derm. 

It makes sense that some dermatologists want to pay select patients to quit.

The obvious problem: patient abandonment is a serious issue in medicine. Before terminating a relationship with a patient, Dr. Derm may be required to ensure continuity of care. Patient dismissal letters can save time and money – and potential lawsuits. Dr. Derm’s payoff may be acceptable as long as there is no abandonment.