A pt reached out to me with the follow issue, what is the responsibility of a large hospital system. Having several hospitals in two states and a large number of physician offices, employing 1000+ physicians.
I asked perplexity.ai?
Question: I had a chronic pain pts that reached out to me and the pt’s PCP is retiring next year and the pt’s current PCP is employed by a very large hospital system – multiple hospitals in two states and maybe upwards of a 1000+ physicians working for the system. This pt cannot find a PCP – even in the same office – that has some 10 different PCP. My thoughts dose the hospital system have any responsibility for helping this pt finding a new PCP within their system? IMO, this pt is on the cusp of being abandoned – your opinion?
A hospital system and its employed physicians have an ethical and some legal responsibilities to support continuity of care when a PCP retires, especially for chronic pain patients who are at heightened risk of abandonment if alternative care isn’t arranged. While individual physicians must notify patients, provide reasonable transition time, and continue care until proper hand off or substitute care is found, large hospital systems should facilitate this process—particularly when there are other PCPs in the same office or network.norcal-group+5
Hospital System Responsibilities
Hospital systems are expected to prevent abandonment by providing notice to affected patients and helping arrange ongoing care, either within the network or by supplying resources to find new providers. Given that your scenario involves a large system with multiple PCPs at one site, failure to offer any assistance or access within their network would constitute poor practice and might risk formal abandonment, especially if the patient is left without appropriate medical oversight or prescription management. Ethically, and under many state regulations, systems employing hundreds or thousands of physicians have added capacity (and expectation) to reassign patients internally, compared to solo or small practices.pmc.ncbi.nlm.nih+5
Chronic Pain and Risk of Abandonment
Chronic pain patients face particular vulnerability due to the complexity of their treatment regimen and the stigma attached to opioid prescribing. Abrupt discontinuation or refusal to transition care exposes them to avoidable harm and potential withdrawal, which courts and medical boards may interpret as gross negligence or reckless abandonment if reasonable transition is not achieved. Professional guidelines and precedents (AMA Code, Joint Commission pain standards) reinforce hospital and PCP duties to ensure patients are not left untreated or unsupported.pmc.ncbi.nlm.nih+4
Opinion
In this case, the hospital system should proactively facilitate PCP continuity—either by transferring care to another physician within the practice or by providing written notice and assistance in locating an appropriate provider. Failure to do so risks formal patient abandonment, especially when the system has adequate resources for such a transition. The patient in question could justifiably feel abandoned; advocacy (with state boards, patient relations, or medical directors) may be warranted if transition support isn’t provided.copic+5
- https://www.norcal-group.com/library/ensuring-continuity-of-care-when-retiring-or-closing-a-practice
- https://www.copic.com/resource/checklist-for-physicians-retiring-from-a-medial-practice/
- https://www.thedoctors.com/articles/closing-or-relocating-a-healthcare-practice/
- https://www.cmadocs.org/newsroom/news/view/ArticleId/28099/FAQ-What-is-the-proper-way-to-terminate-the-physician-patient-relationship
- https://code-medical-ethics.ama-assn.org/chapters/patient-physician-relationships
- https://www.ncbi.nlm.nih.gov/books/NBK563285/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7670398/
- https://onlinelibrary.wiley.com/doi/full/10.1002/hec.4800
- https://www.expertinstitute.com/resources/insights/patient-abandonment-cases-what-you-need-to-know/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC1071521/
- https://www.opiates.com/opiates-blog/doctor-retiring-pain-management
- https://www.sciencedirect.com/science/article/abs/pii/S0047272722000056
- https://creyos.com/blog/continuity-of-care
- https://www.thedoctors.com/articles/terminating-patient-relationships/
- https://www.tn.gov/content/dam/tn/health/healthprofboards/pain-management-clinic/Pain_Clinic_FAQ.pdf
- https://seak.com/blog/uncategorized/10-biggest-legal-mistakes-physicians-make-lead-claims-patient-abandonment/
- https://www.reddit.com/r/ChronicPain/comments/1czzu6x/pain_doctor_retiring_now_pcp_is_saying_they_may/
- https://www.hollandhart.com/firing-patients-avoiding-patient-abandonment
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777855
- https://www.tn.gov/content/dam/tn/health/healthprofboards/pain-management-clinic/ChronicPainGuidelines.pdf
Filed under: General Problems
I am facing the same scenario with my primary care physician leaving at end of month. The practice recommended 4 physicians as potential replacements none if whom are participating in my insurance plan. I wrote back to my pcp Dr and he had one of his staff write back telling me to essentially look through my plan to find Dr’s who are participating. 3 Dr’s later I finally found one but it will be 4 months before I can get an appointment. In the meantime I’ve been told if anything happens go to the ER or urgent care. It feels like abandonment of a sort as there are physicians in his office who could handle his patients until they find another doctor but the excuse is that they are full up even though the insurance shows they aren’t asking new patients still. A mess it seems.
We are dealing with the same issue, our PCP of almost 30 yrs is retiring at the end of 2026. We have had a Meet & Greet with several practitioner – two in the same practice our PCP is in, and are new to the practice and on the hospital website – who owns the practice – says that they are accepting new patients, but one – who is a internist – basically told me that he didn’t feel competent taking on chronic pain pts. The hospital system that are PCP works for is a multi hospital system in two states and has abt 1000 practitioners in various office practice. There is 10 practitioners just in the practice our PCP is in. I may end up talking to the administrator of the hospital system and discuss that after nearly 30 years… I have the sense that we are being abandoned. For the hospital system having ~ 1000 practitioners – NOT ONE WOULD CONSIDER TAKING US ON AS PATIENTS. Maybe this hospital system needs some BAD PUBLIC RELATIONS IN THE MEDIA