Just curious as to how we go about closing down our practice? After 5 years of private practice, I'm ready to close the doors. I want out and I want out now. I can't take this anymore.I still owe over $200,000 in student loans but I don't care anymore. I got on this treadmill wanting to help others. Boy did my 20th century Norman Rockwell physician idealism get corrected quickly by a run in the real world of medical practice in the 21st century.I'm no longer willing to deny my own needs (or even the fact I have needs) or those of my family to serve at the false god of "doing good" or "helping people." I'm no longer willing to have the life sucked out of me by fear of attorneys, audits, etc. I'm no longer willing to have the constant anxiety of keeping my practice afloat financially on top of everything else.I'm burned out by just the sheer pathos I see clinically in America today. Forget money, healthcare reform, paper-work, threats of impending audits which scare the beejeezus out of me. But add the two together and I find the job of being a physician in the 21st century a lose/lose proposition.I look at that "Board Certification" I worked so hard to get and think "what a pity I wasted the first 42 years of my life on a pipe-dream."Now I just want off the merry-go-round. If the definition of insanity is doing the same thing over and over expecting different results then clearly my continued participation as a practicing physician is insane. Is there any other way to put it?I'm tired of waking up at 2 am and 3 am and not being able to go back to sleep; sick with worry over $, my patients, my family, and, yes, ashamedly, myself. All that medical training did successfully program me into a human being capable of nearly every self-neglecting quality one can possess. And for what? This?Just show me the door. Let me off this ride. Check please!For me, it gets progressively worse remaining in practice. I used to be able to overcome my disgust with the current state of healthcare by telling myself that I enjoyed the "small stuff". But now, the insanity has even wiped out what small pleasures I get from being a physician. I'm planning my exit strategy.Reality is behind the post. Get out while you still have time to enjoy your life and spend time with your family. The current society and culture does not appreciate you. Run to urgent care. Take out a classified ad telling the world that you are shutting down. If the medical board does not like the way you did it, get your 15 minutes of fame and tell them why....Gabrielle, good to see you back, but sorry under such circumstances.I know exactly where you are. There are many of us in the same place. You are one of the braver ones, willing to get out with your sanity intact.Think about teaching, either at a college level or at a residency program. You may find some joy in that (albeit with a different set of problems) and you may be able to do some private practice on your own terms on the side.Whatever you do, good luck and know that you have our support.Very sad but the reality is that many physicians feel exactly this way. There is no end in site for us other than to unify and quit playing the game as it is currently. Until enough physicians figure out that we have all the power as we deliver the service, we will be stuck on this merry go round and continue to wallow in our own self pity.I completely understand your frustration, I have felt this process progressing over the past ten plus years and now we are being attacked on all sides. It is difficult to find a quick answer to what to transition towards, changing specialties might do something but still SOS in the end, teaching is OK if you have a propensity for it, slaving one self out if another as long as the terms of employment are strickly defined, finding a business to get involved in is another possibility. Just take the time to research your choices well, don't worry about the money- in the end that will work it's self out. best of luckI feel exactly as you do and am in a similar situation. I'm in my 50s now, and just finishing paying off my own school debt as my daughter gets ready for college. Being a salaried physician has helped keep me sane. I don't have anywhere near the headaches of someone who owns their own practice. There are, of course, disadvantages which have been discussed in numerous other posts.Most PCPs in private practice feel that way. Unfortunately med and premed students don't know what they are getting themselves into. My kids will not go to med school. Veterinary medicine is the place to be: your patients always appreciate you and they pay cash, willingly.Salaried urgent care, salaried in the hospital. Our little community hospital PCPs make $300k a year. Of course, they see 50 patients a day...To close you need to contact your state medical association for the rules in your state. In SC you have to post your intentions at least 3x in the local major rags in the 90 days preceeding the close date, and publish where patients may pick up their records, or to whom they will be sent.Why isn't it an option for the patients to pick up a copy of their records? You'd still need to keep copies, but should have fewer requests. Mine are on EMR and would just need a hard drive back up locked up in a safe at home.I feel your frustration and pain; I have 16 months left on a 5 year residency and can plainly see where I don't want to end up. I'd love to just do free clinic work all the time...too bad I have 200K worth of loans.I like the idea of locums, especially since you just do your work and go home. Shift work isn't for everyone, but the inherent scheduling of it makes the crappiness of medicine feel less overwhelming.BTW, thanks for opening up and being honest. Physicians are known for destroying themselves when in fact, there are tons of us out there that feel the same way. Good luck!Here is a guy... who sees the light for himself... I think many of us would take a career change... Well maybe a job change... but we are all afraid that being in the business for 25 years what are we able to do as a job, and sustain our lifestyles...I couldnt agree with him more... Tired of people talking about healthcare debate. Its only going to make it worse... Something has to be done to level the playing field.I am tired of how one doc gets paid 80 for a vist... and I get paid 53 for the same service. The waste is no longer what it used to be... Now I spend 600 a week in a salary for someone to put things into the computer, and chase the insurance company to see what happened to the check, a computer that cost me 25k to set up.. and another 750 a month for health insurance... plus the 7.65 % social security and medicare taxes... And the question is at what cost? I always knew I was going to work long hours... and I was going to sacrifice my private time... but I didnt think I was going to have to struggle to get my kid thru college? Its broken... and I hope it all crashes... So we can start something new... and that patients realize that they really need to have more respect for the commitment that it took to get here... and the commitment it takes to stay... without feeling like its what they are entitled too for free..I was in your position for the past two years. I would recommend taking time to write down everything you would like to have to make your life more fulfilling and happy. For me, this included more time with my husband and at my own home. I wanted to not have to deal with employees, and the business side of running my own practice. Even though my husband and I ran the office together, there was never any off time. I took an employeed position at a neighboring hospital, and that was better for about 3 months. After that initial honeymoon time, it was clear that all I was looked at was as an object to bring money into the hospital. I looked back at my list of things I really wanted in life to make life worth living again. Even though the wall to achieve those goals seemed insurmountable, my husband and I worked on the list together- taking one at a time. To find what I wanted, we had to move half-way across the country to an entirely different place than I'd ever lived before. It was a good thing for both of us. Now, I am learning how to relax and learn how to enjoy life again. I am still very much in debt, though. This will go away. I am working at a place which is in the health service corps loan repayment program, so by the end of this next year, my many years of loans will finally come to an end. Then I'll just have our personal debt to deal with. Life will get better- although I know it is hard to see that right now.Gabrielle we are with you- good to have made this decision now, you are still young!I am 40 years old and leaving primary care (employed position) to become a full-time hospitalist in 2 months but yesterday would not be soon enough.Today the staff told a woman that she had 15 minutes for her acute complaints of migraines- she proceeded to barrage me with a litany of other complaint and issues, despite my efforts to politely redirect her. She actually said to me "well they told me I only had 15 minutes but I figured you couldn't go anywhere once I had you in the room."This attitude is one of many, many things I will not miss! I am a part-time hospitalist now and for the most part find it stimulating and rewarding- more medicine, far less bull****. Best of all when I'm off I am truly off- and I'll have every other week to enjoy my kids and my life in general. There are other options out there for you- don't feel guilty about leaving, and don't give up!I think I'll change my user name after the switch- zek is a Russian word for prisoner if you've ever read Solzenitsyn.It is time for doctors to ''semi-unionise'' and tell the lawyers of the country..not just the trial attorneys but all their brethren..that one day we will straight go to cash based medicine and charge $25-$50 visit..see 25 patients a day..have only the front office person..do our own BP/Pulse/Injection.. make $25-30k a month and be happy.It is possible to do thatAnd as for the citizens of the country..they need to prioritize..health or their home and car??We are just 788k of us in the USA..that makes it 1 physician for 1 million..bad ratio, bad ratio!!!We can be in good business if we did not have any GOVt or Ins company telling what we can or cannot makeI left practice after 26, mainly for many of the same reasons that Gabrielle did--and the desire not to have to deal with my (now) ex-partner. Now I am hospital based. Not the ideal solution I had hoped for, as there is an entire universe out there that abuses Medicare but, at least I do not have to worry about whether I will take anything home at the end of the month and no night call. I even have time to stop and smell the roses..........I too am closing my practice. I have done full time FP, and part time ER for twenty-seven years and in April I am making emergency medicine my full time job. I like it almost as well, and the pay is literally infinitely better, since I now make zero dollars from the practice for most months. The insurance companies have cut so far back, and demand so much more control, and we have to spend so much time precerting tests and referrals, and documenting to meet billing requirements, that there is little time for anything else including generating an income. The government keeps talking about the importance of primary care, while cutting reimbursement to the bone.Patients think that medical care should be completely free. They argue with the front office that they can't afford and will not pay their co-payments, then leave and go into the nail salon next door and pay $100 for a manicure and pedicure. Not only medicine, but people have dramatically changed over the last 30 years too. There is no respect for me or my time, folks want to be seen when they are two hours late, and noncompliance is as high as I have ever seen. I really do not care much about treating anyone under 70 years old any more. The 20 somethings all live in a world more controlled by their sex organs than their brains, drug seekers are everywhere.Tthere is in our country a profound era of anti-intellectualism and narcissism combined with an individual level of self confidence that is completely disjointed from actual ability. Cognitive dissonance rules the day.I am a living anachronism these days. Honor, empathy, and a work ethic are all out of vogue.God help us all!In my small community , I was the solo guy in a community run by a large, multi-specialty group, a hospital paid group, of under-worked and over-paid narcissists, a community health center that, while well-staffed, had begun competing in the community, because fereral grants and the ability to collect 100% on medicaid, still didn't pay the bills.I received very sparing call coverage from the hospital group and only left town 4-5 weekends per year, and had a week of vacation every 2-3 years. I took call every night I was home, and because I had known most of my patients for a long time, was treated very considerately most of the time. I always took medicaid, but I was very willing to terminate them at the first sign of bad behavior. I have no narcissistic rescue fantasies, I lost them when I was a cop.I competed very well, so well in fact, that I was a frequent target of fairly malicious gossip by the large group, because I wasn't miserable and had no one telling me how to treat pts. or what to prescribe. I also didn't have to sit through endless cheer-leading meetings about increasing productivity and crushing the competition.So why leave? The hospital group decided that covering me 15 days a year, in which they handled 2 phone calls, was too big a burden, at a time when my first grandchild was due in a town 2 hours away. Plus, Newt Gringrich showed up in Spokane and annnounced that making medicine all electronic would solve every problem in medicine and that all of us should be computerized by 2014, at a starting cost of 40k per doc. I lead a small life, without toys or extravagance. My wife is well-employed, well respected and absolutely loves what she does. It was time.I sent my patients 30 day notice letters, and placed an ad in the local paper for two weeks. I sold the equipment I could and stored the rest with my charts. Fortunately, in Washington, you only have to provide records for one year after you retire.I miss doing patient care, and I miss being involved in people's lives. I DO NOT miss having to come up with workable soluttions to impossible problems, only to have the patient ignore me. I DO NOT miss Obama lying about me and how I take care of patients. And I DO NOT miss sitting in endless, stupid hospital meetings that make zero difference in anything.You will have guilt if you see former patients at the store or the fair, as I do. Now, 1 1/2 years later, patients still ask me if I might re-open because they face 2-4 MONTH waiting times to get an appointment.( I was always same day). I feel bad about that, but I didn't make the system. I did the best I could till I couldn't anymore.I owe over 100K from med school, 200K from opening my own FP practice and credit cards on top of all of that. In my wildest nightmares, did I ever envision my financial life going this way. I have a good practice (have been voted "best doc" in my community twice) but can't make any money.I am getting radical. We are downsizing from a 400K house to a "manufactured home" for about 75K. I plan on being totally debt-free in 3-5 years by living very frugally. I am 42 so I figured I still have some time. I too looked at the employment route. It sucks the life out of me just talking to those organizations..they completely squash your independence.I just closed mine after 15 years - be glad you saw the light in only 5 years. Almost destroyed my marriage even though husband has been running office since day 1. Working for someone is not fix unless you want a CPA to tell you see more patients. It is only going to worsen until dr.s stop allowing non-docs control their every move as you put so well. It is brainwashing - get out now. You will be fine and just hanging in there till it improves is not the solution. Don't destroy your life outside of medicine - the most demanding/difficult patients couldn't give a damn about me as my closure proved.I fully understand where you're coming from, Gabrielle. Years ago a younger physician told me that he felt sorry for because I had been in medicine long enough to remember when it was actually good. I spent 25 years in private practice, mostly solo in smaller cities, and I can honestly say the first 6 or 7 were very fulfilling. Sad, isn't it?I quit two years ago and started doing locums exclusively. I wish I had done it sooner. I work two weeks per month and make more than I did trying to squeeze money out of third parties full time+.A couple practical tips. I was told that I should keep the charts until the statute of limitations is up. Unfortunately that is a moving target in some states so the only sure thing is to keep them at least seven years or until any pediatric patients have turned 21. I had 75 cases of charts in my basement for many years. BTW forget scanning the charts. On one occasion I closed a satellite office. Prior to a move I tried to combine those charts with the main office. Three of my kids spent every spare moment they had for two weeks at my office shredding just the duplicate pages. We generated eight dozen large trash bags of shreds and burned out two shredders.I feel your pain. I am 22 days away from turning 40 (for which I could not care less) but I have almost completed my third year on my own, being a solo physician with over 180K in personal med school debt, not to mention the 275K business loans. I had a busier year last year, grossed close to 500K, and my take home pay was 82K. I have no retirement, I average 4 hours of sleep, and I have to deal with patients throwing it in my face that if I can't see them in a reasonable time frame (within 24 hours on my scale, theirs it is within 2-3 hours that they call) they will take their business elsewhere. I feel your pain.Also, not to start throwing mud, but I was floored when I read rowingcardion respose. I am sorry, but I would not have sleepless nights if I got specialist reimbursements. I would speculate that a cardiologist salary is light years away from what I could dream about. Give me a break, I have to fight with insurance companies to validate my removing a malignant mole, and I might see $100 for the time an effort, but let's just whip up a cath and sit back and watch the dollar signs flow!Good luckI wish the general public could see the litany of problems, complaints, and general despair of physicians in private practice which are posted on this web site. What an illuminating collection of letters!!!!Your last paragraph was EXACTLY the way that I felt 2 years ago when I was 42. I think docs our age have watched the practice of medicine crumble in front of our eyes feeling like we can't do a thing about it unlike our older peers who actually experienced some joy in practice before this last decade and a half of massive changes in how medical care is given and paid for. One year ago I started a direct practice (cash-based) and have not signed any contracts with any insurance company or government programs. We file out of network on behalf of the patient. I admit patients to a hospitalist. Granted, it is a slower start, but I have found some wonderful patients who enjoy the slower-paced, personal care and I am doing things that I would never have dreamt of doing in the past within our community as well as other personal projects. I've never been happier in my career or in my marriage, but we aren't going to get rich doing it this way! I just hope that I can continue when/if reform hits.The 3rd party insurers, lawyers, and our government have destroyed the practice of medicine in this country while the majority of us sat back and watched. I watched almost all of my colleagues get lured in by the HMO's back in the early 1990's only to have their reimbursement be chopped after a few years and have the HMO's control how they practice. We have watched insurance companies take over control of the medical care market . Most of us thoroughly enjoy the pure practicing of medicine, but this is not economically feasible in this country anymore for primary care physicians. The general public still views doctors as fat cats who make a lot of money, when in realty, you have to struggle to pay your overhead in all the primary care fields. As said in a previous note, everybody wants quality care, but few want to pay for it. When you go into medicine you give your life to the profession, and it is definitely not worth it as it takes a toll on your family, your health, and your enjoyment of life. Isn't it time to take back our profession from the insurance companies and government. As more and more physicians quit medicine, who does the government think is going to provide the medical care. I guess they will just do more outsourcing. The poliiticians don't care since they get excellent benefits. We, as tax payors get to pay their salary and their benefits. I left medicine in the end of 2003. I miss taking care of patients, but all the other crape was just not worth it. So what is the next step???Agree with cmorestuff. It's reality. It is the rude awakening of those who are a bit too altruistic that keep trying to maintain a standard of care, and are doing triple time to overcome the damage by all those whose priorities have changed from patient care to insurance sucking up. Look at the recent plethora of posts on the AMA thread the other week. I only speak for me, but I am very disheartened what has happened in the field of medicine. We are devolving ourselves into extinction as physicians. Soon healthcare providers will be almost anyone who can spell their name and find a niche schtick to hang up a shingle. Marcus Welby, MD, come back!Agree though with others to keep your licensing, etc up to date and paid for. Take a time out (no, you don't have to sit on the step or go to your room). Did you have a job in the past or during college you could do part-time to just bring in some monies? There are also NON-CLINICAL physician jobs around. Hard to find the good ones, but they do exist. Just step a side for a while and catch your breath. Don't make any definitive decisions while you feel like this. You are also fortunate that there are many Sermoites who are not just sympathetic (too social workish), but empathetic (a higher ego function that doesn't get enmeshed like MSWs, etc..), or like Counselor Troi, no, she wasn't a doctor, she was only half Betazoid.Hang in there kiddo, many of us are in your boat, we're just invisibile. If you hear mumbling, you are not hallucinating, it's just SERMOITES homing in on you to help you however they can!