Responsibilities for patient care in principal-associate arrangements

Originally published in the November/December 2012 issue of Dispatch

It is not uncommon for the owner or owners of a dental practice to engage the services of associate dentists, whether general practitioners or specialists. The practice owner or principal may own more than one office, and may or may not practise at any of these locations.

In these principal-associate arrangements, it is not unusual for questions to arise about the responsibilities for patient care, access to dental records, and records retention in such arrangements.

Dental practice in a group practice setting should emphasize quality and continuity of care, where the patient’s history, expectations, stage of treatment and necessary follow-up are all of paramount importance. This may be compromised in a setting where a principal is absent and/or no particular practitioner is able to act as the most responsible dentist.

As associates enter and leave the practice, it may become difficult to provide multiple phase treatment, and it is entirely possible that necessary or urgent care will be delayed or neglected.

Whether or not the principal practises in a given office, the associate is still responsible for meeting his/her professional obligations to patients and providing appropriate care that meets the standards of practice. Ideally dental services will be provided in the context of comprehensive treatment planning.

Termination of a principal-associate relationship or disputes between dentists must not be allowed to impact the ongoing treatment of patients or adversely affect their right to receive care from a dentist of their choice. As a result of problems between dentists, the patient may end up receiving only intermittent emergency management rather than consistent, properly sequenced treatment.

Unless requested by the patient or alternate arrangements are made, discontinuation of dental services without reasonable cause must be avoided and the patient should have an opportunity to arrange for continuing care, including any dental emergencies, in the event that there is a breakdown of a principal-associate relationship.

It may be prudent to include transition terms in a written principal-associate agreement, with particular reference to such issues as completion of treatment in progress, handling changes to a treatment plan and/or how re-treatment needs will be addressed. These terms would be especially important in the event that the principal or other associates in the practice are unable to accommodate additional patients or in situations where a patient is in the midst of a complex treatment plan at the termination of a principal-associate arrangement.

Regardless of whether there is a previous written agreement, at the end of a principal-associate arrangement, it may be possible for the associate to be accommodated at the principal’s office for a specified period of time or for the patient to attend at the associate’s new location for completion of some or all of the treatment.

It may also be helpful for the associate to have the option of negotiating contractual rights of access to original patient records to facilitate completion of certain cases. Should patients elect to seek treatment at an office that does not have direct access to their records, the patients would be required to consent to their release.

It is always best for patients to be informed if they will be seeing a different practitioner than planned prior to their next scheduled appointment.

The principal must provide the associate’s new practice location to any patients who request it.

The associate is responsible for care he or she has provided to a patient, and if the patient has concerns or complaints about treatment that the associate has provided it is best for the patient to have the opportunity to address these directly with the associate.