There are times when every physician needs a colleague to cover his or her practice. Whatever the reason for a physician’s absence from work (such as vacation or illness), patients’ uninterrupted access to medical care via their doctor’s office must be guaranteed.

The proper arrangements require more than a verbal agreement between two physicians, however. In order to minimize the professional liability risks for both doctors, all coverage arrangements must be thoroughly discussed, outlined and documented. Again, the primary goal is to ensure seamless healthcare services to patients while the treating physician is away.

The ABCs of coverage arrangements
Practice coverage arrangements are not only important for solo physicians; doctors in group practices should have formal arrangements with their associates as well. It is not enough to let a partner pick up the slack whenever necessary—there should be a plan in place that outlines the specifics.

For solo physicians, there is a critical caveat: Always verify the extent of professional liability coverage of the potential covering physician. Further, ensure that the covering physician has privileges at the same hospital.

Solo physicians should draw their substitutes from the same medical specialty as their own, or at least from another specialty that is appropriate to the situation. In all cases, substitutes should have the necessary training to take over. If a gynecologist, for instance, arranges for coverage by a family practitioner, and a patient requires a specialized procedure that the family practitioner cannot perform, the gynecologist may be sued. Another liability concern surrounds the issue of accessibility. All treating physicians must be sure to provide the hospital and answering service with the dates of their absence. They must also provide the name and phone numbers of the covering physician. A physician who takes time off and fails to provide this information to the appropriate parties has failed to fulfill an important obligation and may be sued.

Of course, there are certain circumstances beyond the covering physician’s control that may prevent him or her from seeing a patient in need (e.g., beeper malfunction, traffic jam). In these rare events, it is unlikely that either physician could be proved negligent. In any case, in addition to having a primary covering physician, it is a good idea to have a secondary one for those times when the primary covering physician is unavailable.

Communicate with patients
Patients, especially those who are in the hospital or who can be expected to call with pending medical issues, should be informed of coverage arrangements up front. Hospitalized patients, in particular, should be introduced to the covering physician, if possible.

Treating physicians should also provide covering physicians with a list of patients with anticipated problems, and advise them of the course of treatment during the coverage. This should be documented in the patients’ medical records.

Further, coverage arrangements should specify who will bill the patient. The treating physician should inform the patient of this decision.

Prescription refills
Tying up loose ends before taking time off requires specific attention to prescription refills. The following tips include advice and recommendations from the American Academy of Family Physicians:

• Leave standing orders for prescription refills with the covering physician or with your nurse. This will help limit delays and confusion for patients needing medication in your absence
• Have the nurse keep a master log of prescription refills that includes patient name, medication, dose and quantity refilled. Review the log upon returning to the office, and record the information in patient charts or consult the log during your next appointment with the patient.
• Give appropriate patients sufficient refills on chronic medications that are safe and do not require follow-up visits
• If the requested medication has the potential for misuse, advise the covering physician to pull the patient’s chart to review the refill history, including phone message refills. When in doubt, the covering physician should give a partial refill to maintain the patient’s regimen until you return. Also, the covering physician may consider offering the patient an appointment that day to better understand his or her usage pattern.
• Covering physicians should refill prescriptions only if they are comfortable in their knowledge of the medication and the disorder it is intended to treat. It is acceptable and perhaps even more effective to say, “I’m not comfortable doing that” than “I won’t do that.” Where indicated, recommend and document appropriate subspecialty followup for the patient.
• If the covering physician is not familiar with the medication being refilled, he or she should look it up.

Conclusion
Careful planning and communication are prerequisites for any physician contemplating taking time off from practice. With close attention to a few details, practice coverage arrangements can ensure the best possible service for patients and peace of mind for physicians.