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Most patients are happy with their choice of doctor. They appreciate the job their doctors do. There’s a mutual respect.  

If only that were the case with all patients. 

I spoke with one surgeon last week. He admitted if he had known how difficult one patient would have been, he would have prevented her from scheduling an appointment. In fact, with the benefit of hindsight, he would have actually paid her to never come to his office. Or more preferentially, to have encouraged her to schedule with another surgeon.  

The surgery was performed within the standard of care. The objective results were quite good. Perfect? Well, no. Almost no surgery is done perfectly. We get close. But perfection is an elusive goal.  

This patient then became disrespectful to the doctor. To the staff. She was demanding. Loud. Threatening.  

The magic was gone. 

The surgeon said it would be worth paying her $500 or even $1,000 to go away. He had nothing else to offer her medically. And he just wanted to be left in peace and tend to his other patients who valued his time.  

Normally people are paid for doing something. For an action or activity. For labor. 

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. 

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 similar type of program. 

Once a year, the company offers to pay full-time associates at Amazon fulfillment centers up to $5,000 to leave the company. Employees are eligible after one year of service, but there is a caveat: Those who accept the offer can never work at Amazon again. 

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

The company offers $2,000 to employees who have been at the company one year, and the offer increases by $1,000 per year of tenure, maxing out at $5,000. 

Amazon claims that they don’t actually want employees to accept the offer. In fact, the headline on the memo states “Please Don’t Take This Offer,” according to founder and CEO Jeff Bezos

But according to 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,” it actually enhances employee engagement and is cost-effective in the long run. 

Burchell says that employee engagement tends to be about two things: commitment to stay and discretionary effort. While Pay to Quit may not necessarily push employees to work harder, he says, it does address the issue of commitment to stay. 

“If you choose to actually not take the money and you choose to stay, it means that you’re committed to the organization and committed to your work,” says Burchell. “It helps to frame the employer/employee bargain or that psychological contract.” 

Disengaged employees cost their company about 34% of their salary. A disengaged employee making $50k/yr 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 in the hopes of long-term benefit. 

Back to where we started, what is the cost of having to manage a disgruntled patient who is loud, aggressive, disrespectful, angry, and a time-suck (assuming there is nothing medically different that can be done for him/her)? Hard to say. But there is definitely a psychic cost, if not an actual economic cost. 

I can see why some doctors would pay select patients to quit. 

The elephant in the room – patient abandonment is serious business. Before terminating a relationship with a patient, you must ensure continuity of care. We’ve already published a piece that addresses some of the high-level issues at play. 

Implementing bullet-proof patient dismissal letters will save you time and money – and potential lawsuits. Medical Justice has perfected such documentation. Member doctors benefit from a bevy of other powerful medico-legal resources. 

Click here to discover the benefits of membership – or click here to join now… 

What do you think? Join the conversation developing below… 


Jeffrey Segal, MD, JD, FACS

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.

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