Family Medicine Practice Overhauls Patient Dismissal Process

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Clinicians at an academic family medicine practice in upstate New York serving more than 25,000 patients revised their patient dismissal process after a review found that all immediate dismissals during a six-month period involved Black patients, who represent about 36% of the practice population. The clinic replaced the expedited dismissal approach with a structured review process led by an interdisciplinary Practice Concerns Review Committee.

Why it matters

The redesign aimed to address racial disparities in patient dismissals and create a more fair and patient-centered approach, moving away from defaulting to warning letters or dismissal and instead focusing on patient engagement, shared problem solving, and early intervention.

The details

Rather than immediately dismissing patients, the new approach centers on patient engagement, shared problem solving, collaborative planning, and early intervention. Strategies include offering one-time clinician changes, scripting communications, and equipping the team with tools for boundary setting and difficult conversations. The authors compared behavior-concern referrals reviewed during a six-month pre-intervention period (January–June 2021) with the same six-month period after implementation (January–June 2023), finding referrals declined from 87 to 24 and no immediate dismissals occurred in the later period, with no racial disproportionality observed.

• The clinic revised its patient dismissal process in January 2023.
• The authors compared data from January-June 2021 (pre-intervention) to January-June 2023 (post-intervention).

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