Busy does not mean better. Learning from patients who Choose to Leave.
In primary care, patient growth can look healthy on paper, while the reality tells a different story. Gaining 80 new patients a month feels like momentum, but quietly losing 25 in the same period should trigger curiosity, not resignation. Too often, clinics accept patient transfers as inevitable and simply move on. That is a missed opportunity. If you are serious about building a sustainable, patient-centred practice, every departure is data and every conversation is a chance to improve how you serve people.
A full appointment book does not automatically equal quality care or compatibility. High demand can mask underlying misalignment between practitioner and patient needs. When appointments are rushed, expectations are unclear, or the model of care does not suit the individual, dissatisfaction can build quietly even while the calendar looks full. Retention is a far better indicator of success than volume alone. Compatibility, trust and continuity of care are what keep people engaged long term. Paying attention to why patients leave helps ensure your growth is not just busy, but sustainable and aligned with the type of care you are trying to deliver.
The first mindset shift is remembering that we are not in the business of managing enrolments, we are in the business of caring for people. When someone chooses to leave your clinic, they are not just transferring records, they are ending a relationship. Treating that moment with respect, openness and curiosity can provide insights you will never get from dashboards or reports alone.
Instead of letting patients go quietly, design a process to learn from them. A short, thoughtful survey is a good starting point. Ask the questions you genuinely want answers to. Was there anything we could have done better? Did you feel listened to and supported? Were appointment availability, cost, location, or communication factors in your decision? Was there a specific moment that influenced your choice to move? Keep the tone neutral and non-defensive. This is not about justifying your practice, it is about understanding the patient experience.
However, surveys alone are often not enough. Many patients are busy, unwell, or emotionally checked out by the time they decide to leave. Asking them to complete “one more thing” after they have already broken up with your clinic may feel unrealistic. This is where picking up the phone matters. A brief, respectful phone call can achieve far more than a form. It signals that you care enough to listen, even when the relationship may be ending. These conversations often reveal nuance that no tick-box survey ever will.
In our own nurse practitioner clinic, we assumed a number of patients were transferring out because we did not have a GP on site. Rather than guessing, we asked. We surveyed and personally spoke with 130 patients who had chosen to leave. Only two moved because of the absence of a GP and in both cases this followed incorrect advice from a specialist who told them they needed to be under GP care, which was not clinically accurate. Without asking, we would have continued to believe, and possibly act on, the wrong assumption. In some cases, patients were automatically enrolled when visiting weekend accident and medical clinics.
Once you gather this information, the real work begins. Data without reflection is wasted. Look for patterns. Did many of the patients who transferred live outside your local area? If so, geography may be a bigger factor than you realised. People are often happy to travel once or twice when they are well, but when they are sick, tired, or facing heavy traffic, convenience suddenly matters. If this is the case, consider tightening enrolment criteria to focus on your immediate district. This protects continuity of care and reduces avoidable attrition.
If cost emerges as a recurring reason, that is not always a pricing problem, it is often an expectation problem. Clear, upfront education about fees saves frustration for patients and significant administrative time for your team. Transparent communication allows people to make informed choices early, rather than disengaging later after resources have already been invested.
Sometimes the feedback will tell you something harder to hear - that your clinic simply was not the right fit. This is not failure. Not every practitioner is right for every person and forcing alignment helps no one. When this pattern appears, consider how you can better educate prospective patients before they enrol. Creating a simple checklist or blog such as “What to ask when choosing a nurse practitioner or healthcare provider” empowers patients to self-select into care that genuinely suits them. This reduces future transfers and improves satisfaction on both sides.
The most important part of this process is openness to criticism. Feedback is only useful if you are willing to hear it without defensiveness. Patients are often far more generous and thoughtful than we expect when they feel respected and listened to. Even difficult comments can highlight small changes that make a big difference to the patient experience.
Reducing patient transfers is not about preventing people from leaving at all costs. It is about learning why they leave, improving how you serve those who stay, and designing a practice that aligns with the realities of people’s lives. When you treat departures as learning opportunities rather than losses, your clinic becomes stronger, more intentional, and more sustainable over time.