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CPSO publishes new draft policy on closing a medical practice

Elyse Sunshine
Lonny Rosen

By Elyse Sunshine and Lonny Rosen

The College of Physicians and Surgeons of Ontario (CPSO) is currently reviewing and updating its policy, Practice Management Considerations for Physicians Who Cease to Practise, Take an Extended Leave of Absence or Close Their Practice Due to Relocation (the Current Policy), that sets out expectations for physicians with respect to the steps they should take before they stop practising medicine or in situations where they will not be practising for an extended period of time. At its first meeting of 2018, CPSO’s Council approved an updated and newly titled Closing a Medical Practice draft of this policy (the Draft Practice Closure Policy) that is now being circulated for external consultation. Below, we provide a summary of the key changes in the Draft Practice Closure Policy.

Key changes in the Draft Practice Closure Policy

As explained by the CPSO on their website, the Draft Practice Closure Policy retains the key content and central principles of the Current Policy, such as physicians’ obligations to facilitate continuity of patient care and notification obligations, but also touches on issues not currently addressed by the Current Policy. In addition to addressing these new issues, the goal of making changes to the Draft Practice Closure Policy was to enhance clarity, comprehension and flow in response to research, feedback obtained through a preliminary consultation that ended in August 2016, and trends observed in the context of the CPSO’s ongoing regulatory work.

The key changes to the Draft Practice Closure Policy can be summarized as follows:

- The policy will apply only to physicians who are permanently closing a medical practice for one of a variety of reasons including retirement, resignation, relocation, revocation of a member’s certificate of registration by the CPSO, or sudden illness or death of a physician. Temporary absences from practice will be addressed in other policies that are currently under development.

- With respect to physicians who are closing their medical practice due to relocation, the CPSO requires that the physician comply with the notification requirements set out in the policy, but only requires the physician to meet the expectations regarding facilitating continuity of care for patients who are not moving to the relocated practice.

- All physicians are advised to take steps to ensure their medical practice is appropriately managed in the event of an unexpected illness or death, including identifying a designate to facilitate compliance with the policy in the event the physician is unable to do so.

- The CPSO now expects physicians to provide a minimum of 90 days’ notice to patients to whom they are actively providing care prior to a planned practice closure. Physicians are also expected to provide notice to hospitals or other facilities where the physician holds privileges, employers, and to the CPSO. The policy sets out specific requirements regarding the contents of the notice, timelines for providing it, and acceptable methods of notification.

- The policy sets out steps that physicians must take when closing a medical practice to minimize the impact on patients and to not impede their ability to access care, including:

    • Arranging ongoing care by being as helpful as possible to the patient in finding a new health care provider, recognizing that certain patients may require additional assistance
    • Ensuring that patients have continued access to their medical records, as required under the Personal Health Information Protection Act, 2004
    • Facilitating access to prescription medication, by providing the patient with renewals or repeats of the required medication(s) where medically appropriate in order to allow the patient reasonable time to find alternative care, or arranging for or advising the patient to attend another physician as soon as possible to have their prescription(s) renewed
    • Advising patients that repeats or renewals for prescriptions written prior to the date of the resignation or revocation, and standing orders for laboratory or other tests, will not be legally valid after the date of resignation or revocation

Next steps

The Draft Practice Closure Policy is being circulated for external consultation until April 30, 2018. The CPSO is inviting feedback from all stakeholders, including members of the medical profession, the public, health system organizations and other health professionals. Comments can be submitted through the CPSO’s discussion forum, via email, by completion of an online survey, or through regular mail. The CPSO has indicated that it will carefully review the feedback obtained and use it to evaluate the Draft Practice Closure Policy. All feedback received during the consultation and the final draft policy will be posted on the CPSO’s website before it is considered for final approval by Council. It appears that the CPSO also intends to publish a FAQ document setting out information about specific practice closure scenarios to accompany the finalized policy. We will provide more information on our blog as it becomes available.

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