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Accepting New Patients

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Approved by Council: November 2008
Reviewed and Updated: April 2009, May 2017, May 2019, May 2025

Companion Resource: Advice to the Profession

 

Policies of the College of Physicians and Surgeons of Ontario (“CPSO”) set out expectations for the professional conduct of physicians practising in Ontario. Together with Essentials of Medical Professionalism and relevant legislation and case law, they will be used by CPSO and its Committees when considering physician practice or conduct.

Within policies, the terms ‘must’ and ‘advised’ are used to articulate CPSO’s expectations. When ‘advised’ is used, it indicates that physicians can use reasonable discretion when applying this expectation to practice.

Additional information, general advice, and/or best practices can be found in companion resources, such as Advice to the Profession documents.
 

Definitions

Discrimination: An act, communication, or decision that results in the unfair treatment of an individual or group, for example, by excluding them, imposing a burden on them, or denying them a right, privilege, benefit, or opportunity enjoyed by others. Discrimination may be direct, indirect, intentional, or unintentional.

Good faith: A legal term that means a sincere intention to act in an honest, fair, and decent manner with others.

High or complex care needs: High or complex care needs include, but are not limited to, conditions or needs requiring urgent care; chronic conditions or comorbidities, particularly those that are unmanaged; activity-limiting disabilities; and/or mental illnesses. Social determinants of health may also contribute to patients’ high or complex care needs.

Policy

  1. Physicians are permitted to decide:
    1. Whether their practice is accepting new patients; and
    2. Which patients to accept into their practice.
    These decisions must be made in good faith and in accordance with this policy.
  2. Physicians must not refuse to accept patients based on any of the prohibited grounds of discrimination set out in the Ontario Human Rights Code.
  3. Physicians must not refuse to accept a patient solely on the basis that the patient has:
    1. High, complex, or chronic health-care needs;
    2. A history of prescribed opioids and/or psychotropic medication;
    3. Needs that require additional time to manage;
    4. A physical or mental health condition or disability that may require the physician to prepare and provide additional documentation or reports; and/or
    5. Beliefs or ideologies which do not align with the physician’s own and which may impact the patient’s therapeutic choices.
  4. Physicians are permitted to establish criteria for accepting new patients. These criteria must:
    1. Be directly relevant to the physician’s clinical competence, scope of practice, and/or focused practice area;
    2. Comply with the terms and conditions of the physician’s certificate of registration and associated practice restrictions, if applicable;
    3. Be fair and promote equitable access to health-care services;
    4. Be clearly communicated to prospective patients seeking care; and
    5. Be shared with CPSO, on request. 
  5. Where physicians refuse to accept a patient, they must:
    1. Do so in good faith;
    2. Clearly communicate the reasons for the refusal to the patient; and
    3. Document the reasons for the refusal.
  6. Physicians are permitted to prioritize patients with high or complex care needs, family members of current patients, and those belonging to priority populations. Physicians must use their professional judgment to determine whether prioritizing patients is appropriate, taking into account the patient’s health-care needs and any known social factors that may influence the patient’s health outcomes (e.g., social determinants of health). 
  7. Physicians may determine, on rare occasions, that they are unable to accept a patient into their practice after an intake appointment has taken place. In these situations, physicians must: 
    1. Ensure that their reasons for refusing the patient are not discriminatory, in accordance with Provisions 2-3 of this policy;
    2. Inform patients, as soon as possible, that they have not been accepted into the practice;
    3. Clearly communicate the reasons for the refusal to the patient, in accordance with Provision 5b of this policy; and 
    4. Document the reasons for the refusal, in accordance with Provision 5c of this policy.
 

Endnotes

  1. For more information, see the Ontario Human Rights Code, R.S.O. 1990, c H.19.

  2. The expectations set out in this policy apply broadly to physicians and to those acting on their behalf. For instance, physicians may rely upon clinical managers and/or office staff to accept new patients on their behalf. Organizations may also act as a physician’s representative in this context.

  3. Prohibited grounds of discrimination (also referred to as “protected grounds”) include age; ancestry, colour, race; citizenship; ethnic origin; place of origin; creed; disability; family status; marital status; gender identity; gender expression; receipt of public assistance; record of offences; sex; and sexual orientation. For more information, see the Human Rights Code (“Code”) and CPSO’s Human Rights in the Provision of Health Services policy.

  4. Physicians are advised to consult CPSO’s Prescribing Drugs policy for further information on blanket ‘no narcotics’ prescribing policies.

  5. Physicians should be aware that under the Code, the term ‘disability’ is interpreted broadly and covers a range of conditions. ‘Disability’ encompasses any degree of physical, mental and learning disabilities, mental disorders, hearing or vision disabilities, epilepsy, drug and alcohol dependencies, environmental sensitivities, and other conditions. The Code protects individuals from discrimination because of past, present and perceived disabilities.

  6. This could include, for example, the decision to refrain from being vaccinated or the decision to have an abortion.

  7. Physicians with a ‘focused practice area’ may include those with a commitment to one or more specific clinical practice areas, such as geriatrics, psychotherapy or adolescent health, or who serve a defined target population.

  8. Physicians who are not accepting patients or whose practice is closed to new patients are not required to inform patients of any criteria they use or have used for accepting patients.

  9. While the policy permits physicians to prioritize family members of current patients, physicians are not required to do so. It may be inappropriate for physicians practising in certain specialties (e.g., psychiatry) to accept family members of current patients into their practice.

  10. The Public Health Agency of Canada defines “social determinants of health” as a specific group of social and economic factors (within the broader determinants of health) which relate to an individual’s place in society such as income, education, or employment. For more information, see Social Determinants of Health and Health Inequalities.

  11. For more information on intake appointments, see Advice to the Profession: Accepting New Patients.