Providing Physician Services During Job Actions

Policy Number:#1-14
Policy Category: Practice
Under Review: No
Approved by Council: September 1999
Reviewed and Updated: September 2010; March 2014
College Contact: Physician Advisory Service

Downloadable Version(s): Providing Physician Services During Job Actions


Physicians provide the people of Ontario with quality health care on a daily basis and are committed to delivering this care in an ethical and professional manner. However, there may be rare instances where physicians consider withdrawing their services as part of a job action.

Physicians are aware that their decision to withdraw services can have significant negative implications for individual patients, specific patient populations and/or the public at large. Withdrawal of physician services may expose patients and/or the public to risk of harm, and may compromise physicians’ ability to fulfil their professional responsibility to patients and their collective responsibility to the public. In addition, when the withdrawal of physician services puts patients and/or the public at risk of harm, it negatively impacts the public’s trust in the profession. As such, physicians must give serious consideration to any contemplated withdrawal of services and act in accordance with the principles and expectations set out in this policy.

This policy sets out expectations for physicians who contemplate and/or undertake a withdrawal of services during a job action. These expectations are consistent with the values, principles and duties of medical professionalism in the Practice Guide, and reflect the profession’s ongoing commitment to care for patients.


This policy articulates the College’s expectations regarding the provision of physician services during job actions.

Physicians who cease to provide medical care for other reasons, such as when ending a physician-patient relationship, taking a leave of absence, retiring from practice or choosing not to provide care in a health emergency, should refer to the relevant College policies on these specific topics for further information.1


Job Actions: Job actions occur when physicians, individually or collectively, take some sort of action (e.g., participate in a work slowdown or a withdrawal of services, etc.) in order to protest or to raise awareness about concerns they have, with the ultimate goal of resolving those concerns.
Job actions can occur for various reasons, including those related to: patient safety, practice environments (e.g., concerns about work environments and/or conditions, such as on-call schedules, available resources, hospital administration, etc.) and/or compensation. 

Withdrawal of Physician Services: Withdrawal of physician services occurs when physicians limit the services they provide in the context of a job action. Withdrawal of services can vary in degree, from narrow or localized activities, such as declining to take on-call shifts in circumstances where appropriate coverage would otherwise be lacking, to broad, more significant actions, such as a complete withdrawal of all medical care.


The key values of professionalism – compassion, service, altruism and trustworthiness, as articulated in the Practice Guide – form the basis for the expectations set out in this policy. Physicians embody these values and uphold the reputation of the profession by:

  1. Always acting in the best interests of patients;
  2. Fulfilling their professional responsibility to individual patients and collective responsibility to the public;
  3. Demonstrating their commitment to service by ensuring safe medical care is provided to those in need; and
  4. Maintaining public trust in the profession by ensuring patients are not abandoned and the public has access to medical care.


Physicians must fulfil their professional responsibilities and uphold the reputation of the profession by providing services to those in need during job actions, as set out in this policy. Given the significant negative implications a withdrawal of physician services can have on patients and/or the public, the decision to participate in a job action cannot be made lightly. 

When contemplating a job action, physicians must first explore all alternative options2 that may be available to resolve the concern that has motivated their desire to withdraw services. If the concern cannot be resolved, physicians must consider the following before making the decision to withdraw their services:

  • What is in the best interests of patients;
  • Whether patients will be abandoned;
  • Whether the public will be deprived of access to medical care; and
  • Whether patients and/or the public will be placed at risk of harm.

If after carefully considering the above factors, physicians decide that proceeding with a withdrawal of services is not contrary to their professional responsibilities,3 they must mitigate the adverse impact of the withdrawal on patients and/or the public.

Notwithstanding the above, the College expects that during a job action, physicians will provide medical care that is urgent or otherwise necessary to prevent harm, suffering and/or deterioration. This will include ensuring health-care concerns are assessed and appropriately triaged so that urgent and/or necessary medical care can be obtained.

What constitutes urgent and/or necessary medical care to prevent harm, suffering and/or deterioration is a matter to be determined by a physician’s clinical judgment, and will be informed by the existing health status and specific needs of individuals, and physicians’ individual and collective responsibilities to provide care.4

If any concerns arise regarding the provision of physician services, or lack thereof, during job actions, the College will consider them in accordance with its duty to serve and protect the public interest.5


  1. Ending the Physician-Patient Relationship; Practice Management Considerations for Physicians Who Cease to Practise, Take an Extended Leave of Absence or Close Their Practice Due to Relocation; Physicians and Health Emergencies.
  2. The options would vary depending on the nature of the concern and circumstances of each case. For example, in a clinic or hospital setting, physicians could consult with an ombudsperson, relevant committee, senior management, board of directors, etc., in accordance with its established policies/procedures, as applicable. In the context of fee negotiations between the Ministry of Health and Long-Term Care (MOHLTC) and the Ontario Medical Association (OMA), physicians could proceed with the facilitation and conciliation process set out in the MOHLTC-OMA Memorandum of Agreement.
  3. Physicians may want to obtain independent legal advice from the Canadian Medical Protective Association (CMPA) or legal counsel regarding their legal responsibilities.
  4. Physicians’ individual and collective responsibilities refer to the ethical and professional obligations physicians have, as articulated in the College’s Practice Guide on pages 2, 3 and 6.
  5. Section 3(2) of the Health Professions Procedural Code, Schedule 2 of the Regulated Health Professions Act, 1991, S.O. 1001, c.18.