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Availability and Coverage

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Approved by Council: September 2019

Companion Resource: Advice to the Profession

 

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

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

 

Definitions

Sustained physician-patient relationship: A physician-patient relationship where care is actively managed over multiple encounters.

Temporary leaves of absence: Vacations and leaves of absence (e.g., parental leave, educational leave),1 as well as unplanned absences due to, for example, illness or family emergencies.

 

Policy

Being Available by Phone (or other means)

  1. Physicians must have an office telephone that is answered and/or allows voicemails to be left during regular business hours.2
  2. Physicians must ensure that the outgoing voicemail message is up to date and accurate, indicating, for example, office hours, any closures, and relevant information regarding coverage arrangements or access to appropriate care outside of regular office hours and during temporary absences from practice.
  3. Physicians must ensure that voicemail messages are reviewed and responded to in a timely manner. What is timely will depend on, for example, when the message was left and the impact to patient safety that may be caused by a delay in responding.
    1. Physicians who offer electronic means of secure communication3 must similarly ensure that messages are reviewed and responded to in a timely manner.

Communicating with Other Health-Care Providers

  1. Physicians must respond in a timely manner when contacted by other physicians or health-care providers who want to communicate or request information about a patient. What is timely will depend on, for example, the impact to patient safety that may be caused by a delay in responding.
  2. Physicians must include their professional contact information when ordering a test, writing a prescription, or making a referral4 and must provide relevant coverage contact information directly to other health-care providers (e.g., laboratories, diagnostic facilities) where it is appropriate to do so.

Facilitating Access to Appointments

  1. Physicians providing care as part of a sustained physician-patient relationship must structure their practice in a way that allows for timely access to appointments for urgent or time-sensitive issues.

Supporting Access to Appropriate After-hours Patient Care

  1. Physicians providing care as part of a sustained physician-patient relationship must inform patients of when and where to access appropriate care outside of regular office hours (e.g., Telehealth, local walk-in clinics, emergency department, any coverage arrangements that have been made5, etc.).6

Managing Care During Temporary Absences from Practice

  1. Physicians who will be unavailable during temporary absences from practice must make specific coverage arrangements with another health-care provider(s) to:
    1. Receive, review, and provide or coordinate immediate care that is required during the temporary absence for all outstanding tests; and
    2. Receive, review, and provide or coordinate immediate care that is required during the temporary absence for outstanding consultation reports.
  2. Physicians must also have a plan or coverage arrangement in place that allows other health-care providers to communicate or request information pertaining to patients under their care during temporary absences from practice.
  3. Physicians providing care as part of a sustained physician-patient relationship must make reasonable efforts to arrange for another health-care provider(s) to provide care to patients during planned temporary absences from practice. What is reasonable will depend on, for example, the length of the absence, the needs of the physicians’ patients, and the health-care provider and/or health system resources available in the community.
    1. If specific arrangements are made, physicians must inform patients seeking care during the temporary absence of these arrangements;7 or
    2. If after reasonable efforts are made it is not possible to make specific arrangements, physicians must inform patients seeking care during the temporary absence about appropriate alternative access points of care (e.g., Telehealth, local walk-in clinics, emergency department, etc.).

Coordinating Coverage for Critical Test-Results

  1. Physicians must ensure that critical test results8 can be received and reviewed at all times, including outside of regular office hours and during temporary absences from practice, and that appropriate steps can be taken to notify patients if immediate emergency intervention is required.
 

Endnotes

1. This does not include suspensions of a physician’s certificate of registration. For expectations relating to suspensions, please see the Closing a Medical Practice policy.

2. In a group practice, institutional, or departmental setting, there may be a common phone and voicemail system shared among a number of physicians.

3. For example, e-mail or a messaging portal. All communication must comply with privacy legislation, including, the Personal Health Information Protection Act, 2004 S.O. 2004, c. 3 Sched. A. (hereinafter, PHIPA).

4. See the College’s Managing Tests, Prescribing Drugs, and Transitions in Care policies for more information.

5. This would include any after-hours or weekend coverage arrangements that are made as part of contractual agreements with the Ministry of Health and Long-Term Care.

6. Provision 2 of this policy sets out expectations regarding the type of information that is appropriate to include on an outgoing voicemail message. Otherwise, the policy is not prescriptive about how physicians must inform patients and allows for flexibility.

7. Again, provision 2 of this policy sets out expectations regarding the type of information that is appropriate to include on an outgoing voicemail message. Otherwise, the policy is not prescriptive about how physicians must inform patients and allows for flexibility. For example, staff could notify patients upon calling the office or in some instances physicians may elect to proactively inform patients depending on, for example, the nature and length of their leave.

8. Critical test results are those that are of such a serious nature that immediate patient management decisions may be required. See the Managing Tests policy and the Advice to the Profession companion document for more information.