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Closing a Medical Practice

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Approved by Council: September 2006, February 2007
Reviewed and Updated: September 2007, 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

Practice closure: Occurs when physicians cease to practise (due to retirement, resignation, revocation, suspension, illness or death) or continue to practise but at a new location (i.e., relocation).

 

Policy

This policy applies to all physicians who are closing a medical practice, including those who work in group practices or institutional settings, regardless of practice area or speciality. Some of the expectations set out in the policy only apply in specific circumstances and this is noted in the policy.

Planning for unexpected practice closures

  1. Physicians must take steps to proactively plan for unexpected practice closures due to death or illness1 so that their practice is managed appropriately and in compliance with this policy and physicians’ legal obligations. This could include, for example, identifying a designate to facilitate compliance with the policy in the event the physician is unable to do so.2

Facilitating access to ongoing care following a practice closure

  1. Physicians must take reasonable steps to arrange for the ongoing care of patients when they close a practice, including instances where a practice is relocated and patients are unable or choose not to move with the practice. What is reasonable will depend on the reason for the practice closure, patient needs, and the health-care providers and/or health system resources available in the community.03

Facilitating access to prescription medication

  1. Where a renewal or repeat of a prescription is necessary to allow a patient a reasonable amount of time to find another provider, physicians who maintain their certificate of registration must provide a renewal or repeat when one is clinically indicated.
  2. Physicians who do not maintain their certificate of registration, or where it would be clinically inappropriate4 for physicians to provide a renewal or repeat, must take reasonable steps to arrange for another provider to assume responsibility for the prescription, or where this is not possible, inform the patient of the need to attend to another provider as soon as possible.

Ensuring follow-up for outstanding tests

  1. Physicians must ensure that appropriate follow-up occurs for tests ordered by the physician where the test results are pending.5

Ensuring patient access to medical records

  1. Physicians must ensure that patients have continued access to their medical records following a practice closure.
  2. Physicians must ensure that records are retained for 10 years from the date of the last entry in the record or, in the case of patients who are children, 10 years after the day on which the patient reached or would have reached 18 years of age subject to the exception below.6
    1. Family physicians or those providing primary care have the option to destroy medical records after two years. In order to exercise this option, physicians must:
      1. cease to practise medicine;
      2. notify each patient that the records will be destroyed two years after the notification and that the patient may obtain the records or have them transferred to another physician within the two years; and
      3. only destroy records after two years from the date of notification.07

Notifying patients of practice closures

  1. Physicians must notify patients whose care is being actively managed8 of a practice closure. In cases where the patient is incapable, physicians must notify the patient’s substitute decision-maker.
    1. Physicians with custody of the medical record have additional notification obligations and must notify all patients if they intend to transfer custody of the medical record.9
  2. Physicians must provide patients with at least 90 days’ notice of a planned closure.
    1. In instances where a successor will be in place to take over the practice the notice period may be shortened, but physicians must use their professional judgment to determine an appropriate timeframe that does not unduly impair their patients’ ability to find a provider other than the planned successor.
    2. In instances of sudden or unexpected closures (e.g., illness or death, revocation or suspension) where it is not possible to provide 90 days’ notice, physicians (or their designate) must provide notice as soon as possible after learning of the need for a practice closure.
  3. Physicians must include the following information when notifying patients of the practice closure:
    1. The date of the closure;
    2. Whether a successor is taking over part or all of the practice, and options for patients if no successor is available or they do not choose to continue with the planned successor; and
    3. Information about how to access or request transfer of their medical record including, whether or not records are being transferred to another person or entity.
  4. Physicians must notify the patient directly, either in writing (i.e., letter-mail or secure email), by telephone, or in person at a scheduled appointment.10

Notifying the College of practice closures

  1. Physicians who are resigning from membership must complete a resignation form.11
  2. Physicians who are closing a medical practice, but are maintaining their membership with the College,12 must notify the College of a change in their practice address within 30 days of the change.13
  3. With the exception of physicians who are closing a practice due to a change in practice location, physicians who have closed their medical practice must notify the College of the arrangements they have made for storing medical records by notifying the College’s Membership Services department.

Notifying others of practice closures

  1. Physicians must notify hospitals or other facilities where they hold privileges and any employers of their practice closure.
  2. Physicians must use their professional judgement to determine whether other health-care providers involved in the patient’s care would benefit from notification of their practice closure and notify them as warranted.

Limitations following a resignation, revocation or suspension

  1. Physicians who resign or have their certificate of registration revoked or suspended by the College must inform patients that:
    1. Standing orders for laboratory or other tests are not valid after the date of resignation, revocation, or suspension; and
    2. Prescription repeats/renewals written prior to the date of resignation, revocation, suspension are not valid after the date of resignation, revocation or suspension.
  2. Following a resignation, revocation, or suspension, physicians must not interpret test results, prepare reports14, or provide follow-up care.
 

Endnotes

1. This does not include temporary leaves of absence due to family emergencies or illness, but rather instances where the physician’s health is compromised to the point that they can reasonably expect that they will be closing their practice.

2. For more information please see the resources section of the Advice to the Profession document.

3. This could include for example, finding a successor to take over the practice or informing patients about how to find a new provider. See the Advice to the Profession document for more information.

4. For example, the physician would not be able to monitor the patient’s medications.

5. Physicians who do not have a certificate of registration (e.g. have resigned, been revoked or suspended) must not engage in the practice of medicine including performing any controlled acts. 

6. Physicians are advised that s. 15(2) in the Limitations Act, 2002 allows for some legal proceedings to be brought forward 15 years after the act or omission on which the claim is based took place and thus may wish to retain records for longer than the 10 year requirement.

7. O. Reg. 114/94, General, enacted under the Medicine Act, 1991; S.O. 1991, c. 30, s. 19(1)(2).

8. For example, where a specialist’s involvement with a patient has already reached its natural or expected conclusion prior to the practice closure, notification would not be required. Please see the Advice to the Profession document for more information.

9. The Personal Health Information Protection Act, 2004 states that where it is not reasonably possible to notify patients in advance of a transfer of records, physicians must notify patients as soon as possible after the transferred has occurred (S. 42(2)).

10. Caution should be exercised when leaving messages on voicemail or with a third party due to concerns regarding patient confidentiality and privacy rights. For more information, please see the CPSO’s policy on Confidentiality of Personal Health Information.

11. Additional information and the resignation form can be accessed on the College’s website.

12. This could include circumstances such as where a physician is relocating their practice; maintaining their membership with the College but practising outside of the province; or where a physician is ceasing to practise (i.e. retiring) but is maintaining their certificate of registration.

13. College by-law requires physicians to report any change of a practice address within 30 days. Physicians can consult the College’s website for additional information on how to report this change.

14. Only administrative work required to finalize an outstanding report can be completed during the suspension period, or following resignation or revocation. Administrative work includes editing draft reports, summarizing conclusions or signing reports completed prior to resignation, revocation or suspension.