Approved by Council: September 1999
Reviewed and Updated: September 2010; March 2014
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.
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.
- 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.
- When contemplating a job action, physicians must first explore all alternative options that may be available to resolve the concern that has motivated their desire to withdraw services.
- If the concern cannot otherwise 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 responsibilities1, they must mitigate the adverse impact of the withdrawal on patients and/or the public.
- Notwithstanding the above, during a job action physicians must 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.
- In determining what constitutes urgent and/or necessary medical care to prevent harm, suffering and/or deterioration, physicians must use their clinical judgment, informed by the existing health status and specific needs of individuals, and physicians’ individual and collective responsibilities to provide care.