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COVID-19 FAQs for Physicians

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Updated March 27, 2020
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We know physicians have questions and that those questions are evolving as the nature of this outbreak is evolving. Ideally, we would have clear answers on all aspects of this pandemic, the reality is that there will be decisions that require in the moment exercise of good professional judgement.

We know physicians are working hard to support each other and the public through this public health emergency. To help you continue this work, we’re keeping an updated list of frequently asked questions and answers. If we haven’t addressed your question, please contact us.

 

Registration and Licensure

I’m a resident in my final year of study and have completed the necessary exams already – can I be fast-tracked to get an independent license now so I can help with the pandemic?

We’re doing everything we can to fast-track registration and enable physicians who are prepared to practice to support the pandemic response. If you have your RCPSC certification, have completed the necessary exams (MCCQE 1 & 2), and your program will confirm that you’ve completed your training, the College can fast-track your registration. Contact [email protected] and we’ll help you assess your situation.

I’m a resident in my final year of study and am unable to sit the RCPSC/CFPC/MCCQE 2 because of the pandemic — am I eligible for a license after completion of my training this year?

As soon as we learned that the CFPC, RCPSC and MCC exams were being postponed, we began working on a special provisional license that we could offer to any resident in the 2020 cohort who has finished their training and is exam-eligible. We have also amended a number of rules to allow our residents to continue to practice unabated. That includes reducing supervision requirements and ensuring that residents will not be forced to pay additional registration fees at the end of this period.

Some residents have understandably expressed concern about some of the pre-existing provisions and language in the application package, which is currently being revised. We apologize for any uncertainty and confusion that it may have created. We will be monitoring the situation closely over the coming months and will continue to work with PARO to provide the flexibility required to ensure that they are not penalized by these unique circumstances; and that they can continue to do their important work.

To apply under this policy, reach out to [email protected] and we’ll help you assess your situation.

I’m an out-of-province physician – how can I help?

You can provide virtual care to Ontario patients in line with our Telemedicine policy. This means being licensed in the province where you are located, complying with the requirements of licensure in your province, and practising within that standard of care.

To help alleviate the increased demands on the system during the COVID-19 pandemic, we are offering Short Duration certificates, which provide for a supervised license for a period of 30 days (with an opportunity to extend beyond this time if the crisis continues).

This is a special, time-limited route intended to facilitate short-term licensure under these extraordinary circumstances. Applicants and their supervisors should be aware that if they subsequently apply for another type of certification of registration, their application will be considered in the usual course at that time, independent of any Short Duration certificates that are granted. In some cases, applicants eligible for Short Duration certificates may not have the qualifications for other types of certification.

 

Providing Care

*I want to provide care or write a prescription for myself, my family, or someone else close to me to help relieve some pressure on the system. What do I need to know?

The College’s Physician Treatment of Self, Family Members, or Others to Close Them policy sets out when it would be acceptable for physicians to provide care, including prescriptions, for themselves, their family, or others close to them. Generally speaking, physicians are permitted to provide care for minor conditions or in an emergency, but only if another qualified health-care provider is not readily available.

Given the pressure on the system to deal with the pandemic, patients may be finding it difficult to access care in a timely manner as many health care providers may not be readily available at this time. Physicians providing care to themselves, their family, or others close to them as permitted above may be able to relieve some pressure on the system and indirectly help other patients access the care they need. In so doing, physicians must always act within the limits of the knowledge, skill, and judgment and remain mindful of the risks of compromised objectivity when treating those close to them.

While the policy does not allow physicians to provide recurring care for minor conditions, the College recognizes that if the pandemic persists, having physicians provide recurring care in this way would also help to relieve pressure on the system and support access to care more generally. However, physicians must limit the care they provide to anyone with whom they are sexually or romantically involved with in order to avoid being subject to the sexual abuse provisions of the RHPA. In these instances, they must not provide recurring care.

Notwithstanding the above, physicians are reminded that they are not permitted to prescribe narcotics, controlled drugs or substances, monitored drugs, cannabis, or any drugs/substances that are addicting or habituating in these instances. Physicians are also directed to the restrictions set out below regarding the precautionary prescribing of anti-malarial, anti-biotic, HIV and other anti-virals that might prove beneficial for treating COVID-19.

I have capacity to help but don’t know where or how to get involved. Is someone coordinating the system response?

Yes. The Ministry of Health has launched a website where current and former members of regulated health professions can indicate that they are interested in getting involved. Specifically, they are looking for health care providers who have the capacity to get involved or former health care providers (e.g., retired or currently inactive) who want to get involved. The aim is to understand regional capacity and coordinate the deployment of health human resources throughout the system.

The College is fully supportive of this effort and is working with the Ministry to help enable registration of individuals where it makes sense to do so. See as well our FAQ on temporarily practising outside of scope (below) and those under the “Registration and Licensure” heading.

Should I be ramping down elective care and other non-essential activities?

Yes. The Chief Medical Officer of Health has ordered that all non-essential and elective services provided by regulated health professionals be reduced to minimal levels, subject to certain exceptions, including the need to provide time-sensitive care or in order to avoid negative patient outcomes.

The College fully supports this order and physicians will need to exercise their professional judgment in operationalizing this directive. You can continue to provide virtual care where it is appropriate to do so and your capacity permits. Reducing the provision of elective care and other non-essential activities supports social distancing, helps to allocate resources to the highest-need patients, and enables physicians to deploy their services in support of broader system responses to the pandemic.

Decisions to suspend non-essential or elective care will need to be made in a fair, principled, and transparent manner that reflects the needs of your patients, but also with consideration to the needs of the broader patient population.

I know I should be ramping down non-essential care, but what counts as non-essential or elective care?

The Chief Medical Officer of Health was clear that there are exceptions to the directive that allow for the provision of time-sensitive care that will avoid negative patient outcomes; or a situation that would have direct impact on the safety of other patients.

The directive also recognizes that you, as a professional, are best positioned to make this decision based on the specific nature of your practice, your ongoing capacity to provide care, and the needs of your specific patient population.

The dividing line between essential and non-essential care is not always clear. What is essential for one patient may not be for another and your answer to this question may change over time.

Consider the following factors as you determine which care be safely postponed and which care you should continue providing:

  • Your ability to continue providing these services, both now and with an eye to the future as the pandemic evolves;
  • Whether the decision limits the potential for patient harm, including whether there are other alternatives available to your patients to relieve any pain or suffering until the care can be rescheduled;
  • The importance of treating patients within the same category (i.e., level of urgency) equitably;
  • Recognizing that different populations will be disproportionately burdened as a result of reducing all non-essential services (e.g., patients being treated for multiple health issues); and
  • That patients will need to be monitored and re-evaluated as time passes.

It is also important to consider whether you are able to balance the needs of your patients against the needs of the broader public and your colleagues as we face this pandemic together. For example, if you’re able to minimize the non-essential care you provide, perhaps that will minimize your need for PPE and enable you to donate them to others in the system who are desperately in need of that equipment.

I want to help patients and my colleagues during this public health emergency, but getting involved might mean practising outside of my scope of practice. What can I do to help?

While physicians are typically required to only practice within their scope of practice, the CPSO’s Public Health Emergencies policy enables physicians to depart from this expectation during times like this. To do this safely, physicians will need to use their professional judgment and work with their colleagues to determine the right medical care to provide.

Given these exceptional circumstances, the CPSO supports physicians temporarily practising outside their scope of practice where urgent medical care is needed, another physician is not available to provide the care, and patients are not put at greater risk. For example, a paediatrician might help to cover a colleague by seeing some of their adult patients. Hospitals too may be able to grant temporary privileges and the CPSO would be supportive of, for example, a family physician who does not normally practice in an emergency department, providing support in this capacity. While we encourage physicians to get involved and assist in any way they can, physicians must always be mindful of the limits of their training and experience. Where a physician’s training or experience does not allow them to treat patients directly, they may wish to perform more administrative or indirect activities that support the response effort or temporarily expand the capacity of their practice to help alleviate strain on the system.

I want to use virtual care to help screen and/or provide care to my patients. What do I need to know?

Use of virtual care has rapidly been rolled-out across the province. The provincial government has introduced a temporary fee code change that allows physicians to more flexibly bill for virtual visits.

There is a lot of information online to help physicians understand their virtual care options from both the OMA and OntarioMD. The Quality division of Ontario Health and OTN have also released a guidance resource for physicians looking to integrate virtual care into their practice.

I’m unable to see patients who require regular and ongoing care - what do I do?

If you are unable to see patients who require regular and ongoing care unrelated to whether they have - or are suspected to have - COVID-19, there are a number of steps you can take to help your patients.

  • First, try implementing virtual care (more information below) to provide that care directly and ensure they get the care they need or to help triage patients, help them problem solve their issue, and re-direct them as needed.
  • Second, try coordinating with colleagues to provide coverage. This may include colleagues whose scope of practice is different than yours, but who are able to provide assistance either virtually or in-person (more information on scope of practice below).
  • Third, while pharmacists are also currently experiencing the pressure of delivering care during the pandemic, they may be able to assist in some instances, like extending of renewing prescriptions.
  • Finally, avoid as much as possible simply redirecting patients to the Emergency Department of your local hospital. Hospitals are also being overwhelmed and finding means for providing care in the community as much as possible helps the entire system respond to this public health emergency. Instead, do your best to help patients navigate the system to find the care they need while you’re unavailable to them.

I have patients with mental health concerns that I see regularly. How do I support them during this public health emergency?

We understand the difficult position the pandemic has put you and your patients in. As with many other physicians, the new virtual care offerings available to you might help you to continue to provide regular and ongoing care in a meaningful and connected way. See the resources we’ve linked to above for more information on getting set up to provide virtual care.

 

Prescribing

As a precautionary measure, should I keep an office supply of anti-malarial, anti-biotic, HIV and other anti-virals that might prove beneficial for treating COVID-19? Can I prescribe these drugs for myself or my family?

No. These drugs have an intended use and prescribing these drugs as a precautionary measure has led to drug shortages and is compromising care for other patients. Additionally, should these or other drugs prove useful in combating COVID-19 their use will need to be carefully managed and preserved for those who need them the most.

At a time where resources are liable to become scarce, actions like those mentioned above dramatically depart from the core values of medical professionalism, may be in contravention of the College’s Physician Treatment of Self, Family Members, or Others Close to Them policy, and undermine the trust the public has in the profession at a time when they are most vulnerable.

My patient is in self-isolation or isolation due to a confirmed or potential positive COVID-19 test. How should I help patients access their regular medication?

Tell the patient not to go into the pharmacy as it’s important for these patients to stay home and not put patients and pharmacy professionals at risk, especially as pharmacy professionals do not have access to any personal protective equipment. Send the prescription to the patient’s pharmacy of choice and explain the situation. The patient and pharmacy can then coordinate to arrange for delivery of the medication or alternative pick-up by a family member, friend, etc.

I prescribe opioids for chronic pain/provide addictions treatment which requires regular contact with and/or observation of patients. How do I support social distancing and provide ongoing care during the pandemic?

The pandemic has created unique challenges for physicians prescribing opioids for chronic pain patients or within the context of addictions treatment. The need for social distancing and potentially self-isolation dramatically alter these relationships and prescribing practices.

It is essential that all decisions be made in the best interests of the patient, but the pandemic requires a balancing of the risks inherent in prescribing opioids along with those associated with the pandemic and using your professional and clinical judgment given the specific circumstances of each patient and the evolving nature of the pandemic.

There are changes happening that will support you in providing this care.

First, virtual care is being widely adopted across the system and may greatly assist you in terms of counselling, assessing, and generally treating patients.

Second, Health Canada has made the following temporary changes to the Controlled Drugs and Substances Act to enable providers and patients to comply with social distancing and self-isolation requirements without compromising access to medication. These temporary changes will enable:

  • Pharmacists to extend prescriptions;
  • Pharmacists to transfer prescriptions to other pharmacists (helping to distribute resources);
  • Prescribers to issue verbal orders (i.e. over the phone) to extend or refill a prescription; and
  • Pharmacy employees to deliver prescriptions of controlled substances to a patient’s home or other location (e.g., if they are self-isolating).

The changes relating specifically to pharmacists are anticipated to come into effect in the coming weeks, as regulatory change is also needed at the provincial level to operationalize them. But you can start issuing verbal orders now. Health Canada has also answered some frequently asked questions about these temporary changes.

Be mindful that your pharmacy colleagues are also over-extended at the moment, but we would encourage you to proactively coordinate with them to help implement these changes in preparation for when they are in effect as these changes give both prescribers and pharmacists some flexibility in managing this otherwise heavily-regulated space.

The Centre for Addiction and Mental Health along with others have developed a set of guidelines to help with the management of opioid agonist therapy with methadone and buprenorphine during the pandemic. The intention of these guidelines is to help prescribers make appropriate decisions to support social distancing, self-isolation, and quarantine where there is community transmission of COVID-19. It does not replace good professional and clinical judgment, but will help prescribers during this exceptional time where departing from the norm is needed in order to best protect all patients. We expect these guidelines to continue to evolve as the nature of the pandemic evolves so please check back regularly for updates.

How do I send prescriptions if I’m working remotely?

We understand the challenges you may face in practicing remotely, away from your regular premises and perhaps without access to your usual phone, fax, and EMR/e-prescribing system.

Even in these exceptional times, it’s important to support your pharmacy colleagues by using established channels such as phone, fax, or e-prescribing systems when issuing a prescription. This helps to prevent fraud, avoid undue pressure on pharmacists to verify the authenticity of prescriptions, and to deliver safe and timely care to patients. Ideally, you should be able to use your EMR remotely or phone to continue sending prescriptions.

However, we understand that these exceptional circumstances may require you to sometimes work outside these established channels and work closely with your pharmacy colleagues to help deliver safe, timely, and appropriate care.

The Ontario College of Pharmacists also recognizes the exceptional nature of these circumstances and has recommended to their members that they dispense prescriptions received through non-traditional routes, provided they are able to validate the source and content as appropriate. Coordinating ahead of time will be helpful to streamline this process. Given the extra care required for narcotics (as defined in the Narcotic Control Regulations), you must continue to use traditional routes of communicating prescriptions for these drugs (see above for new protocols that allow for verbal authorization).

As always, ensure your prescriptions are complete, specific to your patient, and include both your and your patient’s identifying information so pharmacists can validate the authenticity of the prescription. If using non-traditional routes of communications that are unencrypted to share prescriptions, it will be important to ensure you have patient consent to sharing the prescription through this route and pharmacists may confirm with you that you obtained consent prior to dispensing.

 

Professionalism and Complaints

What is the standard of care during a pandemic? How will the College address complaints that arise during this time?

The standard of care is always evaluated in context and the realities of providing care during a pandemic has the potential to dramatically alter how we understand the standard of care. This is not to say there is no standard, just that it can be dramatically altered by the current situation and will continue to evolve with the nature of the pandemic. This includes acknowledging that resources may become scarce or we may end up in a resource negative environment.

Working within a quickly evolving environment can be challenging and it will be important for physicians to be mindful of and practice in accordance with any direction from the Chief Medical Officer of Health and emerging policies and procedures pertaining to COVID-19 management being communicated at the hospital level.

While complaints may result during, and as a consequence of this pandemic, we can reassure physicians that the College will address these complaints with consideration to the circumstances in which physicians are practising.

I want to engage with my colleagues, patients, and the public through social media or email to draw attention to the pandemic, what do I need to be thinking about when I do so?

Physicians are reminded to be aware of how their actions on social media or through other forms of communication may be viewed, especially during a pandemic. Your comments or actions can lead to harm if you are providing a medical opinion that does not align with information being provided by public health officials and all levels of government. It is essential that the public receive a consistent and clear message.

The College’s statement on Social Media – Appropriate Use by Physicians also outlines general recommendations that support appropriate conduct in these forums. This includes acting in a manner that upholds their own reputation, the reputation of the profession, and maintains the public trust. It is important for physicians to be mindful of the important position they hold in society, which is magnified by the current pandemic, and the need to be thoughtful regarding the information they share on social media or through other means.

 

Responsibilities when Screening Patients and/or Self-Isolating

I am worried about my safety or the safety of my family. What do I do? Can I redirect patients who may have COVID-19?

We understand the challenges in balancing your commitment to patients and duty to care for yourself and your family. Each physician needs to consider how to best manage their practice for the benefit of their patients (especially those who are vulnerable) and their own personal health.

It is essential that you implement the appropriate precautions to screen patients, as directed by Public Health Ontario. That includes screening patients by phone before visiting your office, but can also include posting a note on your electronic booking system asking patients to call ahead, posting a sign in your office asking patients to call first, and encouraging patients to use the province’s self-assessment tool. These are critical steps to prevent the spread of the virus.

If a patient meets the criteria for potential infection, you should redirect them in accordance with the latest guidance from your local public health unit, your local hospitals, and/or the Ministry of Health.

Every physician’s situation is unique. Immunocompromised physicians, or others potentially more susceptible to contracting COVID-19 or being significantly impacted should they contract the virus must make a decision that reflects their unique situation and with consideration to the advice of public health officials and the best evidence available at the time.

I’m self-isolated as I’ve just returned from out-of-country/ due to an unprotected interaction with a positive COVID-19 patient. What are my professional responsibilities?

Given new directives from the federal government regarding travel restrictions, Ontario Health has been clear that all healthcare workers returning from out-of-country must self-isolate for 14 days. Unprotected exposure similarly requires all individuals to self-isolate.

We know that you may have a strong desire to continue practising to combat this outbreak and to support patients and your colleagues. But if you meet the criteria for self-isolation set out by Public Health , the hospital system and the Ministry of Health, self-isolation is the right decision to make for you, your colleagues, and your patients.

Given that you are unavailable to your patients, take reasonable steps to help make coverage arrangements for their ongoing care needs where you can (recognizing the stresses on the system) and help patients navigate the system and find the right care for them.

To the extent that you can, take advantage of virtual care options (as outlined above) to provide care remotely even while in self-isolation where it would be appropriate in the circumstances to do so.

I don’t have the necessary personal protective equipment (PPE) to provide care safely - what do I do?

We have heard concerns from a number of physicians about the unavailability of PPE. There are coordinated efforts at all levels throughout the system to find and distribute PPE to where it is needed most. This even includes physicians and other health care providers voluntarily donating their PPE to other colleagues. Unfortunately, the supply of PPE is outside the CPSO’s jurisdiction, but we are sharing your concerns with the OMA and government regularly.

The guidelines for appropriate PPE are changing as our understanding of the virus and risks associated with it change. It will be important to follow the guidance of Public Health, the hospital system and the Ministry of Health and apply it to your practice situation and the particular circumstances of the patient before you.

For community-based physicians, it’s important that you only conduct assessments of, or engage with, at-risk patients if you are able to take the appropriate precautions. If you are unable to protect yourself appropriately, shift as much of your work to virtual as possible, re-direct patients appropriately and in accordance with guidance from Public Health and the Ministry of Health, and support your patients as much as you can to  access care you cannot provide (see above).

We know that many front-line physicians, especially those in hospitals, may be faced with difficult decisions if access to PPE continues to be a challenge, while the need to care for at-risk or positive patients continues to increase.

If you are no longer legitimately able to practice safely, it will be important to protect your health as much as possible to ensure you are available to support patients throughout the pandemic. You’ll need to exercise your judgment as to whether to provide care in a particular situation, considering:

  • the need to support not just the patient in front of you, but future patients as well
  • the potential for harm, both to yourself and the patient given the specific circumstances of the situation; and
  • whether the patient is known to have COVID-19 or not and the likelihood of you being exposed.