Updated April 17, 2024
(* indicates a newly added/updated question)

Physicians are working hard to support each other and the public during this time when our health system is under significant pressure. Our goal is to provide clear information to help guide you as you exercise professional judgment to practise in this environment. If your question is not addressed here or if you need support beyond the information provided below, please contact us.

Providing Care

*Can physicians practise outside their usual scope of practice to help address the health human resource shortages being experienced within hospitals and across the system?

Given the significant strain on the health care system due to health human resource shortages, physicians may find themselves being asked to practise outside their usual scope of practice to help address significant patient demands, particularly in hospitals.

While CPSO’s Public Health Emergencies policy would normally only apply in a declared emergency, we recognize the need to apply this policy in these similar circumstances, enabling physicians to practise outside their usual scope of practice. The Canadian Medical Protective Association has similarly issued a message of support, indicating the necessity of taking these steps at this time and provided additional guidance in this regard.

As in all cases, physicians must exercise professional judgment when temporarily practising outside their usual scope of practice, and work with their health care colleagues to determine what appropriate medical care they can provide, in line with their knowledge, skills, judgment, training, and relevant legislation.

This exceptional approach will remain in place for as long as there is a health human resource crisis.

*Can I restrict in-person care to those who do not have any flu or COVID-19 symptoms?

No. Patients cannot be denied access to necessary in-person care based solely on having flu or COVID-19 symptoms. In-person care can be provided safely by taking appropriate precautions, including screening and isolating patients with these symptoms and using necessary personal protective equipment (PPE).

*How can I help alleviate the pressures Ontario hospitals are facing?

It is critically important for physicians to prioritize seeing sick patients who require an in-person assessment in the office whenever possible and to minimize direct patient referrals to the emergency room when the care can be safely provided in an office setting. This can help alleviate the pressures Ontario Hospitals are facing. When choosing to assess a patient by virtual means, physicians must meet the expectations of CPSO’s Virtual Care policy.  

*Can I continue to ask my patients to wear a mask?

Physicians or health care facilities can continue to implement masking policies that request staff, patients, or visitors to wear a mask when in the office based on either a point-of-care risk assessment, in a high-risk patient care environment (e.g. in an area where immunocompromised patients are cared for) or in an area where an outbreak has been declared. The decision to implement a masking policy should be aligned with mitigating risk to patients, staff and visitors.

What if a patient refuses to wear a mask?

If you have a policy that asks patients to wear masks, it’s important for patients to adhere to that policy. Some patients may have health conditions that make it difficult or inhibit their ability to wear a mask. In these cases, physicians are expected to offer appropriate options to ensure care can safely be provided.

If you encounter a situation where a patient not in need of an accommodation refuses to wear a mask, explain the expectation in your practice is that a mask be worn. When deciding how to proceed, consider that in most cases in-person care can be safely provided with appropriate precautions (e.g., donning appropriate personal protective equipment (PPE), isolating patients, providing care during set times), that physicians have a duty of care where care is urgently needed, that virtual care may be an appropriate alternative, and that redirecting patients to other parts of the system may exacerbate existing and significant resource challenges.

Physicians are not expected to tolerate verbal abuse or threats of physical violence and can take appropriate steps in these instances to defer or delay non-emergent care.

*What do I do if a patient has an expired health card or a red and white health card? 

Until further notice, the Ministry of Health has requested that health care providers continue to accept expired green photo health cards and red and white health cards from Ontario residents, provided the card belongs to the person presenting it and the card passes Health Card Validation.

You can also encourage patients to renew their expired green photo health cards or update their red and white health cards to the more secure green photo health card.

If a patient does not have OHIP coverage, the patient may obtain health services by paying for services directly or through private health insurance. If the patient requires urgent care, then care should be provided first and questions about health coverage can be addressed later.