Advice to the Profession: Accepting New Patients

The Accepting New Patients policy sets out physicians’ professional and legal obligations when accepting new patients and helps to ensure that decisions to accept new patients are equitable, transparent, and non-discriminatory. This companion Advice to the Profession document is intended to help physicians interpret their obligations as set out in the Accepting New Patients policy and provide guidance around how these obligations can be met.

Acting in "good faith"

The term “good faith” is a legal term that means a sincere intention to act in an honest, fair, and decent manner with others.

In the context of accepting new patients, physicians can act in good faith by:

• Closing their practice when it has reached capacity, and not as a way to refuse patients who may be perceived as less desirable;
• Assessing, in a fair and honest manner, whether their medical knowledge and clinical skills will meet a patient’s health-care needs, and not using a lack of medical knowledge or clinical skills to unfairly refuse patients with high or complex health-care needs;
• Prioritizing access to care because a patient truly has high or complex health-care needs, and not because a patient is believed to have easy-to-manage care needs and/or requires less time or resources; and
• Not using medical questionnaires or other screening tools to unfairly vet prospective patients.

Priority populations 

“Priority populations” refers to any population group that experiences (or is at risk of experiencing) health inequities and/or that would benefit most from health services. While priority populations may differ depending on a physician’s practice type and location, some common examples of priority populations include:

• Pregnant people and newborns;
• Older people;
• People living in rural, remote, or other communities with limited access to care;
• People experiencing homelessness;
• People experiencing severe and persistent mental illness;    
• Indigenous people; 
• Black, 2SLGBTQI+, and other marginalized people;1 
• Refugees, asylum seekers, and migrants;
• People with substance use disorders; and
• People experiencing poverty.

Communicating physician criteria for accepting new patients 

To promote patients’ understanding and ensure that decisions to accept new patients are equitable, transparent, and non-discriminatory, physicians are encouraged to inform patients of any criteria they have for accepting new patients at the earliest opportunity, for example, when the patient first inquires whether the practice is accepting patients.

Physicians’ criteria for accepting new patients must be directly relevant to their clinical competence, scope of practice, and/or focused practice area. Appropriate criteria for physicians who serve a defined target population could include, but are not limited to, the following examples:

• Family physicians focused on Indigenous health may decide to mostly accept First Nations, Inuit, and Métis patients.
• Family physicians with a focused practice on addiction medicine may decide to primarily accept patients with substance use disorders.
• (Sub)specialists who provide limited or highly specialized services may primarily accept patients with a specific condition, or those with a higher likelihood of having that specific condition.

Informing patients that they will not be accepted into a practice

Some individuals may interpret refusal as discrimination even when the physician’s reasons for refusing to accept the patient are non-discriminatory. Effective communication which promotes patient understanding can help dispel perceived discrimination. The Canadian Medical Protective Association’s (CMPA) Patient-centred communication offers guidance to physicians on how to communicate effectively with patients to optimize their care.

Accepting patients with a history of opioid use

Physicians who feel that treating patients with a history of prescription opioid use is legitimately outside of their clinical competence and/or scope of practice are reminded that:

• Responsibly prescribing narcotics and controlled substances is part of good clinical care, and refusing to prescribe these drugs altogether (e.g., “no narcotics” policies) may lead to inadequate management of some clinical problems and leave some patients without appropriate treatment.
• There are relevant resources and clinical practice guidelines that can assist in managing the care of patients with a history of prescription opioid use. For example, the Centre for Addiction and Mental Health (CAMH) has developed the Canadian Opioid Use Disorder Guideline, a national clinical guideline for Canadian prescribers of opioid agonist therapy.2
• Where elements of a patient’s care needs are legitimately outside a physician’s clinical competence and/or scope of practice, the patient will need to be referred to a provider for those elements of care that they are unable to manage directly.
• Given the broad scope of practice of primary care physicians who provide comprehensive care, there are few occasions where scope of practice would be an appropriate ground to refuse a prospective patient, and determinations about whether a patient’s health-care needs fall within their clinical competence and/or scope of practice must be made in good faith.

Defined catchment areas and patients who live a significant distance away from a practice

CPSO recognizes that, depending on their practice structure, physicians may have agreements (e.g., with the Ministry of Health) that require them to accept patients who reside within specific catchment areas or geographical boundaries. Nothing in the Accepting New Patients policy prohibits physicians from accepting patients on this basis, provided the policy expectations are otherwise met.

Likewise, patients may inquire whether a physician would consider accepting them into their practice even though they live a significant distance away from that practice. In these cases, physicians can use their professional judgment to determine whether they will be able to provide quality care to the patient despite the significant geographical distance between them3. When determining whether to accept a patient who lives far away from their practice, physicians can discuss with the patient how the geographical distance between them could impact the patient’s ability to receive the care they need.

Using waitlists

Physicians who use self-managed waitlists in their practice need to use them cautiously and carefully manage patient expectations by clearly communicating the expected waiting period.

Resources such as CMPA’s Wait times when resources are limited contain additional guidance for physicians who use waitlists.

Where available, physicians who are accepting new patients are encouraged to use provincial wait lists (e.g., Health Care Connect for unattached patients seeking a primary care provider) and/or centralized referral systems (e.g., physician networks within Ontario Health Teams).

Intake appointments

Physicians may use intake appointments for a number of reasons, including:

• Gathering a patient’s personal health information;
• Taking a medical history;
• Sharing information about the practice;
• Disclosing information about their scope of practice or focused practice area; and/or
• Determining in collaboration with the patient whether there is a good foundation for an effective therapeutic relationship. 

Typically, an intake appointment will result in the establishment of a physician-patient relationship, and patients can reasonably assume they have been accepted into the physician’s practice following an intake appointment. Sometimes, however, physicians may determine during (or soon after) the intake appointment that they are unable to accept a patient into their practice. In these rare cases, physicians are responsible for complying with the obligations set out in the Accepting New Patients policy relating to informing patients that they will not be accepted into the practice, communicating to them the reasons why they will not be accepted, and documenting the reasons for the refusal.