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What about death?
I understand that the policy may be a guideline. However, I believe that the CPSO should specify in their policy what to do in different styles of practice, ie, solo practice, group practice, academic practice, etc etc…
The reality is that if one is in a group practice, the other colleagues may take some of the “retiring” MD on.
Also, there are situations where an MD in a solo practice finds it hard to provide a replacement MD for a variety of reasons and through no fault of her/his own. These situations have to be taken into account. Unfortunately, OHIP or other employers, do not provide funds to look after these eventualities in MDs lives. Should the CPSO consider these facts in the content of the policy? It is very easy to establish policies that punish the MDs but do not have or offer any support in cases that may be related to unforeseen circumstances for an MD. We are human beings as well as being MDs….
thanks to the gov fee cuts and the ever more draconian CPSO now investigating all complaints as non-frivolous, expect many more closures. Is that why this is being reviewed now?
The policy seems reasonable for a solo specialist like myself but I can appreciate the concern expressed by physicians in shared practices and walk-in clinics. It could be difficult to sort out which patients are actually receiving ongoing management by other physicians in the practice, and those whose care is being discontinued.
I read and reviewed the draft policy. It seems to be comprehensive and quite complete.
Closing a practice may be voluntary or not voluntary. Once the CPSO receives the letter of intent to close the office it should send out in point form, easy to read and understand a “to do
list” to those involved.
This could be a difficult time in certain circumstances
It would be useful for the policy to provide more guidance about the nature of duty of ongoing care as part of a group of physicians, wherein the patient has been assessed and treated by more than one member of the group, selected perhaps by feasibility or convenience, wherein the departing physician is one member of the group. In other words, if the group continues to provide care, it is not clear what is the obligation of the departing physician in terms of notification.
As well, the obligations of the departing physician in regard to notes related to visits at hospital clinics should be made explicit. If there is no change in the hospital overall, and if access to the notes is not impacted by the physician departure, it would seem that no action is warranted in terms of preparing the records for practice closure. The same may hold for other medical organizations.
In general, the proposed policy is useful.
It would be great to know at least a year before if possible or more. It would also be great if the doctor who is leaving could introduce patients to someone who might take over or provide a list of doctors accepting new patients. This is much more serious than switching hair dressers.
As Managing Director of a medical records storage company, we have to deal with a lot of the gray areas that are not specifically addressed by the provincial Colleges of Physicians or the CMPA. One of the big ones is in the case of an EMR and a retiring doctor within a group (ie. a FHO) where the records are technically accessible by all of the members. If another doctor in the group is able to assume a small percentage of the patients from the closing practice:
- Is the assuming doctor (within that FHO)permitted to start working with that patient’s chart in the absence of an Authorization for Release of Information signed by the patient?
- Is the exiting doctor required to take an extract of all his/her patient charts from the EMR for retention?
- If a new doctor comes in to assume all the outgoing doctor’s patients (who wish to transfer to him/her), does the outgoing doctor still have to take an extract of all patient charts for retention or is it enough to have an agreement that he/she can have access to those EMR charts as needed for future medico-legal purposes, etc.?
- If there is a group of doctors that equally share ownership of a walk-in clinic where they each see any of the patients that walk in, who takes responsibility for, and what must be done with respect to retention of the charts if the clinic closes and the group disbands?
There needs to be some clarity about the recommendations for destroying charts – CPSO says this is acceptable after 2 years if patients are properly notified and if the md is fully retiring.
Questions include –
what if the md is not fully retiring but is leaving his/her full practice to do some occasional work as a locum or walk-in? – would the 2 year interval still apply?;
What if the charts are properly transferred to a responsible md, who then leaves practice within a short time interval, and perhaps does not look after the charts properly- who then is responsible for the charts/files?
why the discrepancy between CPSO and CMPA which usually suggests the longer 10 year interval for medico-legal reasons (and longer for children, possible reaching 28 years…..which is unreasonable time committment for a retiring md at the age of 65 or more. Even the CPSO adds a caveat that charts should be kept for 15 years for medicolegal reasons and the Limitations act.
All very confusing.
Overall, the policy provides good guidelines. Some clarification may be needed around the resignation form though. The draft policy makes it sound like the form needs to be submitted immediately upon deciding to retire, whereas in fact there is usually a discussion with CPSO as to the retirement timeline, and especially the need to indicate when the final billings are submitted (so the CPSO doesn’t cut off the physician’s access to compensation by the Ministry prematurely). This discussion may affect the actual resignation date. Also, the retirement process is a bit more complicated and may take longer for physicians who are incorporated, and it would be good to include that fact, as well as maybe referring people to the OMA services related to incorporation & retirement.
Closure notification essential by posted office signs and local press notices et al;—- and personal attention to current active ‘problem’ patients. Many specialists see patients for only 1 or 2 visits and their chart and computer lists may be in the hundreds of thousands. Not practical to send a letter to each (hundreds of thousands of dollars) and many (most senior) do not have email addresses. Thank.you.
I agree that “time to destruction of office records” is confusing…?2, ?10, ?15 years, all of which are mentioned in government or CPSO sources. Not too helpful to have such variety without an explanation as to why one would choose one or the other (think court/legal ramifications).
Any policy that is passed by the CPSO has to recognize the significant limitations within and failures of the health care system in accessing primary care. Ongoing medical manpower issues which are now stretching into over 2 decades through mismanagement by the Government of Ontario and the Ministry of Health has made obtaining comprehensive care through a family physician between challenging and impossible. To place the onus on the retiring/relocating physician to find a replacement is inappropriate as the system has failed to properly plan for the well known demographic changes and corresponding demands that are occurring. (This challenge would also applying as senior physicians begin to decrease their workload as they wind down and transition towards retirement.)
I think we need a union like PAIRO but for those of us inpractice. This doesnt seem like a policy but a means to impose financial burden and tasks to already overworked doctors. We are all pretty responsible and look out for our patients. i suggest the CPSO invest in more important issues for physicians than making us assign someone to find dr for our patients if we cant, to ensure we store charts for cpso to know where they are (like cpso would ever go look for a chart!?!) and imposing expectations that make us legally liable. Not happy. This policy too generic and diesnt consider specialties. Active patient varies from specialty to specialty as how thats defined. This is a pilicy begging for lawsuits based on its adoption. Lets focus on stopping pot access to those under 25, awareness of risks to health by trauma, increasing services to therapies and fixing this ridiculous free meds to kids but not allowing pediatric dosing to be covered!!
A comment has already been made regarding the requirement for written notification, but I would like to add my comment. My practice has a high proportion of elderly immigrants, many of whom do not speak English. They do not have email addresses nor fax numbers The cost of postage (and labour) to mail notification to these thousands of patients is frightening. I would hope that the College’s policy will be sensitive to this issue and not saddle physicians with punitively high expenses as they are about to enter retirement.
Any other job one can quit by giving two weeks notice.
THREE MONTHS notice seems really unfair in this age of walk in clinics at every corner.
CPSO website makes it effortless to complain about mds by quickly populating a pdf. I have feeling that, that is the reason for sudden jump in frivolous complaints against Physicians. I am expecting a barrage of older MD’s quitting in disgust after receiving frivolous complaints and their lifetime of hard work and dedication being belittled by frivolous complaints facilitated by CPSO website.
At a basic minimum, a Written letter by patient with proper signature should be required to initiate a complaint. Make the complaint process more accountable on BOTH ends.
Many physicians may retire from their own practice BUT continue to work in Walk in clinics or assisting in surgeries.
There is a profound distrust of the CPSO, OMA amongst colleagues of my vintage. In principle the policies seem fine. In practice it would likely be a different scenario.there also seems to be an over abundance of physicians whom are entertaining the idea of retirement..the decision to do so seems to be directly related to is in no small part due to increasing legislation and policies that have contributed to excessive paperwork unrelated to the traditional practice of medicine. Furthermore, these responsibilities come with a considerable financial and personal cost from which there is no relief or compassion. Those who have had the courage to take this step all experience regret that they did not do it before. Young physicians are obviously more tolerant as they have little choice and know no different.
As the draconian policies continue unabashedly ,
my concern is that the laws and policies of the future are applied to practices that were terminated prior to their implementation. It would seem obvious that this should be expected. Nonetheless, as I did previously mention, there is little If any trust of the cpso and Oma by most of my colleagues. It is with regret that I have decided to take the next step to retirement, as I do enjoy medicine, patients, cme of my choice.
Too many changes, too much silly political correctness is on it’s way to destroying a common sense society as we knew it.
It is with regret that I
So if I read this policy correctly, the minimum time notification for a partner leaving a group (relocation) is 90 days to the other partners of a group. Any shorter notice would violate CPSO policy and become unprofessional conduct, be reportable to and punishable by the CPSO. Further the notice would have to be in writing or by secure email. After all we can’t treat the public one way and treat our colleagues worse.
The CPSO needs to define who a patient actually is and for how long after the last visit they remain. No question if they are rostered. But if they are fee for service, when do I no longer have an obligation to notify them?
2 years from time of last visit would probably be reasonable.
Does the written notice have to go by Canada Post or can it be hand delivered at the time of an appointment? This needs to be spelled out.
Does each member of a household have to be sent their own letter or is one per household enough to satisfy the CPSO?
Regarding informing patients by letter, please clarify further what is the criteria to be considered as ‘Actively involved in Patient care’. What is the timeline? Many patients change address and move and do not inform physician. It should be mentioned that Physician is not responsible if patient did not update his contact information.
As a physician approaching retirement my preference would be for an expectation of direct contact rather than a mail out. I would hope that in a planned retirement from clinical practice with closure of office that patients could each be met with in the year prior to practice closure to allow them to raise their specific concerns and that a mailout would only be a preferred method of contact for situations of short notice.
I would greatly advise that you offer different guidelines to specialists versus primary care providers.
What happens when a physician retires in a practice where we all share charts.
The retiring physician has his/her own charts but they are kept in a common chart room/EMR.
The remaining physicians are willing and able to look after the retiring physician’s patients.
Does the retiring physician still need to contact all of his/her patients and say they can be seen by one of the other MDs in the group and/or offer to transfer their file somewhere else.
We will have a situation like this coming up soon.
Agree with the draft however we may consider a situation when the patient asks to take the records until he or she finds a new doctor. Would this be acceptable?
Thanks for writing the draft policy, it looks ok to me. I was relieved I did not have to contact each patient either personally, by telephone or by mail. I am planning to give my practice to someone who will take over all the patients, I was reminded that even though the practice is not closed, “my practice “ will be closed and the policy apply to me.
I was interested in some over the superscripted numbers which would have referenced other documents, but were not available in this copy.
When retiring from a long-established practice I feel it is a good idea to start giving the archives ( old charts more than 3 years) to the patient starting a year before retirement with the signed proviso by the patient that the doctor may ask for them back at any time. This will take the onus off the doctor for having to store the charts for 10 years and longer for children. The College has stated that while the information in the chart is the property of the patient, the actual physical chart is the property of the doctor. As well the patient will incur much less cost when retrieving the remainder of the chart from a commercial company.
Policy needs to reflect realities as a specialist we may advise patients about future testing that should be carried out and whether this constitutes a follow up obligation.
If a gastroenterologist recommends regular colonoscopy at the age of 50 does this constitute a follow up even if a decade later.
As an allergist I may recommend retesting in a few years for a peanut allergy, but perhaps a decade for penicillin. will I be required to notify the patients?
When does a recommendation become a concept of continuous care?
A serious illness such as cancer may prevent a physician from giving timely notice or arranging for a take-over of the practice. The policy as stated is too strict. Also Most physicians do not have some-one who can step in and handle files once they have retired unless they give to a service such as docu-david which is a company which charges the patient a fee to photocopy the record. No mention of this is given in the draft policy. Also what about patients who have not been seen in 2 years. Does the M.D. have to notify every-one regardness of when they are last seen?
Professional Association of Residents of Ontario
Response in PDF format.
Information and Privacy Commissioner/Ontario
Response in PDF format.
The draft is missing information. The OMA guidelines are much more extensive and even those omit so many details on how to close a practice. One more important is to contact CMPA. That seems to be omitted. Also, it is my understanding that recommending another specialist is not considered ethical. So a substitute physician for a specialist I understood was not required. It would be required for a family doctor.
The Canadian Medical Protective Association
Response in PDF format.
Your expectations when a physician is disabled or dies are both unreasonable and conflict with your privacy policies.
The physician who is disabled or dies is obviously unable to fulfill requests for patient information.
It is unlikely that their caregiver or executor will be a physician who is also a member of the CPSO, thus will have no legal basis to access confidential patient information. Moreover they are unlikely to be willing to do so on a timely basis.
The CPSO has no jurisdiction over caregivers or executors.
I would suggest that the CPSO be willing and offer to take responsibility for patient records should a physician become disabled or die.
I have a comment regarding closing a practice and record disposal.
Two years ago, I had a sudden spinal stenosis crisis and my daughter and daughter-in-law coped with the abrupt closure, arranging for my record storage and the many other details. I was available to assist by phone.
I had an acquaintance who dropped dead in his parking lot. Two days after the funeral, his widow, had the office stripped and the records destroyed, to the dismay of his patients and I assume the horror of the CMPA. I am sure you know of similar cases. When a patient expressed some annoyance, she basically said, “They’re mine as part of this estate and I can do what I wish.”
I would suggest that the draft policy should include some reference to the responsibility of Executors or Trustees. I don’t think lawyers consider records when drawing up a Will. This might reduce the incidence of record destruction. No system is perfect, but at least it will help.
This could be a difficult time in certain circumstances.
When the CPSO receives a letter of intent to close a practice it should send to the person or persons involved in point form a “to do list” of what the protocol and action should be.
Yes there is a cost involved and there should be a Basic OHIP compensation for it