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As a new physician, one of the challenges I face when accepting new patients is to discourage doctor-hopping amongst patients. I ask my receptionist to inquire why a patient is seeking a new doctor when they call to make their appointment, and try to prioritize those without any current physician to get an earlier appointment. I always start the visit by asking the patient about their previous provider care and if they states they are switching doctors, I ask what they are hoping to achieve with me that their doctor was not doing. If I feel my methods may be similar to their doctor, I inform them that it may not be in their best interest to switch. I think this should be addressed in the CPSO policy, as it addresses issues of professionalism amongst colleagues, as well as teaching patients that continuity of care is important if they have a complex medical history. It may be tempting to accept new patients to grow one’s practice, but this should not be the incentive if it is not in the patient’s best interest. However, there should be very little reason why a patient should not be accepted by a physician (if in their scope of practice). Physicians should not be able to pick the “easiest” of cases, but should have a good reason if they are going to refuse taking on a patient.
“Doctor-hopping” says it all. It implies a doctor-centric and patient-negative starting point, encouraging an attitude similar to the field of employment where the “reason for leaving” is judged merely as a proxy for judging the patient according to his career “wound”, with the inevitable digging into that wound and the default judgment being that the employer/doctor is probably fine, but the person leaving or being without a provider is the problem. Trust me: trying to find a family doctor is so time-consuming and soul-destroying almost-nobody will engage in it willingly. The serious issues can include persistent ridicule, written or uttered falsehoods, poor attention to detail, the doctor refusing to see you when you arrive for an appointment, assault…
The whole line of questioning/assessment is a trap for the patient. If you tell the truth about the serious issue(s), what you’ve already tried to solve/mitigate them, etc., you can offend the new doctor’s collegial sensibilities or even be accused of slander, but if you choose the opposite tack and withhold or minimize the issues to avoid being called a complainer or “difficult”, you can be labelled “not in need”. Either way the patient is inevitably held responsible for the breakdown.
Oh, and most doctors and centres accepting new patients make it abundantly clear that they won’t see you at all if you’re rostered elsewhere or “seeing another doctor”. We, on the other hand, aren’t often told if we’re rostered, the gov manual merely asks the physicians to “please” notify the patient, but revenues can be higher if they keep that information to themselves…I tell ‘ya, it’s becoming like a cartel, as the practitioners either fight over patient exclusivity (as in London), or protect their colleagues’ power and control by paternalistically deferring to their colleague. It makes one wonder if “continuity of care” isn’t a euphemism for “continuity of billings”.
I won’t even bother going into what I went through when my last family doctor closed her practice. I was in need (pre-diabetes under control) and without care or statin support, but not sick enough for some, and “doctor-shopping” was uttered with such contempt by receptionists (with the first few minutes of a first phone call) I soon learned that it was often used as another euphemism for a narcotics-seeker. Let’s treat everyone seeking a doctor with suspicion!
I agree with what this person has said about this situation. Everyone will eventually have a “serious” problem – diabetes, or need for opioids, or whatever. Even the doctors themselves who are refusing patients with these exact problems that they will one day have to deal with. Doctors shouldn’t be able to refuse anyone from their practice. I am a family doctor saying this, and I have never refused anyone from my practice, and never regret that. In fact, I learned a lot and enjoy my practice more by having a variety of patients. See my other comment about opioids too.
Do take into consideration that not all patients leave a doctor to go to another because it is something we want to do. There may very well be a legitimate reason we are doing this. So, is it respectfully OK to stay with a doctor that is fully aware of a patient that has spent a duration of a month in the hospital as a result of a very complex health issue and then it was recommended for the patient to be seen by a Specialist for ongoing follow-up and the patients family physician repeatedly did not see just cause for this and felt that they could they were just as capable of looking after the patient, all the while the condition continues to worsen and patient goes into see doctor about the declining condition and doctor repeatedly ignores it and request to see Specialist as recommended per discharge from hospital. What about the eagerness to get patient out of office at appointments and not hearing patient out or brushing patient off and making them feel there is nothing wrong, only for patient to go to ER and test results show otherwise? In my opinion this is just cause for seeking a new physician and the opinion of many others. I will not allow for my health to go into a fourth year of declining!
Geography, of course, is a factor in this discussion. Sometimes patients are ‘shopping’ for a new doctor because their existing doctor is in another city where they previously lived. So I do think that aspect has to be taken into consideration. If the patient has a family physician but has to drive outside their resident city to see them then that’s reasonable cause to be looking for a new physician.
I am a patient with complex health issues. One of the challenges that I have faced in the past 6 years, is having one family physician and then another practitioner that has not shown enough interest in my health issues to refer me to a Specialist that can take care of the health condition at hand and instead allow for the condition to progress. There is one practitioner I had for several years and had to leave in October 2014. I unfortunately got DVT in my entire left leg up to pelvis and through heart into both lungs, spent an entire month in the hospital. I now have advanced vascular condition in my left leg. I was never referred to a Vascular Surgeon, though requested to be so more than once. Also with this physician, every time I went to an appointment for a health issue, was already standing up and ready to leave office in a matter of a couple minutes and I never had chance to finish what I had to say about health issues and this went on for the number of years indicated above. I leave this doctor to go to a Nurse Practitioner Clinic and expressed concern of my advanced vascular condition in leg from DVT/bilateral PE and it is quite obvious from looking at leg and they tell me that a Vascular Surgeon can do nothing for me. I am now waiting for an up and coming appointment for a Meet and Greet with a prospective new doctor in a few weeks.
What is it with these doctors that are aware that their patients have complex health issues and do not want to take care of us and allow for our health to decline. I need a doctor where my healthcare is going to be a priority.
A few comments on a complex issue:
As an “experienced” physician, my reasons for NOT accepting new patients are mainly personal (health, time for family/non-medical issues, easing into retirement,etc.) However, there is also the feeling that “I’ve contributed enough” and that newer physicians should “pick up the slack”, especially accepting those complex patients that need the care. Is this a fair stance to take? Should new physicians be forced to take new patients (rather than just offered incentives)? Should older physicians be forced also?
On the patients’ side, I have had many requests to change physicians because their current one is “not listening to me” or is obviously not treating their patients appropriately. Should physicians look at themselves, and ask why their patients want to change? Should the college take a greater role here?
There is also no doubt that some patients are “doctor-shopping”, to find someone more convenient (location/hours) or willing to cater to their needs (appropriate or otherwise).
“Should physicians look at themselves, and ask why their patients want to change? Should the college take a greater role here?”
Yes and Yes. As long as the college doesn’t try to replicate Health Care Connect, I’d be fine with this. That was just another level of screening that was added on top of physicians’ existing methods, and non-disclosure as to what their criteria was remained largely-secret. At the beginning of 2014, the CPSO had a box you could check in the Doctor Search with regards to whether or not they were accepting, but it’s gone now. I’d like to see it back, plus more info, and for the CPSO to be more involved in helping to “share the load” so that not just a few new doctors get all the harder-to-care-for patients, while others can effectively try to get all the “easier, healthier and wealthier” ones. That latter strategy will be self-defeating in the end, as all their patients will age or become “complex” at roughly the same time. Financial “incentives” alone don’t work, as they resulting improvements in access to a doctor lasts only as long as it takes to collect the checks.
I agree 100%!! There is clear research showing that the young, healthy and wealthy are being preferentially selected. Even worse, I have seen several patients let go because they are “too complex”. This usually occurs in FHT where a ministry funded NP looks after large numbers of patients (who of course are rostered to an MD they never see). When a patient becomes too complicated they get a letter telling them they have exceeded the scope of practice of the practitioner and must find care elsewhere. I have seen these letters firsthand. Ridiculous, unethical and maddening? Yes. Illegal? Sadly, no.
What is good faith please explain. if the patient is on narcotic and can you not refuse this patient in good faith because he will be seeing 2 doctors for pain medication. similarly if the patient has serious problems with law and police like anger issues so you cannot refuse a patient in good faith to the public and other patients who will be waiting to see a doctor. what about non compliant patients how do you enroll them in family practice when they don’t listen to your advise or act against your advise.
The current policy states, “Physicians who are able to accept new patients into their practice should use a first-come, first-served approach… It is not appropriate for physicians to screen potential patients…”
What about taking into account severity/urgency?
Regarding OPIOIDS as a reason to refuse taking on patients as a blanket “clinic” or “doctor’s” policy:
Given the existing CPSO statement on accepting new patients, “Clinical competence and scope of practice must not be used as a means of unfairly refusing patients with complex health care needs or patients who are perceived to be otherwise “difficult.””, I believe that the many family doctors who refuse to accept patients if they are on opioids fits in the category of trying to avoid “difficult” patients. Family physicians need to read the highlights of the Canadian Opioid Guideline, and if that doesn’t inform them about how to prescribe opioids, they should read the entire guideline, since chronic pain is a huge portion of all of their practices. They should not be avoiding patients on opioids because they don’t want to take the time to learn how to prescribe opioids appropriately.
Any revisions to the guideline MUST address refusal to accept patients who have chronic pain or who are on opioids, especially since we now have a guideline to help family physicians manage these patients. Just because a patient is on opioids when they apply to new doctor doesn’t mean that the new doctor must agree to prescribe them. They should, however, be required to take a patient and do their best to help them with their pain, even if that means to help them get off their opioids and get them on something that works better for them. Some patients will need opioids and will do so in accordance will all of the recommendations of the Canadian Opioid Guideline. These patients should be accepted into a new doctor’s practice, and be maintained on their opioid if there is evidence of ongoing benefit and no harms.
Starting a new practice is challenging I find
but my personal experience is accept patients on a first come and first served basis rather than screening in any way as it can be seen by patients as discriminatory.If patients are on regulated prescriptions,I would like to have access to their records or know the background of their problem before writing a prescription and sometimes new patients want treatment right away withou appropriate documents.does the college has advice or policy in this particular matter?
This is a good question, we got to examine patients previous medical records before we can decide accepting patients. and the physician who prescribed narcotic for the first time to a patient is most responsible for the patients narcotic needs on a regular basis rather than any new family physician
What if the records are unavailable? Mine were locked up with a records company that wanted hundreds of dollars for them (just under the legal limit), and when I couldn’t afford it the salesperson wanted names, titles, and phone numbers of other people to call to try and find out if they would pay the fee on my behalf. I finally got a small portion of them from another corporation that wasn’t legally allowed to sell them to me at all. It felt like a drug deal going down. Reading the subjective opinions within a few was horrifying.
What if the records are inaccurate or falsified?
What you’re saying is that the word of the doctors in control of the records are the definitive sources, and you want to hear from your colleagues before accepting a patient. That’s a dangerous path.
No, I am NOT a narcotics seeker. I received one prescription for oxy in my life from a hospital, and still had some left from the only bottle 2 years later.
You might want to read an article on this site about a physician’s moral duty to trust a patient, as it’s pretty hard to trust doctors when we’re treated with such distrust from the get-go. I’ve been trying to build a PHR, but these posts make me afraid anything that comes from me instead of another physician will be distrusted.
This is how my old family Doc did it. He was great. I now keep a copy of my medical file, as best I can have it, since that doc’s office would not give me any doc notes or any record of me actually going to my family doc during the 7 years I was with him. But I have all the reports that were sent to him.
I am a family physician with 35 years experience. I did accept all patients for many years and felt it unethical to do otherwise, based on their health condition. The exception was those who were obviously drug seeking. About ten years ago I began restricting my practice to those referred by a current patient or friend. I feel that after this amount of time in practice I don’t want to start over with large numbers of new patients.
I believe that the thing that makes us skittish about taking on those patients who are doctor shopping or those who are on opiods is that I’m sure we have all been burned by one or more of those patients who have made our lives miserable. I know I have.
Unfortunately, those who are legitimately seeking care may suffer as a result of being “tarred by the same brush”.
I really feel some of the problem lies with the lack of education that is available to give physicians the skills to deal with difficult patients or opoid dependant patients. If this were more readily available, the reluctance to take a chance on a new patient might be mitigated.
I think that ALL residents of the province should be registered with A general practitioner and ALL general practitioners should be required to accept patients as they come.
Being a doctor is a privilege and carries with it serious responsibility to “pay back” to society. We should not take the easy way out.
I think that the intake questionnaire which helps to screen out WSIB, MVA, LTD or opiods cases should be banned, just like questions about gender, religion, and race are excluded from applications for employment.
“Difficult” patients are opportunities for learning and should not be seen as trouble. Patients are difficult if their values clash with the physician’s, but often, calm explanation and patient acceptance will accomplish the goal eventually.
I agree with this, especially the fact that we are very privileged. In the new primary care models, especially teams, complex patients in primary care can be supported by an entire team, and this will help prevent the burn out that having too many complex patients can bring.
I do also recognize the issue of doctor shoppers who want a new doctor if their current MD does not give them what they want. I did have my staff ask if the patient already had a physician, and if they did, I would decline to take on the new patient as I felt it was my duty to first serve the “unattached”.
I believe it is every Ontarian’s right to have a Family Physician. However, that does not mean that I must accept every person that wishes to join my practice.
One hallmark of Family Practice is the doctor-patient relationship. If it is clear from the introductory appointment that there is an incongruity of expectations for my role as their physician and their role as my patient… there is no sense in accepting them into the practice. It should be my right to refuse to accept a new patient based on reasonable parameters, just as the patient has the right to refuse to be taken into the practice, or to find a new physician if they are unhappy.
The vast majority of Family Physicians in this province are NOT supported by a team of allied health professionals. We are independent practitioners plying our craft to keep our patients healthy and treat illness in a socialized system. Our resources are limited and they cannot be spent repeatedly looking after the concerns of one, single patient who refuses to adhere to the rules of care set forth by the practice. The government has set up clinics to look after these patients, based on a completely different funding model: The community health centre.
I personally enjoy caring for elderly and medically-complex patients. It should be my right to tailor my practice to be in line with this special interest, just as Family Physicians who practice obstetrics look to have a practice of young women and children.
A blanket rule of ‘no refusals’ cannot be applied equally to all.
With regard to the “first come first serve” clause, that is modified at the end of the policy by the statement “it is appropriate for patients in need to receive priority access to care”. In my specialty practice, with long wait lists for both consultation and surgery, I feel obliged to advise referring physicians to seek other options for referral, but do not decline the referral. So in essence, I encourage some degree of “shopping”, and in a resource limited environment I do not know a better way of managing waiting times. I do expedite care to those in need, and am encouraged about the balanced approach this policy suggests. I have always wished there were more recommendations regarding waiting times, but I realize it is difficulty to set in to policy an issue that really needs to be assessed on an individual practice basis. I do suggest that as we sit at the feet of this demographic bulge, some guidance around waiting times would be helpful. Is there ever a point at which a physician should decline referrals as the wait times are just too long? I suspect not, but I have a sense of professional guilt as my wait times climb, that perhaps patients could get more expeditious service elsewhere.
I agree that the statement “in good faith” needs some definition. I suspect in truth we all know what that means in the context of the human rights comments in the policy, but I would like to see a more fulsome wording of that very important summary statement.
If the physician is not able to provide timely care to the patient for the reason of lack of resources, perhaps that patient should be referred to another provider. Problem would arise if all providers in the region are refusing to accept this patient for the same reason. That would prompt the health authorities in the region to address the problem – whether there is a need to recruit another specialist, or there is a need to increase your OR time, or some other way to improve access to care in your area. Expecting specialists to accept all patients referred to them, even when their resources are maxed out would perpetually propagate endless wait times. That would be akin to expecting primary practice physicians to keep accepting all patients into their practice without limit. There is only so much one human can do, once that limit is reached, you should be allowed to say no to a referral or to a new patient in primary care.
I agree with what’s been said overall and I think the current policy is pretty good without need for much revision. My only comment to consider, from my experience, when talking with new patients who want to transfer from another physician, sometimes after hearing a new patient’s story I think to myself that I probably would have done the same thing as their previous physician. I still don’t refuse them, but I feel bad because often enough I end up equally frustrating the new patient because my care plan is not much different than their previous doctor nor in-line with what they wanted. For example, I might see a new patient with dizziness. After hearing the history of this problem and what his previous doctor did, I might not have much to really add or do differently, as much as I might really wish I that I could. Then, I feel bad because their hopes were up.
My only other comment is to say that their may be some benefit to allowing physicians to build a diverse practice. When I started, I happened to take on a lot of older, complicated folks – I think my office just happened to be in a more established part of town. I love taking care of them, but I found that I wasn’t seeing a lot of children or pregnant women, or young men, etc… and my skill and knowledge in those areas were fading. I ended up moving (NOT because of my patient population demographics)my home and practice to accommodate my spouse and children a little distance away (Most of my patients followed me) and I found that I started having new patients of a different demographic, which allowed me practice and hone my skills and knowledge and I hope to be a better doctor, I think.
Put in another way, I had two colleagues who started out wanting to ONLY look after complex patients. Very soon, they found, despite their well meaning intentions, they needed to diversify their patient population because they weren’t keeping up their skills and knowledge in healthcare of other demographics.
Anyways, I hope I shared my thoughts clearly. As I said, I think the current policy seems good and that basically if a physician is accepting patients, they accept everyone who presents to them regardless of complexity. However, as they are human beings too, we cannot expect them to do more than they can handle and provide false hope that they can guarantee better care than a patient’s previous doctor.
I would like a particular attention paid over accepting patients who decline immunizations. While there should be respect to patient’s autonomy in making this decision, other patients in the practice who are vulnerable should not be exposed to preventable communicable diseases. I would like the policy to allow opportunity to decline accepting patient to practice if it is felt that it jeopardizes health of current patients in the practice.
the need to protect the public must be balanced with the need to protect our physicians.
it is nice to the public to accept new patients indiscriminately, many physicians are bombarded with patients who has poor attitudes & unreasonable expectations, rude & impolite. One basis of denying patients should be the above mentioned issues. Bear in mind 5% of our practices are difficult patients. They gave us 95% of our stress.
The problem is that now the power is all on the side of the physicians, so there is no balance. They have their individual criteria, which they keep to themselves, and patients are expected to lay out everything about themselves in the questionnaires and auditions…to be judged or “assessed” as to whether or not they meet the physician’s criteria for acceptance.
As for “poor attitudes, unreasonable expectations,rude & impolite…5% of our practices are difficult patients…gave us 95% of our stress” Gee, it must be so hard for you when we’re dying or don’t get better. Perhaps your expectations need revision: you can’t heal everyone, but it’s not our job to protect you from stress, provide you with job satisfaction, or meet your standards with regards to manners. Bear in mind: what’s rude to some people is actually the other trying to show respect in their own way that may not be familiar to you – so one needs to be extremely careful before “denying patients” based on these issues.
Maintenance, listening, and not being judged socially against hidden criteria after a few minutes is also good, and sometimes all that patients expect from their physicians. I like the CPSO’s “first come first served” policy, and do fear that the caveat offered to this is being used as a loophole so big…
There has to be a professional relationship between the physician and the patient at all times. Keeping in mind that there are challenges, as alluded to in both comments above, both parties must approach this professionally. Rudeness, disrespect, impoliteness has no place on either side. Physician and patient should be allowed to terminate a relationship due to reasons of poor and disrespectful behaviour on another’s part. This is probably in the domain of CPSO policy relating to termination of relationship and not acceptance to practice – one could not know anything about patient until the patient is accepted into practice.
Physicians building a practice need to have the ability to choose who they accept into their practice. They are trying to build a practice that is sustainable over time and only they can determine the case-mix that will be sustainable. I’ve seen new doctors take all-comers and then burn out after a year or two because they are overburdened with too many complex patients.
The issue that I am starting to see in my practice is with new borns.
Parents call in and say they have an Apt with the pediatrician but it is 2 weeks from now and the Hospital has told them to have the baby seen within 2 days ! As I am the parents FP I am expected to see the baby untill seen by the pediatrician.
I find this is misuse of my and my receptions time to start a new file knowing the pt is moving on to a pediatrician !
I do understand it is a “system problem” but needs to be addressed in the CPSO policy.
Perhaps GP’s should spend 5 minutes in the ER and see if those clinicians get to pick and choose who they treat. If you are unable or unwilling to show compassion for the patients seeking your care don’t become a doctor – become a banker or lawyer instead. On a different note, child and maternal care in Canada is complete nonsense. I worked for the National Health Service in England and had my two children in the UK prior to returning to Canada. There, a midwife is responsible for post-natal care of mother and baby for up to 28 days (at hom), followed by a health visitor who you can see in weekly drop in clinics until a child is 5. Paediatricians are reserved for children with specialist needs – not treatment of the sniffles. Equally, obstetric care is reserved for complex pregnancies thus allowing OBGYN’s more time for thier gynaecological work. Bring in more nurses and allied health professionals into GP practices to reduce the burden and improve patient care all round. At my UK GP surgery, it was a nurse who performed pap smears, cleared ear wax, or gave injections – and guess what? I didnt have to wait days on end to see my GP when I really needed her.
I agree with this policy. Refusing patients for any reason except workload and competence is unacceptable. ‘Difficult patients’ are simply a challenge whose behavioral foibles should be accepted simply as part of their overall presentation, and enjoyed as variation in clinical experience.
I hope that this rule would not result in doctors extending courtesy, professional or otherwise, to friends and acquaintances becoming subject to consequences of this policy, but obviously, such exceptions should be exceptions.
Despite the current guideline stating that MD’s should not exclude patients based on their medical conditions, this practice is rampant in my community. The family health team that I belonged to would have patients complete a questionnaire and then refuse to take patients who were old, on multiple medications or suffering from complex medical and mental health conditions. I had one patient whose sister was accepted, not her.
There are doctors in family practice who will refuse to take chronic pain patients. And that they will not prescribe opioids. Family MD’s cannot abrogate their duty to treat patients who have chronic pain, even if it means that they refer the patient to someone else to manage the pain.
Other doctors will “close” their practice, but then take on generally healthy uncomplicated patients. In the rostered environment that we now live in, some MD’s have commented openly about their strategy of rostering a lot of healthy young people who will not come frequently to their office.
I hope that this updated guideline will stress the fact that MD’s have to look after everyone, especially those patients who rae disadvantaged and complex.
I am a specialist And I have faced considerable challenges finding family physicians with a willingness to provide primary care to my HIV patients. The reason for refusal of these patients is generally the “out of scope” one. Unwittingly , the CPSO has created a Frankenstein by focussing so much on the issue of practice scope that it now serves as an exit strategy from the proposed policy. The policy has great intentions, but poor enforceability. It reminds me of anti-discrimination policies that are meant to prevent racism, sexism and homophobia from entering hiring decisions – great on paper but hard to enforce. On a more positive note, I do commend the CPSO for taking on this issue, as the “cream skimming” by some family health teams needs to be stopped. Can’t have generous remuneration from rostering without the headaches of “tough cases”.
The CPSO should also consider the issue of where it is appropriate for specialists to refuse referrals. Sometimes, we have little to add (aside from an opportunity to bill OHiP if we want to take the easy way out and simply see every referral.)
I agree; the “out of scope” rationale is an exit strategy, a loophole, a euphemism, allows discrimination based on prohibited grounds…and ultimately makes the policy of accepting new patients on a first-come-first-served basis unenforceable.
If family physicians don’t want to be generalists anymore, become specialists. Just don’t try to have it both ways, as anyone can see through this “out of scope” for what it is: a transparent ducking of responsibility based on personal preferences and the ability to pick and choose, or skim the cream, for those patients you like.
I consider this issue more a system problem than an ethical one.
The fee for service model of practice, under which more than 90% of physicians operate, gives physicians a large incentive not to accept complex, demanding, or mentally ill patients.
This is simply because such patients require more time and resources than others, while the fees are the same.
Rather than threaten physicians with draconian policies to accept everyone, the Ministry of Health should bear some responsibility and give physicians an incentive to see complex, demanding and mentally ill patients.
“Rather than threaten physicians … the Ministry of Health should bear some responsibility and give physicians an incentive to see complex, demanding and mentally ill patients.”
Actually, the MOH does give financial incentives for physicians to take on these less-desirable patients…and then the docs roster them to get the incentive, and de-roster them as soon as they can because there’s more $ in de-rostering and keeping them on the FFS basis.
Don’t for a minute think that docs don’t know how to play the game to maximize their business income. Even patients can read the online SOB and other docs from the MOH, it doesn’t take a medical degree, and businesses catering to doctors’ businesses are openly advising physicians how to do the above. All you have to do is listen to some of these “consulting company” podcasts.
So it’s not a “system problem”. It *is* an ethical one, as it’s a question of the CPSO being forced to formulate a policy to guide their members in how to ethically choose the patients whom they accept into their practices. It shouldn’t be all about the $ as you suggest by discussing “incentives” and fees.
There should be explicit wording to discourage Family Health Team physicians from using Nurse Practitioner’s as a shield against “difficult” patients. The scam goes like this. No doctor in the Family Health Team is ever officially taking patients as they are always “full”. However new patients are welcome to meet and greet with a ministry funded Nurse Practitioner. If the patient is low needs, they are accepted to the practice (and their rostering money distributed amongst the physicians who supervise that NP). If the patient has mental health issues, chronic pain or multiple medical problems they receive a letter stating they are “too complex” for the provider. I have seen these letters firsthand from some of my new patients. This practice is unethical and embarrassing in my opinion. Patients don’t complain because they simply don’t know their rights. I hear “thank you for taking me” from many of my new patients. I always tell them that the choice has always been in their hands.
Thank you for exposing this scam. I experienced others in my search, but not this one, so I’ll be on the lookout if I ever have to move, my new current doc retires, etc. I had one bad experience with an FHT, and it was so doctor-centered it was unreal. The constant “no outside doctors” I heard and read so often in <6 mths was more about protecting their billings, all the tests they wanted me to undergo from the start was on the list of bonus-payment-eligible ones…
"I hear “thank you for taking me” from many of my new patients. I always tell them that the choice has always been in their hands."
Patients are grateful for acceptance by ethical practitioners like you. We're grateful for care. Some of us know our rights, too, but that doesn't mean they're honoured – another basis for gratitude. The FHT doc also told me the choice of a mammogram was mine, I said "no thank you", she asked in an aghast tone, "With your history?!" (she didn't know my history yet, just my mom's) and when I repeated my decision, she rolled her eyes and turned her face back to the PC monitor. Yes, she also stated that the choice of a physician was mine, but this isn't actually true when you've already been rejected by so many others, and as soon as I'd signed the rostering agreement her attitude went further downhill. 6 mths later I found I'd never been rostered by this doc at all, which made all the pieces fit together for me: they wanted me to believe I was rostered so I wouldn't go elsewhere, but thought that they'd get higher revenues by keeping me on a FFS basis. Businesses catering to physicians openly encourage moving patients from rostered status to non-rostered/FFS to maximize revenues – and it's in the doc's best interests to not inform the patient (supported below).
With all due respect, the choice is not truly ours if we're ridiculed when we exercise a choice – or when the supply-and-demand is out of whack, or when docs aren't required to be truthful with us about rostering or other matters (the gov. manual asks docs to "please" notify patients). The "scam" you helpfully share with us in your post is just another way patients are manipulated and actually become afraid of doctors' power.
My Dear wife and I were fortunate in always having a family doctor.When our Doctor had to retire due to poor health,I applied to a Husband and wife team to accept my wife and I as patients.I am very happy to be with a great Team—–both Doctors are so pleasant and interested in helping keep me well.I appreciate very much both my Doc’s.
We recently had an issue with our FHO. One of our new physicians in the FHO saw a patient in the after hours FHO clinic from another physician in that FHO. The patient took a liking to our physician and wanted to switch. We had a general policy that we do not take patients from other physicians in the FHO. We called the CPSO and they stated a patient is allowed to go wherever she likes to go. We were then accused by the other physician of “poaching” patients.
This policy that patients have all the rights and physicians have no rights is not fair, in my opinion.
I think you should have a discussion with your colleague who accused you of ‘poaching’ patients. This type of comment reflects the relative importance that physician places on the financial compensation from patient care, rather than the patient’s autonomy. Patient always has a choice and both your clinic and the previous MD must respect that choice. Physicians have many rights, but the right of the patient to select his care providers lies with the patient.
New patients must be accepted by family physicians as long as the patient living close to the physicians area and request him or her as family physician provided his practice is accepting patients at that time., ie he has more room for new patients and the practice is closed for new patients. Yes some patients are complex non cooperative unreliable about keeping appointments filling prescriptions compliance with medications.,
The main obstacle for the patients not being able to be accepted to a physician’s practice is the government’s monopoly to the health care delivery. The concept of a physician-patient contract is still valid. A physician cannot be forced to accept any patient for any reason except in an emergency.
It’s not the government who has the monopoly. It’s the physicians who are the gatekeepers, most are corporations in their own right, and they can say “no” in many ways in most situations (often in passive-aggressive ways). They’re also self-regulated, and the government has ceded most of the powers to physicians, the CPSO, OMA, hospitals, etc. The gov’s main role is to pay the bills.
-I am a specialist.I accept new patients,only on referral basis,but I have a wait-list,which is managed by my secretary.However,if the referring physician cares to call me&explain any urgent need,I would expedite the referrel ASAP.By ans large,I built a professional&harmonious relationship with primary care in our community.
-I accept patients of all diseases in my specialty,not just chosen one or two,thus building&seving a diverse population in a way.I find it rewarding,enjoyable,educational,professionally fulfilling&also motivates me to keep my knowledge&skills,uptodate.
I don’t think a doctor should be forced to accept any patient.
A patient might have expectations a doctor is unable or unwilling to fulfill in order to continue practicing with integrity and have a sustainable practice. Examples include a patient on excess opioids or a patient with a dependent personality who demands frequent lengthy visits for chronic stable issues.
If a doctor gives up their integrity and acts against their better judgment to satisfy a patient’s unreasonable demands or expectations ultimately they will do more harm than good, both to themselves by losing self-respect and to their patients.
I think there needs to be an active campaign to inform patients of their rights – namely it is their choice whether or not to join a family practice and not the other way around. In my practice I have met many new patients who say “thank you for taking me” which highlights their fundamental lack of awareness. Typically these patients have been interviewed (often by a ministry funded NP used by a FHT to shield the doctors from taking on difficult patients) and then declined. This practice is unethical and embarrassing to the profession. We all need to do our fair share – if we don’t what good are we anyway?
Unfortunately, many physicians hate or fear those patients who know their rights. I’m rather empowered myself, and have found a lot of negativity on the part of physicians if I mention any of my awarenesses: most have reacted with a “I went to medical school” or other shut-up tactics designed to re-assert their dominance in the encounter. Of course, this negative attitude toward me often comes from younger, newly-credentialed physicians who may be insecure, and not those physicians who are more established and secure in themselves and their practices.
I like your post, but fear that knowing our rights won’t help us, and may even harm us if this knowledge results in us getting perceived as “litiginous” or “difficult” by a physician. Any physician, secure or insecure, can feel irritated by any word about rights, as it does take time and offers a challenge to the doctor. Just look at the physician posts on this site: any talk about patient rights inevitably gets met with vociferous posts about doctors’ rights.
I was trying to load the accepting new patients policy and it would not load. I would suggest that the College physicians refrain from screening patients and then deciding whether or not they accept a patient. I think that it is fine for doctors in primary care to have a focused practice as long as that is made clear at the start. For example I know colleagues who are interested in asthma or diabetes and are happy to treat these kind of patients. I do not think that it is appropriate or fair to the public that a doctor interview a person and then refuse them because they have certain conditions that the doctor feels may be problematic (for example an active WISB file). This in my opinion is a form of discrimination.
I think the policy could be clarified in the following way:
1. Outline specifically how the information about the scope pf one’s practice can be communicated to colleagues and patients (without interference with CPSO advertising policy)
2. Outline specific reasons and the acceptable ways to communicate these reasons with patients and colleagues (i.e. reason for referral is outside of scope of practice; not able to provide care in a timely manner, etc.)
As a GP Psychotherapist, I cannot always tell at the outset whether a new patient who has sought out my care or who has been referred to me is suited to the skill set I have, i.e. whether that patient can apply themselves to the kind of therapy I do, which is psychoanalysis. Only after some time of working with such a patient may I be able to determine that person’s suitability to psychoanalytic work. By that point, however, a patient may have assumed that I will continue to be their therapist, and just provide supportive therapy. This would not likely be an optimal situation for either patient or physician. Could the policy reflect nuanced dilemmas like this?
“a new patient who ,,, is suited to the skill set I have i.e. whether that patient can apply themselves to the kind of therapy I do”
Perhaps your skill set needs to be expanded?
This endemic notion, that patients must conform to the physician’s preferences and skills or be rejected, is apparent in so many posts on this site — and it worries me precisely because it is echoed in so many physician posts.
We are seniors and due to my wifes serious health condition[diabetes,c.o.p.d.,ostiyo we decided that the distance to our former Dr.was
getting more difficult for my wife.the ontario health in formed us in order to get a Dr. in our area we would have too sign off & drop our present Dr. before we could get another local Dr.A month now i have tried to find a Dr. as per instructed by ont.health while they would notify us if they find a Dr. in our area.so far i have been shifted from one health care worker to another.One in markham gave me a ph. # for a local dr. who had no idea why they would tell me that he may be taking on patients.This has me wondering about ONT. HEALTH’s procedures.
so here we are no Dr. thanks to Ont. Health Canada,& no idea whether they are even trying to find us a Dr.
just what are we supposed to do?
where do we go from here?
I am not concerned about my-self,but worried that my wife has no Dr. at all for guidence.
or any one to prescribe her many prescriptions.
ONTARIO HEALTH HAS LEFT US IN A PREDICAMENT.
Information and Privacy Commissioner of OntarioResponse in PDF format.
Professional Association of Residents of OntarioResponse in PDF format.
Like the policy
All inclusive transparent care.
Ontario Medical AssociationResponse in PDF format.