Who we heard from

• 108 submissions were received in response to this consultation.
• Feedback was primarily submitted by physicians, but we also heard from members of the public and the following organizations: the Ontario Medical Association (OMA); Health Care Connect Provincial Care Connectors; Professional Association of Residents of Ontario (PARO); College of Physicians and Surgeons of Alberta; and OMA Section on General and Family Practice.

What we heard

Other important considerations

• Overall, respondents expressed support for the draft policy. The majority of respondents felt that the draft policy was clear, comprehensive and reasonable.
• Many physician respondents expressed support for the first-come, first-served approach. Respondents agreed that the first-come, first-served approach helps physicians to satisfy their legal obligations under the Ontario Human Rights Code.
• Despite broad support for the first-come, first-served approach, physicians were divided as to how this approach aligns with their ability to make decisions regarding their patient population. For instance, some physician respondents felt that they should be able to balance their own practices, or refuse patients who are rude, abusive and/or are “doctor shopping”. Others commented that patients without family doctors should be prioritized.
• Respondents generally agreed with the expectation set out in the draft policy that introductory meetings and medical questionnaires are not to be used as a means to vet prospective patients. Some respondents, also, requested clarification on the appropriate uses of introductory meetings and medical questionnaires.
• Respondents were divided on whether the draft policy clearly articulated how the first-come, first-served approach applies to specialist physicians. Specifically, respondents requested clarification on how the first-come, first-served approach is to be reconciled with specialists’ frequent need to triage patients requiring urgent care.
• Respondents requested clarification on physicians’ obligations where a patient is not accepted into the practice. Specifically, whether the draft policy obligated them to refer that patient to another health-care provider. We heard from several respondents that such a requirement would be burdensome and unrealistic.
• Overall, respondents were supportive of the exception that allows physicians, with otherwise closed practices, to accept the family members of current patients. A minority of respondents, however, felt that this exception was inappropriate because of, for example, concerns associated with maintaining confidentiality among family members and the perception that they may be facilitating queue jumping.

• In addition to the feedback, we considered a wide range of other information while developing the final policy. This included:
• A comprehensive literature search;
• A jurisdictional comparison of guidance on accepting new patients provided by medical regulators and medical associations, both within Canada and abroad;
• A preliminary consultation on the current policy; and
• A public poll of a representative sample of Ontarians.

How we responded to your feedback

• Overall, the revised policy retains the key content and central principles of the draft policy that was released for consultation.
• While the changes made are not substantive, the revised draft includes updates primarily to enhance the clarity of the document.
• Some specific examples of revisions undertaken in response to feedback are set out below, along with two instances where revisions were not made.

• Content added to signal that the first-come, first-served approach does not prevent physicians from determining when their practice is “closed”.

• This change was made to clarify that physicians have discretion to determine when their practice is no longer accepting new patients. The policy emphasizes, however, that such determinations must be made in good faith.

• The revised policy maintains the requirement that introductory meetings and/or medical questionnaires are not be used to vet prospective patients. The body of the policy now also provides examples of how introductory meetings and medical questionnaires may be used appropriately after a patient has been accepted into the physician’s practice.

• This change was made in response to feedback that the policy should also highlight the appropriate uses of introductory meetings and medical questionnaires, particularly in the course of establishing an effective physician-patient relationship.

• Content has been added to the policy to emphasize that a departure from the first-come, first-served approach may be required for specialists to triage patients with urgent health care needs.

• This change was made in response to feedback that further clarity was needed around the application of the policy, particularly first-come, first-served approach, to specialists.

• The policy was amended to clarify that physicians are only required to refer current patients to another health-care provider for those elements of care that they are unable to manage directly, and that this expectation does not apply to prospective patients.

• It was evident from feedback received that this expectation had not been clearly articulated in the draft policy, and as a result was misunderstood by numerous respondents.

• No change was made to the exception to the first-come, first-served approach that permits physicians providing primary care, with otherwise closed practices, to accept the family members of current patients.

• While this feedback was seriously considered, it was decided that caring for patients and their family members is important for the provision of quality primary care.

• No change was made to permit physicians to prioritize patients without a family physician.

• In keeping with the principal set out in the policy that patient autonomy and freedom of choice of health-care provided be respected, this change was not adopted.

The final policy

• The Accepting New Patients policy received final approval from Council on May 26, 2017, and is now an official policy of the College of Physicians and Surgeons of Ontario.

Read the Final Policy

• A Frequently Asked Questions document has also been developed, which provides elaboration on key issues grounded in the principles and expectations of the policy.

Key messages of the final policy:

1. Reminds physicians that new patients must be accepted in a manner that is fair, transparent, and respectful of the rights, autonomy, dignity and diversity of all prospective patients.
2. Clarifies that the policy applies to all physicians, and those acting on their behalf, regardless of practice area or specialty.
3. Requires that physicians follow the first-come, first-served approach when accepting new patients.
4. Outlines circumstances where the use of introductory tools, such as ‘meet-and-greet’ appointments and medical questionnaires, are appropriate and when they are not. Specifically, the final policy states that it is inappropriate for physicians to use introductory tools to vet prospective patients and determine whether to accept those patients into their practice. Introductory tools may however, be appropriately used after a patient is accepted into the physician’s practice to, for instance, identify a new patient’s needs and expectations, and to determine whether the physician’s practice approach is acceptable to the patient
5. Provides two limited circumstances where physicians are justified in deviating from the first-come, first-served approach when accepting new patients. These exceptions include: when caring for higher need and complex patients, and existing patients’ family members in a primary care practice. The policy reminds physicians that any decision to prioritize a patient’s access to care must be made in good faith.