In brief
- Refer to your regulatory authority’s (College’s) policies and standards on responsibilities when closing or leaving a practice. 1
- When planning to leave your practice, make reasonable efforts to ensure all work in progress will be completed, reviewed, and appropriately acted on. Pay special care to the transfer of vulnerable patients, such as the elderly, young children, and those with complex physical and mental health issues.
- Primary care physicians should make reasonable efforts to facilitate continuity of care. Consulting physicians should consider appropriate transfer of care for patients who are in active treatment.
- What is considered reasonable by the Colleges will depend on factors that include the reason for the practice closure, the needs of specific patients, and the healthcare resources available in your community.
Unforeseen circumstances
Many Colleges require physicians to proactively plan for unexpected practice closures, as may occur in the event of a physician’s sudden illness, death, or other unforeseen circumstances. Physicians may need to develop a practice closure plan in collaboration with partners or colleagues.
When it is not possible to provide advance notice of a physician’s departure, a business partner, colleague, family member, or an executor for the estate of a deceased physician may take the necessary actions described in this article to close the practice.
Primary care physicians
If you are a primary care physician and planning to close your practice, it’s important to attempt to maintain continuity of care. However, there may not be any other primary care physicians to easily transfer care to. In this situation, you should be able to demonstrate that you made reasonable efforts to facilitate continuity of care.
What is considered reasonable by the Colleges will depend on a variety of factors, including the reason for the practice closure, the needs of specific patients, and the healthcare resources available in your community. Reasonable efforts can include referring patients to matching programs (such as Québec’s Guichet d’accès à un médecin de famille), or to other programs through the relevant provincial or territorial ministry of health.
Consulting physicians
If you are a consulting physician and planning to close your practice, you should consider appropriate transfer of care for patients who are in active treatment.
Other actions to take include the following:
- Inform your patients’ primary care physician of your intention to close your practice, and refer patients back to the primary care physician for follow-up where appropriate.
- In some cases, there may not be a primary care physician to refer a patient back to, and the patient may be vulnerable and in need of active treatment. In these situations, you should be able to demonstrate that you made reasonable efforts to ensure the patient had access to follow-up care or further referral.
- What will be deemed reasonable will depend largely on the circumstances of each case, including the patient's condition and the resources available in the community. Reasonable efforts might include advising the patient of providers or clinics in the community accepting new patients, or referring the patient to matching programs through the relevant provincial/territorial ministry of health.
- Inform patients about symptoms and signs that suggest the need to seek immediate medical assistance.
Downsizing or limiting a practice
Before closing a practice entirely, physicians may choose to transition to eventual closure by reducing the size of their practice.
Most Colleges generally permit physicians to terminate doctor-patient relationships to reduce their practice size, and some Colleges have published standards and guidelines in this area. See, for example, the Collège des Médecins du Québec’s Diminution des activités en prévision de la retraite ou pour des raisons de santé [PDF] (available in French only), and the College of Physicians & Surgeons of Nova Scotia’s Reducing the size of a medical practice. As well, the CMPA article “Ending the doctor-patient relationship” offers steps in terminating doctor-patient relationships, aimed at ensuring the well-being of patients is safeguarded and compliance with physicians’ professional obligations.
Notifying patients
College policies may stipulate the minimum required duration to notify patients of a planned closure. In Ontario, Québec and Alberta, for example, at least 90 days notice is required, unless the closure is unexpected or due to circumstances beyond the physician’s control, in which case the notice must be communicated as soon as reasonably possible.
You are generally required to notify patients directly through one or more channels: letter-mail, email, telephone, or in-person at a scheduled appointment. Where direct notice is impractical, indirect notice may generally be relied upon, such as by posting a notice in the office and online. Consult your College’s policies on specific requirements in your jurisdiction.
Notifying others
Some Colleges require physicians to notify them when closing a medical practice and of the arrangements made for storing medical records. This may apply whether or not the physician continues to hold a licence.
You should also notify other affected parties of a planned closure, such as:
- colleagues and employees
- healthcare organizations such as hospitals, labs and specialty medical centres
- local pharmacists
- provincial or territorial paying agency
- professional associations and federations
Contact CMPA and tell us about your plans, such as if you intend to do a different type of medical work or change your province of work.
If you are practising under an employment or contractual arrangement with a hospital, health authority, research organization, or government agency, review your contract or service agreement and contact your personal legal counsel to understand your responsibilities with respect to your retirement or relocation to another practice setting.
Clinical care in progress and prescription renewals
Physicians should make reasonable efforts to ensure all work in progress will be completed, reviewed, and appropriately acted on. Issuing renewals of prescription medications will provide patients with time to find another physician.
Consider arrangements for alternative care for patients who have outstanding results or need follow-up after a recent test or procedure. If patients under your care are in hospital or another health facility, complete the transfer to another physician and document this in the medical record.
Transferring and storing medical records
Patients who find a new physician may need to have their medical records transferred. You are required to facilitate this process once you have received the patient’s authorization to do so.
The transfer should take place as soon as reasonably possible, or as prescribed by your College. You may charge an appropriate fee for this service, which may be set by provincial or territorial medical associations (federations) or in regulations.
Advise patients how they can access their records. You may also need to notify your College of the location of the records.
In a group practice such as a clinic, it should be clear who will retain the medical records when you leave the practice. Clarity can be achieved by entering into a written agreement when joining the group. Provincial medical associations (and federations) or personal counsel may assist in preparing an agreement that allows you to have continued access to the medical records that you entered even after leaving the practice.
Your access to medical records is important to ensure you meet your College obligations and records retention requirements, and will be indispensable in the event of medico-legal issues that may later arise.
Once the applicable retention period for a record has expired, destroy the original record in a secure manner. This task can be outsourced to a commercial service provider and the date of disposal should be documented.
Some Colleges require physicians to implement a succession plan and designate a custodian to ensure retention and access to records if they are unable to continue as custodian. In Alberta, for example, physicians are required to have in place an information sharing agreement to manage patient records in the event a physician ceases to maintain custody of existing records, and to identify another physician who will maintain them.
Original records, whether in digital or paper form, should be retained for at least 10 years from the date of last entry or, in the case of minors, 10 years from the time they would have reached the age of majority. For obstetrical care, CMPA recommends that maternal records (e.g. prenatal and labour and delivery records) be maintained for at least 10 years from the time the infant reaches or would have reached the age of majority.
Where a record storage company is relied upon to retain medical records, the physician remains the custodian of the records, and is responsible for the protection and control of the records. Most Colleges and/or privacy statutes require physicians to enter into a written agreement with commercial storage providers. In Québec, the storage provider must be located within the province.
For more information, see “How to manage your medical records: Retention, access, security, storage, disposal, and transfer.”
CMPA protection and advice
If you are closing your practice but want to continue practising medicine, even on a limited basis, you must maintain your licence as well as your CMPA membership.
Your eligibility for CMPA protection continues throughout your retirement. Because CMPA provides occurrence-based protection, if a medico-legal difficulty arises for care you provided while a CMPA member, you remain eligible for assistance. Protection eligibility also extends to your estate, as long as the medico-legal matter pertains to clinical care you provided in Canada while you were a CMPA member.
When a transition in your practice happens unexpectedly or if you encounter challenges when closing your practice, CMPA’s physician advisors are available to provide advice.
Additional reading
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