College Direction to Physicians Regarding Access to Care for Patients During the COVID-19 Pandemic
These are extraordinary times. We commend physicians for their service and flexibility as we move through the pandemic.
Across the province, primary care physicians are providing both virtual and in-person care. Physicians have developed office systems to pre-screen and sequester potentially COVID-19 infectious patients. They are practicing safely and effectively, accessing the supplies of Personal Protective Equipment (PPE) available through the NSH.
We are aware that there is a scattering of primary care providers practicing virtual medicine exclusively or only offering in-person care to the fully vaccinated and asymptomatic.
Physicians and the public have contacted the College seeking guidance regarding virtual and in-person care. Here we provide answers to frequently asked questions to inform your primary care practice. We encourage physicians to check back regularly for updates.
Frequently Asked Questions
What are the relevant policies and standards of the Department of Health and Wellness (DOHW) and the College?
The College’s Professional Standards Regarding Virtual Care aligns with the DOHW’s Provision of Publicly Funded Virtual Health Services Policy which directs physicians to deliver virtual care in conjunction with in-person care.
Appropriately balance in-person and virtual care. Not all patients will be able to get the care they need virtually as there are limits to what can be done virtually. In-person care is essential for many conditions. The patient choice regarding an in-person appointment is paramount. Preceding with a virtual care appointment requires the exercise of professional judgement by the physician as to whether the matter is appropriate for virtual care. (Refer to the College’s Professional Standards Regarding Virtual Care)
Can I refuse to see a patient in-person because they are unvaccinated?
No. Physicians must not restrict in-person care to only those patients who have been vaccinated or have a recent negative COVID-19 test result.
With appropriate measures in place, all practitioners should resume routine in-person visits based on clinical needs and patient preferences.
In-person care can be provided safely to all patients by taking appropriate precautions including screening patients and using necessary PPE.
Is there any guidance available to physicians from the CMA and its Code of Ethics and Professionalism?
The CMA Code of Ethics and Professionalism provides the following professional responsibility:
- Respect the decisions of the competent patient to accept or reject any recommended assessment, treatment, or plan of care.
Can a physician ask for proof of vaccination from a patient before booking in-person appointment?
Physicians must ensure unvaccinated patients are given the same access to care as vaccinated patients.
Physicians cannot require documented proof that a patient has been vaccinated as a prerequisite for attending their office. However, it is reasonable for a physician to request that patients report their vaccine status to them. Once aware of a patient’s vaccine status, physicians may manage appointment times in a way that does not compromise the health of other patients or their medical office staff.
What if I am a physician in a high-risk population?
With the right safety precautions, physicians are able to provide in-person safely. PPE has been demonstrated to allow for safe and effective care.
Every physician’s situation is unique. If you or your family are in a high-risk population, you will have to consider the best way to manage your practice given your unique situation the advice of public health officials, and the best evidence available at the time. In extenuating circumstances where you are unable to provide care to your patients, there are steps you can take to support them in accessing the care they need:
- Use virtual care to provide what you can or help triage and re-direct patients as needed;
- Coordinate with colleagues to help provide coverage for in-person care;
- Engage with local pharmacists who may be able to assist with some types of care, like extending or renewing a prescription;
- As much as possible, avoid simply directing patients to the emergency department when these resources aren’t required, and instead do your best to help patients navigate the system to find the resources best suited for their care needs.
How can I access Personal Protective Equipment (PPE)?
PPE supplies are available from Nova Scotia’s centralized COVID-19 Inventory.
Physicians may order PPE by completing the online Provincial COVID-19 Inventory Request Application. Applications are typically processed within 2 business days.
What advice is offered by the CMPA?
The advice of the Canadian Medical Protection Association aligns with the guidance provided by the College and can be found at the CMPA COVID-19 Hub.