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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:  

  1. 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. 

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. 

 


Message from the Registrar: Guidance to Physicians Regarding Medical Exemptions for COVID-19 Vaccinations

Throughout Nova Scotia, many organizations are requiring that all staff and visitors be vaccinated against COVID-19.  It is not unreasonable to expect that, in response, physicians will be asked to provide medical notes for patients who have chosen not to be vaccinated.

As physicians continue to work to mitigate any further spread of COVID-19, the College aims to support their leadership with clear guidance on their responsibilities in this circumstance.  Physicians must only support requests for a medical exemption from COVID-19 vaccination for patients with a legitimate medical condition that would warrant an exemption.  

The office of the Chief Medical Officer advises the following are valid medical contraindications to receiving the COVID-19 vaccine… Read more.


Scope of Practice for Physicians Deployed in Response to COVID-19

We wish to express our appreciation to all physicians who have been deployed by Nova Scotia Health or IWK to contribute to the pandemic response in ways outside their normal scope of practice. As the province moves through the third wave of the pandemic, physicians have continued to demonstrate leadership in their commitment to providing care. 

These continue to be stressful times, with physicians raising their hands to help wherever needed. We wish to reassure physicians the College will not hold deployed physicians to practice within a scope strictly consistent with recent training and experience.

This approach applies to physicians privileged and working under the direction of Nova Scotia Health, the IWK (inpatient or outpatient settings), and/or the Chief Medical Officer of Health’s office. This may include, but is not limited to, work within COVID-19 primary assessment centres, case tracing and monitoring, provision of vaccinations, and COVID-19 testing as deployed by the health authorities.

Rest assured, if you are deployed by your Health Authority to work outside your normal scope of practice, be advised you will not face disciplinary measures from the College for practising outside your scope of practice.

We thank you for your service.


Scope of Practice & Physician Deployment During COVID-19

Given the public health directives in response to the recent increase in COVID cases, licensed physicians may be asked by their Health Authority to contribute to the pandemic response in ways outside their normal scope of practice. The College wishes to reassure physicians its support of this measure.

When deployed by a Health Authority to support the pandemic response, the College will not hold physicians to practice within a scope strictly consistent with recent training and experience. 

This approach applies to Physicians privileged and working under the direction of NSH,  the IWK (inpatient or outpatient settings), and/or the Chief Medical Officer of Health’s office.  This may include, but is not limited to, work within COVID-19 primary assessment centres, case tracing and monitoring, provision of vaccinations, and COVID-19 testing as deployed by the health authorities.

To restate: if you are deployed by your Health Authority to work outside your normal scope of practice, be advised you will not face disciplinary measures from the College for practising outside your scope of practice.


Emergency licensure available to support COVID-19 Immunization

Retired physicians within three years of practice may be eligible for an Emergency Licence. The College is working closely with Nova Scotia Health to license those retired physicians wishing to assist in the COVID-19 immunization efforts. There is no fee for this emergency licensure. A streamlined process is in place to quickly issue such licences.

Physicians who are interested in supporting immunization clinics have been asked by Nova Scotia Health to complete please complete the Covid-19 immunization intake form.


Pandemic-Related Exceptions to MCCQE Part II

The College has instituted a new policy in recognition of the postponement of the Medical Council of Canada’s Qualifying Examinations Part II. As a result of this exam delay, a number of physicians are unable to meet the requirements of obtaining LMCC for Full licensure. 

The College’s Pandemic-Related Exceptions to the Requirement for the MCCQE Part II Policy allows exceptions for those who were affected by the postponement of this qualifying examination. Review the new policy.

Currently, Nova Scotia is the only province with such an exemption and therefore we encourage postgraduate trainees to continue to challenge the MCCQE Part II as it becomes available so as not to limit their licensing options throughout Canada.


Covid-19 Measures for Physicians

This Fall in Nova Scotia we have not experienced the significant number of COVID-19 cases as elsewhere in Canada. 

Physicians across the province are playing key leadership roles in safely caring for patients during the pandemic. The College expects that physicians in all practice settings adhere to the direction provided by public health regarding safety protocols and to clinical guidelines developed by health professionals.

We are truly grateful to patients and physicians who continue to take all measures necessary to protect the health of Nova Scotians.


COVID-19: Leaders from the Health Community Identify Lessons from the First Wave and Concerns for the Second

On October 2, 2020, Dalhousie’s Faculty of Medicine and the MacEachen Institute for Public Policy and Governance (MIPP) hosted a roundtable at which 27 people met online to discuss what went well and what lessons were identified from the health sector’s response to COVID-19. Participants included senior representatives from both the public health and healthcare systems of New Brunswick and Nova Scotia, as well as academics. Most of the participants were from Nova Scotia, which was the focus of most of the discussion. 

The briefing note starts by highlighting selected observations that were drawn from these discussions, and summarize the goals and methods and the discussions that took place at the session. 

Read the briefing note: COVID-19: Leaders from the Health Community Identify Lessons from the First Wave and Concerns for the Second