Accepting New Patients

Professional Standard and Guidelines Regarding Accepting New Patients

Preamble

This professional standard and guidelines applies to all physicians accepting new patients in their practice.

This standard reflects ethical responsibilities of physicians set out in the Canadian Medical Association’s Code of Ethics.

Physicians who are accepting new patients into their practices should use a first-come, first-served approach. Decisions to accept or refuse new patients must be made in good faith. With respect to the specifics that may arise, the College provides the following direction.

Professional Standard

Physicians may not discriminate against patients at any time including when considering them as new patients in their practice.

As providers of professional services, physicians are bound by the Nova Scotia Human Rights Act, which prohibits discrimination regarding provision of or access to services or facilities on the basis of age, race, colour, religion, creed, sex, sexual orientation, gender identity, gender expression, physical disability or mental disability, an irrational fear of contracting an illness or disease, ethnic, national or aboriginal origin, family status, marital status, source of income, political belief, affiliation or activity, or an individual’s association with another individual or class of individuals having characteristics aforementioned.

(Excerpt from Section (5) of the Nova Scotia Human Rights Act)

Guidelines

1. Scope of Practice

Clinical competence and scope of practice are permissible grounds for limiting patient entry into a practice and must be communicated to all individuals who initially inquire about becoming a new patient and prior to scheduling an introductory meeting with a potential new patient.

Where the focus is legitimately based on clinical competence and a clearly defined scope of practice, this would be a generally acceptable reason for refusing to accept a potential patient. In such cases, it is expected that physicians will, to the best of their ability, provide a referral to another physician with the appropriate expertise.

A defined scope of practice must not be used as a means to discriminate against patients as defined by law or unreasonably refuse patients:

• with complex or chronic health needs; or
• with a history of prescribed opioids or psychotropic medications or currently being prescribed opioids or psychotropic medications; or
• requiring more time than another patient with fewer medical needs; or
• with an injury or medical condition that may require the physician to prepare and provide additional documentation or reports.

2. Introductory Meeting

While an introductory meeting is deemed acceptable practice for physicians to get to know new patients and to learn of their health concerns and history, these may not be used to select “easy patients” and/or screen out those with more difficult health concerns, such as chronic or terminal disease.

A physician who offers an introductory appointment must:

1. advise patients in advance when an introductory appointment is not a medical appointment;
2. not bill or charge for such an appointment;
3. comply with all relevant privacy legislation and standards of practice with respect to retaining, disclosing or disposing of information collected during the introductory appointment; and
4. the College encourages the physician to document the reasons for not accepting a patient.

Caring for patients’ family members is part of the ethos of family practice. Accordingly, physicians who are not otherwise accepting new patients are justified in accepting immediate members of existing patients’ families into their practices.