Reducing the Size of a Medical Practice

Professional Standards and Guidelines Regarding Reducing the Size of a Medical Practice

Preamble

Tension exists between the professional duty not to abandon patients and the physician’s freedom to manage the size of their practice.

Physicians may not discriminate against patients at any time including when considering discharging them from 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).

This standard addresses the physician’s responsibilities when reducing the number of patients in their practice.

Professional Standards

Physicians must:

1. Not discharge a patient from their practice based on a prohibited ground of discrimination as defined in the Nova Scotia Human Rights Act.
2. Provide notice to patients of the criteria by which the size of their practice will be reduced and adhere to the criteria in all cases.
3. Comply with the College’s Professional Standards and Guidelines for Ending the Physician-Patient Relationship.
4. Notify the patients affected by the reduction of the practice and provide a reasonable timeline for discharge from the practice. Physicians are referred to the College’s Professional Standards Regarding Permanently or Temporarily Closing a Medical Practice.
5. Make reasonable efforts to arrange transfer and follow-up medical care.
6. Ensure that all outstanding reports and work in progress (investigations, tests and consultations) are reviewed and acted upon.
7. Facilitate patient access to prescription medication required for long-term or chronic conditions.

Guidelines

1. Notification of patients

Physicians should provide their patients being discharged from their practice with notification as soon as possible. A reasonable period is three months (3). Such notice should include information on where patients can obtain urgent care and how patients can obtain information from their medical records. It is acceptable to have patient notification done by a designate of the physician.

Acceptable methods of notification are:

1. 1. Scheduled appointment, and/or
   2. Written letter from physician, and/or
   3. Telephone call from physician or designate, and/or
   4. Email notification, and/or
   5. E-messaging.

2. Provisions for patients requiring ongoing care

Physicians should make every effort to ensure that patients requiring ongoing or chronic care, or requiring post-operative follow-up will continue to receive the necessary care. Ideally, they should arrange to have another physician cover or assume care for these patients. Physicians may provide a list of physicians in their geographic location who are accepting new patients.