While the previous version of the College policy “Medical Practice Coverage” established the College’s expectation that all physicians involved in direct patient care have an obligation to arrange for 24-hour coverage of patients currently under their care, as well as the expectation that any arrangements made by physicians have to be mutually acceptable (i.e. a physician cannot unilaterally offload patients to another clinic or SHA facility), it did not provide much guidance as to the scope of the expectations and the various components to be considered in ensuring appropriate practice coverage.

At its meeting in late March, the Council adopted an amended version of the policy “Medical Practice Coverage.”  This concluded the work of a committee that had been appointed to review the policy, as well as a comprehensive process of stakeholder consultation including an opportunity for feedback from physicians and a number of stakeholder organizations.  More than 65 physicians participated in the online survey.  All of the feedback received was considered by the committee, and recommendations were then provided to the Council.

Expectations included in the amended policy

The amended policy includes the following:

• Clarity that the expectations apply to all physicians involved in direct patient care, and address physician availability, after-hours coverage and coverage during temporary absences from practice;
• A definition of “Physicians involved in direct patient care” that includes primary care physicians (including those working at urgent care/walk-in/episodic care clinics), and specialists/consultants providing care as part of a sustained physician-patient relationship, regardless of mode of service delivery (in-person or virtually). A “sustained physician-patient relationship” is defined as a physician-patient relationship where care is actively managed and where the care will be provided on a longitudinal basis;
• An expectation that physicians have an office telephone that is answered and/or a voicemail that is operational at all hours which gives clear information as to office hours, coverage information, and instructions on how to access emergency care;
• An expectation that physicians ensure that any practice location in which they work has appropriate systems in place to receive and review investigations results after-hours, to permit them to take appropriate action in response to critical test results; 
• An expectation that physicians (or their designate) are available to respond to after-hours inquiries from other health-care providers, depending on the urgency of the inquiry;
• An expectation that physicians make coverage arrangements for patient care and management of test results during planned temporary absences, as well as proactively plan for the management of unplanned temporary absences;
• An expectation that physicians ensure that voicemail and email messages are reviewed and, if appropriate, responded to within a reasonable timeframe.  Physicians are also expected to ensure that any outgoing message or automatic replies are current and accurate;
• An expectation that physicians take reasonable steps to structure their practice to allow for appropriate triaging of patients with time-sensitive or urgent issues, and to be prepared to offer a reasonable alternative for care if the patient can’t be accommodated. 

We encourage physicians to review the amended policy and to consider the more detailed expectations in the context of their own practices.  Please don’t hesitate to contact our office if you have questions arising from this policy.

Possible proactive enforcement of the policy

While the College has responded to concerns it received about physician/clinic non-compliance with the requirement for 24-hour coverage, it has not engaged in any proactive enforcement of that expectation to date. 

The College Council has indicated that it may consider whether or not to institute some program for proactively ensuring physicians/clinics have implemented the expectations in the policy.  However, its direction in March was that it would not consider this until there had been sufficient education of physicians with respect to the amended policy, as well as a reasonable period of time to permit physicians to implement the various expectations included in the policy. 

Any decision as to proactive review / enforcement will be communicated in a future issue of DocTalk, as well as on the CPSS website.