Preamble
This professional standard replaces the Closing a practice professional standard.
When a physician closes their practice for reasons of retirement, relocation, or any other reason, they are obligated to make adequate provisions to minimize any impact on their patients. This obligation also applies to an extended absence from practice.
The standard sets out expectations relating to notification, continuity of care and the patient medical record, in the event that a physician closes their practice or takes an extended leave.
In addition to respecting this standard, a physician closing their practice must also respect the requirements of the Continuity of care professional standard and the Patient medical records professional standard.
Definitions
“Active treatment”: providing care to a patient on a regular, including annual basis, including patients rostered to the physician’s panel. (traitement actif)
“Extended leave”: the temporary closure of a physician’s practice for three months or longer (i.e. sabbatical leave, parental leave, educational leave, medical leave, or disciplinary action). (congé prolongé)
“Ongoing care”: in an established physician-patient relationship, both the physician and patient have a reasonable expectation that the care provided will extend beyond a single encounter. (soins continus)
“Practice closure”: Occurs when a physician ceases to practice temporarily or indefinitely (either planned or unexpectedly) or relocates their practice to a new location that is not reasonably accessible to their previous patients. (fermeture de cabinet)
Notification
The College
A physician must notify the College of their practice closure or leave from practice in advance of the closure or leave, unless an unexpected closure (as discussed below) prevents them from doing so. Notification to the College must include:
- A forwarding address,
- Date of practice closure,
- The location where their medical records will be stored,
- The name of the physician or other health care provider taking over their practice, if applicable, and
- Whether they intend to maintain their licence, and if so, where they will be practicing.
Patients
A physician must notify patients of a planned closure of practice or leave from practice. This notice should occur as soon as the physician is able to provide specific information as to when their services will no longer be available, to allow patients as much time as possible to find an alternate provider. Unless exceptional circumstances exist, notice should not be less than 90 days before the planned closure or leave.
Notification should be provided in the following circumstances:
- A physician who has seen a patient in the past year with an expectation of ongoing care must notify the patient directly. This notification can be given in-person, by phone, by email, or other personalized communication. Notification should be documented in the patient’s file.
- A physician must notify patients who have not been seen in the past year but still have an expectation of ongoing care. However, this notification may be provided either directly or indirectly, such as by a social media post, a notice posted in the office, an ad in the news, or a voicemail on the office phone line.
- Specialists must notify the patient directly if the patient is receiving active treatment or if there is an expectation of ongoing care. This may include patients who have not yet been seen but have an appointment for consultation or are waiting to receive one.
- Notification of practice closure is not required if the physician’s practice is one where there is no expectation of an ongoing physician-patient relationship (i.e. emergency medicine physician).
The notification should include the following information:
- The date of the physician’s planned closure of practice or leave from practice,
- The name of the physician or other health care provider who will assume responsibility of the medical practice, if applicable,
- Details on how the patient can obtain a copy of their medical records,
- Where patient medical records will be stored following closure of practice or leave from practice (if known at the time of providing notification), and
- The plan for continuity of care for patients, where required, including follow-up on diagnostic tests and referrals for consultation.
Others
A physician also has the obligation to notify other organizations, programs or individuals of a practice closure or leave from practice. The below list provides guidance, but each physician should assess whether other organizations, programs or individuals should be notified:
- Applicable Regional Health Authorities
- New Brunswick Medical Society
- Medicare and Physician Services
- Private lab and diagnostic facilities
- Health care providers to whom the physician frequently sends referrals or from whom the physician frequently receives referrals
- New Brunswick Prescription Monitoring Program
Medical Records
A physician who closes or leaves their practice is responsible for the secure storage and disposition of original patient medical records from that medical practice. This responsibility also applies to physicians working in a group or collaborative setting. According to the Patient medical records professional standard, these physicians should have a written agreement specifying who will become the custodian of the patient medical records in case of an extended leave or practice closure.
There are many ways a physician can meet the responsibility to securely store and dispose of original patient medical records. Some common examples include transferring the custodianship of the records to another physician or records storage company.
When a physician transfers records to a storage company, both parties must sign an agreement. This agreement should state that the storage company acknowledges its obligations under the Personal Health Information Privacy and Access Act to adhere to the same requirements for protecting, retaining, and securely destroying Personal Health Information as those applicable to the physician.
Consent of the patient is not required to transfer the custodianship of the records. If the physician does not maintain custody of their records, they must provide patients with the information necessary to access their records or obtain a copy of their records in advance of, and following, the closure of their practice.
A physician closing a practice must also comply with the requirements set out in the Personal Health Information Privacy and Access Act regarding providing enduring access to medical records as well as the transfer, retention and destruction of medical records.
Continuity of Care
Transfer of Care
A physician must identify patients who are under acute, active treatment, and who require ongoing care. A physician must make, and document, reasonable efforts to place them with another provider. Where, despite reasonable efforts, the physician is unable to place the patient with another provider, they should make the patient aware of all other available options.
A physician must not accept referrals or new patients if they do not expect to resolve the matter before they close or leave a medical practice.
Lab results and diagnostic imaging reports
In the period following the notice of closure of or leave from practice, a physician must communicate their intended plan for reviewing lab results and diagnostic imaging reports to patients when they are provided with requisitions.
The physician should make arrangements with another physician or health care professional to communicate any outstanding results to patients. If the physician is unable to make arrangements, they must advise the patient that they will need to follow up with another healthcare provider to obtain their lab results or diagnostic imaging reports if they have not been received after the practice has closed.
Issuing prescriptions
A physician must facilitate access to prescription medication required for long-term or chronic conditions that are likely to remain stable for the duration of the dispensing period. This can include:
- Where medically appropriate, provide patients with renewals or repeats of the required medication(s) to allow patients reasonable time to find alternative care; or
- Advise patients to see another physician or health care provider as soon as possible to have their prescription filled.
A physician is expected to use their professional judgement with respect to the number of renewals ordered without further medical assessment.
Disposal of Materials
A physician is responsible for the disposal or return of medications, equipment, and supplies in a safe manner.
Unexpected Closure
The College recognizes that there will be instances where a physician is unable to provide patients with a minimum of 90 days’ notice, such as sudden illness, a family emergency, or death. The physician must proactively plan for an unexpected closure of their practice. This could include identifying a designate who can provide notification and arrange for storage of medical records.
ACKNOWLEDGEMENTS
The College acknowledges the assistance of the College of Physicians and Surgeons of Nova Scotia, the College of Physicians and Surgeons of Newfoundland, the College of Physicians and Surgeons of Alberta, the College of Physicians and Surgeons of Saskatchewan and the College of Physicians and Surgeons of British Columbia in preparing this document.
APPROVALS
Initial adoption date: March 2009
Version: 3
Amendments: April 1, 2025, June 2017
REVIEW DATE
March 2028
