The decision to close or relocate a medical practice can be a difficult one, with consequences for patients as well as for the departing physician’s colleagues. Thoughtfully managing the various aspects of closing or relocating a clinical practice ensures the needs of patients continue to be met and potential medical-legal risks are mitigated.
Where advance notice of a physician’s departure is not possible (as in the case of sudden illness, death, or other unforeseen circumstances), responsibilities related to practice closure may be undertaken by a business partner, colleague, family member, or an executor for the estate of a deceased physician. Some Colleges require physicians to proactively plan for unexpected practice closures.1 In these cases, physicians may need to lay out a plan in collaboration with partners or colleagues.
Primary care physicians
When closing a practice, maintaining continuity of care is an especially important consideration for primary care physicians. However, there may not be any other primary care physicians to easily transfer care to. In this situation, physicians should be able to demonstrate that they made reasonable efforts to facilitate continuity of care.
The Colleges generally recognize that what is considered reasonable will depend on a variety of factors, including the reason for the practice closure, the needs of the patient, and the healthcare system resources available in the physician’s community. Reasonable efforts can include referring patients to matching programs through the ministry of health.
Consulting physicians should consider appropriate transfer of care for patients who are in active treatment. Special care should be paid to the transfer of vulnerable patients (such as the elderly, young children, and those with complex physical and mental health issues).
Consulting physicians should inform their patients’ primary care physician of their intention to close their practice, and refer patients back to the primary care physician for follow-up where appropriate. However, in some cases, there may not be a primary care physician to refer a patient back to, and the patient may be vulnerable and in need of active treatment.
In these situations, consulting physicians should be able to demonstrate that they made reasonable efforts to ensure the patient had access to any follow-up care or further referral. What will be deemed reasonable will depend largely on the circumstances of each case, including the patient's condition and the resources available in the community.
Reasonable efforts might include advising the patient of providers or clinics in the community accepting new patients, or referring the patient to matching programs through the ministry of health. The duty of care also generally requires that consulting physicians inform patients about symptoms and signs that suggest the need to seek immediate medical assistance.
Both primary care physicians and consulting physicians should refer to their College’s policies and standards on responsibilities when closing or leaving a practice.
College policies may stipulate a minimum required duration for notification to patients of a planned closure. In Ontario and Alberta, for example, at least 90 days notice is required, unless the closure is unexpected or due to circumstances beyond the physician’s control, in which case the notice must be communicated as soon as reasonably possible.12
Physicians are generally required to notify patients directly through one or more channels: letter-mail, email, telephone, or in-person at a scheduled appointment. Consult your College’s policies on specific requirements in your jurisdiction.
Transferring medical records
Patients who find a new physician may need to have their medical records transferred. You are required to facilitate this process once you have received the patient’s authorization to do so. The transfer should take place as soon as reasonably possible, or as prescribed by your College. You may charge an appropriate fee for this service, which may be set by provincial or territorial medical associations or in regulations.
In a group practice such as a clinic, it should be clear who will retain the medical records when you leave the practice. Clarity can be achieved by entering into a written agreement when joining the group. Such an agreement will allow you to have continued access to the medical records that you entered even after leaving the practice. Access to these records is important to ensure you meet your College obligations and records retention requirements, and will be indispensable in the event of medical-legal issues that may later arise. Once the applicable retention period for a record has expired, you should destroy the original record in a secure manner. This task can be outsourced to a commercial service provider and the date of disposal should be documented.
Some Colleges require physicians to implement a succession plan and designate a custodian to ensure retention and access to records if they are unable to continue as custodian. In Alberta, for example, physicians are required to have in place an information sharing agreement to manage patient records in the event a physician ceases to maintain custody of existing records, and to identify another physician who will maintain them.2
Original records, whether in digital or paper form, should be retained for at least 10 years from the date of last entry or, in the case of minors, 10 years from the time they would have reached the age of majority. For obstetrical care, the CMPA recommends that maternal records (e.g. prenatal and labour and delivery records) be maintained for at least 10 years from the time the infant reaches or would have reached the age of majority. For more information, see How to manage your medical records: Retention, access, security, storage, disposal, and transfer.
Clinical care and investigations in progress
Physicians should make reasonable efforts to ensure all work in progress will be completed, reviewed, and appropriately acted on. Consider arrangements for alternative care for patients who have outstanding results or need follow-up after a recent test or procedure. If patients under your care are in hospital or another health facility, complete the transfer to another physician and document this in the medical record.
When planning to leave a clinical practice, you should inform colleagues, clinic owners, and employees in a timely manner. You should also inform healthcare organizations such as hospitals and specialty medical centres, other healthcare professionals such as local pharmacists, as well as the provincial or territorial paying agency, and professional associations.
Some Colleges require physicians to notify them when closing a medical practice, whether or not they continue to hold a licence.
You should contact the CMPA and tell us about your plans, such as if you intend to do a different type of medical work or change your province of work.
If you are closing your practice but want to continue practising medicine, even on a limited basis, you must maintain your licence as well as your CMPA membership.
If you are practising under an employment or contractual arrangement with a hospital, health authority, research organization, or government agency, review your contract or service agreement and contact your personal legal counsel to understand your responsibilities with respect to your retirement.
CMPA protection—Peace of mind in your retirement
Your eligibility for CMPA protection continues throughout your retirement. Because the CMPA provides occurrence-based protection, if a medical-legal difficulty arises for care you provided while a CMPA member, you remain eligible for assistance. Protection eligibility also extends to your estate, as long as the medical-legal matter pertains to clinical care you provided while you were a CMPA member.
Regardless of the circumstance of leaving a medical practice, advance preparation and notice benefits everyone. When a transition happens unexpectedly or if you encounter challenges when closing your practice, the CMPA’s physician advisors are available to provide advice.