Scarcity of resources and delays in care

Updated: September 2023

The current Canadian healthcare environment is facing intense pressures—with scarcity of resources and staff shortages being among the most significant. There is no perfect solution for resource dilemmas and staff storages, but you can take steps to help ensure patient safety and minimize medico-legal risk.

Articles

• Limited healthcare resources: The difficult balancing act (4 minutes)
• Being on call when resources are limited (2 minutes)
• Wait times when resources are limited (12 minutes)

Podcast

• COVID-19: Reasonable care (15 min)

FAQ

• Because the healthcare system is currently facing significant human resource shortages, many patients do not have primary care providers. As a hospitalist/specialist, what are my obligations when providing care to patients in these circumstances?
• Many of my patients’ investigations, treatments, or elective surgeries have been delayed or cancelled. How can I reduce my medico-legal risks related to these delays?
• Due to the significant shortage of healthcare workers and overcapacity in some hospital departments, I have been asked to provide care outside my usual scope (e.g. non-physician or physician duties). What are the medico-legal risks and will the CMPA assist me if I perform duties outside my usual scope?

Because the healthcare system is currently facing significant human resource shortages, many patients do not have primary care providers. As a hospitalist/specialist, what are my obligations when providing care to patients in these circumstances?

Generally speaking, once a patient has been assigned to a physician for treatment, a duty of care arises. The duty of care includes the obligation to act in the patient's best interest, refer the patient in appropriate cases to another physician, to order and follow-up on any necessary tests and to attend to the patient as long as good medical practice requires.

Where a hospitalist/specialist is aware that a patient does not have access to a primary care provider, they may have certain responsibilities to make reasonable efforts to ensure that the patient has access to any necessary 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. The duty of care also generally requires the hospitalist/specialist to inform patients prior to discharge about symptoms and signs that suggest the need to seek immediate medical assistance. These discussions should be documented in the patient’s medical record.

Hospitalists/specialists should also make reasonable efforts in the circumstances to discuss with the patient any available options for alternative primary care. This may 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.

It is also critical for health sector stakeholders to engage on these issues in order to help alleviate and prepare for resource shortages. In this regard, physicians have an important voice in an environment of scarce resources.

Many of my patients’ investigations, treatments, or elective surgeries have been delayed or cancelled. How can I reduce my medico-legal risks related to these delays?

Manage your risks by doing your best in the current circumstances to meet your continuing responsibilities for the care and appropriate follow-up of patients.

This may include:

• consulting with colleagues, hospitals, public health, and specialty organizations for guidance to determine what services and care are reasonable to delay or cancel
• monitoring and managing patients’ conditions while awaiting care
• reassessing patients regularly to determine if the urgency of the investigation, procedure, or surgery has changed
• informing patients and referring physicians of the signs and symptoms that should warrant a call to your office to re-evaluate their rank on your wait list
• informing and updating consulting physicians when a patient’s condition changes and the need for care becomes more urgent
• exploring other available options for patients to receive interim care, if necessary
• advocating for patients with professionalism, integrity, and transparency

Document your care plan and follow-up actions in the patient record, as well as any advocacy efforts you took on behalf of the patient.

Due to the significant shortage of healthcare workers and overcapacity in some hospital departments, I have been asked to provide care outside my usual scope (e.g. non-physician or physician duties). What are the medico-legal risks and will the CMPA assist me if I perform duties outside my usual scope?

The CMPA recognizes the immense strain on the healthcare system due to the healthcare human resources crisis, the pandemic, surges in other infectious diseases, the opioid crisis, and more. Physicians are being called upon to take on new roles to support their colleagues and the larger system due to the lasting effects of the health emergency and the changing environment. It is challenging to predict all the types of medico-legal difficulty that physicians may face arising from the provision of care in these circumstances.

Physicians asked to perform duties outside their usual scope – whether medical duties or non-physician duties – will want to ensure they have the necessary skills to perform the requested duties or obtain the appropriate support or training to do so. Physicians who do not feel they are sufficiently qualified or competent to perform the requested duties can try to seek guidance from another health professional who is competent and/or has the requisite information to perform these duties or even redirect care where that is possible. Role clarity is also important where physicians are performing non-physician duties. It is expected that hospitals and health authorities will provide guidance for the healthcare team to delineate the expectations for performing non-physician duties or those outside a physician’s usual scope of practice, and how this will work operationally.

The Colleges generally recognize that in exceptional circumstances, such as a public health emergency, it may be necessary for physicians to temporarily practise outside their scope of practice. It will therefore be important for physicians to carefully document the circumstances that led to providing care outside their scope of practice or performing non-physician duties. Keeping such records will be helpful to demonstrate the clinical judgment exercised in the circumstances of scarce resources, should there be any medico-legal difficulties that arise at a later time.

Members who are called upon, on an exceptional basis, to provide care not typically falling within their normal scope of practice remain eligible for CMPA assistance. Members who have specific questions about their eligibility for assistance are encouraged to discuss their concerns with CMPA before providing care, where possible.