Legally Speaking
March 2022
By Sheila Torrance, Legal Counsel, CPSS
and Dr. Werner Oberholzer, Deputy Registrar, CPSS
Medical Practice Coverage Policy - FAQ 


The Medical Practice Coverage policy has now been in force for nearly one year.  At the March 2022 meeting the College Council will consider whether to institute any form of proactive enforcement to ensure physicians/clinics have implemented the expectations in the policy.  While the Registrar’s Office will inform physicians of the details if the Council directs this, one option the Council will consider will be after-hours phone calls to physicians/clinics to ensure the appropriate arrangements have been made and the necessary information communicated to callers.

To date, the College has provided the following education regarding the application of the policy:

Over the past months, the Registrar’s Office has received a number of inquiries from physicians and clinics as to the requirements of the policy.  We thought it might be helpful to share some Frequently Asked Questions with physicians who are considering their own compliance with the policy.
 
 

FAQ 1:  How will this policy be applied to sole practitioners in small towns who cannot find any coverage?

Answer: The College does not expect coverage provision that is not sustainable.  The policy will be applied reasonably, and cases will be assessed in the context of what is available.  In some of these cases, the Saskatchewan Health Authority (SHA) may be able to assist.  Rural and remote physicians can also consider whether they might be eligible for the SMA Rural Relief Program during planned absences.

Many small-town physicians have a telephone message for patients to call the ER after-hours, where the physician(s) themselves provide services. The Nursing staff work collaboratively with the physicians to assess and triage complaints, to reduce the burden of callouts.

On occasion, some small centres will be unable to provide coverage for short periods of time, despite efforts by the physician, SHA and SMA. When this happens, patients are directed to visit nearby towns where ER services are available. Such absences must be clearly communicated to the population served by the ER – in social media, newspapers, on answering machines, etc., and coordinated with EMS services 

FAQ 2:  How will this policy be applied to physicians who provide services intermittently in communities not otherwise served by physicians?  Are those physicians expected to provide 24/7 coverage in communities where they may attend only one day per month?

Answer: Physicians who provide intermittent services in remote communities cannot reasonably be expected to provide 24/7 coverage in those communities.  Many of those communities will have a health centre or clinic staffed by allied healthcare providers, such as Registered Nurses or Nurse Practitioners, who provide services.  The expectation would be that the clinic/facility clearly communicate and document who will be responsible for any after-hours follow-up

FAQ 3:  The policy states that physicians can make “mutually acceptable agreement” with the SHA for their patients to attend at an emergency department and/or physician emergency clinics if they have needs that arise after-hours.  What is required to establish this “agreement”?

Answer:  The Registrar’s Office suggests that any such arrangement be formalized with the Area Chief of Staff (ACOS) or the area lead/head of the emergency department.  The key is to ensure this is not a unilateral offload of patient care to other facilities. This will also provide clarity to the ER staff when they, for example, receive a call about a critical result for a patient of the practice which needs to be managed.

FAQ 4:  Can physicians suggest that patients use the 811 Healthline before deciding whether they need to speak to a physician?

Answer:  Yes, as long as the intent is that 811 will review the patient complaint and make recommendations, and not be the only or primary management option.  The 811 service does not have access to patient records or results (for example, though the eHR Viewer), so is unable to address specific questions about conditions requiring access to those.  

FAQ 5: Is it expected that there is always a physician available to speak with a patient?

Answer:  While this would be ideal, the College recognizes that this is not always feasible.  Many physician groups have a designated on-call physician who carries a cell phone to field after-hours patient calls.  This implies that the physician can provide advice, triage, and direct patients (for example, proceed to the ER now; wait until tomorrow; proceed to the extended hours clinic, etc.).  Even when there is not a designated on-call physician, there should be arrangements in place for patients to obtain care if required after-hours, and those arrangements should be clearly described in the office telephone message.  As noted above, any arrangements should be formalized with the physician/group who will take call and/or provide after-hours coverage.

FAQ 6:  Are specialists expected to arrange for a coverage schedule over and above the call schedule existing through the SHA/hospital?

Answer:  No.  All specialist groups have an on-call roster via the Saskatchewan Health Authority (SHA), whereby a member of the group can be contacted through SFCC or switchboard.  The expectation is that 24-hour coverage is available through the existing call schedule.  This meets the policy requirements.

FAQ 7:  What is the expectation with respect to urgent results from laboratory or diagnostic imaging?

Answer:  All physicians must have a system in place whereby emergent results can be relayed to a physician or designate, who must be able to manage the concern on an emergent basis.

 
One last piece of advice:  CLARITY is key. 
Patients who phone a physician’s office must be provided with clear directions on how to obtain care.  It is not sufficient to simply state “the office is closed, please call back tomorrow”, or “go to the ER.”
 
 


  Sheila Torrance is Legal Counsel at the
College of Physicians and Surgeons of Saskatchewan.

 
  Dr. Werner Oberholzer is Deputy Registrar at the College of Physicians and Surgeons of Saskatchewan and specializes in Family Medicine, Emergency Medicine, and Care of the Elderly.