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Medical Practice Coverage

Policy: Medical Practice Coverage

  1. All physicians involved in direct patient care have an obligation to arrange for 24-hour coverage of patients currently under their care.

  2. Recognizing the impossibility for a physician to be available continuously, where physician numbers permit (four or more), they are encouraged to form call groups with physicians of similar interest and training to share responsibility for after hours and weekend coverage.

  3. Physicians who transfer coverage of patients in their practice to another physician should have the agreement of the physician before doing so.

  4. If it is not possible or practical to arrange alternative coverage with another physician or group, physicians may make mutually acceptable arrangements with an RHA, one or more hospital emergency departments and/or physician emergency clinics to cover the after hours needs of their patients. These arrangements should include, wherever feasible, ability for the covering physician to contact someone from the physician's call group when necessary.

  5. Physicians who sign over coverage to a hospital or clinic emergency department should be prepared, if requested, to participate in the one-call roster, provided the physician has the required training and/or experience to do so.

  6. Information should be made available to patients providing clear directions as to when, where and how they can seek physician care when their own physician is unavailable.

Companion Paper: Medical Practice Coverage

The College of Physicians and Surgeons has adopted a six-point policy position on medical practice coverage. The Council of the College wishes to make two observations that serve as contextual clarification for this policy position.

  1. Access to Vital Patient Information on a 24/7 Basis

    The provision of optimal patient care requires timely physician access to information about a patient's health status and previous investigations. Medical practice coverage arrangements often involve call sharing between physicians who may not have personal knowledge of the patient and/or access to the patient's records.

    In an ideal world all vital information about a patient should be available with patient consent to all health professionals involved in the care of that patient. Such optimal access to important patient information will only be achievable when comprehensive electronic medical record keeping becomes the norm throughout Saskatchewan.

    The College of Physicians and Surgeons recognizes and appreciates the work being done by the Saskatchewan Health Information Network (SHIN) to incrementally build an electronic medical record by progressively consolidating existing health data such as prescribing data and laboratory data. However, a comprehensive electronic patient record will not become a reality until all physicians adopt electronic record keeping technologies. At present a small number of physicians have adopted this technology in their practices. The College expresses a hope that electronic record keeping will be adopted by all Saskatchewan physicians, so that all physicians might have timely access to relevant patient information when they are attending patients.

  2. Integration of Community Based Medical Practice Call with RHA Service Arrangements

    Historically the ethical obligation of physicians to sustain continuity of care for patients with whom they've established a doctor-patient relationship has been considered quite independent from the arrangements made by hospitals and/or RHAs for public access to urgent/emergent health care on a 24/7 basis.

    Physicians have historically maintained after hours on-call services for their practices and hospitals have used a variety of strategies to assure patient access to physician care in their emergency departments. Hospital emergency departments in large urban centres tend to be medically staffed by fulltime ER physicians. Hospital emergency departments in smaller centres are medically staffed by a rota of community based physicians who now receive compensation for this on-call service.

    Across most of Saskatchewan, with the exception of Regina and Saskatoon, there has evolved significant integration between call coverage for community practices and call coverage for hospital emergency departments. Particularly in the smaller communities with hospitals the physicians on call for the hospital effectively "double" as the physician on-call for the community and the hospital emergency department therefore becomes the locus through which the public accesses all urgent medical care outside daytime/weekday hours.

    The situation in Regina and Saskatoon remains quite different. The over-whelming majority of physicians involved in direct patient care in these centres do sustain practice call arrangements that allow a patient telephone access to an on-call physician. Such patient-physician dialogue by telephone often culminates in physician advice and/or other physician action that obviates the need for an emergency room visit. If emergency room care is required by the patient, the patient may be attended in the ER by the community-based physician on call. More commonly, the patient is referred to the ER where he/she is attended by a fulltime ER physician.

    The position of the College of Physicians and Surgeons is that all physicians involved in direct patient care retain an ethical responsibility to make appropriate arrangements for their patients to obtain access to essential medical care when they are not personally able to provide that care.

    If physicians can make mutually acceptable arrangements with an RHA to have after hours care delivered through RHA governed facilities and programs, that satisfies the ethical expectations of the College. However, it is not ethically accept-able for physicians to unilaterally offload professional responsibilities on RHA facilities and programs without a mutually acceptable agreement with the RHAs in which they hold a medical staff appointment.

    The College Council perceives a trend towards greater integration between call coverage for community practices and the patient services arrangements organized by RHAs. Indeed, policy proposals for primary care reform generally include an expectation that Regional Health Authorities will organize mechanisms through which citizens in their regions can access primary care services on a 24/7 basis. Proposals for primary care reform also call for greater interdisciplinary collaboration in the provision of primary care services, which infers that the responsibility for patient care during inhospitable hours will also be shared between the members of interdisciplinary teams.

    The College of Physicians and Surgeons supports this transition to inter-disciplinary team practice in the provision of primary health care services. It is not the College's expectation that physicians should exclusively be obligated to assure continuity of care to patients when they work as members of an interdisciplinary team. Rather, it is the College's expectation that physicians will assume their reasonable share of call responsibility along with other members of such inter-disciplinary teams.