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Ontario Medical Review
December 23, 2020
JN
Jackie Noel

This article originally appeared in the November/December 2020 issue of the Ontario Medical Review magazine.

Closing your practice due to retirement?

Answers to the top 20 frequently asked questions; OMA tools and resources for retiring physicians

by Jackie Noel 
OMA Practice Management & Education 

Are you considering retirement? For most physicians, this can be a difficult and emotional decision. Whether it’s the result of an unexpected change in personal or professional circumstances, or part of your life plan, you are about to stop working in a career that has been a significant part of your life for many years. 

Retirement means different things to different people. For some physicians, the transition from work life to life-after-work will be relatively smooth and eagerly anticipated; for others, the experience may be far more complicated. Regardless of whether you are going to close your doors completely, or hand over the keys to another physician, the first step is to decide on a closing date and create a plan. Without a plan, the transition process may be too daunting for you and your family, who should be included every step of the way. 

Depending on the circumstances, you will need to contact certain professional bodies, such as the Canadian Medical Protective Association (CMPA), College of Physicians and Surgeons of Ontario (CPSO), Royal College of Physicians and Surgeons of Canada (RCPSC), or others. There are also legislative and regulatory procedures and protocols that must be adhered to. And you may need to consult with independent legal counsel, your accountant and/or financial advisor, among other professionals. 

Whatever the reason for your retirement, you will have many questions. This article provides answers to the most frequently asked questions received by the OMA from retiring physicians across the province. Please note that the nature and scope of the answers provided may depend on the type of physician practice (Example: solo, group, academic, employed, locum). 

1. When should I inform my staff? 

You should notify your staff well before you notify patients. Inform them at least three months before your closing date. Please keep in mind that some staff may tender their resignations as they look for employment opportunities elsewhere. You may want to avert this by offering some bonuses or severance packages, and provide at least one of your staff members with some incentive to stay with you until the end, and possibly longer – until after the practice is closed. Before having these discussions, it is strongly advised that you obtain legal advice regarding your obligations. 

2. When should I notify my patients of my practice closure? 

Informing your patients that you are winding down or closing your practice is probably the most emotionally difficult step you will be taking in this process. As a matter of good professional practice, you should notify your patients of your intent so that they will have adequate time to find another physician. A minimum of three months is suggested. Patient template sample letters are available in OMA’s Closing a Practice: A Guide for Physicians

3. How should I notify my patients of the practice closure? 

Acceptable methods to notify your patients of your practice closure may include:  

  • calls to active patients 
  • letters to active patients that emphasize the importance of continuing care, and provide information on where to find another physician  
  • printed notice posted in the office somewhere accessible  
    (even when the office is closed)  
  • newspaper advertisement  
  • recorded messages on the office voicemail  
  • mail services  
  • posts on your practice website if you have one  
  • electronic medical records (EMR) one-way emails to patients 

4. How do I ensure continuity of care for my patients? 

You and/or your office staff should review your patients’ records to identify which ones require transfer of care and follow-up. It is your legal and professional duty to take reasonable steps to transfer care for these patients. What is considered a reasonable effort depends on your reason for closing, patient needs, and health care resources in your community. The CPSO has outlined guidelines for physicians on continuity of care (search “Transitions in Care” and “Continuity of Care”). 

5. Am I obligated to help my patients find another physician to take over their care? 

No. However, the CPSO’s policy requires “physicians to take reasonable steps to facilitate ongoing care. Recognizing that what is appropriate will depend on the reason for the practice closure, the needs of the patient, and the risks to them if ongoing care is not arranged, as well as the system resources that are available in the physician’s community. For example, what steps are reasonable would look different for a family physician in a well-resourced community compared to an underserviced community, or when planning well in advance of an upcoming retirement when compared to an unexpected closure due to an illness.” 1 

6. How do I transfer my patient records to another physician? 

You must retain your patients’ original medical records if you are the Health Information Custodian under the Personal Health Information Protection Act (PHIPA). Any record that you transfer should be a copy of the original. Even then, you must only transfer copies of patients’ records if you are permitted to or required to do so by law. For electronic records, you can arrange for access to the files if they are transferred to a new physician by way of a legal agreement. For more information on such agreements, contact legal.affairs@oma.org

When transferring, always send a copy of the entire record unless otherwise indicated by the receiving physician and/or patient. Make sure the transfer is secure and document the date and method of transfer in the medical record. This transfer must occur in a timely manner, no later than 30 days after a request (and urgently if necessary). You may also want to contact OntarioMD for guidance on transferring medical records from an electronic medical records system. For more information, refer to the CPSO’s Medical Records Management policy.  

7. Am I allowed to charge patients for copies of their medical records due to my retirement? 

Yes. You are entitled to charge patients a fee for obtaining a copy or summary of their medical records. However, the CPSO has outlined guidelines that must be followed, such as when determining a reasonable amount to charge the patient. When determining a reasonable fee and for guidance, please refer to the OMA Physician’s Guide to Uninsured Services. This guide is updated annually.  

8. How long do I have to keep patients’ medical records? 

The CPSO’s regulation requires that physicians keep medical records for the following periods:

  • Adult patients: 10 years from the date of the last entry in the record.
  • Patients who are children: 10 years after the day on which the patient reached or would have reached 18 years.

Beyond these requirements, the CPSO recommends retaining records for a minimum of 15 years. This is because of a provision in the Limitations Act which states that some legal proceedings against physicians can be brought 15 years after the act or omission on which the claim is based took place. Please refer to the  CPSO’s Medical Records Management policy (search “Medical Records Management”). 

9. Can you recommend a medical storage company? 

Unfortunately, the OMA does not endorse or make recommendations for vendors, including medical storage companies. However, we can provide a list of medical storage companies for your information. We suggest that you request physicians’ references from the company you select. If you choose to enter into an agreement with a storage company, you are still responsible for the records and must ensure that the storage company adheres to the same standards required of physicians. It is strongly recommended that you have a contract in place with the company you use. 

10. I am in possession of patients’ medical records whom I have not seen in over 10 years. Can I shred their records? 

The CPSO’s policy states that physicians must only destroy medical records once their obligation to retain has come to an end. However, it is strongly advised that you contact the CMPA to discuss your options before shredding medical records. CMPA has also recommended that you make a list of the names of patients whose records are to be destroyed, and that this be kept permanently in a secure location. 

11. Another physician is taking over my practice, what are my legal obligations? 

In such a situation, both physicians must engage in discussions about several aspects of the practice prior to the final handover. To facilitate patient access, you must make appropriate arrangements for the retention, storage, or transfer of patient medical records. OMA Legal Services has developed a document that outlines your legal obligations.

12. I am in a Family Health Organization (FHO). Can I sell my spot? 

In recent years, due to the limited number of FHO spots available, some physicians have been able to sell their spots. However, the OMA does not intervene when these negotiations occur between members. You are advised to speak with your accountant and/or independent legal counsel. 

13. How should I notify my licensing and professional organizations? 

Written notification must be given to licensing and professional organizations of the pending change in your practice. This should be done as soon as you have decided on a closing date. These include, but are not limited to, the Ministry of Health, CPSO, CMPA and OMA. For a list of professional organizations, please refer to OMA’s Closing a Practice: A Guide for Physicians. 

14. When should I notify my business associates and organizations? 

You may have entered into contractual agreements with some of them, therefore, it is advisable to review the departure clause specified in the contracts regarding notification. Otherwise, notify the people with whom you work or do business with of your intentions at least three months prior to closure. They include, but are not limited to, colleagues, associates, employer, financial institutions, hospitals where you work, laboratories where you send patients, pharmacies and utility companies, to name a few. Sample letters and a list of utility companies for notification can be found in the OMA’s Closing a Practice: A Guide for Physicians. 

15. How and when should I contact my professional advisors? 

Meet with your professional advisors, for example, your lawyer and accountant, to inform them of your decision and to start the legal and financial procedures of winding down your practice. They can assist you with setting timelines for what you need to do and what information you must provide to them. Doing so will help ensure that you have a smooth transition (e.g., evaluating terms of your lease or giving notice to your landlord, human resources obligations, and terminating contractual agreements, etc.). It is also important to notify your OMA Insurance advisor about your plans to retire as your insurance needs and retirement saving priorities may be different than they were 10 years ago. Talk to your OMA Insurance advisor to learn how the Advantages Retirement Plan™ may help physicians like you transition into retirement and understand your retirement income options. Contact OMA Insurance at info@omainsurance.com or call 1-800-758-1641 (select option one). 

16. Do I need to maintain my membership to continue with the OMA’s Insurance? 

Yes. You must maintain an OMA membership to maintain your OMA insurance coverages. However, your membership fee may be reduced as you will no longer require all support services and benefits. 

17. Where can I sell or donate my medical equipment? 

Contact your medical equipment suppliers and ask them to provide you with a reasonable estimate of what your equipment would be worth. If your equipment is in good condition, your suppliers may purchase it from you. You may also consider donating your equipment to non-profit organizations that perform medical missionary work. Investigate sources via the Internet regarding where you can donate medical and office equipment. 

18. How long do I have to keep appointment scheduling books and billing records? 

You can destroy the appointment scheduling books as patients’ scheduled visits would have been noted in their medical records. However, in accordance with the Canada Revenue Agency (CRA), billing records become part of your financial records and they must be kept for seven years. For more information regarding CRA rules on maintaining financial records, please consult with your accountant. 

19. What resources are available to assist with succession planning? 

Ontario Health – Health Force, is a marketing and recruitment agency that assists physicians with various aspects of the process around the transition out of practice, including succession planning. They may also be able to assist you with finding a physician to take over your practice or a locum who may be interested in your practice. For more information on succession planning, visit Health Force Ontario (search “Transition out of Practice”).  

20. While I recognize that some anxiety about retirement planning is to be expected, I wonder if there are specific supports by the OMA to help me or my spouse/partner during this emotional time? 

The OMA understands that the process of retirement is a significant transition in a physician’s career and life, and can impact their loved ones as well. The OMA’s Physician Health Program (PHP) is a service that is ready to support or assist in these circumstances. Please call the PHP confidential line at 1-800-851-6606 or email php@oma.org.  

Reference 

1. College of Physicians and Surgeons of Ontario. Advice to the profession: closing a medical practice [Internet]. Toronto, ON: College of Physicians and Surgeons of Ontario; [unknown date] [about 8 screens]. Accessed: 2020 Nov 17.