Retiring from Practice Requirements

Registrants who are retiring from practice are expected to make reasonable plans and arrangements to ensure good continuity of care for their patients. In general, registrants should have a plan in place well before their date of retirement. Doing so reduces stress on the retiring registrant and benefits patients and colleagues. 

If exceptional circumstances impede a registrant's ability to make appropriate arrangements, contact CPSM as soon as possible. If it concerns a health issue, the Physician Health Program can provide support.

Three main areas that need to be considered and addressed, as applicable, when retiring include (click to jump to each section):

• Communication and Notice
• Arrangements for Continuity of Care
• Practice Environment Considerations

Communication and Notice

Appropriate communication with your patients about your intention to retire is essential to ensure continuity of care, and communication with your colleagues is vital to the smooth functioning of the practice.

CPSM has specific requirements for communication and advance notice, but you should also exercise good professional judgment in the context of your unique professional practice to ensure patient interests are adequately addressed.

Who Needs to be Notified?

Physicians are part of a greater community in the healthcare system and need to let others know when retiring from practice.

CPSM requires that registrants provide notice of intention to retire to (as applicable):

• patients or their representatives;

• other registrants with whom you may refer or consult with;

• any regional health authority in which you have privileges;

• any personal care home(s) at which you practice;

• CPSM;

• Manitoba Health, Seniors and Long-Term Care;

• Doctors Manitoba;

• Canadian Medical Protective Agency (CMPA).

What Information Needs to be Included in the Notice to CPSM?

CPSM’s Standard of Practice of Regulation and the Standard of Practice - Practice Management specify the information a retiring registrant must provide to CPSM. There are several reasons why CPSM requires this information, one of which is that it allows us to respond to questions former patients may contact CPSM for, including where they can find their records.

Your notice to CPSM must include the following:

• The anticipated date of retirement.
• The particulars of any care arrangements that have been made for patients.
• Information about where patient records will be located and how the records can be transferred to another registrant or how copies can be obtained (if applicable). This must include relevant contact information.
• A general description of how notice was provided to patients (e.g., a standard letter to all patients in the system, posting of the notice, etc.) and general details about the information contained in the notice to individual patients, as required. A list of patients is not required.
• The arrangements that have been made for the secure storage of the patient records and appointment records (if applicable).
• A forwarding mailing address and contact information for the registrant.

Registrants should use the Retirement Reporting Form to notify CPSM. Once completed, the form can be submitted to registration@cpsm.mb.ca.  

Notifying Patients

How notice is provided to patients will usually be a matter of professional judgment.

• Depending on the nature of your practice, a publication on the website and in the common areas of their practice setting, a mass text, email or mailed notice with generic information may be sufficient to inform your patient population. A pre-recorded voice message notifying patients who phone the practice would be prudent.
• CPSM requires that patients who have appointments booked before the date of retirement and patients who call to arrange an appointment before that date receive individual notifications.
• Individual notice should also go to patients or their primary care provider (e.g., referring physician), where continuity of care will be significantly impacted. For example, long-term patients who rely on your care in the context of an established physician-patient relationship. This would not include sporadic or unanticipated calls.

When does notice need to be provided?

The purpose of the notice is to make sure those in the system with whom the registrant is connected are made aware and can plan accordingly.

Unless a registrant leaves a medical practice due to illness or other urgent circumstances, at least 90 days' notice must be provided. Otherwise, notice must be provided as soon as possible.

Questions?

Registrants may contact CPSM with questions about notice requirements at 204-774-7433 or by email at registration@cpsm.mb.ca. Inquiries may also be directed to the Canadian Medical Protective Association or Doctors Manitoba. 

Arrangements for Continuity of Care

Registrants are expected to take reasonable, commonsense measures to ensure good continuity of care for their patients when retiring. This includes ensuring arrangements for follow-up to referrals for consultations, diagnostic requisitions, and requests for prescription renewals.

The Standard of Practice - Good Medical Care includes the following requirements, which apply in the context of retirement:

• You are responsible for ensuring that specific arrangements are in place to receive communication respecting critical test results. This includes registrants who provide episodic care. 
• If you are unable to be personally available to receive the critical test results, you must plan with another registrant to be available to receive the critical test results and to provide the appropriate follow-up communication and care to the patient promptly.

Continuity of care entails making sure patients or their representatives have appropriate access to their patient records, including if records need to be transferred to another care provider. 

If you are a primary care physician:

When retiring, primary care physicians are expected to make reasonable efforts to arrange suitable alternative care for patients, particularly those who are in the course of treatment at the time of the closure or where there is an established physician-patient relationship. In terms of reasonable efforts, the retiring registrant would be expected to:

• Make reasonable efforts to let the patient know you are leaving practice.
• In advance of leaving practice, provide or arrange for a follow-up on any outstanding investigations.
• Provide or arrange for care concerning any serious medical conditions or for necessary emergency care up to the date of retirement as appropriate in the context of your current professional practice.
• Provide or arrange for any ongoing medications for a reasonable period.
• Have a system in place to monitor for reports, correspondence, etc., that may come in the months following retirement from practice.
• Document your efforts.

We recognize efforts may not always be successful depending on the availability of an alternate care provider.

If you are a specialist:

If you are a specialist, the care of the patient may, by agreement of the specialist and the referring registrant, be returned to the referring registrant. Patients may also be referred to another healthcare provider, in which case the patient should be consulted.

• The best effort possible should be made to avoid abandonment of ongoing care.
• It is prudent to notify the primary care provider, in writing, respecting retirement plans. It would be for them to act in accordance with good care and professionalism respecting the patient, assuming the patient remains in their practice, which is not always the case (e.g., the referral arose from an episodic encounter).

Practice Environment Considerations

CPSM requires that retiring registrants ensure the secure storage of any patient records as required by the Standard of Practice for Maintenance of Patient Records in All Settings. This applies only to registrants who are trustees with maintenance responsibilities.

• Securing patient records in a home office may be reasonable if other requirements are met. Registrants will need to review the Standard of Practice to ensure they are compliant.
• The Standard of Practice for Maintenance of Patient Records requires that another CPSM registrant act as a successor trustee for patient records. Registrants should have the necessary paperwork in place (see section 4.29 of the Standard).
• CPSM cannot provide legal advice on whether you are compliant in any particular circumstance. The provincial government also regulates personal health information (i.e., the Personal Health Information Act). Registrants may seek advice or information from CMPA or Doctors Manitoba. 

CPSM requires retiring registrants to safely dispose of medication, laboratory specimens, equipment, and supplies.