Beginning the Process
There are four main reasons for closing a practice:
- The sale or transfer of a practice
- A move or relocation
- Accidental death or illness
Although there are a variety of reasons that can cause a physician to close his or her practice, there is fortunately a cohesive set of guidelines that can help guide the process whatever the motivation. As long as a practice is aware of protocols overseeing notifications and the handling of medical records, it will be in good stead. The following summarizes the laws, requirements and guidelines defined by medical colleges and legal statute.
Holding Periods & Privacy Issues
There is no specific time period for retaining medical records defined by provincial or federal law; however, there is a “best practice” suggested by the law that applies. In summary:
- A written policy regarding record retention should be created for the practice
- This policy should contain a minimum and maximum amount of time for the retention
- In general, any personal data or information in the record should be destroyed (through shredding, for example) when there is no longer a legal or business need to retain the record.
- Holding a record indefinitely should only occur when there is a clear justification
- According to the advice of the CMPA, a period of 10 years for adults is recommended. For minors, the 10 year period should begin after the date they would have reached majority.
Provincial & CMPA Guidelines
The CMPA, as well as provincial Colleges and medical associations all have guidelines regarding medical record retention. These guidelines are not legal statute but rather act as a legitimate frame of reference for a practice. If provincial law in your area does not cover record retention, the CMPA should be referred to first for guidance, with the provincial associations acting in a supplementary capacity.
Provincial Legislation Regarding Retention:
- B.C. – 6 years
- Ontario – 10 years
- Quebec – 5 years
All other provinces and territories do not address the issue in legislation.
CMPA Recommends: The Canadian Medical Protective Agency defines 10 years as the appropriate time frame for retaining the medical record. The CMPA prefers that ORIGINAL records be kept. The entity also recommends keeping call logs and appointment books.
Provincial Colleges Recommend: Retaining the record for 10 years is the most common recommendation. Some provinces diverge on this and suggest 6 or 7 years. The Quebec College’s suggestion is 5 years, with 10 years suggested for genetic tests.
Medical Associations: Every provincial MA is silent on retention, except for Doctors Nova Scotia. The majority of MAs recommend looking to provincial colleges for guidance.
There is general consensus amongst the colleges and provincial MAs that notifications should take place at least 3 months before closure. Notifications should be face-to-face, in written form, or by phone. A practice should also give its patients clear instructions as to how they can get a copy of their records.
If the situation is that another doctor is taking over a practice, use the written notification as an opportunity to present the new doctor to the patients. If there is no transfer taking place, it is considered a best practice to give the patients a comprehensive list of practitioners in the area.
Notifying the Provincial College
Every provincial college except for the CPSO requires that physicians notify them when closing a practice or moving. The physicians should also remit the address of the storage facility/location of the medical records.
Notifications should also be given to:
- Insurance Provider
- Provincial Medical Association
- Hospitals in the Area
- Local Nursing homes
- Any physicians involved in referrals or consults
- Local Pharmacies
- Lawyers, Accountants, and related Professionals
- On Call Group
- Utility Companies
- IT professionals servicing the practice
- Banks and Credit Card companies
- Provider of fringe benefit plan
- Medical equipment/furniture vendors
- Local labs
Usually with group practices, there will be an associates’ agreement defining length of notice. If this is not the case, it is considerate to arrange your departure in a time and manner that will allow your partners to most easily relocate or find another partner.
Refer to your province or territory’s labour standards to determine the legal requirements for employee notification. There should be a minimum period of time defined or pay in lieu of notice. Both are determined by the length of the employment. Referring to a labour lawyer in the area familiar with the details of the law is also advisable. Keeping a small number of employees on after closing the practice can be necessary- they will need to oversee the resolution of billing questions, the transfer of records, et al.
Even if another doctor is taking over the practice, it is still advisable to give your employees notice and terminate the existing contracts. If there is not a break between employment, vacation and termination entitlements will continue from the date of the original contract. The period of time that must exist between the two contracts varies from province to province.
Selling/Transferring Practice Equipment & Furniture
There are several options to consider when deciding what to do with a practice’s furniture and medical equipment. If the practice is transferring to another doctor, it is best to assess the value of the equipment in one of three ways transfer ownership to the new doctor:
Using the market value – determined by reputable vendors
Using the book value – determined by accounting records
Using the buy/sell value – determined by agreement between buyer and seller
If equipment is leased, try to arrange the closure or transfer of the practice to line up with the lease termination dates; alternately, consider transferring the lease to the new doctor, if possible.
Additional options to consider are placing advertisements or notices in medical journals, with med associations or at local facilities. Keep in mind that certain pieces of medical equipment must be handled in accordance with regulations regarding medical devices in the Food and Drugs Act. Information regarding this can be found at:
Disposing of a Practice’s Drugs and Samples
Disposing of a practice’s drugs and samples is one of the most critical aspects of closing a practice. Drugs that are not responsibly disposed of can cause contamination to local water systems. It is the responsibility of physicians to dispose of all drugs associated with their practice in the most conscientious way possible.
If you are transferring your practice, you may be able to transfer the drugs to the new physician. You can also ask your pharma rep if you can return samples to him or her. Medical waste companies and pharmacies can sometimes handle the disposal of drugs as well.
The Controlled Drugs and Substances Act can provide clarification and guidance:
Medical Record Retention & Handling
Maintaining a continuum in patient care is important when closing a practice. Responsibly handling and maintaining medical records is a big part of that. Patients should be given information on and access to their records. Keep the following in mind when dealing with the medical records at your practice:
- A patient’s request to transfer his or her record to a new doctor takes priority
- All transfers should be executed in a timely manner
- An attempt must be made to transfer a record to another doctor in the area if the patient cannot be found and/or has not requested the record
- Records should never be put up for sale to another practitioner or clinic
- Full and easily managed access to all records should be maintained in case of future litigation.
Professional Storage Facilities
There are professional storage facilities that can retain records left under the care of your practice after it closes. Some regions, like Newfoundland and Labrador, will permit a physician to store records with a member of his or her family. If utilizing a professional facility, a physician should draft an agreement with that facility covering privacy issues, destruction of records (if needed), fees, and access.
It is advisable to retain legal counsel on the matter. Some provinces’ medical associations have sample agreements on their websites that physicians can reference.
After Closing the Doors
As a redundancy, consider retaining your practice’s phone number for at least three months after closing, and leaving an outgoing message stating that the practice has closed. Include details as to how patients can access their medical records or transfer records to another physician.