After-hours coverage is a professional and legal obligation

The January/February issue of the College Connector included a reminder from the Physician Practice Enhancement Program (PPEP) that office practice assessors too often find that after-hours coverage is deficient. Some physicians have indicated to the College that the advice was unclear. In the meantime, there have been media reports of disputes in this regard between physicians and medical regulators in other provinces:

Doctors not on board with on-call orderWinnipeg Free Press

Alberta doctors neglect after hours careEdmonton Journal

There is no ambiguity in British Columbia: the provision of after-hours coverage is a professional and legal imperative for all physicians. It is both a professional standard of the College Board titled After-Hours Coverage and a part of the common law duty of care (see CMPA’s Medico-legal handbook, under Duty of Care).

Among other things the professional standard states that:

  • The provision of ongoing medical care is not only the responsibility of the family physician, but also of specialists and other focused-practice physicians who are involved in the treatment of patients.
  • Physicians may assign on-call coverage to groups of physicians or to local emergency departments if all parties have agreed to this arrangement in advance. It is not appropriate to leave a message for patients telling them to go to an emergency department for after-hours, non-urgent care if this has not been arranged with and agreed to by the physicians in the emergency department.
  • Physicians must also ensure that their patients are aware of the on-call or after-hours coverage that is available to them.

The CMPA’s Medico-legal handbook states: “Referral or coverage arrangements must be made when the physician will not be available to continue to treat the patient.”

Recorded voice messages should provide callers with contact information for a physician who has agreed to provide coverage. Family physicians and specialists in groups should normally ensure that someone is designated to field phone calls, usually as part of an on-call rota. Given the reality that patients do not call as often as they once did, some physicians advise that they fulfill this obligation by providing their personal cell phone numbers and cover the practice themselves. Where group call is not feasible, such as the situation of solo subspecialists in small communities, physicians must make explicit arrangements with other physicians to ensure that the practice is covered when they are not available. It is also acceptable to have calls managed initially by a first-tier responder (such as an advanced practice nurse or even a lay answering service), but only as part of an established protocol; a physician must be immediately available to the first responder.

Registrants should be aware that recorded messages with general direction to attend at an ER or walk-in or call the BC NurseLine are not acceptable.

In the event of a civil action or a College complaint where availability after hours is an issue, these are the standards by which physicians will be judged.