Closing your practice

Office space

Contact your realtor if you own the building and want to sell it. If you rent, talk to your leasing agent and review your lease agreement for:

• Whether it allows for termination before the expiry date
• When you must provide notice that you will not renew the lease (to avoid an automatic lease extension)

Consider setting a retirement date that corresponds with the end of the lease to avoid penalty fees. If the lease terms are unclear, it is advisable to speak with your lawyer before giving notice to terminate the agreement.

Inform partners or employers (if part of a group)

If you are part of a physician group, let your partners/employers know of your plans well in advance. Review your contract with them, which should state some of your professional obligations and responsibilities (e.g., taking over patients, staff, medical equipment, etc.). Inform your staff
Employment law applies to physicians closing a practice. If you plan to terminate, consider:

• Whether there is a formal employment contract. Check the contract for information on notice requirements and ensure they align with the Employment Standards Act
• If there is no employment agreement, case law will determine your obligations to staff, which may exceed ESA requirements. Ensure pay in lieu of working notice to staff aligns with Ontario labour laws. This will vary depending on length of employment

Selling a practice: Determine whether the incoming physician will use your staff. If the outgoing physician does not formally terminate the existing employees, the incoming physician assumes their employment under Ontario law. This can have financial ramifications for the incoming physician if
they later wish to terminate their employment.

Group practice: If no one is taking over your practice, your colleagues may reduce staff hours. This raises the same legal considerations as termination and it is prudent to contact a lawyer.

Ways to support your staff:

• Offer financial bonus or other incentives to stay until closure and/or honour their employment
• Help staff find other employment with colleagues or connections

Retain staff records: Under the Employment Standards Act, you must:

• Retain employee records for a minimum of three years from the date staff employment ceased
• Retain a record of the number of hours your employees worked (each day and week) for three years after providing that information to them
  For more information, consult with your lawyer about staff obligations, read the ESA or contact the Ontario Ministry of Labour at 1-800-531-5551

Settle accounts with tax and utility companies

• Tax offices: Canadian Revenue Agency and municipal office
• Canada Post (to have mail redirected)
• Utility companies (e.g., internet, phone, heat, hydro, water)
  Note: Keep your phone line active for three months after practice closure to continue patient notification

Wind down business with suppliers

Cancel standing orders and contractual obligations. The list of suppliers includes, but is not limited to:

• Pharmaceutical companies
• Medical and office supply vendors
• Health information technology vendors (OntarioMD, electronic medical records and Ontario Health)
• Medical equipment vendors
• Biological waste removal
• Linen service
• Janitorial service
• Landscaping/plant service
• Subscriptions (e.g., magazines, journals)
• Website administrator

Liaise with computer software/hardware companies to secure patient information

• Software vendor: You can ask the vendor for assistance in maintaining patient confidentiality of EMRs
• Computer hardware: If selling your computer hardware, you must ensure all patient information
  is removed. Simply deleting files does not remove confidential data
• Visit the OMA’s Practice Support Directory (member only) for a list of companies in your community

Dispose of medical equipment

There are several options to dispose of your medical equipment, such as:

• Ask your medical equipment suppliers if they want to purchase it back
• Donate to non-profit organizations that accept medical equipment
• Ask colleagues. They may be interested in the equipment or know of other physicians who are
• Advertise it in medical publications (e.g., the Ontario Medical Review) or on hospital notice boards
• Group practice: You may sell any portion of equipment (for which you are the partial owner) to the group or the new physician

Dissolve your Medicine Professional Corporation

When a physician ceases to practice, the MPC is no longer eligible to remain as is. However, if you want the MPC to continue for income and tax-planning purposes, you must make changes to the corporation name and scope of activities for it to continue acting as a standard business corporation. For more information, visit the OMA web page, Converting your MPC into a regular OBCA corporation (member only), call 1-800-268-7215 or email the OMA.

Close your business account

You should cancel all business accounts, including business credit cards. However, leave a bank account open for outstanding OHIP payments for at least three months.

Need to retain: According to the CRA, you must keep manual or electronic documents to support your financial records for at least seven years.
For more information, consult your accountant or call the Ministry of Finance at 1-866-668-8297.

Notify patients

The College of Physicians and Surgeons stipulates patients must be notified at least 90 days before an elective departure to give them time to arrange for a replacement physician. However, the OMA encourages members to give their patients a longer notice period (about six to nine months) to give them more time to find another physician, especially in under-resourced communities.

The CPSO’s policy on acceptable methods of notification includes:

• Calls to active patients
• Letters to active patients
• Printed notice in the office (even when the office is closed)
• Public advertisements (e.g., newspapers, magazines, websites)
• Recorded message on the office answering machine
• Post on your practice website or patient portal
• One-way email, via EMR systems

Keep a log that includes the method and date of notification for all active patients. Save receipts from certified mail notices and copies of any public advertisements you place. In case of a legal dispute around providing proper notice, you will need evidence of publication (this could include an affidavit from a publisher, printer, etc. as to the publication of any legal notice).

For up to three months after your practice has closed, maintain a voice message that:

• Reminds patients you have closed
• Provides patients with information on finding another physician
• Provides details on where patients can retrieve copies of their medical records

Use the voice message after closure template. 

Maintain continuity of care for complex patients

Physicians have a legal and professional duty to exercise reasonable efforts to arrange appropriate transfer and follow-up care for those patients who require it. Some patients need more than a notification that their physician is no longer available. You and/or the office staff should review a list of those patients, which would include:

• Urgent referrals
• Patients waiting on lab/test results (ensure alternate care and follow-up for patients to avoid missed or delayed diagnoses)
• Chronic pain patients
• Patients on medications that require frequent, ongoing monitoring
• Obstetrical patients (ideally, refer them to a physician at the delivery site)
• Patients who require ongoing care (e.g., in a hospital or other health facilities under your care) or post-operative follow-up. For these patients, you must complete and document (in the medical record) the appropriate transfer of patient care to another physician

For more information visit the OMA webpage Continuity of Care, read the CMPA’s information sheet, Considerations when leaving a medical practice, and the CPSO’s policy, Closing a medical practice. Before taking any action, ensure you are looking at the most current version of the policy, as the CPSO reviews it every three years.

Review medical record storage guidelines and source companies

Medical records requirements

The CPSO’s regulation requires physicians to keep paper and electronic 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 old

The CMPA suggests maintaining records for a minimum of 15 years due to a provision in the Limitations Act, which states that some legal proceedings against physicians can be brought up to 15 years after the act or omission on which the claim is based.

It is recommended you have a record transfer, retention and access agreement with the storage company to ensure access to your medical records.

When creating access agreements:

• Include timing and appropriate destruction of the medical records (e.g., shredding of paper
  charts, or permanently deleting hard drives and backup records of electronic records)
• Negotiate patient retrieval rates, including them in patient communication
• Follow CPSO guidelines on medical records management
• Email OMA Legal Services for assistance

eConsults

Store all eConsult data as part of your patients’ electronic medical records. Ensure there are no pending requests or future eVisit appointments scheduled.

Contact OTN to deactivate your account.

Medical storage companies

Visit the OMA’s Practice Support Directory  (member-only content) for companies in your community.

How patients can obtain their records

Medical records are the physician’s property. To release copies of the records, physicians need written authorization from the patient(s). Do not give originals to patients and keep the written authorization with the records. For contact support, consult with your lawyer or email OMA Legal Services.

For more information, visit the CPSO’s medical records management webpage, or contact the physician advisory service at 1-800-268-7096, Ext. 606. Information is also available from the CMPA on its managing your medical records webpage or at 1-800-267-6522.

Review your EMR vendor contract and user agreements

EMR is the gateway to digital patient data. Review your EMR contract with your vendor, as it may specify advance notice requirements needed to shut down.

• Let the providers of the digital health services integrated with your EMR know you are winding down your practice (e.g., OntarioMD, Ontario Health)
• Email OntarioMD for assistance

Deactivate digital health services integrated with your EMR

Digital Health Drug Repository/Ontario Laboratories Information System/ConnectingOntario ClinicalViewer

If you are the health information custodian, you must notify Ontario Health to have your DHDR/OLIS/cON deactivated. If you are not a health information custodian, your connection status can be updated directly within your EMR.

• For more support, email Ontario Health or call 1-866-250-1554

Deactivate Health Report Manager and Insights4Care Dashboard

• Notify OntarioMD to deactivate your i4C Dashboard and HRM. This process can take up to 15 business days
• Let Sending Facilities know where to send any forthcoming reports (you could opt to revert to paper, fax to another address, etc.)
• Email OntarioMD for assistance

Inform hospitals, long-term care facilities, laboratories, pharmacies and referring/referred colleagues

• Inform any hospital/long-term care facility and/or other health-care institutions you regularly work with
• Send a notice to frequently referring/referred colleagues you work with. This includes notifying the eReferral program. To do this, email the Ontario eServices program or call 519-885-0606
• Where applicable, it would be useful to share the name of a replacing physician, the physician’s forwarding address or where to send a report if alternate arrangements have not been made

Inform the Ministry of Health

You must notify the OHIP office where you submit claims of your intent to cease practice at least three months in advance to resolve any outstanding claims, queries and/or payments. Visit the OHIP claims office or call them at 1-800-262-6524.

Inform colleges and professional associations of address change and practice status

Notify associations at least three months before your practice closure.

Canadian Medical Association

Visit the CMA website or call 1-800-267-9703.

Canadian Medical Protective Association

If medical-legal difficulties arise from medical professional activities performed while your CMPA membership is active, you and your estate remain eligible for assistance.

Group practice: For a clinic to be eligible for assistance, all physician owners must be CMPA members. If you are a physician owner (or part owner) and you retire from medical practice, you and any family members must dispose of all ownership shares/proprietary interest for the clinic to remain eligible for assistance.

Locums: You will need to change your CMPA coverage if you decide to work in a locum.

Notify the CMPA of any contact information changes, so they can contact you regarding any medicallegal concerns.

For more information, visit the CMPA’s web page on interrupting or ending your membership or call 1-800-267-6522.

College of Family Physicians of Ontario

Email the college, call 1-800-387-6197, ext. 250, or visit the CFPC website.

College of Physicians and Surgeons of Ontario

You must notify the CPSO about where your medical records are stored and how patients may access them.

To do this, email the CPSO, go to the resignation from membership web page, or call them at 1-800-268-7096, ext. 673, or 416-967-2673.

Ontario College of Family Physicians

Visit the OCFP website or call them at 416-867-9646 or 1-800-670-6237.

Ontario Medical Association

You can retain your membership under the retired fee category, at a reduced membership fee, to continue to receive OMA benefits and services, including OMA Insurance and member discounts. For more information, email the OMA or call 1-800-268-7215.

Royal College of Physicians and Surgeons of Canada

Email the Royal College, call 1-800-461-9598 or read their membership web page.

Determining the value of a practice

If selling your practice appears to be the best option, enlist an accountant’s assistance.

The accountant will determine the book value of your practice’s hard assets and the value associated with the “goodwill” of your practice. The overall value becomes a calculation that will inform potential purchasers and provide you with knowledge of the practice’s theoretical value.

Some factors to consider when thinking about selling your practice:

• The history and specialties of the medical practice
• The current and forecasted economic climate
• Physician supply and demand, locally and provincially
• Estimated value of intangibles
• Estimated cost of equipment and other materials
• Location and historical ability to recruit physicians to the area
• Marketability of the practice
• Desirable assets, such as an EMR system

Develop a practice profile to determine readiness

A practice profile describes key elements of your practice to help you find a physician who would be the best fit for the practice. This includes:

• Roster size and type of patients
• Staff
• Overhead expenses
• Technology and equipment
• Existing agreement

Some physicians have found it advantageous to take on an associate for a year or two prior, with the intent that they will then buy the practice.

Also discuss

• Transfer of medical records
• Retention of staff

Considerations for group practitioners

Your options will be based on your agreement with the other physicians. For example, the agreement may allow for the buyout of a departing partner or shareholder. If it doesn’t, you may have to negotiate the purchase price of your stake in the practice. It may also be possible to sell your practice independently, similar to if you were practicing on your own.

It is essential to review the agreement to determine the notice required prior to the act of withdrawal and any obligations upon departure (e.g., dealing with assets, patients’ medical records, etc.).

If a group corporation continues to exist after the physician’s departure, you must transfer ownership shares to another physician licensed in Ontario. Directors of medical professional corporations have to be licensed members of the CPSO.

If you are in a group practice without an agreement, give your partners and/or associates plenty of notice. Ideally, try to arrange to leave at the end of the current lease (if your name is on it). This gives your colleagues time to decide what they want to do with the practice.

Consult with a lawyer, an accountant, or other tax advisers concerning the legal and tax considerations involved in the disposition of a practice.

OMA Legal Affairs provides:

• A template agreement for the purchase/sale of a medical It’s a useful starting point, but will need to be updated and modified to account for your particular circumstances
• A medical records transfer, retention and access agreement template

Note: The transfer/sale/purchase of a practice involving other physicians and OMA members creates a conflict of interest. As such, the guidance and information OMA legal counsel can provide is limited. The OMA encourages members to work with an independent corporate/commercial lawyer with experience in the complexities of transferring medical practices.

Maintain contact mechanism

For up to three months after closure

• Keep a bank account open for outstanding OHIP payments
• Keep a voice message for patients (after the practice is closed or after you leave the group practice)

Update contact information

• CPSO: For access and retrieval of patient medical records
• CMPA: Medical-legal issues that arise after retirement

Followup reports and requests for medical records

You are responsible for:

• Following up on any outstanding reports (lab, medical/legal, consultations, etc.)
• Responding promptly, usually within six weeks of the request for medical records

Documents that need to be retained

Financial documents: Retain financial records for at least seven years for tax purposes.

Employee records: Retain for a minimum of three years from when staff cease to be employed.

Patient medical records (if you did not transfer them to another physician):

• 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
• The CMPA recommends maintaining records for a minimum of 15 years