Leaving a Practice Guideline

Leaving a Practice Guideline PDF

Introduction

It is common for physiotherapists to change employers several times over the course of their career. The College of Physiotherapists of Alberta often hears from business owners and physiotherapists alike at the end of an employment relationship. The situations we hear about often take on the air of a “bad divorce” once notice is given. All too often the client and their interests, rights, and preferences seem to take a back seat to the business and professional interests of the parties involved.

This Leaving a Practice Guideline was developed to help physiotherapists and physiotherapy businesses work through the process of parting ways in a manner that is professional, collegial, and puts the client’s rights and interests first. Key considerations include:

• The client’s right to autonomy and choice of health-care provider
• The physiotherapist’s duty of care to the client
• Privacy of health information
• Client and physiotherapist ongoing access to health information

According to the Code of Ethical Conduct, physiotherapists:

• Conduct and present themselves with integrity and professionalism.
• Practice collaboratively with colleagues, other health professionals and agencies for the benefit of clients.

How a physiotherapist conducts themselves during a change to their practice location can directly affect how clients perceive the physiotherapist’s professionalism and affect the trust they have in the physiotherapist.

Autonomy

The client has the unalienable right to choose their health-care providers. Neither the physiotherapist, nor the physiotherapy business, have the right to interfere with the client’s informed choice of where and from whom they receive treatment. No one “owns” the client. The client may choose to follow their physiotherapist to their new location, decide to remain at the original practice site, or they may choose to seek care at a different practice setting entirely.

The decision is the client’s alone.

For the client to make an informed choice and exercise their autonomy, the physiotherapist and the physiotherapy business need to provide the following information to the client:

The client’s treatment options, which include:

• Following the physiotherapist to their new location
• Transferring care to another physiotherapist within the current practice
• Transferring care to a physiotherapist at another practice site in the community

Other relevant information that will inform the client’s decision:

• Where the physiotherapist is going
• Any likely interruptions in their care
• The skills and services available at the practice location if the client were to remain, rather than following the physiotherapist to their new location

Duty of Care

Physiotherapists have a duty to serve the interests of their clients, and to enable the client’s ongoing access to physiotherapy services despite the change in the physiotherapist’s practice location. Respecting a client’s right to make informed decisions includes respecting their right to choose their health-care providers. The physiotherapist:

• Recognizes that clients have the right to make informed decisions about their own care…
• … has a duty of care to their clients and an obligation to provide for continuity of care whenever a therapeutic relationship with a client has been established.
• Makes appropriate arrangements for continuity of care… when leaving a practice setting.
• Ensures continuity of care, making appropriate arrangements for transfer of care to another physiotherapist or providing the client with information regarding other physiotherapy service options.

Client Notification Scenarios

Given that the client has the right to choose their health-care provider and the physiotherapist’s duty of care, it is essential that the client be notified of any pending changes that affect their physiotherapy care. Three common scenarios to consider:

• The client has upcoming appointments scheduled before the physiotherapist’s last day.
• The client has an appointment scheduled after the physiotherapist’s last day at the practice.
• The client has no upcoming appointments but is not yet discharged.

Clients who are undergoing active treatment or have an appointment booked after the physiotherapist’s last day must be notified of the change as soon as possible.

It is not acceptable for the client to arrive at the practice site for their appointment expecting to see their physiotherapist only to be told that they will be seeing a different person.

A sample letter is provided for physiotherapists and their employers to modify as necessary.

In the case of clients who do not have an appointment scheduled nor a current plan for follow up, the physiotherapist should treat these clients as discharged and follow their usual procedures regarding the completion of discharge summaries and other documentation before their last day at the practice setting.

The Health Information Act includes provisions that prohibit the use of client registration information (phone numbers, email addresses) for marketing purposes. This means that neither the physiotherapist leaving the practice setting, nor the owners of the practice setting may use registration information for the purpose of promoting a new practice location or notifying former clients of clinic staffing updates.

Scenario

Jusuf has recently left a clinic that he worked at for years. One of his past clients found him online and told him that when they called Jusuf’s previous clinic, the clinic advised the client that Jusuf no longer worked there, and that they didn’t know where he went.

If a client who has been discharged later calls the practice wishing to re-book with Jusuf, who has since left the practice, they must be informed that Jusuf has left the practice and be provided with information regarding their treatment options, including the Jusuf’s new location, if it is known.

The employer cannot refuse to share information about Jusuf’s location if they know it, simply to avoid a business loss.

In the event the former employer does not know the physiotherapist’s location, the employer needs to advise clients that they can obtain this information from the Verify a Physiotherapist section of The College of Physiotherapists of Alberta’s website.

It is also not acceptable for the practice to book an appointment for the client and not inform them that Jusuf has moved until the client arrives for the appointment.

Privacy

Health information must be in the custody and control of an individual or organization designated as a custodian under the Health Information Act.

Registrants of the College of Physiotherapists of Alberta are designated as custodians under the Health Information Act and have legislated obligations to protect their client’s privacy and ensure that a client’s health information is secured and used appropriately. However, within a given practice setting, an individual physiotherapist may fulfill the role of custodian or be designated as an affiliate to another custodian under the Act. Physiotherapists are required to know their role as custodian or affiliate, as those terms are defined in the Health Information Act.

Physiotherapists who believe they are an affiliate to a custodian must have clear documentation, such as a contract or job description, that identifies their role as affiliate and identifies the custodian of health information for the practice setting. The identified custodian must be an individual or organization designated as a custodian under the Health Information Act, Section 1(1)(f) or the Health Information (Ministerial) Regulation, Section 1.

In accordance with the Health Information Act:

• A physiotherapist retains full responsibility as a custodian of health information if they are employed by someone who is not a custodian, or if they have not been designated an affiliate of a custodian designated under the Health Information Act.

A physiotherapist serving in the role of “custodian”

• Has ongoing responsibilities related to the collection, use, access, amendment, security, and disposition of health information in their custody and control.
• Retains health information for 10 years after the last date of service (or 10 years past the eighteenth birthday of a client who was treated while they were under 18 years of age).
• Prevents abandonment of client records by designating an eligible successor custodian to ensure the retention, accessibility, and security of client health information in the event that the physiotherapist is unable to continue as custodian of health information.

If the physiotherapist is the custodian of health information they have two options when leaving the practice site:

They take all client health information related to physiotherapy services with them when they leave, because they are the custodian of the health information.

They identify and enter into a formal agreement with an eligible successor custodian who agrees to take custody and control of the health information. This may be another custodian working at the practice setting or any other custodian designated under the Health Information Act.

It is not an option to leave health information with someone who is not a designated custodian under the HIA.

A physiotherapist who has been designated as an “affiliate” to a custodian under the Health Information Act has no authority to take health information with them at the time of their departure from the practice setting. This includes both care and treatment information and registration information. The custodian of the health information is responsible for the retention and security of the health information.

Scenario

Raj works for a chiropractor who is a custodian under the HIA and who has designated Raj as their affiliate. Raj is leaving his current practice and does not trust his employer to notify his clients of the change once he leaves. Raj wants to email all his clients to thank them for their business and provide them with information about his new practice location.

Client registration information (including telephone numbers, email addresses, and mailing addresses) is identified as registration information and is protected under the HIA. The custodian must protect health information from unauthorized access or use. Once Raj is no longer an affiliate of the custodian, he is no longer an authorized user of that health information. The custodian must employ measures to ensure Raj does not have access to the client contact information after he leaves the practice.

When custodians collect a client’s individually identifying information, they are required to do so for an identified purpose and may only use that information for the purposes identified at the time of collection. Authorized purposes include the provision of health services, which would include contacting clients about upcoming appointments or sending appointment reminders.

Use of health information (i.e., registration information) for marketing activities, such as promoting a new business, is prohibited under the HIA unless express consent for this use has been provided. This means that the client’s contact information may not be used by Raj for the purpose of notifying clients of his new location. The custodian is also barred from using registration information for marketing purposes, such as promoting the services of a physiotherapist hired to replace Raj.

Raj must refrain from inappropriately accessing client information to which they do not have a right to access and from using information for purposes other than those authorized by the Act and identified at the time of collection.

Chart Access and Continuity of Care

Client Access to Health Information

Although the physical record is the property of the custodian, the information contained within the record is the property of the client and is theirs to access if they wish. The client has the right to access their health information, to request an amendment, or to obtain copies of their health information without unreasonable barriers. A practice may charge a fee for the work related to generating a copy of health information for a client, these fees are specified in the Health Information Regulation.

Clients have the right to know that their private information is secure and that it will not be misused. Clients should be notified of the location of their health information and how it is being secured. This may take the form of a notification email or information posted on the practice setting’s website, in addition to being included in the original notification advising current clients of a physiotherapist’s planned departure.

The notification must advise clients of the following information:

• Who the custodian of their health information is.
• How they can contact the custodian of their health information.
• How they can access their health information or request an amendment to their health information.

Both parties (the physiotherapist and the practice setting owners) should know which party has custody of health information and how to contact the other party, in the event that they receive a client request for access to health information.

In the case of a physiotherapist who is an affiliate and is leaving a practice setting, the departing physiotherapist must not access or copy health information to take with them. If a client wishes to follow their physiotherapist to their new practice site, the custodian at the new practice setting may contact the custodian at the original practice setting to request a copy of the client’s health information to enable the delivery of ongoing physiotherapy services. Similarly, if the physiotherapist later requires access to health information, for example in order to prepare a medical-legal report, the same mechanism of custodian to custodian sharing of information would apply.

This type of disclosure of health information between custodians is enabled by Section 35 of the Act.

It is expected that a custodian of health information will provide health information when requested by another custodian in a timely manner, consistent with the custodian’s duties to:

• Provide for continuity of care (Duty of Care Standard of Practice).
• Collaborate with health-care providers and others to provide safe, effective, quality and concurrent care (Concurrent Care Standard of Practice).
• Act with beneficence and respect for client autonomy (Code of Ethical Conduct).

Although the HIA includes provisions that enable custodians to charge a fee for client access to chart copies, those provisions do not apply to disclosure between custodians. Physiotherapists must not charge a fee when disclosing health information to another custodian for the purpose of enabling ongoing care and treatment to the client.

Scenario

James is leaving his current practice and wants to take a copy of all his clients’ charts, so he can treat them at his new practice. James’ role as custodian or affiliate determines whether he can take client health information with him to his new practice setting and how he gains access to health information.

If the clinic owner is the custodian and James is their affiliate, James no longer has a right of access to the health information under the custodian’s custody and control upon his departure. James must ensure that upon his departure from the practice site that he no longer has any client health information stored in any format on his personal devices. The practice setting must have policies and procedures in place to ensure that James’ access to health information is rescinded.

Once James begins to provide services at an alternate location, he may request access to health information in the custody and control of the custodian, for those clients that he is providing physiotherapy services to. The Health Information Act includes provisions that allow one custodian to share health information with another custodian, for the purposes of providing care and treatment to the client.

James must not request access to health information of clients speculatively – he must have a legitimate duty of care and treatment role with the client before he requests access to the health information. The clinic custodian has a positive duty to share health information with James, to enable client care and treatment and must not withhold information to prevent a business loss.

If James is the custodian of client health information, he is responsible to retain health information securely for the required retention period, ensure appropriate access to, and appropriately destroy client records at the end of the retention period.

In this case, when James leaves the clinic, he would retain the original records of client health information, not a copy. The clinic owner and James’ former affiliates at the clinic would no longer have access to the client health information.

If a client opts to continue receiving physiotherapy services at the clinic (e.g., if the clinic hires another physiotherapist), the new physiotherapist, as a custodian of health information, can request access to the health information in James’ custody.

If non-custodian clinic staff want a copy of client health information in James’ custody for other reasons, for example to provide massage therapy services, and a custodian under the Health Information Act is not involved in the request, James must have the client’s consent for the disclosure of the health information before providing a copy of the client’s health information.

Avoiding Trouble

In the event that a physiotherapist is not able to continue in the role of custodian of health information, (for example due to retirement, leaving a practice, leaving the province, or other circumstance) they must designate a successor custodian who agrees to take on the responsibilities of custodian of health information for the physiotherapist.

Scenario

Janka works at a small clinic owned by a Registered Massage Therapist. She is moving to British Columbia this year and does not wish to renew her Alberta practice permit or retain any of her client health information. She needs to identify someone to retain her client records.

Once Janka’s practice permit expires and her registration is cancelled, she is not a custodian under the Health Information Act. Registered Massage Therapists are also not custodians under the Health Information Act so they cannot be the custodian of Janka’s clients’ health information.

If the clinic hires a new physiotherapist, the new physiotherapist would be eligible to take over as successor custodian of Janka’s clients’ health information.

Similarly, other custodians under the Health Information Act (e.g., a chiropractor, physician, or registered nurse) whether they work within the same clinic or at a separate practice setting, would be eligible to serve as a successor custodian of Janka’s clients’ health information.

Janka decides to talk to the new physiotherapist that was just hired to see if they are willing to be the successor custodian of Janka’s clients’ health information. Janka needs to have a formal agreement in place with the new physiotherapist, specifying that they will take over responsibility for the client health information.

Remember, successor custodians must be designated custodians under the HIA.

If Janka cannot make arrangements with an eligible successor custodian, Janka will continue to be responsible for the custody and security of health information. Janka can hire an information manager to store health information on her behalf but must also continue as custodian (i.e., retain their registration and practice permit with the College of Physiotherapists of Alberta) until she can secure a successor custodian for the health information.

Faced with the prospect of a bad divorce, the best prevention is a good “pre-nup.”

The College of Physiotherapists of Alberta does not provide legal advice or resources regarding contracts. This does not mean that these issues are unimportant.

Physiotherapists and physiotherapy business owners are encouraged to know and understand the terms of their contracts and to seek independent legal advice regarding contract terms such as restrictive covenants (e.g., non-compete clauses).

The College of Physiotherapists of Alberta’s perspective is that restrictive covenants limit the client’s ability to choose their provider. For example, if a physiotherapist has a restriction that they are unable to practice within five km of their current practice site, this may prove to be a significant barrier for client access to the provider of their choice. Due to the potential negative effects to the client and barriers to accessing the care they choose, the College of Physiotherapists of Alberta does not support the use of these clauses in physiotherapy contracts.

Contracts must identify the custodian of health information collected, used, and disclosed by the physiotherapist within the practice setting, whether that is the physiotherapist or another eligible custodian. If the physiotherapist is the custodian, the contract must clearly establish that the physiotherapist will develop the policies and procedures related to health information management and otherwise fulfill their obligations established in the Health Information Act, and that they control who they designate as their affiliates. Contract terms must not impair the physiotherapist’s ability to fulfill their legislated obligations.

The contract must also indicate that if and/or when the physiotherapist leaves the practice appropriate communication with clients will be made regarding where their chart records will be kept.

Page updated: 06/08/2026