Changing employment sites multiple times over the course of a career has become the norm for many Canadian workers. A 2014 Workopolis survey reported that 51% of Canadians spent less than two years in one job and that only 30% of employees remained with the same employer at the four-year mark.1 There also appear to be definite differences between generations. While Baby Boomers tend to work for the same firm for 20 years or more, Gen X workers stay at the same job for an average of 3.4 years, and Gen Y workers remained at the same job for 2.7 years according to the survey.1
With these trends in mind, it is important for both employers and employees/contractors to prepare for the possibility of change. Keeping an open dialogue and adhering to the Standards of Practice are key to parting ways in a collegial manner and to ensuring patient care is managed in an ethical and professional way.
The College of Physiotherapists of Alberta often receives calls from physiotherapists and/or employers when the end of a working relationship becomes difficult. When this occurs, terminating the work relationship can be likened to going through a “bad divorce.” As each party starts questioning the conduct of the other, the conversation can deteriorate with neither side able to agree to a workable solution. When one or both individuals may ultimately turn to the College of Physiotherapists of Alberta for help they should know that the College of Physiotherapists of Alberta does not intervene in business matters unless patients and patient interests are affected. When physiotherapists or their employers contact the College in these situations, they are referred to the Standards of Practice and applicable legislative requirements. They will also be directed to specific College resources that can guide their discussions and actions.
The goal must be to ensure the patient’s interests are protected and are central to any decisions made between the physiotherapist and their employer.
Standards of Practice: What to Keep in Mind
At the centre of our profession is the patient. They should be the focus of any discussions about practice transitions. The Client Centered Care Standard of Practice and Code of Ethical Conduct both require that physiotherapists “value the best interests of their clients.”
The Client Assessment, Diagnosis, Interventions Standard includes the requirement to promote continuity in service by collaborating and facilitating clients’ transition from one provider to another.
The Collaborative Practice Standard requires that the physiotherapist communicates effectively with clients, team members, and other stakeholders to facilitate collaboration and coordinate care. The Standard also requires that the physiotherapist treats clients, health-care team members, and other stakeholders with dignity and respect at all times.
Finally, once the physiotherapist has made the move to their new location, they and their former employer are both required to comply with the Advertising Standard and to refrain from advertising that questions or diminishes the skills of other providers or the services of other clinics or facilities.
These Standards of Practice represent the minimum expectations that all physiotherapists must meet.
The key issues
There are two key issues that need to be addressed when a physiotherapist leaves a practice.
Notification of patients
A frequent source of conflict between business owners and physiotherapists is related to the notification of patients when a provider leaves a practice.
Client autonomy is paramount and unalienable.
Patients have the right to choose their health-care providers. No one “owns” the patient. The patient may choose to follow their physiotherapist to the new location or may decide to remain at the original clinic. The decision is the patient’s.
The College of Physiotherapists of Alberta expects patients with scheduled appointments to be provided with the information they need to make an informed decision about their ongoing care. It is not acceptable for patients to arrive for a scheduled appointment and be informed that their physiotherapist is no longer available. It is also unacceptable for an employer or clinic owner to withhold this information from patients because the relationship with the physiotherapist ended poorly or to avoid a business loss.
Informing a patient that the physiotherapist they have been seeing is leaving a practice, and the location of their new practice is not considered solicitation. This is a minimum requirement that supports the patient’s autonomy and right to choose their health care provider.
The College of Physiotherapists of Alberta has also heard of instances where the departing physiotherapist has taken a list of their patients' contact information, including both past and current patients, in some instances representing several years worth of private patient information. This is not acceptable practice either.
This type of information is part of the confidential patient record and can only be used, disclosed or accessed by authorized individuals for the purpose(s) the patient consented to when the information was collected. Once the physiotherapist has left the employer, they are no longer an authorized user and cannot access this private information. Unless the patient has specifically consented to the use of their contact information to notify them of staff termination or changes, it cannot be used by either the business owner or the physiotherapist for this purpose. Accessing or using private information for purposes that the patient did not consent to could be considered a breach of privacy. The custodian of the records may be required to report such a breach to the Office of Information and Privacy Commissioner of Alberta and could face penalties for failing to protect private information.
Custody of patient records
Privacy is a top priority.
Patients have the right to have their personal information remain private. Physiotherapists must ensure all patient records are secure and managed in accordance with the appropriate privacy legislation. While either the physiotherapist or the physiotherapy business can retain custody of patient records, there must be an agreement in place that identifies who will retain permanent custody of the patient record.
Often the employer or business owner will retain custody of patient records. This practice can make it easier for patients to find and request their information when they need it. If the employer is retaining the records, there should also be an agreement in place that addresses ongoing records access after the end of the work relationship. This is essential in the event that the physiotherapist needs to provide a medical-legal report for the patient.
The physiotherapist may also choose to retain custody of their own patient records. Although this is allowed, it is recommended that physiotherapists carefully consider how they will comply with the legislation and ensure records are secure and accessible for the required timeframe.
There can only be one original patient record. A departing physiotherapist cannot take a copy of patient charts if the clinic owner has been identified as the custodian. The physiotherapist can only be provided a copy of the record with a written request by the patient or their agent. If the physiotherapist assumes the custodian role, they will take the original records and copies must not be left at the original physiotherapy business.
The June 2019 Good Practice article: Releasing Patient Records provides members further information on how and when patient records can be released.
Every patient that walks through our doors is entitled to privacy, transparency and autonomy. The patient should fully understand that they get to choose who they continue treatment with, the original physiotherapist or at the original location with a new physiotherapist, without any undue stress. No clinic or therapist “owns” a patient, and the patient should feel supported in their decision. When a patient’s physiotherapist departs a practice, all parties involved should ensure the patient’s record remains private and confidential. If it is leaving the clinic after a request from the patient, then all reasonable measures should be enacted to keep those records safe and secure. During this transition, open and honest communication creates transparency for the patient. They understand that they are the priority as changes are being made and this benefits everyone involved.
- Workopolis (2014) How many jobs to Canadians hold in a lifetime. Available at https://careers.workopolis.com/advice/how-many-jobs-do-canadians-hold-in-a-lifetime/ Accessed Oct. 8, 2019.