Updated advice on patient panel size reduction

Read time: 2 minutes

With the healthcare system facing continuous pressures, we understand how challenging it can be to balance providing high-quality care for as many patients as possible while also working within a sustainable capacity.

If your panel has become too large to safely provide patient care while managing your own health and wellbeing, patients can be discharged from your practice in accordance with the Terminating the Physician-Patient Relationship standard of practice. We know these decisions aren’t made lightly, but if all efforts within your control have been made to manage your existing patient panel, you may need to determine the approximate reduction in panel numbers required to reach a number of patients you can safely manage.

To reflect current best practices during these challenging times, CPSA has updated our Ending the Physician-Patient Relationship Advice to the Profession document. While we previously advised physicians to use a random lottery system to select patients for discharge, we have updated our guidance to better align these tough decisions with the needs of patients, so selections are made deliberately and purposefully.

We recommend exercising professional judgment to establish a system for triaging patients based on their health needs. The selection process must be fair, transparent, compassionate and considerate of the medical needs of each patient, in addition to any other relevant factors. As an example, this could potentially involve discharging patients who do not have a high need for access to care or who have been absent from your practice for a significant period of time to make room for patients who require acute and/or active care.

Your strategy for selecting patients for discharge must also avoid grounds of discrimination, such as discharging patients from your care who have more complex needs. We understand there is no perfect solution to determining how to reduce a panel size while prioritizing every patient but, ultimately, the overarching priority should be to ensure those who require care the most are able to obtain the care they need.

What does this mean for you?

If you need to reduce your patient panel size, please follow the updated guidance in the Ending the Physician-Patient Relationship Advice to the Profession document. If you have used the lottery system in the past to reduce your panel, we understand this is what CPSA recommended at the time. Going forward, we do not recommend the use of the lottery system to select patients for discharge from your practice. Please review the updated document to determine how to best reduce your panel size in a manner that supports patients who need care the most. Your patients may have questions about their discharge—we have developed an Advice to Albertans document to provide patients with more information on the decision-making process that occurs when determining how to reduce your patient panel size.

Reducing a panel is never an easy decision, but we understand it’s sometimes necessary to ensure you are able to continue providing safe, high-quality care to patients.

Questions? Email support@cpsa.ca