List of Pediatricians Who Can Give Medical Examption

COVID-19 FAQs for Physicians

Updated February 11, 2022
(* indicates a newly added question)

Physicians are working hard to support each other and the public through this pandemic. To help inform this work, nosotros're keeping an updated list of frequently asked questions and answers. Our goal is to provide articulate information to aid guide your decision-making, the unique challenges posed by COVID-19 you are asked to go on using your professional person sentence. If your question is not addressed here or if you demand further back up beyond the information provided beneath, delight don't hesitate to contact us.

Providing Care

Given the government's recent announcement, should I still exist seeing my patients in-person?

Every practice is unique and finding the correct balance volition crave judgment on the role of the medico to consider the merits of virtual vs. in-person visits and to make up one's mind which arroyo is in the patient'southward best interest. Physicians should exist continuing to residuum in-person and virtual visits based on clinical need. Information technology is critically of import that the standard of care is met, which means some care will demand to exist provided in-person.

Non all patients will be able to become the intendance they demand virtually as there are limits to what tin can be done nearly. In-person care is essential for many atmospheric condition and some patients exercise non have acceptable access to virtual care. For example, where patients have difficulty communicating virtually, where physical contact is necessary to provide care and services (e.chiliad., newborn care, prenatal care, vaccine assistants) and other diagnostic and therapeutic procedures (e.g., Pap smears and biopsies), or where physical assessments are necessary to make an advisable diagnosis or treatment decision (e.m., infectious atmospheric condition, post-operative care, chronic disease management), patients need to be seen in person.

It is important to call back that the standard of care must ever be met. Equally CPSO'sTelemedicine policy states, physicians are expected to consider the appropriateness of providing intendance near in each instance, and if virtual care is provided, the care must encounter the same standard of practice as would apply in person. In addition to our policy, helpful resources regarding the limits and appropriateness of using virtual care have been adult by the Ontario College of Family Physicians, Canadian Medical Clan, Ontario Medical Association, OntarioMD, and the Quality Division of Ontario Health and Ontario Telemedicine Network.

*The Chief Medical Officer of Health has recently revoked Directive #2 — what does this mean?

On February 10, 2022 the Chief Medical Officer of Wellness (CMOH) revoked Directive #2 which applied to all regulated wellness professionals. The CMOH has adamant that it is at present possible to resume non-emergent and not-urgent surgeries and procedures , due to a steady downward tendency in COVID-nineteen cases, hospitalizations and ICU admissions.

More data can be establish in the Ministry of Health's Questions and Answers document and below.

*What does the revocation of Directive #two mean for hospitals?

Hospitals are now permitted to resume non-emergent and non-urgent surgeries and procedures.

With the revoking of Directive #two, hospitals are expected to follow the operational guidelines provided by Ontario Heath on resuming deferred clinical services. Ontario Health and Chief Regional Officers will work with hospitals to make up one's mind readiness to increase surgical and procedural activities based on the local atmospheric condition.

*How will deferred surgeries and procedures be rescheduled?

Any resumption of not-emergent and non-urgent surgeries and procedures in hospitals volition withal need to exist phased and gradual, as capacity pressures continue to be beyond the organisation.

*What does the revocation of Directive #2 hateful for physicians providing surgeries and procedures in the community?

The previous update to Directive #two on February 1, 2022 already immune for the gradual and cautious resumption of not-emergent and non-urgent surgeries and procedures in the community, provided that doing and then was reasonable in lite of the broader regional health system capacity and the need to maintain the health and human resources to deliver essential and urgent health intendance services beyond the system.

With the revocation of Directive #2, these surgeries and procedures can continue in community settings.

*Does Directive #ii being revoked affect Directive #2.1?

Directive #two.ane, which directs hospitals to use their bests efforts to transfer or support the transfer of patients betwixt hospitals to maximize system capacity and ensure intendance for as many patients as possible, remains in upshot and has been updated to reflect Directive #2 being revoked.

Directive #ii.1 too requires infirmary care providers to participate in system coordination and reporting processes established by Ontario Health.

What does the recent joint memo from the Principal Medical Officeholder of Health and other organisation partners hateful for chief care physicians?*

The nature of the pandemic is quickly shifting as the Omicron variant is becoming the dominant strain of COVID-19 in the province. Every bit a effect, the Chief Medical Officeholder of Health and key system stakeholders are asking primary care providers to reprioritize care commitment over the next few weeks. The goal is to shift resources to dramatically increment vaccination rates among the 3 million Ontarians currently eligible for first, second, and 3rd doses.

Primary care physicians have faced immense challenges over the class of the pandemic, with multiple and continuously changing demands. Your ongoing commitment and back up in response to the pandemic is being called upon in one case again.

Our public wellness officials have asked that yous reprioritize your work where possible, continuing to provide essential and critical services, while deferring non-essential care so yous can to use this time and your staff to back up the immunization attempt. This may hateful spending additional time to reach out to patients and address any vaccination hesitancy or connecting with local clinics or hospitals to directly participate in vaccine administration.

The excess all sectors — including primary care — are facing is unprecedented and the CPSO recognizes that you and your patients are in the best position to determine what care is essential to provide at this time. The Ontario College of Family Physicians has provided boosted information on how you can back up this arrangement wide effort.

Can I restrict in-person care to only those patients who have been vaccinated or accept a recent negative COVID-19 test result?

No. In-person intendance tin be provided safely — even in the absenteeism of a negative examination result or vaccination — by taking appropriate precautions, including screening patients and using necessary PPE. While y'all can encourage eligible patients to become vaccinated, patients cannot be denied access to necessary in-person care based solely on their vaccination condition. Similarly, it is not advisable to deny in-person intendance to patients who screen positive, only have non notwithstanding had a COVID-19 examination if in-person care is needed and adequate condom precautions can be implemented. The Ministry of Health has identified one exception, namely, that in areas where community manual of COVID-xix is not low, patients who are scheduled to undergo a surgical procedure requiring a full general anaesthetic and are not fully vaccinated should be tested, and non-urgent procedures should be delayed if the test is positive.

If yous have questions virtually the precautions you should exist following while providing in-person care, delight refer to the FAQ below, "What condom precautions do I need to take when providing in-person care?" CPSO also recognizes that in rare instances, physicians in loftier-take chances populations may demand to limit access to in-person care. For more guidance, please see the FAQ below, "I am worried about my safe and I'g not currently able to run across patients who require care. What should I do?

How should I manage patients with symptoms of COVID-nineteen seeking care?

Some symptoms of COVID-xix are similar to many other conditions (east.thou., influenza, COPD, sinusitis). Public health guidance states that physicians should not delay assessment and treatment of issues which accept symptoms that overlap with those of COVID-19 just are clinically evident of a different diagnosis. Physicians will need to utilize their clinical judgement, taking into account local epidemiology and exposure history, to assess and treat these types of issues in a timely mode. While patients with these symptoms should exist referred for testing and need to exist told to self-isolate until a negative result is received, admission to appropriate care should not be denied (including access to necessary in-person care, providing appropriate precautions can be taken), fifty-fifty if the patient has not yet been tested.

What safety precautions do I need to take when providing in-person intendance?

It's of import that yous follow guidance provided by the province or public health officials in order to implement safety precautions that are designed to protect everyone. Public Health's Infection Prevention and Control Primal Principles for Clinical Office Practice During the COVID-19 Pandemic checklist can be used to assist with planning and preparing for providing in-person care. You can also inform patients well-nigh the rubber precautions yous've put in identify to ensure compliance with these measures (e.g., propose patients to bring and vesture a mask).

Hygiene: Have systems in place to support hand hygiene amidst staff (due east.g., before/afterward every patient) and make hand sanitizing stations available to patients.

Screening:Screen all patients in accelerate (when possible, through video, phone , or using web-based/online technologies), and at the betoken of care. Follow Public Wellness guidance on what to practice if a patient screens positive. If you are unable to safely isolate and/or provide care to patients with a positive screening consequence, redirect them to appropriate access points (e.1000., emergency room if care is urgently needed). Also know where to direct patients who require testing and know when to written report cases of COVID-xix to your local public wellness unit.

PPE:Follow public health guidelines regarding the appropriate PPE to use for the care being provided.

Physical (Social) Distancing: Prepare up your physical workspace and manage your practice in a mode that enables staff and patients to notice concrete distancing, attempting to maintain at least 2 metres distance where possible (e.g., using barriers at screening points, spacing furniture, minimizing traffic flow with signage and/or markings, having patients wait outside the function (if possible/appropriate), staggering shifts within group practices, etc.). Where it is not possible to maintain at least 2 metres of distance, you should maximize distance and minimize contact and ensure proper masking is followed.

Infection Prevention and Control: Infection prevention and command is more than important than ever. Follow Public Health Ontario's Best Practices for Ecology Cleaning for Prevention and Control of Infections in All Health Care Settings and the sector specific guidance provided by the Ministry building of Health. Public Health Ontario too has online learning resources available to assist build or refresh core competencies in this area.

Ventilation: Consider means to optimize ventilation to maximize airflow in your workspace by reviewing Public Health Ontario's resource on Heating, Ventilation and Air Conditioning (HVAC) Systems in Buildings and COVID-nineteen.

Pandemic-Related Practice Issues

Patients are asking me to write notes supporting a medical exemption from COVID-19 vaccines — what exercise I need to know?

Patients may ask y'all to write notes or complete forms exempting them from getting vaccinated.

If you are asked by your patient to provide information supporting a medical exemption from receiving a COVID-19 vaccine, your patient must have a legitimate medical status that would warrant an exemption.

The National Advisory Committee on Immunization (NACI), the Ministry of Health, and some public wellness units have provided guidance regarding contraindications for COVID-xix vaccines. The Ministry of Wellness has also provided guidance about medical exemptions in the Medical Exemptions to COVID-nineteen Vaccination document, and guidance for specific allergy populations in the COVID-19 Vaccination: Allergy Grade document.

Generally speaking, there arevery fewacceptable medical exemptions to the COVID-19 vaccination (examples include an allergist/immunologist-confirmed severe allergy or anaphylactic reaction to a previous dose of a COVID-19 vaccine or to whatever of its components that cannot exist mitigated, or a diagnosed episode of myocarditis/pericarditis after receipt of an mRNA vaccine).

Given the rarity of these exceptions, and in light of the fact that vaccines have been proven to be both prophylactic and constructive, whatever notes written for patients who qualify for a medical exemption need to clearly specify:

• the reason they cannot be vaccinated against COVID-xix (i.e., document clear medical information that supports the exemption); and
• the effective fourth dimension period for the medical reason (i.east., permanent or time-limited).

While physicians are by and large required to complete third party medical reports for patients when requested, the circumstances of the pandemic back up physicians declining to write notes or complete forms when the patient making the request does not have a medical condition that warrants an exemption. If yous find yourself in this situation, clearly and sensitively explain to your patient that you cannot provide them with a note or form, along with the reasons why.

It is as well of import that physicians work with their patients to manage anxieties related to the vaccine and not enable avoidance behaviour. In cases of serious concern, responsible apply of prescription medications and/or referral to psychotherapy are available options. Overall, physicians have a responsibility to allow their patients to be properly informed virtually vaccines and non have those anxieties empowered past an exemption.

The Centre for Addiction and Mental Wellness (CAMH) has a COVID vaccine dispensary that has been adapted to better support individuals with mental disease, substance use disorders, dementia and other neurodiversity. CAMH offers specialized care, for example, by ensuring that there is no visible medical equipment in the clinic or at the vaccination station, and allowing extra time between appointments for more questions and counselling if needed.

Tin I charge patients for any masks I provide or a fee to help cover the additional costs associated with boosted safety precautions I need to take?

The College recognizes and appreciates the additional investments you lot are making to help serve your patients. These investments volition aid y'all provide care in the short- and long-term progression of the virus. The Ministry of Wellness has confirmed that infection prevention and control products or practices, including masks provided to patients, are constituent elements of the insured services physicians provide and then cannot be charged for.

What if a patient refuses to wearable a mask?

If you encounter a situation where a patient declines to habiliment a mask, sensitively explain the expectation that they wear a mask and the importance of protecting public health by following the recommendations of public health organizations. Public Wellness guidance specifies that patients who are symptomatic for COVID-nineteen or have a recent exposure must habiliment a surgical/procedure mask. However, for other patients, by donning appropriate PPE and safely isolating them from other patients, you may still be able to safely provide care. If an in-person visit is non needed to meet the standard of care, you could alternatively offer virtual intendance. Be aware that some patients have wellness conditions that make it difficult or uncomfortable to wearable a mask, so programme ahead to help suit their needs and find ways to assist them admission care safely (e.yard., providing every bit much care virtually, scheduling appointments during specific times, etc.).

If I guild a COVID-nineteen examination for a patient, am I required to follow-up with patients on all test results, or can I rely on patients to access their results through Ontario Health's online portal or other similar self-directed mechanisms?

Given the significance of a positive effect and the imperative that patients isolate themselves, physicians have a responsibleness to communicate any positive results  directly and promptly to all patients (in exercise, this may often exist done by public health).

However, given the widespread and extensive testing that is underway, a "no news is practiced news" approach tin can exist relied upon for negative results provided that patients are aware of and are reasonably able to access an online portal displaying their results (east.g., provincial online test results website, hospital patient portal, etc.). If patients are not reasonably able to access their results on their own, negative test results volition demand to exist communicated to them directly.

What practice I exercise if a patient has an expired health carte du jour or a reddish and white health card?

Due to COVID-19, the Ministry of Health has extended recently expired health cards (on or after March 1, 2020) and red and white health cards and so that they remain valid. You should notwithstanding be accepting these health cards from Ontario residents at this time until the extension period ends on September xxx, 2022. If a patient does not have a valid Ontario wellness card, you should not turn them abroad. You lot can use the billing codes identified by the Ministry of Health for those without OHIP or another provincial health plan.

COVID-xix Vaccines

Why should physicians get vaccinated?

Having a fully vaccinated health-care profession is critical to minimizing the adventure of COVID-19 transmission and/or outbreaks in offices, clinics and hospitals. Fifty-fifty if you practise non experience ill, asymptomatic infection and subsequent transmission is possible. The COVID-nineteen vaccine reduces your risk of becoming infected and is the best manner to control the spread of the virus, and so getting vaccinated is an essential step to protecting your ain wellness, the health of your patients, and the customs at big.

This pandemic offers physicians an opportunity to atomic number 82 past case. By getting vaccinated, physicians can aid relieve the strain on our health-care system and support the health, safety, and well-being of the people of Ontario.

COVID-19 – now a vaccine preventable disease – is amongst the leading causes of death globally and known to accept prolonged, wide-ranging impacts. High vaccination rates are of import considering they help achieve herd immunity and protect people who cannot exist vaccinated.

While the Higher recognizes that some physicians cannot go vaccinated due to medical contraindications, those physicians tin can all the same provide stiff leadership on COVID-19 prevention and proceed to abet for full vaccination of all those eligible.

Physician Condom

I and/or my family are in a high-risk population and I'm worried nearly my safety. What should I do?

Provided that the correct condom precautions are put in place, nearly physicians will exist able to provide care in person when it is needed. Screening patients, both when scheduling appointments and at the signal of entry to the function, volition assist make up one's mind the level of precautions you crave when seeing patients in person.

If you or your family are in a high-run a risk population, you will have to consider the best way to manage your practice given your unique situation, the communication of public wellness officials, and the best evidence available at the time. In extenuating circumstances where y'all are unable to provide care to your patients there are steps you lot can take to support them in accessing the care they demand:

• Use virtual care to provide what yous can or help triage and re-direct patients every bit needed;
• Coordinate with colleagues to help provide coverage for in-person care;
• Engage with local pharmacists who may be able to assist with some types of care, like extending or renewing a prescription;
• As much every bit possible, avoid simply directing patients to the emergency section when these resources aren't required, and instead do your best to help patients navigate the system to find the resource best suited for their care needs.

Prescribing

How can I send prescriptions electronically when providing virtual care?

Past this betoken in the pandemic, you should be equipped to provide intendance nigh when needed, including transmitting prescriptions to pharmacies using secure and established channels such as phone, fax or e-prescribing systems. Sending electronic prescriptions straight to patients increases the risk of fraud, places undue pressure on pharmacists to verify the authenticity of prescriptions and impedes the commitment of condom and timely intendance.

Equally always, work with your patients to identify their chemist's shop of choice, and then coordinate with the pharmacist to determine how best to transmit the prescription securely. If you run into any challenges, collaborate with your pharmacist colleagues to detect the correct solution for everyone.

I've read about some drugs that might prove beneficial in treating COVID-19: Should I be prescribing these drugs as a precautionary measure? Can I prescribe them for myself or family?

No. Many of these drugs have an intended use and prescribing them as a precautionary measure has or may contribute to drug shortages, compromising treat others. Should these or other drugs prove useful in combating COVID-19, their use will need to be carefully managed to support those who need them the most.

At a fourth dimension where resources may exist scarce, actions similar those mentioned above dramatically depart from the core values of medical professionalism, undermine the public trust in the profession at a time where the public is most vulnerable, and may contravene the College'sPhysician Handling of Cocky, Family unit Members, or Others Close to Them policy.

How can I support patients who are isolating and demand access to medication?

Do not send patients who should be isolating to the pharmacy to access medication. Instead, tell patients to stay dwelling, send the prescription to the patient'south pharmacy of choice, and explain the situation to the pharmacist. Physicians are permitted to share information about the patient's COVID-nineteen status with the pharmacist as they are a member of the circle of care, and the information being shared is directly pertinent to the provision of care. The pharmacist and patient can and so coordinate for the commitment or choice-up of the medication by someone other than themselves.

I prescribe opioids for chronic pain/provide addictions handling — how practice I provide advisable admission to intendance for patients?

Earlier in the pandemic, physicians adapted their practise and provided virtual care to patients using opioids. The Centre for Addiction and Mental Health (CAMH) developed COVID-19 Opioid Agonist Treatment (OAT) guidance to aid with the management of OAT during the pandemic. However, as Ontario is reopening and normal wellness care services are resuming, physicians need to adapt their practices again, including past resuming more traditional approaches to carries and function visits, and notify patients that CAMH's guidance no longer direct applies.

Health Canada has too fabricated temporary changes to theControlled Drugs and Substances Act that enable pharmacists to extend or transfer prescriptions, prescribers to issue verbal orders, and pharmacy employees to deliver controlled substances (meet the Ontario College of Pharmacists and Wellness Canada for more information).

Professionalism and Complaints

What is the standard of care during a pandemic?

While the standard of care is ever evaluated in context, at this stage, many of the pressures that existed early in the pandemic have diminished and in most instances volition non alter how nosotros understand the standard of intendance.

As always, information technology volition be of import for physicians to be mindful of and practice in accordance with any direction from the Chief Medical Officeholder of Health, Ministry of Health, CPSO, and infirmary policies or procedures that are developed to accost managing the pandemic.

What should I exist thinking about every bit I appoint on social media nigh issues relating to the pandemic?

Physicians are reminded to be aware of how their actions on social media or other forms of communication could exist viewed by others, especially during a pandemic. Your comments or actions can lead to patient/public harm if you are providing an opinion that does non align with information coming from public wellness or government. It is essential that the public receive a clear and consistent message. The College's statement onSocial Media – Advisable Use by Physicians outlines general recommendations for physicians including interim in a manner that upholds their reputation, the reputation of the profession, and maintains public trust.

Registration and Licensure

What does the MCCQE Office 2 Pandemic Exemption policy mean for residents?

In March 2021, CPSO Council approved a new registration policy permitting the Registration Commission to upshot a certificate of registration authorizingcontained practice to applicants who had not completed the MCCQE Part two where specific criteria are met. All applications volition crave review and approval by the Registration Committee and interested applicants will need to use CPSO'southward online application portal.

In June 2021, the Medical Council of Canada (MCC) announced that they are stepping away from the delivery of the MCCQE Part 2 going forrad. In October 2021, the Licentiate of the Medical Council of Canada (LMCC) policy was approved and is broader in its application given that the MCCQE Part ii no longer exists.

More information almost the exemption and new LMCC policy can be found by reviewing the policy or companion frequently asked questions. Whatsoever questions can exist submitted via the Fellow member Portal bulletin heart.

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Source: https://www.cpso.on.ca/Physicians/Your-Practice/Physician-Advisory-Services/COVID-19-FAQs-for-Physicians

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