Excluding pediatrics from family practice

[MGN]

Is it practically possible for one not to accept anyone less than 18 years of age into their practice?

[Intrepid86]

1 hour ago, MGN said:

Is it practically possible for one not to accept anyone less than 18 years of age into their practice?

The answer is yes, however be prepared to receive questions about why. For example, if you look after a pregnant woman and then decline to care for her baby after it's born, then it could make for an awkward situation. The family would essentially need another family physician besides you (or instead of you), and it's already difficult for people to find doctors as it is.

[Butterfly_]

Work ltc, hospitalist -no kids

[bearded frog]

14 hours ago, Intrepid86 said:

The answer is yes, however be prepared to receive questions about why. For example, if you look after a pregnant woman and then decline to care for her baby after it's born, then it could make for an awkward situation. The family would essentially need another family physician besides you (or instead of you), and it's already difficult for people to find doctors as it is.

Actually, at least in Ontario, the answer is no to this specific scenario. See the CPSO policy here https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Accepting-New-Patients. I assume it's somewhat similar in other provinces.

So you can say you're not accepting ANY new patients, but if you accept any, you can't discriminate on factors in the human rights code, which includes age. I don't think "anyone under age 18" would qualify as a legitimate narrowing due to competence or focus practice (unless say you wanted to narrow your practice to only geriatrics, which I think would be reasonable).

Butterfly_ is also correct, if you practice outside of the generalist GP context then you can also reasonably avoid certain populations by focusing on others, although there may be places where FM hospitalists care for patients under 18.

[Intrepid86]

6 hours ago, bearded frog said:

Actually, at least in Ontario, the answer is no to this specific scenario. See the CPSO policy here https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Accepting-New-Patients. I assume it's somewhat similar in other provinces.

So you can say you're not accepting ANY new patients, but if you accept any, you can't discriminate on factors in the human rights code, which includes age. I don't think "anyone under age 18" would qualify as a legitimate narrowing due to competence or focus practice (unless say you wanted to narrow your practice to only geriatrics, which I think would be reasonable).

I don't believe that's correct. It ultimately comes down to the OP's reason for not taking pediatric patients. If the reason were due to issues of clinical competence (or lack thereof) with this demographic, and clearly communicated as such, then the refusal could take place under policy point 5. If the main reason for excluding pediatric patients is because he doesn't like kids, then that would be unacceptable under policy point 3.

[bearded frog]

15 hours ago, Intrepid86 said:

I don't believe that's correct. It ultimately comes down to the OP's reason for not taking pediatric patients. If the reason were due to issues of clinical competence (or lack thereof) with this demographic, and clearly communicated as such, then the refusal could take place under policy point 5. If the main reason for excluding pediatric patients is because he doesn't like kids, then that would be unacceptable under policy point 3.

I'm pretty sure the college would not let you completely exclude everyone under 18 due to "clinical competence" when realistically, the issues 17 year olds come to PCPs for are the same as 19 year olds. A stronger argument would be that they don't do babies/small children due to "clinical competence" but as per number 6 in the CPSO policy "Given the broad scope of practice of primary care physicians, there are few occasions where scope of practice would be an appropriate ground to refuse a prospective patient." they may have concerns that a PCP claims they are not clinically competent to manage routine child issues, which is a fairly significant part of family medicine...

[MGN]

Even if I can narrow it down to anyone above 5 years of age that would be great!

[MDee2B]

What about doing a +1 in geriatric, palliative, or even sports medicine? That could raise the average age of your patient demographic.

[bearded frog]

18 hours ago, MGN said:

Even if I can narrow it down to anyone above 5 years of age that would be great!

I foresee you running into problems when you refuse to take on the newborn children of your adult patients who you followed for pregnancy...

[frenchpress]

2 hours ago, bearded frog said:

I foresee you running into problems when you refuse to take on the newborn children of your adult patients who you followed for pregnancy...

Many GPs don’t follow patients for pregnancy at all. Its not uncommon to follow patients until about 24 weeks and then refer to whoever will be delivering, but many of the GPs/midwifes/Obs Gynes I know actually prefer an earlier referral because docs who don’t do a lot of prenatal care have a tendency to miss things / screw things up. And it’s increasingly common that GPs won’t take the kids of their patients because they say their panels are full. Seems silly to me (kids are often pretty easy visits) but it’s happening all the same. 

[bearded frog]

22 hours ago, frenchpress said:

 And it’s increasingly common that GPs won’t take the kids of their patients because they say their panels are full. 

Absolutely (Although it's more common that GPs that generally don't accept patients do accept their patient's newborn children), but they can't just say "no kids, were full, but we'll take adults", at least not ethically.