The Fine Print

CPSO and Ministry of Health Rules on “One Issue Per Visit” Restrictions

Per the College of Physicians and Surgeons of Ontario (CPSO) policies and Ministry of Health guidelines, there are no explicit rules that prohibit physicians from restricting visits to “one issue per visit.” However, this practice exists in a regulatory framework that emphasizes patient access to care and professional obligations.

CPSO Position

The CPSO does not have specific policies that mandate physicians must address multiple issues per visit. However, the College’s continuity of care policies and professional standards emphasize several relevant principles: [1][2]

Physicians must ensure patients have appropriate access to care
Patient safety and quality of care are paramount considerations
Physicians have professional obligations to act in patients’ best interests

Risks to Mitigate

There are risks that need to be considered and mitigated.[3]

Clinical Risks:

Increased possibility of not detecting serious health problems
Patients may be compelled to self-triage their symptoms inappropriately
Risk of arriving at improper diagnoses without a complete clinical picture
Potential for missing important health issues

Patient Relations Concerns:

Patients may view the policy as rigid or insensitive
Negative impressions, particularly for patients who have difficulty scheduling appointments
Misunderstanding of the rationale behind such restrictions

Approaches that can Help

The CMPA has several suggestions:[3]

Improved Communication: Ask patients to describe all concerns when scheduling or at the beginning of visits
Prioritization: Help patients prioritize issues based on clinical urgency
Softer Messaging: Use informative signage that explains time constraints rather than restrictive policies
Visit Conclusion Techniques: Ask “Is there something else you want to address today?” instead of “Is there anything else?”

OHIP Billing Considerations

The fee-for-service model under OHIP contributes to this practice, as physicians receive the same payment whether addressing one or multiple issues during a visit. However, this is a system design issue rather than a regulatory requirement to limit patient access.[4][5]

Access to Care Obligations

CPSO policies emphasize that physicians must not unduly restrict patient access to care. While physicians have discretion in practice management, they must balance this with professional obligations to:[6][1]

Provide appropriate and timely care
Act in patients’ best interests
Maintain continuity of care
Ensure patient safety

Evidence from Practice

Research indicates that family physicians routinely address multiple concerns per visit, with studies showing that 50% or more of visits involve multiple issues. This suggests that blanket “one issue” policies may not align with the realities of comprehensive primary care.[7]

Solutions to Mitigate the Risks

Physicians should consider these suggestions:

Accessibility: Ensure ample timely access to visits to address all concerns in a timely manner
Triage at Booking: Identify complex cases requiring time and attention
Patient Education: Explain scheduling constraints while ensuring appropriate care
Clinical Judgment: Use professional discretion to address urgent or related issues

There is a need to balance practice efficiency with professional obligations to provide comprehensive, patient-centered care while minimizing clinical risks and maintaining positive therapeutic relationships.

The Fine Print

The Fine Print

CPSO and Ministry of Health Rules on “One Issue Per Visit” Restrictions

CPSO Position

Risks to Mitigate

Approaches that can Help

OHIP Billing Considerations

Access to Care Obligations

Evidence from Practice

Solutions to Mitigate the Risks

References