Note

This article contains general legal information. It must not be relied on as legal advice regarding a specific situation. This article is not an official CRPO policy, though it refers to policy documents, such as the Professional Practice Standards for Registered Psychotherapists.

Key points

  • When an RP leaves a group practice, the interests of three parties are involved: Clients, the departing RP, and group practice owners.
  • CRPO does not intervene in business or employment disputes unless an RP acts against professional standards.
  • Practice standards to consider include self-referral, consent, confidentiality, record-keeping, and discontinuing services.
  • The contract between the associate and the group practice can create challenges when the associate leaves the group practice. Legal advice is recommended, ideally before signing the contract.
  • Each situation is different and requires advice and judgment.

Introduction

A group practice is a business where more than one health professional or psychotherapist offers care to clients. A group practice arrangement goes beyond simply sharing office space. Rather, it involves providing services under the same business, such as a clinic. What options do clients have when an RP leaves a group practice, for example, to start their own solo private practice?

While an RP may face this situation at any point in their career, it often affects newer RPs and RP (Qualifying) registrants. Newer registrants might not be ready to open their own private practice immediately. They often join an established group practice where they receive client referrals and can focus on providing therapy instead of building a business.

If the RP decides to leave the group practice to start their own, this affects three parties: the client, the group practice owner, and the RP associate.[1] The client might prefer to continue receiving therapy from the RP, though they might also want to stay with the group practice, seek services elsewhere, or discontinue therapy altogether. Group practice owners want to keep their business viable, perhaps hoping to avoid having clients solicited away. The departing RP associate may hope to build their career and continue serving their current clients. At a certain point, the RP may feel they can earn a better livelihood by operating their own private practice compared with splitting the revenue with a group practice.

How can these interests be balanced?

The Role of CRPO

CRPO does not intervene in business or employment disputes unless an RP acts against professional standards. Contracts are a matter for the courts. In addition, CRPO standards only apply to registrants. Many group practices are not owned by RPs—the owners might be registered with another regulatory college, or they might not be registered with any college. CRPO can communicate its expectations to business owners who are not registrants but cannot directly enforce its standards on them.

Professional Practice Standards

CRPO registrants are required to meet the minimum conduct acceptable for the profession, as set out in the Professional Practice Standards for Registered Psychotherapists. Some of the standards are relevant to an RP leaving a group practice.

Consent

RPs may only provide treatment to clients with informed consent about any relevant benefits, risks, and options (see Standard 3.2 Consent). Similarly, RPs may only collect, use, and disclose personal health information with the informed consent of the client, unless a legal exception applies (see Standard 3.1 Confidentiality). Applying these principles, RPs should ensure clients are aware which business or individual (the clinic, the RP, etc.) has primary responsibility for the client and their record. This up-front information can prevent conflict and confusion later if the RP decides to leave a group practice.

Self-Referral

Self-referral occurs when a registrant suggests that a client see them for a different or additional service, including at a different business. According to CRPO Standard 1.9, when making a self-referral, registrants must tell the client about the benefit the registrant stands to gain from their continued or expanded business, provide alternatives as appropriate, and reassure the client that the existing relationship will not be affected by the client’s decision whether to receive services from the registrant’s other business. If an RP informs group practice clients about their new private practice, they would be engaging in self-referral. RPs cannot always ‘take clients with them’. It is the client who decides after being presented with appropriate options.

Client Records

Section 5 of the Standards talks about record-keeping. If a client agrees to a self-referral to an RP’s new practice, the health record would likely remain in the custody of the group practice. An exception is if the group practice agrees to transfer custody of the record to the RP’s new practice as the successor custodian for that client’s records. Otherwise, the client could request a copy of their health record from the group practice and provide that to the RP’s new practice. Or as a final alternative, the RP would need to start a new health record for the client in the new practice.

Discontinuing Services

Standard 6.3 requires registrants to discontinue services only when appropriate. Providing notice if possible and making referrals when warranted are part of appropriate discontinuation of services. Depending on the circumstances, an RP leaving a group practice might need to discontinue services to some or all their clients. The discontinuation process is a shared responsibility between the RP and the group practice owner. The group practice might have the capacity to refer the client internally to another practitioner, or it may need to assist in referring to external resources.

Contract Issues and Disputes

Applying the above standards becomes more complicated when legal restrictions or disputes are present. These issues can take various forms, including the following:

  • Non-compete clauses: An agreement not to operate a psychotherapy practice for a period of time within a particular area.
  • Non-acceptance clauses: An agreement not to take on any client from the group practice for a period of time after leaving.
  • Non-solicitation clauses: An agreement not to actively solicit or promote the RP’s new practice to clients of the group practice while working at the group practice, nor to copy client lists to use in one’s own business.
  • Compensation arrangements: An agreement to pay a certain amount to the group practice owner if a group practice client or their record is transferred to the RP’s new private practice.

These restrictions might be based on ethical considerations,[2] or they may be financially motivated. There are several steps an RP can take to navigate contractual requirements while upholding professional practice standards. The first and most important is to be careful before entering any contract. RPs should avoid entering into a contract that would make it difficult for them to meet professional standards. Obtaining legal advice about a potential group practice contract is a valuable investment to prevent problems from arising later.

Even if an RP has already signed a contract, it is still valuable to obtain legal advice. There may be some room to renegotiate terms between the RP and group practice. A lawyer might also offer an opinion on the enforceability of some of the terms.[3]

Finally, after entering a contract and obtaining legal advice, a registrant might be faced with a situation where they plan to leave the group practice and open their own private practice. The registrant will need to decide how to balance the interests of clients, the need to meet professional standards, their own business goals, and their contractual obligations to the group practice. Each situation will be different, requiring consultation with advisors and professional judgment. The following reflection questions may be helpful to consider, from the point of view of the RP planning to leave the group practice:

  • What are my contractual obligations on leaving the group practice?
  • Is self-referral an option, or do I need to discontinue services?
  • How can I promote continuity of care while avoiding undue cost or legal risk?

Group practice owners, particularly if they are RPs, should also ask themselves:

  • How can I promote the viability of my business without preventing a client from freely choosing where to receive care?
  • If an associate leaves the group practice, how can I ensure that the transition is as smooth as possible for clients?

Conclusion

In CRPO’s experience, situations involving RPs leaving a group practice to start their own can be challenging for clients, the departing associate, and group practice owners. Even so, it is hoped the above information may be helpful in resolving the issues that arise.

[1] The term associate is used generally to refer to an employee or contractor who works for a business.

[2] For example, a publicly funded agency preventing contractors from profiting from self-referrals provided to vulnerable clients, which could be perceived as a conflict of interest.

[3] For some general information, see: Non-compete agreements | Your guide to the Employment Standards Act | ontario.ca. Note that this information applies to employees covered by Ontario’s Employment Standards Act, not independent contractors.