How doctors are really assessed

Crazy Socks
Oct 18, 2024
4 min read

The College of Physicians and Surgeons of Ontario (CPSO or College) governs and regulates the practice of medicine in Ontario.

All physicians that practice medicine must be registered annually by the College. A duly licensed physician is considered a member of the College.

There are many provincial laws that define the authority and powers of the CPSO; they include the Regulated Health Professions Act (1), the Health Professions Procedural Code (2) under the RHPA and the Medicine Act (3), and Professional Misconduct (4) under the MA. In addition, there is much case law.

"The medical profession has been granted a great degree of authority by provincial law, and that authority is exercised through the college. This system of self-regulation is based on the premise that the college must act first and foremost in the interest of the public.” (5)

MUST ACT FIRST IN THE INTEREST OF THE PUBLIC

The CPSO has policies and guidelines that all of its physicians must abide and follow such as,

Essentials of medical professionalism, (6) for example, conducting oneself with trust, respect, responsibility, recognize and respect humanity, integrity, always put the patient first, truthfulness & integrity
Professional behaviour, for example, harassment and bullying of a colleague is not tolerated.
Boundary Violations, for example, not having sexual relationship with a patient
Conflicts of interest, for example, controlling the investigation into their own misconduct is taboo.
Disclosure of harm, for example, not destroying medical records to hide their malpractice.
Managing tests, for example, repeating the same test endlessly to avoid taking having to take appropriate investigative or treatment actions.
Alternative medicine, for example, ordering massive doses of a vitamin for virtually all medical health conditions.
Ending the physician-patient relationship, for example, threatening to abandon patients, or abandoning patients.
Amongst many others. (7)

The College has a legal obligation to ensure that all of their members provide quality of care. This process is both proactive, known as the Quality Improvement Program (QIP) and retroactive, known as investigations and the Discipline Tribunal. For the purposes of this post, there will only be discussion of the QIP.

It is the goal of the QIP to improve both the safety and quality of care provided to patients delivered by Ontario physicians in need of healthcare services. Furthermore, no one is perfect, which includes all physicians, as imperfection is part of the human condition. The QIP will identify unsafe practice patterns and knowledge gaps, and exact corrective measures before a mishap were to occur. Safer and quality care for patients and better-informed physicians is of benefit to the Ontario health care system.

PROTECT THE PUBLIC AND GUIDE THE PROFESSION

How QIP works

The Quality Assurance Committee (QAC) can ask any licensed physician to undergo a peer and practice assessment. All physicians must comply with the request. There may be circumstances that arise where the QAC exempts or postpones an assessment, such as maternity leave, leave, currently sick or switching from paper charting to electronic.

The most common reasons for the QAC to request a physician to participate in an assessment are;

i) advancing age,

ii) re-entering practice after an extended period of time off,

iii) changing the type of medicine to be practiced,

iv) a desire to become an assessor,

v) concerns expressed by the quality of care by another colleague(s), other health practitioners, amongst others.

vi) amongst others.

The QAC provides to the physician the reason. A detailed questionnaire will be sent to the physician that they must complete and return to the College. At times, a questionnaire about the hospital, facility or clinic the physician from be completed.

All physician assessors will assess the physician’s patient care and medical records using;

i) criteria established in law and College policy,

ii) practice guidelines,

iii) evidence-based practices, and

iv) the physician assessor’s experience and judgement.

There is no other criterion used.

The physician assessors have matched practice experiences as the physician being assessed. For example, family doctors assess family doctors. For example, a family doctors performing obstetrics as part of their practice will be assessed by either a family doctor who does the same or an obstetrician.

The physician assessors are always carefully screened and trained.

The physician assessors will always examine many patient records.
The physician assessor will take a ½ day to 1-day to perform their assessment of their peer’s practice.

The physician assessor will provide their assessment to the College and the doctor assessed in approximately 3 & 10 weeks respectively.

The assessment is never made public. For example, it will never be available in any Clinical Review, Health Professionals Appeal and Review evidence (sworn testimony and evidence) its hearings, or cases before the Ontario Superior Court of Appeals, et cetera.

The outcomes of the assessment as determined by the QAC are specific and neutral. They include either;

i) Satisfactory,

ii) Opportunity to address concerns.

iii) Peer & practice reassessment, that will include a review of patients’ medical records,

iv) Notice of Intent of the QAC to take action. For the purposes of this Blog post, what is involved in the NOI won’t be discussed.

There are no other outcomes, Terms found in the WAHA Clinical Review and WAHA Clinical Review - Primary Care Review such as 'persevered', 'excellent job', 'to be commended','hard working', 'do well' or 'competent' are not used.