Remember the calls for a tough
national recertification program for physicians? The
ones that insisted doctors must prove their medical
mettle every five years? Those who failed would risk
losing their licence. Editorials, commentaries and conference
speeches raged over the idea, some for but most against.
Canadian physicians, it was clear, didn't want their
competence decided by a random exam devised by some
faceless regulatory body. What would they know about
how you practice medicine?
Well, a few years on the debate
has cooled and it appears the sceptics have prevailed.
Provincial Colleges have started rolling out their dreaded
revalidation programs, and from the looks of things
the majority of physicians have nothing to worry about.
Saskatchewan was the first to introduce
a mandatory continuing professional development (CPD)
program, on January 1 of this year. Quebec follows suit
on July 1. Ontario will likely launch its program next
year. All provinces' Colleges of Physicians and Surgeons
are expected to do the same in the near future, but
in almost all cases the changes to the way doctors keep
up to date will be minor.
NATIONAL
STANDARDS
A soon-to-be-released position paper from the Federation
of Medical Regulatory Authorities of Canada (FMRAC),
a coalition of the provincial Colleges of Physicians
and Surgeons, and other stakeholder groups is largely
responsible for the revalidation chatter circulating
now. Designed in part to shore up public trust, the
report will likely recommend that "all licensed physicians
in Canada must participate in a revalidation process
in which they demonstrate a commitment to improving
performance," says FMRAC president Dr Douglas Blackman.
SEVERAL
SOLITUDES
Saskatchewan's system simply requires doctors to participate
in the existing CPD programs of either the College of
Family Physicians of Canada (CFPC) or the Royal College
of Physicians and Surgeons of Canada (RCPSC) and provide
proof to the provincial College's registrar. Quebec's
College has chosen a different tack. Quebec doctors
can either do the CFPC or RCPSC programs, or they can
instead use a program designed and administered by their
own College itself. The College's program focuses on
what it calls self-directed development. It will consist
of five steps, explains Dr Harold Dion, the former president
of the Quebec College of Family Physicians. "First you
reflect on your practice, then identify the areas of
medicine you feel you are weak in. Then you decide what
you will do to improve your knowledge and fill it out
on a form," he says. "Then you go about doing your CPD
activities. You then do an audit afterwards to see what
improvements have occurred, what impact you have seen,
and you send that form in every year when you renew
your license."
If a physician fails to complete
CPD requirements (in any of the three pathways), they
must undergo peer review, and if they fail that, they
will be offered retraining workshops to get them up
to provincial standards. If a physician doesn't meet
those standards, he will not be able to renew his license.
Quebec's third pathway, which will
be administered at no extra cost to physicians, could
attract up to half of the province's doctors, estimates
Dr Andr� Jacques, CPD director of the Quebec College
and chair of the FMRAC committee on revalidation.
VARYING
PROGRESS
While the rest of the provincial Colleges plan to introduce
mandatory CPD programs in the near future as well, there's
no real sense of urgency. "Other provinces may want
to wait and see how Quebec and Saskatchewan are running
their resources, to see how it works," says Dr Jacques.
It's expected that most provinces
will follow Saskatchewan's lead and consider the CFPC
or RCPSC programs sufficient, adds Dr Blackman, simply
to save money. Peer review programs, like the extensive
existing ones already in place in Alberta and Nova Scotia,
are expected to remain in place or even expand, as is
now happening with Quebec's 30-year-old peer review
system.
CRITICAL
ASSESSMENT
Since the dream (or nightmare, depending on your viewpoint)
of national guidelines was never realized, revalidation
requirements are destined to be uneven across the country.
Kathryn Clarke, of the College of Physicians and Surgeons
of Ontario (CPSO), thinks CPD guidelines should be not
only national and mandatory, but also should permit
portability to ensure that doctors from one province
will have a minimum amount of CPD to qualify to practise
in another province.
The most serious criticism levelled
at proponents of revalidation has been, and remains,
that there is no scientific evidence that mandatory
relicensure improves medical outcomes. "Revalidation
cannot assess competence. Rather, it can just assess
commitment to competence," says Dr Suzanne Strasberg,
chair of the Ontario Medical Association's Committee
on Physician Revalidation. The OMA was successful several
years ago at convincing the CPSO to drop the direct
link between revalidation and relicensure — now,
physicians who do not complete revalidation requirements
will still be able to pass peer review assessments.
Dr Blackman confirms the FMRAC recommendations will
not ask provinces to tie CPD to relicensure.
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