Going postal

Issue: BCMJ, vol. 51, No. 10, December 2009, Page 442 Editorials

I was recently at a social event at which one of my colleagues threatened to “go postal” if he had to rejoin the College of Family Physicians (CFPC) to comply with the College of Physicians and Surgeons of British Columbia (CPSBC) directive that all physicians had to be enrolled in a CME program of either the CFPC or the Royal College of Physicians and Surgeons of Canada by 2010. Like many physicians, he had let his CFPC membership lapse. 

When I enquired about the unfamiliar term “going postal,” which I assumed to mean a letter-writing campaign, I found that the term related to a postal worker having gone berserk at work, obviously reflecting deeper emotions than would normally be seen in a letter-writing campaign.

The real issue, of course, has little to do with disaffected physicians who are not members of either of the two national colleges that accredit and set standards for physicians’ continuing professional development. The real issue is this: why is the CPSBC imposing yet another obligation and expense on those of us who are not members of either of the two national colleges? The answer lies in two recent legislative changes. 

The first change was bringing the CPSBC under the Health Professions Act in June 2009, by which we are now governed. The act mandates that the College “establish and maintain a continuing competency program to promote high practice standards amongst registrants.” The College Bylaws now include a requirement to comply with “mandatory continuing professional development requirements and any other requirements for revalidation of licensure.” 

The second change is that under the recent amendments to the Agreement on Internal Trade, fully licensed phy­sicians will have unrestricted mobility throughout Canada. For this to occur, each province must assure the competency of its practitioners using substantially equivalent criteria.

The privilege of self-governance has a price. Increasingly, government demands for more transparent and demonstrable physician competency assurance, known as revalidation, have been a common theme in almost all Western hemisphere health care legislative reforms. However, what constitutes a robust revalidation process that assures currency and competence of medical practice is very much in dispute.

For example, self-evaluation without audit lacks reliability—physicians who have shifted to the left of the bell curve of competency and currency in practice are often in denial. Recertification examinations, usually done on a 10-year cycle, test knowledge that is only a fraction of the competency required of a medical expert according to the Royal College CanMEDS Physician Competency Framework. 

Alberta and Nova Scotia physicians are mandated to participate in the Physician Achievement Review Program. In this program, physician performance is reviewed every 5 years by reviewing completed questionnaires from 25 patients, 8 physician colleagues, and 8 nonphysician health care workers.

Getting back to my friend who is about to go postal, I would suggest that participation in a mandatory CME program is probably the least onerous first step in revalidation and, interestingly, is something that most of the public believes has always been obligatory for physicians.

So why have these two national colleges been appointed as the official CME clearinghouses? These colleges, not the regulatory authorities, have the mandate and expertise to accredit and review educational resources and es­tablished databases for monitoring the activities of their members and subscribers. Their fees are admittedly substantial. The CPSBC has explored alternatives and concluded that the service cannot reasonably be provided for less.

What is the likely direction of phy­sician revalidation in British Columbia? Who knows? At present, man­dating periodic examination rewrites do not appear to be in the cards. Stay posted (but don’t go postal).

Willem R. Vroom, MD. Going postal. BCMJ, Vol. 51, No. 10, December, 2009, Page(s) 442 - Editorials.

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