February 23, 2018

Council Award Presented to Dr. Bill Wong

The College presented its Council Award to Dr. Bill Wong, a Mississauga physician who helped lead his hospital’s efforts to respond to patient requests for medical assistance in dying.

Dr. Wong is the Program Chief and Medical Director of the Department of Anesthesiology at Mississauga’s Trillium Health Partners. He is also the hospital’s Physician Lead for the Cardiac Surgery ICU.

Since arriving at the hospital in 2000, Dr. Wong has worn a number of hats that have placed him at the forefront of initiatives to increase clinical standardization and decrease medical error rates. He has been widely credited with elevating the standard of practice of medicine in the hospital as a result of these initiatives. However, it was his recent work in leading the hospital’s development of policies and procedures for medical assistance in dying (MAID) that was the impetus for his nomination by his chief of staff, Dr. Dante Morra.

In coordinating the hospital’s response to this new medical service, Dr. Wong has stood out as a skilled communicator who respectfully navigated the diverse perspectives of health-care professionals, patients and families to develop protocols that ensured patients have access to MAID and are supported by the hospital and the community.

Policy Consultation on Closing a Medical Practice 

Your feedback is needed on draft expectations for physicians who are permanently closing their medical practice.

The draft is an update of the current policy, Practice Management Considerations for Physicians Who Cease to Practise, Take an Extended Leave of Absence or Close Their Practice Due to Relocation.

The scope of the draft policy has been narrowed to physicians who are permanently closing a medical practice. Temporary absences from a medical practice — for any reason — will be addressed in the Continuity of Care policies currently being developed.

The draft policy now states that physicians must provide 90 days’ notice to patients prior to a planned practice closure. This is consistent with expectations currently set out by other Canadian medical regulatory authorities.

Please provide your feedback by the April 30^th, 2018 deadline.

College Releases Interim Opioid Investigation Update

When the College investigates a physician, any one of a number of outcomes is possible. But the results of our recent investigations into potentially concerning opioid prescribing practices makes it apparent that the College’s preferred choice of action is to support education and continued prescribing with supervision.

At its February meeting, Council received a 2^nd interim update that included the outcomes in the investigations of 81 of the 84 physicians who had been investigated by the College after it received information from the Narcotics Monitoring System (NMS) about potentially inappropriate opioid prescribing.

Nearly half of physicians investigated — 36 — have been ordered to take mandated remediation. This could include an agreement by the doctor to participate in education and practise under clinical supervision, and to be reassessed to gauge improvement. A further eight have been ordered to take mandated remediation and have received a caution. Please see accompanying table for more information on opioid investigations.

“These outcomes demonstrate that the College will choose a remedial approach in clinical investigations, whenever possible, to help physicians practise to current standards,” said Dr. Steven Bodley, College President. “Our goal is to keep the physician in practice and to support education and provide guidance, where the physician’s capacity for remediation is apparent,” he said.

“I think it is critical that members of the profession have a clear understanding of the decisions the College has made in these cases and how they line up with the objectives in our opioid strategy,” said Dr. Bodley. “We want to facilitate safe and appropriate prescribing, protect patient access to care and reduce risk to both patients and the public,” he said.

Dr. Bodley stated that physicians should never abruptly cease their patients’ access to opioids, nor should they rapidly taper their patients’ doses.

Governance Review

Council has decided to proceed with a focused effort to review the governance structure. This initiative relates to the ongoing discussions about possible proposals relating to the modernization of the College model which may include: reduction in size of council, competency based appointments, 50/50 public/physician composition, and separation between council and statutory committees.

While Council has discussed this issue on several occasions over the past few years, it is now of the view that a more focused review should begin, prior to any strategic planning process.

The purpose of the review is to build on governance work completed by the College in 2017. This includes building on Council support for greater independence of the Discipline Committee (the recommendation that there be no overlap in membership between Council and the Discipline Committee), and support of a process and timeline to facilitate the election of a public member of Council as President. It is proposed that initial activity include the collection of information about existing governance models, best practices, and work being done by other organizations.

Increase in Costs Ordered in Discipline Hearings 

Physicians who have committed an act of professional misconduct or are found to be incompetent will pay for a greater proportion of the costs of their discipline hearings than they currently bear.

After a recommendation from the College’s Finance Committee, Council voted to raise the tariff rate – the daily cost of conducting a hearing — from $5,500 per day to $10,180 per day. 

In the past year, as part of an overall effort to address rising costs within the College (which are ultimately passed along as increases in membership fees to the College’s members), the Finance Committee recommended that a greater portion of the College’s fixed costs associated with running a discipline hearing be recovered from the member who is the subject of the hearing. Accordingly, the Finance Committee asked Council that a higher tariff rate be set, one that reflected a greater total of the estimated cost of a day of hearing time.

Although the increase may seem significant, $10,180 per day represents a conservative estimate of the College’s actual costs of conducting a day of hearing, and a fraction of the actual investigative and legal costs and expenses incurred in conducting an investigation and preparing for a hearing.

Reporting a Change of Scope, Re-entering Practice 

A policy was approved that articulates the College’s expectations of physicians who wish to change their scope of practice or who wish to re-enter practice after an extended absence.

The policy — Ensuring Competence: Changing Scope of Practice and/or Re-entering Practice — states that physicians must report an intention to change their scope of practice and/or to re-enter practice after an absence of two years or more. The policy sets out the definitions of scope of practice and change in scope of practice.

The policy retains the key content of the draft policy that had been circulated for external consultation. However, the revised draft policy and appendices have been enhanced for clarity.

Some of the changes include:

• Additional examples of significant changes in scope of practice;
• An updated definition of change in scope of practice that includes “returning to a scope of practice in which a physician has not practised for two consecutive years or more”;
•             Clarification that changes in scope are only permitted once the physician has demonstrated their competence to the College regarding the specific changes they intend to incorporate into their practice;
• A reminder that physicians who have changed their scope of practice continue to comply with the Use of Specialist Title regulation and describe their practice using the appropriate framework set out in the regulation. 

Council requested a FAQ document be developed to expand on a few issues in the policy. This document will be developed shortly. 

Public Health Emergencies 

Council has approved a policy that articulates the College’s expectations of physicians and reinforces the professions’ commitment to the public during public health emergencies.

The Public Health Emergencies policy clarifies that physicians must be available to provide physician services, and that this may include direct medical care to people in need, taking on administrative support roles or temporarily expanding the capacity of one’s practice to offset the increased strain on physician resources.

The policy addresses the importance of preparing for public health emergencies by participating in emergency planning exercises, and proactively informing themselves of the information available that will assist in being prepared.  

The policy acknowledges that the nature of the situation may require physicians to temporarily practice outside of their scope of practice. If certain criteria are met, as laid out in the policy, physicians may temporarily practice outside of their scope of practice during public health emergencies.

Throughout the policy review process certain topics arose that were not appropriate to address in the policy (i.e., temporary licensure and hospital privileges, death and disability insurance, compensation, the role of residents and medical students). Council agreed that these topics would be helpful for physicians. A companion document will be developed shortly to accompany the policy.

Continuity of Care and Test Results Management Policy Development

Council had the opportunity to hear about work currently underway to develop new policies relating to continuity of care and to revise the existing Test Results Management policy. Council was provided with an overview of key positions currently being drafted and Council provided feedback on these positions in order to inform the drafting process.

The Policy Working Group is developing discrete draft policies relating to four key areas of continuity of care that are organized under an ‘umbrella’ policy. 

These areas are:

• Availability and Coverage (e.g., availability to patients and other health-care providers, after-hours and vacation coverage);
• Test Results Management (e.g., ordering, tracking, communicating results);
• Transitions in Care (e.g., hospital discharges, the consultation process); and
• Walk-in Clinics (e.g., connection to primary care, managing unattached patients).

The group is hoping to be able to bring draft versions of these policies to May Council for approval to consult with the profession, the public and other stakeholders on the drafts.

Fee Increase Approved

Council has approved a $100 fee increase to renew an independent practice certificate. This increase brings the fee to $1,725.

The proposed membership fee had been circulated to the membership following the December meeting of Council.

The fee increase is required to ensure the College has the resources to fulfill our statutory obligations. The College continues to face an unprecedented volume of cases and significantly, an increase in the number of complex and time-consuming investigations. Over the last several years, the number of investigations has been steadily climbing – in the last year alone there was a 13% increase in the total caseload, with a 45% increase in the more complex Registrar’s Investigations. And as of October, there were more than 108 open discipline matters – an unprecedented number.