Assessments

Peer and practice assessment is a requirement of CPSO membership as it helps ensure physicians are adhering to a standard level of practice, while also identifying potential areas for improvement.

Being selected for a peer assessment can generate several reactions for physicians: some welcome the opportunity to review their practice; others are ambivalent; and for a significant number of physicians, their primary reaction is anxiety.

The Quality Assurance Committee (QAC) and program staff strive to alleviate these concerns by making the experience productive, collegial and educational. If you’re selected for an assessment, we strongly encourage you to review our information about the process and be proactive in preparing for it, such as reviewing your records using the protocols that apply to your practice. If you identify any issues, you can take action before the assessment and share what you have done with the assessor. The spirit of the process is designed to engage members in an educational experience and the QAC is committed to providing you with feedback and support to engage in lifelong learning.

As demonstrated below, physicians’ reactions following a peer assessment are generally quite positive.

It was not a traumatic experience. I wish this assessment was done twenty years ago.

Helpful, handy, thought provoking.

The assessor’s manner put me at ease in a potentially very stressful situation…overall a positive experience.

I appreciate the guidance [from the assessor] and I particularly appreciated the gentle, careful explanation and its presentation. It will influence my future.

Physicians have the opportunity to provide feedback following an assessment and all suggestions regarding assessors and the process are reviewed, considered, shared with the assessors and considered for future program development.

Why does the College conduct peer and practice assessments?

The College is governed by the Regulated Health Professions Act (RHPA), along with Schedule 2 of the Health Professions Procedural Code (HPPC), which requires that the College have a Quality Assurance Program. The purpose of peer and practice assessment is to “promote continuous quality improvement by providing physicians with feedback to validate appropriate care and show opportunities for practice improvement.”

The goal of regulation is to protect the public by ensuring physicians provide the best quality care for patients in Ontario. Both the College and individual physicians have a responsibility to ensure quality care by members continually improving their skills and the College responding to concerns around practice and or behaviour. The College does this in part by requiring members to engage in activities such as peer and practice assessments. Participation in the peer and practice assessment is required under section 28. (1) of the Ontario Regulation 346/11 made under the Medicine Act, 1991.

The Selection Process

Who is selected for a peer and practice assessment?

At any time and under any circumstance, the Quality Assurance Committee may require a member to participate in a peer and practice assessment. You may have undergone an assessment originating from another area of the College, such as Investigations & Resolutions Department (I&R) or the Premises Inspection Committee (PIC), Change of Scope, Re-entry or Registration; however, this does not necessarily exempt you from participation in a Quality Assurance peer and practice assessment.

The most common criteria when selecting physicians for assessment are the following:

Random selection: Physicians who have been in independent practice for at least five years and who are under the age of 70 are eligible for random selection every 10 years. 

Age-related selection: All practising physicians are assessed at age 70 and every five years thereafter while they maintain a certificate of registration. Those physicians between the ages of 65 and 69 who have received a satisfactory outcome will be assessed every five years from the date of the final decision.

Physicians who work in Long Term Care Facilities: Long Term Care facilities are randomly selected from a list of licensed facilities in Ontario. Physicians who provide care in those facilities may be contacted for peer and practice assessment.

Physicians changing their scope of practice or re-entering practice: Physicians who are in the change in scope or re-entry to practice process may be required to undergo a practice assessment.

Physicians who wish to become assessors: Members wishing to become a peer assessor must first successfully complete a peer and practice assessment.

Methadone Prescriber Focused Peer Assessments: Being a methadone prescriber in Ontario requires participation in a 1, 3, 5 year cycle of assessment. The one-year cycle begins approximately one year after a prescriber begins prescribing methadone for opioid dependence and has a minimum of 6-10 patients for whom they are the most responsible physician. Methadone prescriber focused peer assessments are overseen by a Methadone Specialty Panel which operates under the Quality Assurance Committee.

The College also reserves the right to select members for assessment in support of approved research or identification of other factors for which an assessment would be beneficial.

If you are selected for an assessment

When a physician is selected to undergo a peer and practice assessment —

  • You will be advised why you were selected (e.g. age-related, random selection, etc.)
  • You will be required to complete a Physician Questionnaire and, in some cases, a Facility Questionnaire. This helps program staff determine if you are eligible for assessment and identify the most appropriate assessor for your practice.
    You may have multiple scopes of practice; the scope of practice that will be assessed by the College will be determined after review of the completed Physician Questionnaire. When you receive confirmation of the assessment, it will clearly identify the area of practice (scope) that will be assessed and the specific assessment protocol(s) that will be used by the assessor, which are available to you online.

A peer and practice assessment is conducted by one or more assessors, as required. You will receive a package from the Assessment Coordinator assigned to manage your assessment, in which you will find the name of the assessor visiting your practice. If there are any conflicts identified with your assigned assessor, please inform the Assessment Coordinator as soon as possible.

The assessor will contact you to arrange a mutually convenient date for the assessment and discuss the record selection process. If you use an Electronic Medical Record (EMR) system, you will be asked to make arrangements ahead of time to ensure the assessor has temporary, read-only access to the system — this is required for both office and hospital-based practices.

There may be instances where an assessment is exempted or postponed such as, but not limited to, maternity/sabbatical leave, current illness, or conversion to EMR. Upon completion of the Physician Questionnaire, the Assessment Coordinator will follow up with the physician to discuss those situations.

Registration Pathways Evaluation

Between 2013 and 2017, the CPSO set out to determine if any differences exist in the performance of physicians who achieved Ontario registration through alternative or traditional pathways. The evaluation project's findings can be found in Dialogue.