Practice Profile Resources
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Solo Practice
Numerous studies have found a negative correlation between professional isolation and quality of practice.
Professional isolation is not necessarily about geography but the number of and type of interactions with medical colleagues and trainees in the clinical environment.
- Research evidence suggests that those in solo practice do less well on assessments, have lower scores on re-certification exams and order fewer tests
- Regular interactions with colleagues provide opportunities to learn: new knowledge and ideas may be exchanged and outdated assumptions or practices may be challenged
- Consultations with competent peers, whether formal or informal, are important to affirm an approach to patient care or raise appropriate alternatives
Resources
Ontario College of Family Physicians
Project ECHO
The Foundation for Medical Practice Education
Specialist physicians are encouraged to check with their local academic centre and/or national specialty society for mentoring programs.
Age
Advancing age has been found to impact the currency of a physician’s knowledge base and skill, as medical knowledge changes rapidly.
Advancing age is associated with the following:
- Gradual physical and cognitive decline
- Increased burnout and medico-legal issues
- Increased patient safety concerns (e.g. mortality rates, medication errors, diagnostic errors, less adherence to guidelines)
- Poor performance on practice assessments
Resources
Canadian Medical Association
Ontario Medical Association
- Well Being
- Physician Health Program
- Office Management (link opens to OMA login page unless logged in)
The Canadian Medical Protective Association
The Royal College of Physicians and Surgeons of Canada
Sinai Health
Gender
Evidence shows that male physicians are more likely to:
- Receive more complaints and disciplinary action
- Perform less well on practice assessments
- Have increased risk of prescribing and testing errors
Resources
Canadian Medical Protective Association
The College of Family Physicians of Canada
Physicians Apply
Saegis
Professional Transitions
Experience from medical regulatory authorities has shown that professional transitions have been found to be a risk factor for poor performance.
Transitions include moving from:
- Residency to independent practice
- One health care facility to another
- One country/culture to another
- Full practice towards retirement
- Having more than 3 practice addresses over a 10 year time frame
Any change to scope of practice is considered a transition.
Resources
College of Physicians and Surgeons of Ontario
Ontario Medical Association
*links open to OMA login page unless logged in
Canadian Medical Protective Association
Continuing Professional Development
Medical knowledge and best practices change at a fast pace. As such, all Canadian medical regulators require physicians to participate in a recognized CPD program as a condition of licensure.
Strategies to maximize the impact of CPD on practice:
- Choose CPD based on relevance to your scope of practice, rather than out of habit or ease of access
- Use data, feedback from others, formal and informal practice assessments (e.g., self-audit, peer review) to identify performance gaps and deliberately seek out CPD resources to address them
- Assess your practice broadly focusing on all CanMEDS roles (communicator, collaborator, professional, medical expert, etc.)
- Include interactive group activities in your learning. Group learning is a form of peer engagement, offering opportunities to debate, contrast or reinforce approaches to practice
- Engage in CPD that has been shown to be effective in helping physicians to change their practice:
- Use multiple learning methods
- Learn longitudinally
- Make learning relevant to your practice
- Learn with peers
Resources
The Foundation for Medical Practice Education
Health Quality Ontario
UBC Continuing Professional Development
Suboptimal Performance on Certifying or Licensure Exams
Full licensure in Canada requires that a physician hold both the Licentiate of the Medical Council of Canada (LMCC) and certification by one of the certifying colleges, typically the Royal College of Physicians and Surgeons of Canada (RCPSC) or the Canadian College of Family Physicians (CFPC).
Evidence consistently demonstrates that low exam scores or lack of specialty certification is associated with:
- Poor performance in prescribing, screening and assessment
- High consultation rates
- More regulatory complaints
Resources
Health Quality Ontario
UBC Continuing Professional Development
The Foundation for Medical Practice Education
Practice Volume
Risks associated with practice volume vary from one practice specialty to another and from one age cohort to another.
For example, the risks associated with high volume practices are more pronounced for older doctors.
Studies also show that high volume practices are linked to improved outcomes for some practice specialties (e.g., medical procedures). The rationale is that low volume practices may not offer sufficient exposure to refine and maintain skills.
Resources
Ontario Medical Association
- Office Management
- Managing Patient Workflow Part 1
- Managing Patient Workflow Part 2
- Achieving practice efficiency
The Royal College of Physicians and Surgeons of Canada
Health & Wellness
While a career as a physician can be incredibly rewarding, its many challenges can sometimes take a toll on your health.
Physician wellness is an important part of professional practice. “Wellness” is defined as the condition of good physical and mental health necessary to provide high quality care to patients .
Your wellness is also important for its own sake. Your personal wellness is also important and you should care for patients only when you are well enough to do so.
According to a survey by the Canadian Medical Association, about a third of doctors are burned out or depressed and nearly 1 in 10 have had a suicidal thought in the last past year.
While 81% of those surveyed were aware of resources available to them, only 15% have accessed resources in the last five years.
Resources
Canadian Medical Protective Association
College of Physicians and Surgeons of Ontario
Ontario Medical Association
Institute for Healthcare Improvement
Canadian Medical Association
Specialty
Research evidence demonstrates that some practice specialties are associated with more complaints and disciplinary action.
Surgery, plastic surgery, dermatology, psychiatry, OBGYN and family physicians are more likely to have complaints.
Family medicine, psychiatry and surgery are more likely to be involved in discipline cases.
It is important to note that some specialties are more prone to complaints due to their nature (e.g. plastic surgery).
Resources
Canadian Medical Protective Association
- Principles of Medical Record Keeping eLearning Module
- Informed Consent eLearning Module
- Recognizing Boundary Issues
College of Physicians and Surgeons of Ontario
Previous Complaints
Research evidence indicates that the number of prior complaints to a regulator is a strong predictor of future complaints.
Findings from two landmark studies on complaints and recidivism:
- A small proportion of the membership accounted for a large proportion of all complaints (e.g., in Australia, 3% of the membership accounted for 49% of all complaints)
- Compared to those with one complaint, those with two complaints have double the risk of receiving another complaint
- Those with five complaints have 6x the risk of receiving another complaint
- Those with 10+ complaints have 30x the risk of receiving another complaint
- The first 6 months after a complaint is the riskiest for accruing additional complaints
- GPs, plastic surgeons, dermatologists, and OBGYNs were at increased risk of recurring complaints
- Male and middle-age to older doctors were more likely to have recurrent complaints
Resources
Canadian Medical Protective Association
Organizational and System Level Supports
The current exercise has presented information on physician and practice characteristics that are associated with poor performance.
Research evidence demonstrates that physician practice improvement is supported by the following:
- A sense of autonomy and control over your practice environment
- A supportive learning environment where there is dedicated time and resources to engage in on-going learning and practice improvement
It is important to note that physician performance does not occur in a vacuum; it is contextual and impacted by organizational and system level factors that you cannot always control.
As such, quality improvement initiatives should also consider organizational and system level factors that may impact physician performance. These may include the following:
- Organizational performance incentives
- Systemic resource allocation
- Professional governance
Such organizational and system level supports are becoming more important due to the increasing complexity of practice environments (e.g. more physicians are now practicing in interdisciplinary heath care teams).
Resources
The Canadian Medical Protective Association
