All physician health programs share the goals of a healthy physician membership that provides safe and effective medical care to the population it serves. In Alberta, the College of Physicians [delta] Surgeons (CPSA), as the regulator of the practice of medicine in Alberta, and the Alberta Medical Association (AMA), as the advocacy organization for physicians in Alberta, have shared the responsibility for the physician health program. As the College's mandate is to regulate the profession in the public interest, the College's predominant interest in its physician health role is to ensure the safety of the public. In late 2010, the CPSA came under the Alberta Health Professions Act (1), which required the College to adopt Standards of Practice for its members, such standards setting out the minimum expectations for physicians in Alberta. The Health Professions Act requires that new standards, or modifications to a standard, must be sent to all members (and others) for consultation before final approval by College Council. One such standard dealt with the responsibilities of physicians--and the colleagues of physicians--to report to the College when a health condition could impact practice. From the consultation, the College heard from physicians and the Alberta Medical Association concern that this reporting requirement could influence physicians not to seek appropriate care and perhaps drive them underground. Concerns were also expressed about the need to keep confidential medical conditions and medical treatment of physicians who have health issues.
As a medical regulator we felt that it was essential that medical conditions that could affect a physician's practice be identified and managed. Our College has managed physician health issues outside the disciplinary process for many years and most physicians with health issues return to practice after their condition is managed with ongoing monitoring as needed. Early identification and management of medical conditions prior to any harm occurring to patients was in keeping with the College's obligation to ensure the competency of medical practitioners and the safety of the public.
Genesis of the Health Law Institute Policy Paper
Discussions between the Alberta Medical Association's Physician and Family Support Program and the College did not resolve our differences. We then engaged the Health Law Institute (HLI) to convene a panel of experts (health law, ethics, and public policy) to provide advice and perspective on the ethical and legal aspects to be considered. They were asked the following question:
* For Alberta, what is the recommended model for a program that strives to meet both the regulatory imperatives and the rehabilitative needs of at-risk physicians?
We asked related questions:
i. What should the respective roles of the CPSA and the AMA be in the recommended model?
ii. What agency/organization is best suited to assess the risk of a physician with a condition that could affect his/her ability to provide safe patient care? Who has primary responsibility to assess and determine risk, and what other factors should be considered?
iii. How should questions be framed on regulation applications and annual renewals within the Standard of Practice?
iv. Should the questions only address conditions that have already impacted practice? Should questions attempt to identify risk to patients before practice has been impacted? How should this be balanced with the privacy needs of physicians?
The 2012 HLI report titled Physicians with Health Conditions: Law and Policy Reform to Protect the Public and Physician-Patients (2) carefully examined the balance of public protection with the privacy rights of physicians and its discussion of ethical, legal, public policy, and human rights principles was extremely helpful. Physicians work in a safety sensitive area, and, therefore, their privacy rights are not absolute; however, we acknowledge that not every medical condition has the potential to negatively affect practice. …