Field Notes

Society is quite rightly concerned about instances of physicians negatively impacted by health conditions who continue to practice without proper management, and numerous examples have been widely publicized and reported by the media. This raises questions not only about such impacts on practice but with respect to the regulatory regimes established to protect the public. While such legitimate societal concerns must be addressed, it is also of critical importance that physicians do not face unreasonable barriers to receive the assistance and treatment they need, and that the medical community continue to work towards reducing the hurdles physicians face associated with seeking health care generally, and in particular with respect to conditions that have been associated with stigma.

Regulatory bodies address issues of public safety through application processes established for physicians to practice medicine (i.e. the licensure application and renewal process; the on-going competency assessment process), creation of procedures for physicians and others to follow to report physicians to their regulatory body if and when certain thresholds are met, and programs established to monitor and manage physicians when involvement with the regulatory body becomes necessary, whether through disciplinary or alternative measures. Regulatory bodies in some jurisdictions, Alberta included, utilize approaches that focus on addressing issues wherever possible within the context of a treatment and monitoring regime, separate and apart from the disciplinary process, moving to such measures infrequently and only when necessary to protect the public.

Physician health and wellness programs (PHPs) exist in a variety of jurisdictions as one mechanism to ensure that physicians whose practices are, or are at-risk of, being negatively impacted by a health condition are appropriately managed. Such programs are often established and operated outside of physician regulatory bodies. They may provide a variety of services over a broad spectrum: from prevention and educational initiatives, to the provision of or referral to assessment and treatment by specialists. An appropriate balance between these two key entities (regulators and PHPs) is key to prudent oversight of medical practice and the protection of physicians as patients and individuals.

This broad issue is complex, multi-faceted, and has both theoretical and practical dimensions. Concerns exist around the globe and have been addressed in a variety of ways. In Alberta, the Alberta Medical Association (AMA), as the advocacy organization for members of Alberta's medical profession, and the College of Physicians & Surgeons (CPSA), as Alberta's medical regulator, are both justifiably interested in effective systems for physician health and wellness. While many aspects of the Alberta model were working well, some issues of contention had arisen. As a result, in early 2011, the AMA and the CPSA made a joint request of Tracey Bailey, then Executive Director of the Health Law Institute (HLI) at the University of Alberta, to strike a working group and initiate a comprehensive analysis and review of the ethical, legal and public policy issues surrounding physician health and wellness. To accomplish this task, a national working group was established. In addition to Tracey Bailey and Cameron Jefferies (then a Research Associate with the HLI), the group included Sister Elizabeth Davis (who contributed valuable health administrative experience and represented the public interest), Professor William Lahey (from Dalhousie University, who contributed expertise in the areas of professional regulation, health law, and human rights), and Dr. Philip Hebert (who, as a family physician and Professor Emeritus from the University of Toronto, contributed the physician's experience and expertise in medical ethics). The working group set out to investigate and recommend a model program that strives to meet both regulatory imperatives and rehabilitative needs. …

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