Revalidation and the CFPC

The College of Family Physicians of Canada (CFPC) has received many calls from members seeking information about what “revalidation” of licensure means. Many have expressed concern about these new programs; some mistakenly identify us, rather than the provincial and territorial regulatory Colleges, as the body responsible for medical licenses and for introducing these revalidation programs. While our organization does not carry these responsibilities, it would be inappropriate to leave our members thinking that the CFPC is not involved in revalidation deliberations. Both nationally and through our provincial Chapters, the CFPC meets and dialogues regularly with the licensing authorities. Our objective is to advocate for our members and to ensure that, if and when revalidation programs are introduced, it will be with an educational, constructive, and nonpunitive approach that addresses the needs of both the public and our family doctors. Renewing registration and medical licence to practise has historically been relatively routine for doctors across Canada and in most developed countries. Unless a formal complaint or charge brought against a physician resulted in licence suspension or revocation, maintaining a licence to practise required little more than annually completing a basic questionnaire and submitting the fees. But since the mid-1990s, things have been changing. A series of highly visible cases with adverse and tragic outcomes in several countries, including Canada, (eg, the Dr Harold Shipman murders in England, pediatric cardiac surgery deaths in Winnipeg) have prompted an international surge of activities related to patient safety and professional accountability. Patients are demanding assurance that health care professionals are assessed repeatedly throughout their careers to ensure that their skills and knowledge are maintained. Because reviews of many cases with adverse outcomes demonstrated that the physician review processes of most medical regulatory bodies did not adequately monitor the ongoing practices or re-assess the competence of physicians, governments, media, and the public have placed growing pressure on the licensing authorities to either enhance these programs themselves or to surrender this role to governments or other governmentally appointed agencies. As a result, medical regulatory bodies around the world have been introducing programs to more effectively assess—or revalidate—physicians’ ongoing performance. As part of these programs, physicians are required to participate in activities that will reevaluate their medical knowledge, skills, and attitudes at defined intervals throughout their careers. Practice audits, peer assessments, continuing medical education and continuing professional development (CME and CPD), and re-examination are mandatory components of many programs. What is being contemplated or introduced by Canadian licensing authorities is, therefore, not unique to Canada. In fact, directions taken so far in Canada are, in many cases, more conservative and more considerate of physicians’ concerns than what is being discussed or implemented in many other nations. That being said, the CFPC’s role continues to be to ensure that any revalidation protocols introduced are appropriate, fair, and respectful of Canada’s family physicians. While our Board will still have much to deliberate to formulate our College’s final recommendations regarding revalidation, to date our position includes the following. Programs should recognize and promote to the public the excellent performance and standard of care provided by the overwhelming majority of Canadian doctors. Protocols and programs introduced to review family physicians’ practices should be planned with input from the CFPC and its Chapters. Reviews of physicians’ practices and performance should focus on preventing future problems. Other than the infrequent occasions when serious problems are identified, activities recommended for physicians to address concerns defined during the review of their practices should be constructive and educational rather than disciplinary and punitive. Participation in revalidation programs should be mandatory for all physicians in Canada. Unless serious problems are identified and the status of a physician’s licence must be addressed, participation in revalidation programs and recommended educational follow-up activities should qualify physicians to maintain their medical licences to practise. Family physicians who meet the requirements of the CFPC’s CME and CPD program (Mainpro®) should have their achievements recognized as meeting the CME and CPD requirements of regulatory bodies’ revalidation programs.* The CFPC will explore offering CME and CPD credits (including Mainpro-C) to family doctors who carry out practice audits required by regulatory authorities and will also identify and develop CME and CPD programs (particularly Mainpro-C evidence-based small group reflective learning experiences) to help family physicians meet the educational needs identified and prescribed by the licensing bodies during their reviews. Revalidation programs under the authority of Canada’s regulatory and licensing bodies, if not already here, are coming. The CFPC will support an approach to these programs that is educational and constructive and will advocate strongly to ensure that these programs help prevent adverse outcomes for patients and respect the needs of Canada’s family physicians. To avoid redundant time commitments and added costs for our members, we recommend that licensing bodies recognize the CFPC’s CME and CPD activities as meeting the requirements of their revalidation programs.

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