Physician Performance

Rhonda Kirkwood
Director, Physician Performance

The primary function of the Physician Performance Department is to assess competence through work-place based assessments within our Peer Review and Supervision Programs, or upon the request of an investigation committee or the Registrar. In some circumstances, our assessments call for a physician to undergo remediation. Our department continues to develop resources and foster partnerships in this area, to help identify appropriate remediation and link educational supports for physicians.

The need for assessments and supervision as directed by our committees has expanded. With the College’s strategic priority to support access to care, committees seek valid methods to understand a physician’s competence… In all cases, the goal is to keep competent physicians in practice.


The need for assessments and supervision as directed by our committees has expanded. With the College’s strategic priority to support “access to care” committees seek valid methods to understand a physician’s competence… In all cases, the goal is to keep competent physicians in practice.


The need for assessments and supervision as directed by our committees has expanded. With the College’s strategic priority to support access to care, committees seek valid methods to understand a physician’s competence upon entering practice, as well as for those who have reached the end of their timelines for ongoing licensure. In all cases, the goal is to keep competent physicians in practice. If gaps in a physician’s performance exist, committees may direct that a physician undertake remediation or engage in educational supports to address identified deficiencies — the goal being to raise their performance to the expected standards of care.

This has prompted a variety of assessment and supervision approaches to meet these objectives. In 2019, the College administered two Comprehensive Clinical Assessments of Practice (CCAP). These assessments examined the practices of physicians on a conditional licence who had been unable to achieve Full licensure through certification. These physicians were able to demonstrate competence in their current work environments and have been issued renewable licences, without the requirement for ongoing sponsorship and supervision, restricted in scope to the competencies identified in the assessment. These physicians continue to practice within the province.

Supervision


Our Supervision Program’s main purpose is providing quality assurance to the College, for physicians on a Defined licence. This licence type provides a pathway for (primarily) internationally trained physicians to practice in Nova Scotia as the most responsible physician while preparing to challenge their certification examinations.

A key component of the program, as directed by the Medical Act, relies on the engagement and training of supervisors. The contribution of fully licensed physicians to provide supervision is a critical ingredient in the successful implementation of this program. In 2019, we onboarded 12 new physicians on a Defined licence, with 10 new supervisors. In total, the program monitored 79 physicians on a Defined licence in 2019.

Peer Review


In 2019, our Peer Review program launched 68 new peer reviews, completing 43 by the end of the year. This year demonstrated an unusually high deferral rate of 42%, as many physicians were transitioning their patient records onto a new Electronic Medical Record (EMR).

Program evaluation was supported by external sources. With respect to physician experience and feedback, Narrative Research analyzed 58 respondents who had participated in Peer Review since 2017. Their findings demonstrated a marked positive orientation among participants, with 83% of participants indicating that the review process helped them to guard against risks to practice quality, and 89% indicating that the review accurately reflected their practice.

In addition, the program began an early evaluation of its Physician Factors triaging rubric, exploring its ability to appropriately stream physicians into off-site versus on-site peer reviews. The rubric is built on the emerging evidence that physician and practice factors can help identify positive or at-risk practice. Statistical analysis and consultation were provided by Dr. Elizabeth Wenghofer, a full professor at Laurentian University’s School of Rural and Northern Health. Her analysis suggested early trends that the rubric is appropriately identifying physicians with assessed practice quality concerns. However, a greater number of reviews will be required to make definitive statements on these findings.

Physician Remediation


Another area of physician performance that continues to expand is the remediation of practising physicians. Physicians are mainly referred to the department through our Professional Conduct Department. The scientific literature makes clear that effective remediation of physician deficits is difficult, resource intense, and not always possible. The College strives to develop meaningful approaches to direct physicians towards educational supports that address identified gaps in performance. One area of collaboration of note for the department was with Dalhousie University’s Department of Continuing Professional Development, whereby a new online Medical Record Keeping course has been developed, with the intent to launch in early 2020.

Peer Review


In 2019, our Peer Review program launched 68 new peer reviews, completing 43 by the end of the year. This year demonstrated an unusually high deferral rate of 42%, as many physicians were transitioning their patient records onto a new Electronic Medical Record (EMR).

Program evaluation was supported by external sources. With respect to physician experience and feedback, Narrative Research analyzed 58 respondents who had participated in Peer Review since 2017. Their findings demonstrated a marked positive orientation among participants, with 83% of participants indicating that the review process helped them to guard against risks to practice quality, and 89% indicating that the review accurately reflected their practice.

In addition, the program began an early evaluation of its Physician Factors triaging rubric, exploring its ability to appropriately stream physicians into off-site versus on-site peer reviews. The rubric is built on the emerging evidence that physician and practice factors can help identify positive or at-risk practice. Statistical analysis and consultation were provided by Dr. Elizabeth Wenghofer, a full professor at Laurentian University’s School of Rural and Northern Health. Her analysis suggested early trends that the rubric is appropriately identifying physicians with assessed practice quality concerns. However, a greater number of reviews will be required to make definitive statements on these findings.

Physician Remediation


Another area of physician performance that continues to expand is the remediation of practising physicians. Physicians are mainly referred to the department through our Professional Conduct Department. The scientific literature makes clear that effective remediation of physician deficits is difficult, resource intense, and not always possible. The College strives to develop meaningful approaches to direct physicians towards educational supports that address identified gaps in performance. One area of collaboration of note for the department was with Dalhousie University’s Department of Continuing Professional Development, whereby a new online Medical Record Keeping course has been developed, with the intent to launch in early 2020.