Ontario family physicians' perspectives about their scope of practice: what is it, what drives it and how does it change?

Background: There is little evidence to show what scope of practice (SOP) means from the point of view of family physicians, how family physicians think about their SOP as it changes over time, or what factors shape and influence their SOP. Understanding family physician perspectives on SOP and the factors that influence it can aid our understanding of how it can constrain and enable physicians' agency and autonomy in professional practice.

Methods: Using qualitative description and incorporating constructivist grounded theory data collection and analysis techniques, four focus groups were conducted involving twenty-four Ontario-based family physicians from different contexts, at different career stages, and with different practice experiences.

Evaluation of a High Stakes Physician Competency Assessment: Lessons for Assessor Training, Program Accountability, and Continuous Improvement.

Introduction: There is a dearth of evidence evaluating postlicensure high-stakes physician competency assessment programs. Our purpose was to contribute to this evidence by evaluating a high-stakes assessment for assessor inter-rater reliability and the relationship between performance on individual assessment components and overall performance. We did so to determine if the assessment tools identify specific competency needs of the assessed physicians and contribute to our understanding of physician dyscompetence more broadly.

A rural approach to quality improvement for small rural hospitals: Lessons from rural Texas.

This article describes the Rural Physician Peer Review Program (RPPR©) developed by the Texas A&M Rural and Community Health Institute and presents it as an example of a program that could be implemented in rural Canada as an effective means of continuing professional development (CPD) for rural Canadian physicians. RPPR© post review survey responses from 574 physician participants across rural Texas indicate that they are highly satisfied with RPPR© and that their competency in medical knowledge and patient care improves as a result of participation. A pilot project with two to four northern Ontario hospitals would enable RPPR© to be modified to ensure applicability and feasibility in the northern Ontario context to create an RPPR© "North.

Workload of French-speaking family physicians in francophone rural and northern communities in Ontario.

Introduction: Previous studies have shown that French-speaking family physicians (FSPs) in Ontario are less numerous in areas with high proportions of francophones. The purpose of the current study was to assess whether the degree of concordance between physicians' language of competence and the linguistic profile of the community in which they practise is associated with workload and to explore variations in this relation in rural and northern regions of the province.

Methods: This was a secondary analysis of the 2013 College of Physicians and Surgeons of Ontario Annual Membership Renewal Survey.

Geographic variation in FP and GP scope of practice in Ontario: Comparative provincial study.

Objective: To describe and compare the scope of practice (SoP) of GPs and FPs between the rural northern, rural southern, urban northern, and urban southern regions of Ontario.

Design: Cross-sectional retrospective analysis of the 2013 College of Physicians and Surgeons of Ontario official register and annual membership renewal survey data.

Setting: Ontario.

Evolving Professional Regulation: Keeping up with Health System Evolution.

In this article, we reflected on the notion that an evolving healthcare system requires evolving professional regulation to keep pace with system growth and change. The importance of interprofessional and patient-centred care for Ontario's healthcare system is clear. However, the profession specificity of the system is strongly embedded through Ontario's institutional and legislative structures.

Impact of the rural pipeline in medical education: practice locations of recently graduated family physicians in Ontario.

Background: The "rural pipeline" suggests that students educated in rural, or other underserviced areas, are more likely to establish practices in such locations. It is upon this concept that the Northern Ontario School of Medicine (NOSM) was founded. Our analysis answers the following question: Are physicians who were educated at NOSM more likely to practice in rural and northern Ontario compared with physicians who were educated at other Canadian medical schools?

Methods: We used data from the College of Physicians and Surgeons of Ontario.

Value of General Medical Knowledge Examinations in Performance Assessment of Practicing Physicians With Potential Competence and Performance Deficiencies.

Introduction: Problems with a physician's performance may arise at any point during their career. As such, there is a need for effective, valid tools and processes to accurately assess and identify deficiencies in competence or performance. Although scores on multiple-choice questions have been shown to be predictive of some aspects of physician performance in practicing physicians, their relationship to overall clinical competence is somewhat uncertain particularly after the first 10 years of practice.

The effect of continuing professional development on public complaints: a case-control study.

Objectives: This study aimed to investigate the relationship between participation in different types of continuing professional development (CPD), and incidences and types of public complaint against physicians.

Methods: Cases included physicians against whom complaints were made by members of the public to the medical regulatory body in Ontario, Canada, the College of Physicians and Surgeons of Ontario (CPSO), during 2008 and 2009. The control cohort included physicians against whom no complaints were documented during the same period.

The relationship between physician participation in continuing professional development programs and physician in-practice peer assessments.

Purpose: To investigate the relationship between physicians' performance, as evaluated through in-practice peer assessments, and their participation in continuing professional development (CPD).

Method: The authors examined the predictive effects of participating in the CPD programs of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada one year before in-practice peer assessments conducted by the medical regulatory authority in Ontario, Canada, in 2008-2009. Two multivariate logistic regression models were used to determine whether physicians who reported participating in any CPD and group-based, assessment-based, and/or self-directed CPD activities were more or less likely to receive satisfactory assessments than physicians who had not.

Predictors of physician performance on competence assessment: Findings from CPEP, the Center for Personalized Education for Physicians.

Purpose: To identify factors associated with physician performance in a comprehensive competence assessment.

Method: The authors conducted a retrospective analysis of 683 physicians referred for assessment at the Center for Personalized Education for Physicians from 2000 to 2010, who were evaluated as either safe or unsafe to return to practice. Multivariate logistic regression was used to determine factors predictive of unsafe assessment outcome.

Promising quantities, disappointing distribution. Investigating the presence of French-speaking physicians in Ontario's rural Francophone communities.

Introduction: Previous studies have suggested that there may be a lack of French language healthcare services in the province of Ontario. The purpose of this study was to determine if physicians in Ontario who expressed a proficiency in providing services in the French language are located in 'Francophone communities'.

Method: Responses from 10,968 Ontario-based family physicians (FPs) certified by the College of Family Physicians of Canada and uncertified general practitioners (GPs) who responded to the 2007 College of Physicians and Surgeons of Ontario Annual Membership Renewal Survey were analysed and compared to the 2006 census of the population of Ontario.

Nurse practitioners' perceptions of interprofessional team functioning with implications for nurse managers.

Aims: To determine the perceptions of nurse practitioners (NPs) about the level of functioning of their interprofessional teams.

Background: Interprofessional teams are a global trend, and nurses play leadership roles in their management. Little is known about the impact of specific barriers to team functioning and the role of the nurse manager on team functioning.

Recommendations for Tobacco Control on Post-Secondary Campuses that are Geographically Isolated.

Background: Many Ontarians continue to report exposure to second-hand smoke in public spaces. Completely smoke-free environments are the preferred and socially responsible option for non-smoking policies; however, when considering the variety of landscapes in which post-secondary institutions are located, 'a one size fits all' smoking policy is unrealistic to implement and enforce. The purpose of the study was to: 1) gain a better sense of the prevalence of smoking and exposure to second-hand smoke in a post-secondary context that is geographically isolated; 2) assess the awareness of existing non-smoking initiatives; and 3) identify preferred approaches for tobacco control.

Examining the geographic distribution of French-speaking physicians in Ontario.

Objective: To determine how many physicians in Ontario express a proficiency in providing services in the French language, and to assess the geographic distribution of such physicians.

Design: Population-based analysis of the 2007 College of Physicians and Surgeons of Ontario Annual Membership Renewal Survey.

Setting: Ontario.

Pharmacists' experiences with dispensing opioids: provincial survey.

Objective: To explore pharmacists' beliefs, practices, and experiences regarding opioid dispensing.

Design: Mailed survey.

Setting: The province of Ontario.

A closer look at Ontario's northern and southern rural physician demographics.

Introduction: In Ontario, Canada, there is a tendency to conflate rural and northern issues and although much of northern Ontario is rural, this is not exclusively the case. In this study, data were utilized from the licensing and regulatory body of physicians in Ontario to provide a more nuanced understanding of the distribution of the physician population across varying degrees of rurality in northern and southern regions.

Methods: This is a report on the geographic distribution of the 22 688 GPs, and specialists certified by the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada who had their primary practice address in Ontario.

Survey of Ontario primary care physicians' experiences with opioid prescribing.

Objective: To measure physicians' experiences with opioid-related adverse events and their perceived level of confidence in their opioid prescribing skills and practices.

Design: Mailed survey. Setting The province of Ontario.

Factors affecting physician performance: implications for performance improvement and governance.

Background: A physician's personal and professional characteristics constitute only one, and not necessarily the most important, determining factor of clinical performance. Our study assessed how physician, organizational and systemic factors affect family physicians' performance.

Method: Our study examined 532 family practitioners who were randomly selected for peer assessment by the College of Physicians and Surgeons of Ontario.

Physician-patient encounters: the structure of performance in family and general office practice.

Introduction: The College of Physicians and Surgeons of Ontario, the regulatory authority for physicians in Ontario, Canada, conducts peer assessments of physicians' practices as part of a broad quality assurance program. Outcomes are summarized as a single score and there is no differentiation between performance in various aspects of care. In this study we test the hypothesis that physician performance is multidimensional and that dimensions can be defined in terms of physician-patient encounters.

Effectiveness of an enhanced peer assessment program: introducing education into regulatory assessment.

Introduction: The College of Physicians and Surgeons of Ontario developed an enhanced peer assessment (EPA), the goal of which was to provide participating physicians educational value by helping them identify specific learning needs and aligning the assessment process with the principles of continuing education and professional development. In this article, we examine the educational value of the EPA and whether physicians will change their practice as a result of the recommendations received during the assessment.

Methods: A group of 41 randomly selected physicians (23 general or family practitioners, 7 obstetrician-gynecologists, and 11 general surgeons) agreed to participate in the EPA pilot.