Strategies being developed to address appropriate physician resources, workforce mobility and use of technology in training

OTTAWA| Dr. William Fitzgerald, the new president of the Royal College of Physicians and Surgeons of Canada, has some unique qualifications.

Dr. Fitzgerald, invested into the Order of Canada earlier this year, is surgeon-in-chief at the Charles S. Curtis Memorial Hospital in St. Anthony, N.L., and a University of Toronto medical school graduate.

“I bring the perspective of a rural surgeon whose professional circumstances have meant that I’m no stranger to creative problem-solving and resourcefulness,” the general surgeon said upon his recent installation.

It will be under Dr. Fitzgerald, whose two-year term began in late September, that the Royal College plans to implement Focus 2020, its new vision for the future. He plans to work closely with governments, among others, to develop a strategy to address interprovincial and international mobility issues.

But as the Royal College moves forward, Dr. Fitzgerald also wants to promote its history and heritage as the springboard for learning about health care in Canada. “This is a crucial time . . . an ideal time for the Royal College, working in collaboration with other partners, to ensure Canadians have an appropriate supply of physician specialists.”

Dr. Fitzgerald has held many appointments throughout his career, including clinical professor of surgery at Memorial University of Newfoundland and several visiting professorships. He is a past-president of the Newfoundland Surgical Society and the Canadian Association of General Surgeons.

The Medical Post presented Dr. Fitzgerald a list of questions in one of his first interviews in his new national position.

1. Which of your qualifications—coming from a relatively small community in a relatively have-not province and practising in a relatively small clinical specialty—would you say are most important to you as you begin your term as Royal College president?

When resources are scarce—as they so often are in rural hospitals—you’re challenged to look beyond the obvious for solutions. Collaboration is a given in a small community where a limited number of service providers work together to see that patient and community needs are met. You have to be creative and think outside the box when you approach issues.

2. Continuing professional development is very controversial among both specialists and family doctors right now. Why does it have to be so hard to maintain a doctor’s professional competence?

Fellowship in the Royal College is voluntary, and we have more than 42,000 fellows who participate in a mandatory maintenance of certification (MOC) program. This program reflects the Royal College’s continued commitment to ensuring high standards of excellence in specialty medicine.

Professional development is at the cornerstone of maintaining excellence in medical and surgical practice. Although medical education plays a significant role in a physician’s ongoing education, professional development encompasses a more holistic approach to learning.The MOC program is a nationally validated educational process designed to enhance the continuing professional development of individual specialists. It reflects the commitment of the Royal College to promoting lifelong learning at all stages of specialized practice, and being transparent and accountable to society as a profession.

For example, three provinces (Saskatchewan, Ontario and Quebec) require physicians to participate in an educational program to maintain their licence. Alberta made this mandatory as of January 1.

3. What’s the role of the Royal College in safeguarding quality of care and training opportunities for Canada’s doctors when the prevalence of private health care and medical centres is increasing?

The Royal College has long affirmed its support for Canada’s public health-care system and the principles enunciated in the Canada Health Act. However, it also recognizes that the health-care landscape in Canada is evolving.

In a new policy statement, “Safeguarding the Quality of the Educational Continuum and Medical Workforce in Canada’s Complex Health Care System,” the Royal College outlines far-reaching recommendations to safeguard the quality of care and training opportunities for Canada’s doctors as the prevalence of private centres increases.

4. The Royal College’s annual meeting this year emphasized simulation as an important emerging medical education technique. Isn’t there a danger that could take the “personal element” out of the learning process?

Actually, this year the Royal College sponsored the first international conference on residency education, attended by more than 1,000 people. One of our goals was to bring educators and fellows of the Royal College together to explore issues in postgraduate medical education. The simulation summit provided an opportunity for participants to learn more about the potential benefits of simulation.

I view simulation as an extension of the learning experience. Simulation allows one to concentrate exposure, often to critical emergent situations, that would be difficult to duplicate in ordinary practice or to perfect new skills in a secure environment without compromising patient safety.

5. What role does simulation play in possibly replacing clinical teachers at a time when their numbers aren’t keeping up with their need, given the popularity of distributed learning?

Simulation is not about replacing clinical teachers. It is about leveraging tools that can assist residents in their training. We know that technology is evolving, and we see increased use in our daily lives from BlackBerrys to laptops to twitters and wikis.

6. Can the technologies used in simulated teaching help deliver health-care services to relatively isolated communities and facilities?

I’d answer with a qualified “yes.” Video conferencing is a reality throughout most of Canada, including Newfoundland and Labrador. Indeed, Memorial University pioneered this evolving technology going back to the 70s. Certainly simulation has a role in education and telementoring applicable to rural health care.

7. What’s the Royal College’s position on a proposal by Quebec and France to mutually recognize the professional qualifications of physicians trained in each jurisdiction?

The Royal College is responsible for maintaining high standards of postgraduate medical education. We want to ensure those entering the country meet the same standards as those who trained in Canada so every patient is provided safe, quality care.

8. It’s generally acknowledged that there are four ways to deal with physician/specialty shortages: train more doctors, allow more IMGs, repatriate Canadians trained abroad and allow allied health professionals to expand their role in collaborative care. What’s the Royal College policy?

The college has developed a position statement on appropriate physician resources for Canada: Toward Achieving Responsible Self-sufficiency. The statement outlines the need for a balance between the domestic education and training of medical professionals and immigration policies; ensuring that there are ethical policies for the inclusion of international medical graduates into the Canadian system; a pan-Canadian approach to recruitment and retention of physicians; and greater attention to the infrastructure for education and practice.

9. What does the Royal College do to help ensure proper distribution of specialists across the country?

The Royal College has no control on how the regulatory or licensing authorities distribute the specialist workforce throughout the country, but we do take every opportunity to hold constructive dialogue to ensure every Canadian has access to properly qualified physicians and surgeons. Planning for the proper distribution of specialists requires a co-ordinated approach, and we’ve long advocated for a pan-Canadian, needs-based approach to health human resources planning.

10. What new or lesser-known initiatives is the Royal College sharing with the College of Family Physicians of Canada?

The CFPC partner on many initiatives and projects, among them the National Physician Survey which included the CMA and whose 2007 data we rolled out earlier this year. Another example is the Collaborative Action Committee on Intra-Professionalism.

CACI meets regularly to discuss enhancing intraprofessionalism and exploring ways to inculcate desired behaviours to optimize physicians’ intra-professional relationships. Working groups have been established to focus on education, training and accreditation, as well as intra-professionalism in practice.

The Royal College has had recent discussions regarding adoption of our CanMEDS Framework by the CFPC for the training and practice of family medicine. It represents an important step toward a single Canadian standard for postgraduate medical education and will underpin the work of both colleges to improve medical education across the continuum.

11. Focus 2020, your group’s plan for the future, deals with meeting the complexities the national health system is likely to encounter down the road. Do you see a major shift in the role of the Royal College as a result?

With Focus 2020, the Royal College is formalizing the role we’ve played in national health policy development with our partner organizations. The College contributes to development of sound health policy by providing support, information and influence to improve the health of Canadians and the health-care system.

This strategic plan provides us with a roadmap to ensure specialty medical education is responsive to societal health needs. Yes, the plan is ambitious, but it’s important for the Royal College to address not only member needs but the health needs of all Canadians.

12. What are your relations like with the Federation of National Specialty Societies of Canada? (Does it even still exist, it’s been so quiet over the past two years?)

The Royal College has ongoing discussions with the Federation on issues of common concern. In fact, we recently held a one-day event on health human resources in mid-November and the federation will participate in these discussions.

13. How would you describe the interest level of members in Royal College activities across the country? Are there areas where interest significantly exceeds that shown by members in other areas?

I’m not sure if your readers are aware that the Royal College has some 1,800 fellows who volunteer their time to develop national certification examinations in 61 specialties and subspecialties. These fellows are very active on our examination committees.

They’re also involved in a number of other committees, providing expertise on issues such as medical education and continuing professional development. We also have regional advisory committees meeting regularly to discuss common issues and concerns and share information. The Royal College is examining these regional advisory committees and our governance model so we better engage and serve our more than 42,000 members and most importantly enhance specialty health care for all Canadians.