Can The CPSO Regain The Trust of Physicians?

Disclaimer:  As always, the views below are mine, and do not represent those of the OMA, even though I happen to be the President- Elect.

The College of Physicians and Surgeons of Ontario (CPSO) governs, licenses and oversees the conduct of Ontario’s physicians.  Through a combination of a tone deaf, paternalistic attitude, and fear that “bad press” will lead to a loss of something called self-regulation, the CPSO has sadly lost the respect of physicians across Ontario.

Instances of poor physician behaviour continue to be (thankfully) very rare.  Despite this, it is safe to say that the CPSO has been under siege in the media.  Some of it is their own doing.  The CPSO actually once went to court to try to get a decision that their own Discipline Committee made enhanced – in effect they sued themselves.  Some of the media siege is due to zealous reporting (stories of “rich” doctors doing bad things sell newspapers).  Regardless, the media has clearly not been kind to them.

The CPSO response to the media was shockingly defensive.  Rather than trying to ensure a fair complaints process,  they decided to double down and severely prosecute physicians for truly ridiculous reasons.  The perception amongst front line physicians is that the CPSO is trying to “look tough” to get the press off their backs.

The most egregious example of this by the CPSO occurred during the debacle that surrounded the failed tentative Physician’s Service Agreement (tPSA) of 2016.  Emotions ran high in the profession  and physicians, being human, said things that they would not normally say.

Some of these things were clearly inexcusable no matter what the situation.  The CPSO was right to discipline physicians who repeatedly sent abusive emails to former Ontario Medical Association (OMA) President Dr. Virginia Walley.  But they went overboard in many cases.

When someone comes to my office who is angry, and using foul language, the CPSO expects me to show some compassion, try to find out why they are feeling the way they are, and work with them to reform them.  Yet the CPSO refused to extend that humanity to physicians who committed minor infractions.  Would it really have hurt the CPSO to ask these physicians if they were feeling burnt out, considering the magnitude of the physician burn out crisis?

I will not embarrass these physicians more by linking to media reports, but I will state for that record that the following physicians were disciplined, paid at least $10,000 each to the CPSO, and publicly shamed:

• one physician, who replied to an anonymous email address with “stop sending me these f$%@#$ emails”
• A physician who called Health Minster Eric Hoskins a “reichmaster” on facebook
• Another physician who called Hoskins a “F@$% P#$&*” on facebook
• A physician, who told a clearly inappropriate joke on a private electronic forum

NO patients were harmed.  NO medical incompetence was exhibited.  NO threat to the public.  And NO humanity exhibited by the CPSO to see if these physician were feeling all right.  If using the “f” word is cause for discipline, then judging by her Twitter feed, Dr. Jennifer Gunter, a leading expert in the fight against pseudoscience, had best not re-apply to practice in Ontario.

Worse, the CPSO exhibited a clearly one sided approach to how they meted out discipline.  In the aftermath of the tPSA, the OMA Executive faced a non-confidence vote.  Dr. Philip Berger, who has a well deserved reputation for social activism, decried the leaders of the non-confidence motion as “right wing coup plotters”, “dictators”, “fanatics” and so on.  Full disclosure, he is referring to me, current OMA president Nadia Alam and others.

In response, one physician on a facebook forum suggested Berger should take Ativan (a mild tranquilizer) and another suggested a stronger tranquilizer.  Guess who the CPSO decided to investigate, even though a formal complaint was NOT laid? (The CPSO can investigate at the discretion of their Registrar).  Guess who DIDN’T get investigated for making unprofessional comments about another colleague at the discretion of the Registrar?  The message from the CPSO was clear.  You can disparage another physician only if you have the right political view point.

For the record I will not lodge a complaint against Dr. Berger for disparaging me.  It would be a stupid, idiotic waste of the College’s time, and it was pathetic for the CPSO to wade into this in the first place.

More recently, workers striking at a family practice clinic wrote an open letter to the CPSO complaining about physician behaviour in a clear negotiations tactic.  Instead of realizing it for what it was, the CPSO instead sent their communications director to follow up and “offer support in filing a formal complaint.”  The fact that they were completely blind to this being simply a negotiation tactic is befuddling.  This was proved when the doctors in Owen Sound stated that the union withdrew the complaints as part of the negotiated settlement.

In fairness, new CPSO Registrar/CEO Nancy Whitmore appears to be trying to change all that.  She has promised efficiencies in the painfully long complaints process.  This would allow her staff more time to deal with serious complaints about physicians’ competency and misconduct, while quickly dismissing frivolous ones.

Additionally, I confess that I’ve been pleasantly surprised at how co-operative the staff at the CPSO have been with the OMA to modify the Continuity of Care Policy.  The original policy would have placed unreasonable bureaucratic burdens on physicians, and might have killed off family medicine and walk in clinics.

These are welcome changes in approach and should be lauded by every one.

I do feel Dr. Whitmore genuinely cares for physicians, and wants a fair process to help them and protect patients.  However, this might be seen as too little too late by many members.  The CPSO has governed the profession by fear (instead of respect) for so long that physicians are extremely jaded about the organization.  Public dissatisfaction with the CPSO doesn’t help either.  Here’s hoping that Dr. Whitmore can maintain the reform minded approach she has initiated.  It will be best for patients, physicians, and the CPSO.