Special Consultation: Standards of Practice Review Process
Unless physicians give us feedback, we won’t know if we have it right.Dr. Karen Mazurek, Deputy Registrar
You can help guide your profession.
“Why are these changes being made?”
“It’s too difficult to hunt for the proposed changes.”
“There are too many consultations.”
“There are too many standards to review.”
“The College sends too many communications: my time is better spent treating patients than reading all these emails.”
We’ve received comments on our consultation process for the standards of practice, and we want to hear more.
We want to know how the CPSA Standards of Practice impact physicians, their patients and their co-workers in day-to-day practice. As members of a self-regulated profession, physicians play an important role in setting and meeting the standards. We also want to hear from government, the public and other stakeholders. Your input is vital, to help College Council keep the standards relevant and practical for our members, while ensuring good patient care.
- Do you participate in consultations on the standards? Why or why not?
- Is the 60-day consultation period enough time to provide feedback?
- Do you receive adequate notification and reminders of consultation deadlines?
- Are the draft amendments to the standards clear and easy to understand?
- Can we make it easier for you to participate, or improve the consultation process overall?
Talk to us – we are listening. You can provide your input in 3 ways:
All feedback is subject to the College’s Privacy Statement.
Deadline to provide feedback is April 30, 2017.
Tell us what you think
Editor’s note: This special consultation is seeking input on the consultation process and not on any specific standard of practice. We encourage all members to offer feedback on standards under review during the formal consultation period, promoted through direct email, The Messenger newsletter and social media. Are there better ways to consult with you? Please let us know.
This is a challenging area for all of us here in Alberta. My specific area of specialty is bone and muscle tumors and therefore urgent referrals are typically handled "urgently" and seen within a few days. For all other referrals the typical wait time is up to 12 months. I have significant concerns with the requirements to contact patients and referring providers every three months while patients wait for a consult or surgery. As you are likely aware, the demand for hip and knee replacement care is growing each year. This trend is reflected in our wait times. Many patients will wait 6-12 months for a consultation with an Orthopaedic Surgeon and an additional 6 – 12 months for surgery. At any given time across Alberta there are nearly 10,000 patients waiting for a hip or knee orthopaedic consultation.
There is a significant resource implication for contacting patients 3-4 times each. My clinic receives referrals 24/7 with no interruption. Our focus is on ensuring we have good referral management practices and as such these referrals are reviewed by myself personally and my staff as they arrive. They are triaged accordingly based on the pathology and this includes my review of any pertinent imaging that may be available. The requirement, of notifying patients every three months, adds a layer of complexity to an already complex system and takes my team away from working with patients to managing paper. In my work with the Alberta Hip and Knee clinic it is clear that a central referral process is the most streamlined way of dealing with subspecialty referrals and should be considered the vanguard for the referral process and applied to all subspecialties. The focus of Alberta Health services and the role of the CPSA in this regard should be to champion these efforts and make the transition to central referral systems a requirement for as many subspecialty areas as possible. 77
the standard of practice concerning referrals and the need to communicate back to patients every 90 days as to the status of their referral is not reasonable; as an orthopaedic spine surgeon I have hundreds of referrals waiting (approx 2 year wait list for first consultation) - to report back to a patient on average of 7 times before their appointment is unreasonable - particularly because I have no control over the burden of disease and limited resources to treat same(all spine surgeons have similar waits in Calgary - as the clinical head of the ortho/neuro spine program in Calgary our estimated mean wait time for new consults is 22 months)
this new guideline will only add administrative work and will not enhance patient care when we stop taking on new referrals in effort to reduce our bloated wait lists; referring docs will become more frustrated than they already are
As an orthopedic surgeon, I find that there are far to many consults to review than time to see those patients. By adding these changes, the college is now placing unrealistic expectations on our profession. Added to that, we will now be forced to either hire more staff, or purchase software to notify patients of their consultation appointments. Even though we have set up a central intake process with the 11 orthopedic surgeons in Central Alberta, and have significantly streamline the process, I fear that we may have to close down our office to new referrals. This of course will be opposite of the intended goal. Your video states"...if there are workflow issues that impede...". There ARE work flow issues, in so far there are too many consults and not enough surgeons. Until the system rectifies this imbalance, the college can set up as many rules, regulations, and standards as they want, but it doesn't change the math.
I would agree with the comments from the group of 4 Orthopaedic surgeons in Edmonton. As a solo practice surgeon, my lone staff member cannot handle the communication requirements of the new guidelines. Effective immediately, I will be severely restricting which referrals I accept. This will help to decrease my waitlist to a more manageable level. I understand what the CPSA is trying to accomplish and I agree with the guidelines in principle. But the practical application of these guidelines will cause physicians to change their practice patterns. This will be good for those patients that are lucky enough to get on a waitlist, but I suspect more patients will struggle to find a specialist at all.
Honestly, I would like to thank the CPSA for these new guidelines because I've always stressed and struggled with my long waitlist and this will give me the impetus to do something about it.
This comment pertains to the new guidelines for referrals. We are a group pf 4 Orthopaedic Surgeons in Edmonton. While we can manage to adhere to the College's new (ill thought out) guidelines regarding the referral process, we have only been able to do so by severely curtailing the number of referrals we agree to see. We are not prepared to hire extra staff whose only task is to notify patients and their referring physician of the status of the referral every 3 months. Thus many of the referral letters are declined solely because the patient cannot be seen/managed within the parameters set out by the CPSA. It is inconceivable that the new guidelines have been productive in any way.
Recently a new standard has been implemented regarding prescription of opioids and Benzo. While it's a good step, patients are complaining as we are tapering Benzo and Narcotic analgesics and I am sure CPSA will receive a lot of complains from Patients against Physicians when they will not write Benzo or Narcotic Analgesics or try to taper dose. The first line Primary Care Physicians are intimidated by many patients every day and then by CPSA by acting on those illegitimate complains. Unfortunately no measures for Physicians protection noted and all burden is left on Physicians shoulders to face such patients who are already been addicted and going doctor to doctor to get the pills. A simple complain by a patient creates a havoc and nightmare for Physician. Stress, loss of income, shaken to perform and provide better care, long term anxiety and impairment of skills due to constant fear of another such forthcoming complain. Who is responsible for all that if complain is false? I agree that patient has right to complain but what about the false complains? Physicians will continued to be victims of intimidation every single day.
ARE YOU LISTENING??
CPSA has been very clear in our messaging to physicians and the public that opioids should not be abruptly discontinued or rapidly tapered. Additionally, Professional Conduct carefully and thoroughly investigates every complaint received; if physicians are following best practices with regard to prescribing and maintaining detailed records of all patient interactions, they should not fear spurious complaints.
If a physician has a patient who is threatening or intimidating them, it may be necessary to assess the physician-patient relationship under the Terminating the Physician-Patient Relationship standard of practice.
If you have questions regarding prescribing of drugs with the potential for misuse or diversion, please contact Ed Jess, Director of Physician Prescribing Practices, at email@example.com.
If you have concerns regarding potential complaints, please contact Professional Conduct at 1-800-661-4689 or firstname.lastname@example.org.
I have completed the survey already. In general, my main concern is not that there are not avenues to communicate, but that no one listens when I do contribute. I provided constructive, collaborative suggestions. I have no idea as to whether anyone ever read my suggestions. It feels FUTILE to contribute.
The Referral Consultation process was especially challenging because the only avenue for feedback was an online blog. If there was ANY other way to contribute, not even our section's provincial rep knew about it. Really? An online blog? And what came of the Referral Consultation process? A "solution" that caters completely to one side.
I spent considerable time and energy,concerning wait times for consultation.I specifically pointed out that two specialties ,GI and Rheumatology had long waitimes(3 years and nine months respectively).In addition,they recommended tests ,and even suggested referral to alternative practitioners,including chiropractors.I do not think this behavior was "good medicine,that's what we are all about".The recent conclusion by the committee,put the onus on the on the consultee as the problem.No mention was made of the actions of the consultants! Some suggest more tests! Aside from arrogance,this is hardly "choosing wisely"To suggest further tests without seeing and examining the patient is just terrible medicine.Of course the committee made no mention of this!
Another thing,the College cares little of its doctors.I have personal experience with this attitude.When I discussed this with the registrar I was told that The College died not get involved with my type of problem! Very depressing.The AMA,was sympathetic ,but also did not get involved.Therefore in our massive beaurocracy,there in no one who protects the individual physician from tyrrany of our colleagues.It is patients first, --doctors ????