On leaving the College
In this, my last report as Registrar of the College of Physicians & Surgeons of Alberta, I wish to express my thanks to College Council, the profession and CPSA staff for the opportunity to serve the College and the public for the past 12 years.
No one can succeed in this position without a lot of help, and I have had a lot of help from a lot of people.
I’ve struggled mightily with writing this piece. How can I properly recognize all the people, past and present, who’ve supported me and helped this College thrive? A complete listing would be very long, so I’ve chosen to keep this short, accepting that many worthy individuals have not been included.
I have had this opportunity only because Larry Ohlhauser hired me to work in the College’s Complaints Department, where Don Chadsey was my mentor. Bryan Ward was a relatively new Assistant Registrar when I started at the CPSA in January 1998, and Bryan became the Deputy Registrar and the source of much of my education in medical regulation, as well as a great friend. These colleagues gave me the training and exposure that kindled my interest in the job of Registrar.
The College operates at the intersection of medicine and the law, so access to sound legal advice is essential. The College relies on external legal counsel for much of our legal work and advice. For most of my time in this office Craig Boyer has been a wonderfully responsive, ethical and respected legal advisor to me and my staff.
Marian Albright has been my Executive Assistant for the entire 12 years; indeed, Marian has been the EA to every Registrar from Roy LeRiche onwards. Marian is loyal, smart, critical (in the best sense) and endlessly supportive. She is the first point of contact with Council members, and has fostered a respectful relationship between Council and staff for over 30 years.
The Directors look after the day-to-day running of the organization, managing the people and the work of the College. Our Directors – Sharon Barron (Professional Conduct), Tracy Simons (Operations), Kelly Eby (Communications & Government Relations), Sandra Hanington (Accreditation), Erin Anderson (Competence), Bruce Leisen (Registration), Ed Jess (Physician Prescribing Practices) and Jim Kiddoo (Information Technology) – have taken on increasing responsibility over time with skill and aplomb. They are the engine of the organization.
Presidents of Council – Gordon Arnett, Jim Bell, John Pasternak, Irene Pfeiffer, Cheri Nijssen-Jordan, Randall Sargent, Jim Stone and Kate Wood – are my primary liaison with Council. Each of these presidents has respected the relationship and the roles, and has ensured good governance without interference in day-to-day operations.
Finally, I want to thank all the CPSA Registrars, past and present, with whom I’ve had the good fortune to work. These are the people at the College who, in concert with the Directors, do the real work of the organization. They represent the College with the profession, with individual members, with Alberta Health Services, with government and at national tables. We at CPSA are proud of our contributions and cooperation with the Federation of Medical Authorities of Canada, the Medical Council of Canada, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada, and much of that liaison and collaboration is the result of the hard work and relationships developed by the Registrars.
Our current team – Karen Mazurek, Susan Ulan, David Kay, Jeremy Beach and Michael Caffaro – are all stellar performers in their various roles. I am proud to work with them, to share their wisdom and to take credit for their accomplishments. I would be remiss if I didn’t include those Registrars who’ve retired from the College or moved on to other jobs – John Swiniarski, Paul Flynne, Janet Wright, Kate Reed, Ken Gardener and Owen Heisler – all highly competent people who contributed to the development and success of our College.
I tell staff that I have only two goals for this organization: to be a great place to work, and to be the best medical regulator in the world.
We are a great place to work (this is not just my opinion) and we will continue to strive to be the best medical regulator in the world. Will we ever get there? I’m not sure, but I am sure the CPSA will always strive to be better than it is, to do better than it does. And if I played a small part in bringing that attitude to this place, then I leave the best job I could ever have feeling satisfied and fulfilled. I know I didn’t accomplish this by myself. Thanks to everyone who helped me, and contributed to our collective success.
Alberta’s Auditor General’s Office just published the report titled Better Healthcare for Albertans. I encourage everyone to read this important report.
I believe the Auditor General has accurately identified the primary systemic barriers to Alberta having a high-performing healthcare system.
The medical profession is central to both the structural barrier and the absence of physician integration in our health system. While the OAG doesn’t attempt to offer solutions, the problems identified beg for answers and correction.
I think many physicians recognize these barriers, although not perhaps as articulated by the Auditor General. I also think many physicians understand the need for a ‘reset’ of the relationship between physicians and the health system. While this report doesn’t outline how we get from our current state to a preferred future state, it does make clear what that current future state might (should?) encompass which, by itself, offers something of a roadmap. For insightful physicians, the report may catalyze identification of the elements that a ‘reset’ of the relationship would contain.
Mifegymiso is a two-drug pharmaceutical product that provides a medical option for early abortion. While new to Canada, the drug has been available for many years in Europe and the US.
In approving this drug, Health Canada recommended strict conditions of use, including the requirement that physicians provide the first dose directly to the patient. The product monograph includes this requirement.
However, the product monograph is not a legally-binding document. The position of the College of Physicians & Surgeons of Alberta is that physicians may use their professional judgement in determining what is in the best interests of their patients in their prescribing and dispensing of this drug. The following outline possible scenarios for the prescribing and dispensing of Mifegymiso:
- Patients can take the prescription to a pharmacist of their choice and have the drug delivered to the physician’s office to take, which is consistent with the product monograph, or
- Patients can take the prescription to a pharmacist of their choice and take the drug at home as directed by the physician, with no requirement to have the ingestion witnessed, or
- If the prescribing physician is authorized to dispense in accordance with the College of Physicians & Surgeons of Alberta, the drug can be sold, dispensed and taken by the patient in the physician’s office.
I emphasize the importance of the prescribing physician clearly informing the patient – and the pharmacist – the directions for dispensing and ingesting this medication, as the directions may vary from the product monograph.
I thank the CPSBC and the Alberta College of Pharmacists for sharing their advice on this drug. As always, I welcome your comments.