Originally published December 2013
As a result of a review or disciplinary process, medical regulatory authorities (Colleges) may identify physicians requiring remediation through retraining or supervision. Remediation requires the active involvement of another physician who undertakes to supervise a colleague for a defined period of time.
Through its assistance to members, the CMPA has witnessed instances where doctors who require a supervised period of retraining are having increasing difficulty finding physicians to mentor, supervise, or assist them with retraining. Remediation is an important condition to retain or regain licensure to practice, making the role of supervisors critical to physician colleagues.
The CMPA recognizes the valuable role of supervisors and the benefits of remediation. Physicians who act as supervisors are eligible for CMPA assistance, should they face medico-legal difficulties.
A clinical supervisor is usually an experienced physician who supervises a period of retraining required for another doctor to retain or regain his or her medical licence. The supervisor normally meets with the physician on a pre-determined basis, may observe direct care, review patient records, provide guidance to the doctor, and report to the College. Retraining periods vary in length, and this impacts the time commitment required of clinical supervisors.
Imagine needing to secure a supervisor, but being unable to do so after contacting dozens of potential physicians? While supervisory roles can deepen medical experience and be both personally and professionally fulfilling, doctors have expressed a number of reasons for being reluctant or unwilling to undertake supervisory roles. The primary reason is the time commitment. Even when physicians have an interest in clinical supervision, many doctors are already overloaded in their practice. The idea of taking on additional responsibilities can be overwhelming. Other reasons include lack of clarity about the roles and responsibilities of the doctor and the supervisor, as well as the lack of support tools to assist supervisors. Physicians may also have concerns about the medico-legal risks, about remuneration, and also about working with doctors who may display difficult behaviour. These are all valid concerns that need to be addressed on a case-by-case basis. For physicians willing to act as clinical supervisors, Colleges often have specific criteria pertaining to medical specialty, necessary experience, and objectivity.
When supervisors can't be found
When doctors cannot find supervisors and are unable to meet remediation requirements, they most likely won't be able to practise or at least practise fully. This is clearly a loss of a valuable medical professional, which affects access to care for patients. And physicians may suffer significant degrees of stress as their career and livelihood are placed in jeopardy.
When a supervisor is identified and accepted, it is sometimes the physician requiring remediation that must pay for the supervisor's time. Beyond the obvious potential conflicts of interest, the cost to the physician requiring remediation can be significant, if not prohibitive.
If physicians are reluctant to participate in supervisory roles due to medico-legal concerns, members will be reassured to know they are generally eligible for professional liability protection from the CMPA for their medical work related to clinical supervision.
The issues around clinical supervision are multi-faceted and require a multi-stakeholder approach. The CMPA believes remediation is a useful and valuable means through which to assist doctors in meeting the clinical and professional standards expected by Colleges. Remediation can offer significant benefits to doctors, patients, and the healthcare system. Remediation should not be allowed to fail when an individual physician cannot find a supervisor.
Colleges can play an important role in identifying supervisors, recognizing the importance of their contribution to the medical profession and patients. An example is the Collège des médecins du Québec's agreements with universities to find medical faculty to act as supervisors. This leads to enhanced collective action to address the availability of clinical supervisors.
The CMPA supports the clinical supervisor approach, where a physician works with a colleague to redress areas of remediation. Given the need within the profession and the opportunities for growth and challenge, physicians in all specialties should consider this role. The CMPA is here to guide members with questions about assistance and protection related to clinical supervision.