Originally published December 2018
In November 2017, the CMPA launched the Member Support Program to proactively identify and assist members experiencing a high volume of medical-legal events.
We recently sat down with Dr. Todd Watkins, the CMPA’s Managing Director of Physician Services, to discuss the program, learn how it’s been received, and share next steps.
Q: Tell us about the program. Why was it developed?
Every one of our members aims to provide the best care possible, but there are so many pressures facing healthcare providers that sometimes members find this challenging. Often these struggles lead to difficulties with communication, collaboration, or professionalism, which in turn can trigger complaints and contribute to the possibility of legal actions.
At the CMPA, we are in a very privileged position to assist members, and we recognize that a pattern of increasing or recurring medical-legal events may be a sign that a member needs help—not punishment. We developed the Member Support Program (MSP) to help us get to know our members and identify their individual needs to reduce their medical-legal risk. The program is open to all members, but is primarily focused on assisting members whose medical-legal experience is greater than their peers. For some of our members, an increasing pattern of medical-legal issues can be a precursor to significant restrictions being placed on their practice. We want to help these members identify and address the factors contributing to their risk, and in this way prevent future issues.
Q: What is mutuality and how does it tie into the MSP?
Mutuality is one of the defining principles of the CMPA. It means the CMPA and our members have reciprocal roles and expectations. Part of the CMPA’s role is to support our members as best we can to help reduce their medical-legal risk. Our members, in turn, are expected to practise in a safe manner in keeping with the practices of the broader membership, including working proactively to decrease their medical-legal risk.
The MSP provides all members who need assistance with a way of reducing their medical-legal risk while improving the quality of care they provide and regaining confidence in practising medicine.
Q: How does the MSP work?
The first step is getting to know our members better. When we see certain patterns in a member’s medical-legal experience, we reach out to the member to see if we can help.
Next, we take a closer look at the member’s medical-legal history to try to pinpoint any underlying factors contributing to the increased rate of medical-legal events. Each situation is unique, so we seek input from the member to understand his or her practice environment and the context around events. Sometimes the pattern of medical-legal experience is truly situational or temporary—and in this case, the member likely does not need our ongoing assistance. However, most often we can identify practice-related factors that may be driving the increased risk, such as poor documentation, communication struggles, and professionalism issues.
Once we’ve identified the underlying factors, we develop an individualized education and support plan to address the member’s specific areas of need. This plan can include recommended education resources and courses, focused advice, targeted education goals, and discussions about wellness.
The final step of the program is follow-up and assistance in achieving the member’s goals. For example, we might create a schedule to check in with the member at regular intervals and provide guidance and advice.
Q: What has the response been to the program so far?
The response from our members—including MSP participants—has been overwhelmingly positive. While our focus has initially been on a small number of members, the program is available to all members. Members have told us that they support the program not only as a way of improving their own practices, but also as part of the CMPA’s broader commitment to safe medical care.
Members receiving assistance from the MSP are actively engaged and grateful for the opportunity to reduce stress levels and prevent future medical-legal events. Many have expressed relief when provided with a plan to improve their practice. In fact, participants have asked why this service was not available years ago. There is no doubt that participants want to provide quality and effective care. The Member Support Program aims to guide members back to a fulfilling and joyful practice.
Q. Have there been any surprises?
We have seen significant benefits in simply raising members’ overall understanding and awareness of their medical-legal experience as it compares to others. Physicians generally do not speak to their colleagues about medical-legal events, so it’s difficult to know what’s normal or expected. Without this baseline understanding, it is easy to dismiss an increase in medical-legal events as a consequence of a difficult practice environment or the "cost of doing business." Many members contacted don’t realize that their medical-legal experiences are outside the norm. We have learned that simply sharing this information often motivates members to make positive practice changes.
There is research linking physician burnout to an increased rate of medical-legal events.12 When speaking to program participants we often ask about wellness and discuss how wellness could be contributing to medical-legal risk. Again, awareness tends to drive insight and encourage change. Interestingly, many participants have already taken steps to try to improve their well-being and address workload issues.
Q. What’s next?
As we begin our second year, we are focusing on evaluating and refining the support we provide. We are currently analyzing feedback from members participating in the program and evaluating the impact of each intervention. This includes assessing how the suggested courses and guidance have affected members’ practice, attitudes, and behaviours. Information from this analysis will allow us to further develop the MSP and better assist members with specific needs. The overall success of the program will be defined by our ability to reduce future medical-legal events and enhance member satisfaction and well-being.
We are also considering how to address physician wellness. At our 2018 Annual Meeting and Information Session, we discussed the need for a collective response to support a system-level approach to improve the wellness of physicians and, by extension, the safety and quality of care. Moving forward, we will examine opportunities, leveraging our position as a trusted organization, to collaborate with partner organizations to help physicians combat burnout and improve wellness. While member-specific interactions with participants in the MSP remain confidential, the overall themes learned from the program will be central to how we shape practical solutions to this important issue.
- West CP, Huschka MM, Novotny PJ, et al. Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. JAMA. 2016;296(9);1071–1078
- Balch CM, Oreskovich MR, Dyrbye LN, et al. Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg. 2011;213(5);657–667