Geographic variation in FP and GP scope of practice in Ontario: Comparative provincial study.

OBJECTIVE: To describe and compare the scope of practice (SoP) of GPs and FPs between the rural northern, rural southern, urban northern, and urban southern regions of Ontario. DESIGN: Cross-sectional retrospective analysis of the 2013 College of Physicians and Surgeons of Ontario official register and annual membership renewal survey data. SETTING: Ontario. PARTICIPANTS: All independently practising GPs and FPs with a primary practice address in Ontario. MAIN OUTCOME MEASURES: For each of the 4 regions, we determined the distribution of GPs and FPs, the mean number of hours worked per week, the mean number of clinical activities reported, the proportion of GPs and FPs reporting specific clinical activities, and the proportion of time dedicated to each activity. RESULTS: The rural north has 2.4% of the province's GPs and FPs, who on average report working more hours per week (a total of 50.82 hours a week) than practitioners in all other regions do. Rural northern and rural southern GPs and FPs report participating in more types of clinical activities than their urban counterparts do. The types of clinical activities reported vary across regions. For example, 13.3% of GPs and FPs in the urban south reported that emergency medicine was an aspect of their clinical activities, compared with 57.5% in the rural north. Urban GPs and FPs engage in fewer clinical activities and thus spend proportionately more time on each clinical activity than rural GPs and FPs do, indicating that clinical practice concentration and narrower SoP is more common in urban practices. CONCLUSION: The SoP for GPs and FPs is not uniform across Ontario. Rural physicians work more hours and engage in a broader spectrum of clinical activities. Clinical activity variation was found across all practice locations, indicating that SoP is driven by patient and community needs, which vary from region to region. Our findings are relevant for rural and northern policy and program development in medical education, continuing professional development, and physician recruitment and retention.

Evolving Professional Regulation: Keeping up with Health System Evolution.

In this article, we reflected on the notion that an evolving healthcare system requires evolving professional regulation to keep pace with system growth and change. The importance of interprofessional and patient-centred care for Ontario's healthcare system is clear. However, the profession specificity of the system is strongly embedded through Ontario's institutional and legislative structures. The result is an evolving system of care with the system of health professional regulation being somewhat left behind. Health professional regulators now have a challenge to "un-silo" regulation in a healthcare system that is evolving toward "un-siloed" care. Regulatory structures that govern single professions in a system that requires collective and additive competence is thus potentially problematic and may lead to attribution of blame to individuals where improvement is required at the level of the team. The shift in culture needed for interprofessional regulation challenges both how providers see themselves in the healthcare system, and the very foundations of professional autonomy.

Rural Health Care Access and Policy in Developing Countries.

Compared to their urban counterparts, rural and remote inhabitants experience lower life expectancy and poorer health status. Nowhere is the worldwide shortage of health professionals more pronounced than in rural areas of developing countries. Sub-Saharan Africa (SSA) includes a disproportionately large number of developing countries; therefore, this article explores SSA in depth as an example. Using the conceptual framework of access to primary health care, sustainable rural health service models, rural health workforce supply, and policy implications, this article presents a review of the academic and gray literature as the basis for recommendations designed to achieve greater health equity. An alternative international standard for health professional education is recommended. Decision makers should draw upon the expertise of communities to identify community-specific health priorities and should build capacity to enable the recruitment and training of local students from underserviced areas to deliver quality health care in rural community settings.

The effect of continuing professional development on public complaints: a case-control study.

OBJECTIVES: This study aimed to investigate the relationship between participation in different types of continuing professional development (CPD), and incidences and types of public complaint against physicians. METHODS: Cases included physicians against whom complaints were made by members of the public to the medical regulatory body in Ontario, Canada, the College of Physicians and Surgeons of Ontario (CPSO), during 2008 and 2009. The control cohort included physicians against whom no complaints were documented during the same period. We focused on complaints related to physician communication, quality of care and professionalism. The CPD data included all Royal College of Physicians and Surgeons of Canada (RCPSC) and College of Family Physicians of Canada (CFPC) CPD programme activities reported by the case and control physicians. Multivariate logistic regression models were used to determine if the independent variable, reported participation in CPD, was associated with the dependent variable, the complaints-related status of the physician in the year following reported CPD activities. RESULTS: A total of 2792 physicians were included in the study. There was a significant relationship between participation in CPD, type of CPD and type of complaint received. Analysis indicated that physicians who reported overall participation in CPD activities were significantly less likely (odds ratio 0.604; p = 0.028) to receive quality of care-related complaints than those who did not report participating in CPD. Additionally, participation in group-based CPD was less likely (OR 0.681; p = 0.041) to result in quality of care-related complaints. CONCLUSIONS: The findings demonstrate a positive relationship between participation in the national CPD programmes of the CFPC and RCPSC, and lower numbers of public complaints received by the CPSO. As certification bodies and regulators alike are increasingly mandating CPD, they are encouraged to continually evaluate the effectiveness of their programmes to maximise programme impact on physician performance at the population level.