CPSO Value for Money?

Hunter BootsWe find money for things we value. A fool parts with his money for little value in return.

But price-value mismatch makes most of us shop for a better deal. When we find what we need for less than we expected to pay, no amount of pecuniary anxiety can stop us.

Apple iPhone 6 $800

Hunter Boots Women’s Original Nightfall Pull On Rain Boot $320

Xbox 360 Wireless Racing Wheel $7,716

Compact Brushless Hammer Drill/Brushless Impact Combo $500

Montegrappa Horse 2014 Fountain Pen $28,995 (!)

CPSO – College of Physicians and Surgeons of Ontario

At a round-table on self-regulation last year, two things stood out:

1 – Doctors’ anger at the CPSO

2 – Doctors’ devotion to self regulation

The CPSO is debating whether it’s a good time to raise dues for Doctors.

Maybe some people just enjoy watching doctors suffer. As new graduates field calls from their lenders, working doctors face > 30% net cuts by 2017, and as our glamorous, new Prime Minister seeks to emasculate professional corporations, the CPSO ponders increasing dues. It feels out of touch by half.

Dr. Rob Stern agreed to share the letter he wrote to the CPSO as one of many who spoke up:

Dear CPSO,

I find it doubly shameful regarding your fee increase for 2016.

Initially, we are asked to increase dues paid to you when many members are facing anywhere up to 20% or more in fee cuts due to the unilateral action by the Ministry of Health/Ontario.  You should also be tightening your belts and doing more with less as your membership has been experiencing.

Secondarily, we are asked for our opinion, but advised to “MAIL” in our feedback rather than providing our opinions online.  It is almost as if you folks are making it difficult for us to send in feedback and hope you don’t get too many negative opinions to justify your increase.  It is not clear that your “discussion forum” is being taken into advisement by the CPSO or is simply a forum to vent our frustrations to fellow members.  I hope you are taking comments there seriously as I am not sure I have seen a positive response there as yet.

Shame on you for your fee policies and pathetic attempts at providing “objective opinion feedback” from members.

..Dr. Rob Stern

cpso #60770

Dr. Stern’s comments reflect many others on the CPSO website.

But doctors’ anger about the CPSO goes beyond dues. It hinges on the CPSO mandate and how the college carries it out (see CPSO portrays doctors as untrustworthy – gated).

We need to ask what the CPSO is trying to achieve and whether it’s the best way to achieve it.

Doctors support governance by our peers but roil at nontransparent collusion with government. The CPSO exists largely unchanged, even after Justice Corey thrashed the “devastating” Medical Review Committee (MRC) in 2005. Many of the same senior leaders still hold court.

Long before we relied so much on regulation and legislation, doctors adjusted behaviour based on peer feedback: weekly case conferences, morbidity and mortality rounds, or time spent in the doctors’ lounge debating conundrums.

Since talking with friends went out of fashion, we now rely on random CPSO audits from ‘peers’ every 10 years. Despite horror stories, most go fine (gated link).

But even monthly CPSO peer chart audits — done by people doctors do not know or trust, using secret methods and ambiguous feedback — would never match the value of doctors talking together.

Old docs used to mentor younger ones. Both learned in the process.

Doctors support the rule of law – common law, not the continental variety.  A jury of our peers judges us best. Secret police or self-appointed judge-jury-and-executioners do not promote high performance or enthusiasm for patient service.

Regulation does not inspire excellence and innovation. Regulation strangles creativity and progress. Like salt, a pinch of regulation improves the mix, but too much ruins everything.

Doctors bristle at the price of regulation inside the CPSO monopoly. It might encourage doctors to shop for a better deal.

photo credit: Amazon.ca

9 thoughts on “CPSO Value for Money?”

  1. One of the members of my FHG is going to retire rather than go through the ever so friendly audit process. The CPSO is an arm of government and no they have no business increasing their fee. A true self governing body would submit policy changes to the members of the profession for approval or disapproval. The College is nothing more than the governments appointed bullies to now be joined by bureaucrat bullies in LHINs and mini-LHINs

    1. Excellent point, Ernest!

      I’m just so used to things the way they are that your comment never occurred to me. Of course we should approve policy changes!

      Beyond general guidelines, a central authority will never build quality and innovation anywhere near as well as groups of local physicians.

      I sure appreciate you taking time to comment!

      Best,

      Shawn

  2. I applaud Shawn on the way he has woven together the references in his blog. Another example of the great effort and great writing skills that he puts into these articles. As Shawn encourages comments here, I will add mine.

    The fact that the CPSO would even consider a fee increase at this time is a huge sign of DISRESPECT to the hard working physicians of Ontario.
    Many times over my 40-year career I have felt this type of disrespect from the College. The heinous Medical Review Committee was administered by the CPSO. Among their diabolic findings was that A PEDIATRIC Respirologist repay OHIP for failing to conduct “rectal/gynecological assessments” on patients as part of a general exam.

    This column about the College’s Medical Review Committee (MRC) was written in 2004 during the Judge Cory Commission’s investigation of the MRC:
    http://www.theglobeandmail.com/news/national/gentle-dr-hsu-and-the-audit-that-haunted-him/article746626/

    Here are some quotes from the column along with my comments. Get a barf bag before you continue reading.

    “London PEDIATRIC respirologist Brian Lyttle, was similarly ordered to repay the Ontario Health Insurance Plan for his failure to conduct ‘rectal/gynecological assessments’ on his young patients as part of his general examinations.”

    “Even college president Barry Adams, registrar Rocco Gerace [who has held this job at the CPSO for as far back as I can remember], and Rachel Edney, the current chair of the embattled MRC … agreed that the [MRC] audit system is PERCEIVED AS UNFAIR, SECRETIVE AND UNJUST by many doctors and has lost the confidence of the profession.”

    “As the three were discussing a problem of ‘perception,’ Judge Cory quickly added a clarification. ‘The perception, and in some cases the reality,’ he said, ‘is that doctors have been mistreated and abused’ by the MRC.”

    “ ‘I don’t think the system is truly unfair or unjust,’ [the Chair of the MRC] said, adding that contrary to claims by some doctors, the MRC always gives written reasons for its decisions, and physicians who are audited always know the allegations against them. But she agreed the hearings aren’t transcribed”

    I do not impugn the 100’s of Ontario physicians who generously give their precious free time to act as Peer Reviewers to help their colleagues improve patient care. Reading what the College representatives said at the Cory Commission shows that the mind set of the CPSO as an institution has become one of a self-serving narcissistic organization.

    There is even more along these lines:

    “Outside the hearing, Dr. Gerace said it was the college itself which, about 18 months ago, began the push for reform behind the scenes, but that it was also statutorily bound to continue participating even as the system’s flaws became apparent.”

    One of my best friends had volunteered to be an auditor for the MRC. After ONE audit, as soon as he realized how unfair the investigations were, he stopped being an auditor.

    I also remember that The College had been pressured for years by a group of physicians that regularly posted some of the contemptible MRC doings on the OMA Internet Forum. One of the most prolific posters was a physician had been investigated by the College’s MRC. He had been exonerated and had to pay back zero to OHIP. Nevertheless, he felt strongly enough about the intimidating and strong arm tactics of the MRC that repealed and continually railed against it. He was even involved in the organizing of a vigil in front of the CPSO offices on a bitterly cold winter day to protest against the vile MRC process.

    I would like to thank Shawn again for giving me the opportunity to re-post here what I posted on the CPSO Website in my reply to the College request for feedback on their possible $25 fee increase this year.
    In response to a new act of disrespect, I am making sure that I see no more patients after May, 31, 2016. It gives me great pleasure to say that I will never pay dues to the CPSO again.

    1. Wow. Thank you, Gerry, for take the time to put together such a thoughtful, thorough comment!

      The MRC marks a black corner of regulatory history in Canada. The other provinces still pale in comparison to the policies drafted by the CPSO.

      I sure appreciate you taking time to draft such a helpful note!

      Best regards,

      Shawn

    1. Thanks so much for adding this, Lee!

      Yes, the NHS has gone through the silliness we now endure. The PSA papers say what we’ve been trying to articulate. I hope everyone gets a chance to look through them. With the threat of being taken over by the government always at the front of their minds, I wonder if the CPSO has the brain space to try innovative thinking like the PSA groups describe.

      Docs change behaviour on advice from trusted peers, people they know.

      Thanks so much for taking time to share! I really appreciate it.

      Highest regards,

      Shawn

  4. The CPSO, like any unchecked and unfettered bureaucracy, is in permanent expansion mode. It is extending it’s mandate far beyond self-regulation into persecution and flagellation of the profession. In promoting physicians as untrustworthy and posting everything willy-nilly on the doctor profiles, it further justifies this expansion. It also allows them to look down with impunity upon those killing ourselves in the trenches because the increased amount of work that the CPSO has GIVEN ITSELF to do justifies (in their minds) the fee increase.

    Bureaucracies run amok become cults and they lose their way. They cannot see the forest for the trees not appreciate the consequences of their actions. If the truly ‘served the profession and protected the public’ (a previous mission statement, I think), they would stop devising or aiding/abetting government policies that hamper effective physician and drive them out of Ontario. The CPSO now only serves one thing…ITSELF.

    1. Sorry, Shawn, but I saw this first. 😉

      Paul, you have hit the nail on the head. Bureaucracies act to protect, expand and justify their own existence.

      re: “run amok” and “cannot see the forest for the trees” :
      When the internet was relatively new, many doctors complained that the CPSO was putting physician exact birth dates on the College website for patients to check out. We pointed out that the banks were using this detail to verify that we were the real person calling the bank. The College said that they had no choice but to publish the birth dates as it was in the Regulations. Idiots! The College wrote the regulations.

      Rantingly,
      Gerry

      1. Excellent comments, Paul, and thank you, Gerry, for responding!

        You both make solid points. The CPSO makes policy to placate its handlers in a bid to avoid extinction. Government holds the puppet strings, and the Toronto Star tells government what show to perform.

        I don’t see an easy end to all this. Symbiotic relationships end poorly for both parties if one half gets crushed.

        Thanks again for sharing your thoughts!

        Best

        Shawn

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