Canadian Medical Association

We surveyed e-Panel members about their views on medical professionalism. The results offer insight into how Canadian physicians demonstrate professionalism, how they take accountability for the care they deliver, and their ideas for enhancing physician accountability.

Completed:
September 2015

Distributed to:
4,305 e-Panel members

Responses:
858

Response rate:
20%

Want to share your perspective? Visit the CMA Member Voice e-Panel page for more information on how to participate in future surveys.

Assessment tools are important in all aspects of patient care. However, each physician should be able to devise their own assessment tools based on their practice population and setting. This is where research skills come in handy, as it allows a professional to answer the question: ‘Am I performing at a level where I should be?’

-Member Voice e-Panel respondent

What members said

Definition of medical professional

CanMEDS 2015 defines the role of the medical professional as “a commitment to the health and well-being of individual patients and society through ethical practice, high personal standards of behaviour, commitment to the profession, profession-led regulation, and maintenance of personal health.” Respondents listed the adjectives they would use to describe a medical professional:

  • Dedicated
  • Compassionate
  • Competent
  • Available
  • Altruistic
  • Collaborative

Coverage of professionalism in formal education

The degree to which medical professionalism was covered in respondents’ formal education varied: 51% said there was limited or no coverage, while 38% said there was good or very good coverage.

Although there was no specific teaching or even mention of the subject, teachers made abundantly clear by word and by action what was expected of a professional.

-Member Voice e-Panel respondent

Opinion of peers’ performance

We asked participants to reflect on how their peers demonstrate medical professionalism. Respondents indicated their agreement or disagreement with following statements:

  • Seek out opportunities to enhance quality care (72% agreed or strongly agreed; 7% disagreed or strongly disagreed)
  • Actively participate in collaborative care (69% agreed or strongly agreed; 11% disagreed or strongly disagree)
  • Maintain and promote a culture of collegiality and respect (69% agreed or strongly agreed; 13% disagreed or strongly disagreed)
  • Seek out opportunities to improve patient safety (64% agreed or strongly agreed; 9% disagreed or strongly disagreed)
  • Engage patients as equals in decisionmaking about their health (51% agreed or strongly agreed; 18% disagreed or strongly disagreed)
  • Demonstrate a commitment to personal health (e.g., maintain a healthy lifestyle, balance demands of work and home life) (48% agreed or strongly agreed; 21% disagreed or strongly disagreed)
  • Participate in regular self-assessment (e.g., 360° evaluation or equivalent) (31% agreed or strongly agreed; 33% disagreed or strongly disagreed)
  • Recognize and respond to the unprofessional behaviour of others (31% agreed or strongly agreed; 35% disagreed or strongly disagreed)

Tools to assess performance

Respondents were divided on whether they had tools to assess their own performance, with only a slight majority (54%) indicating that they did. The tools respondents currently use or have access to include:

  • Performance assessment reviews
  • 360° evaluations
  • Continuing medical education
  • Electronic medical records
  • Peer review
  • Audits
  • College assessments
  • Benchmarking
  • Conferences

Respondents also identified areas where tools should be developed and implemented:

  • Quality improvement tools
  • Performance statistics
  • 360° evaluations
  • Assessment from patients and other physicians
  • Assessment of non-clinical skills (e.g. communication)
  • Continuing medical education
  • Patient safety
  • Physician health

As a resident I certainly have access to my preceptors' subjective evaluations of my performance, which is invaluable. However, objective measures that I can use to self-assess and improve are lacking.

- Member Voice e-Panel respondent

Improving quality of care and physician accountability

We asked participants to what degree they support the following ideas for improving quality and accountability when providing patient-centred and collaborative care:

  • Physicians should work in multi-disciplinary teams that are integrated across multiple care settings, and involve social and community services to address underlying social determinants of health. (76% agreed or strongly agreed; 10% disagreed or strongly disagreed)
  • Patients should be equal partners with physicians in decisionmaking about their health (76% agreed or strongly agreed; 11% disagreed or strongly disagreed)
  • Physicians should be required to participate in a robust process of revalidation that includes regular testing of clinical competence (51% agreed or strongly agreed; 27% disagreed or strongly disagreed)
  • Physicians should be measured against a clinically relevant set of outcome measures with results available to colleagues and the public (37% agreed or strongly agreed; 42% disagreed or strongly disagreed)
  • Physicians should be held financially accountable for the outcomes of their clinical performance, whether delivered individually or as a team (19% agreed or strongly agreed; 65% disagreed or strongly disagreed)

We also asked respondents’ to indicate their agreement with the following:

  • Performance measurements, including benchmarks and targets, can be beneficial to medical practice provided they are developed by frontline practising clinicians and have patient care as their primary motivation. (72% agreed or strongly agreed; 12% disagreed or strongly disagreed)
  • Having data that allows me to see how I compare to my colleagues in terms of variation and patient outcomes would influence how I practice medicine. (69% agreed or strongly agreed; 12% disagreed or strongly disagreed)
  • Fee-for-service and other volume-based payment models serve as a barrier for effective patient-centred care. (45% agreed or strongly agreed; 34% disagreed or strongly disagreed)
  • I struggle to balance the needs of my individual patients with the needs of the broader community in which I practice. (44% agreed or strongly agreed; 25% disagreed or strongly disagreed)
  • Increasing physician accountability for patient and system outcomes would be a welcome development in Canadian health care. (44% agreed or strongly agreed; 27% disagreed or strongly disagreed)

Fee-for-service may be a barrier, but not necessarily the most significant one. It has pros and cons, but addressing the system as a whole is more important. Improving primary care through government action on recommendations to make health care sustainable must be regarded together.

-Member Voice e-Panel respondent

Professional autonomy

We asked respondents, “What does professional autonomy mean for the modern physician?” They offered a variety of definitions, with the following emerging as major ideas:

  • The ability to make clinical decisions without pressure from above
  • Freedom to uphold values, morals, ideals
  • Having the support of professional bodies while maintaining an arm’s-length relationship with government
  • Having influence on how decisions are made in the healthcare system
  • Having control over where, when and how to work
  • Balance of professional autonomy with system and patient needs

We also asked what components of autonomy should be preserved and valued. The following were the most frequent responses:

  • All components
  • Decisionmaking
  • Flexibility
  • Morals
  • Advocacy
  • Accountability
  • Patient–physician relationship

Autonomy is building a practice based on my interests and skills. Being able to practice with moral integrity — my set of moral values, not those of others — and balancing that with patient autonomy. Finding a way that physician autonomy and patient autonomy can both be met.

- Member Voice e-Panel respondent

What’s next

In support of our multi-year strategic initiative to define a progressive vision for medical professionalism in Canada, we distributed the findings to our members and asked them to reflect on other opportunities to enhance physician accountability for health outcomes. The insights we gathered through this survey continue to feature in discussions with our members about medical professionalism.

Other e-Panel survey summaries

See what CMA members had to say about other health topics: