Professional Self-Regulation: Learning from the Disciplinary Process.

Medical regulatory colleges have a mandate to protect and promote the health and safety of the public by regulating the practice of medicine by physicians. In Canada, provincial colleges of physicians and surgeons fulfill this mandate through activities related to a) the registration of physicians to practice, b) the regulation of how physicians practice (either proactive or reactive regulatory activities), and c) remediation of physicians where specific deficiencies are identified and where remediation is appropriate. Throughout most of the 150-year history of selfregulation of the medical profession in Canada, this role has been performed primarily by reactive regulation, i.e., disciplining physicians who have been found to be practicing in a manner that members of the profession would consider to be dishonourable, disgraceful, or unprofessional. As important as remediation may be, the disciplinary process remains a key means of maintaining the public trust in the profession. This is reactive regulation, as it results from a specific complaint, inquiry, or report to the college about a physician’s behaviour or performance. It is important to emphasize that most colleges have remediation programs that manage clinical practice deficiencies identified during the complaint process. Disciplinary procedures are invoked only when major unprofessional practices are found. By law, the college’s disciplinary proceedings and outcomes are transparent to the public. Disciplinary findings result from a formal adversarial legal process after an extensive investigation of the merits of the allegations. Formal charges are filed, and the physician involved is allowed to mount a thorough defense to the allegations. Although individual disciplinary findings are published by each provincial regulatory body, the report presented by Alam et al. in this issue of the Journal is the first systematic evaluation of disciplinary findings against anesthesiologists in Canada. The report follows the publication of their data on all disciplined physicians in Canada from 2000-2009. The authors conclude that publication of the causes of disciplinary actions may result in ‘‘interventions aimed at educating physicians around standard of care’’ and prevent such problems. Whether education can prevent such serious lapses of professionalism remains speculative at best, but their data give us the first specialty-specific, national perspective on this important issue. Their first contribution is to compare the scope of the problem for anesthesiologists with that for all physicians in Canada. They emphasize that there were 721 disciplinary findings against physicians of all specialties in Canada from 2000-2011, whereas only 11 findings were against anesthesiologists. This frequency represents disproportionately fewer anesthesiologists than many other specialties. This result differs from the report from California’s State Medical Board where anesthesiologists were overrepresented among disciplined physicians. Complaints that reach the Discipline Committee represent only 2-3% of the total number of patient complaints about physicians. This number probably The author is a member of Council of the College of Physicians and Surgeons of Ontario and has no other competing interests to declare.