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Health Law Blog

The Catch-22 That Keeps Ontario Doctors from Re-Entering Practice

July 15, 2014

This is a cautionary tale of one physician’s comeback trail.

The Story

In March of 2005, Dr. X. was diagnosed with a medical disability and, in accordance with the rules and guidelines set out by the College of Physicians and Surgeons of Ontario, his certificate of registration for independent practice was suspended. Dr. X. sought help for his medical issues and began taking the necessary steps to re-enter practice.

Following the first step, a needs assessment, the College deemed that Dr. X. must undertake a Competence Evaluation which required him to arrange work in another physician’s practice; the latter would act as supervisor. According to the Guidelines, a supervisor must practice in the same discipline as the physician who wishes to re-enter practice and must also be approved for the role by the College.  He or she must agree to carefully monitor the re-entering physician’s work, complete and submit progress reports to the College, and report immediately to the College if illness, vacation or a personal emergency gets in the way of fulfilling supervisory obligations. The College may disqualify a proposed supervisor if the re-entering physician knows him or her through a previous relationship including, but not limited to, employment, family, social or personal, and business.

The Issue

Despite being a tall order, this guideline is important. The College of Physicians and Surgeons of Ontario has put it in place to balance safe, quality patient care with a physician’s rights. It is the College’s duty to protect the public and this is just one example of the many ways they effectively carry out their charge.

Unfortunately, there is a catch; at issue is the fact that once a suspended physician is deemed medically fit, there is no formal mechanism to assist him in sourcing a suitable supervisor.

This, at least, is what Dr. X. found.  As his health improved, he worked on finding a supervisor yet, despite his best effort, he was unable to locate a suitable candidate that met the College’s re-entry guidelines. Unable to return to work, Dr. X. began to feel lonely and isolated. Poverty became an issue and eventually, he claimed bankruptcy.

The Turn Around

I met Dr. X. when he contacted me about representing him pro bono after he had been given my name by the Ontario Medical Association. By the time we met, things had gotten so bad for Dr. X. that he couldn’t even afford a telephone. I gave him money for the pay phone so that he could call me to discuss his case.

Understanding that Dr. X. would never get back to work until he found a supervisor, I reached out to my network. Because of my connection to the medical community and the sizeable network of health care professionals I’ve developed through my work, I was able to connect Dr. X. with a contact of mine, a physician who agreed to be Dr. X.’s supervisor. Dr. X. began by shadowing this individual, then eventually progressed to Most Responsible Physician (MRP). He continued to slowly gain responsibilities and his supervisor continued to review Dr. X’s charts on a daily and weekly basis. They continued in this fashion until his supervisor’s last report was delivered to the College, indicating that Dr. X. should be able to work independently as an MRP. Dr. X. had a Peer Assessment with the College and finally, approximately one year after he first met his supervisor, Dr. X. was allowed to return to independent practice.

The Importance of Connections

 Though grateful to be back at work – Dr. X. has been working in a clinic and was also recently offered a position filling in for a physician who will be going on maternity leave – it goes without saying that he doesn’t wish his experience on anyone.

“My story could be anyone’s story,” he says. “It was so important who was part of what I call my ‘inner sanctum’. Some were on the medical side and some were on the legal side. Tracey stood in as a bridge between the medical and legal communities. She took me under her wing and was personally available to me. I didn’t know it at the time but meeting Tracey was a fork-in-the-road moment for me. She was always there for me whenever I needed her.”

The Alternative

In addition to the current guidelines, one suggestion is for the College of Physicians and Surgeons of Ontario to also put in place a system for re-entering physicians to find a suitable supervisor. This is already commonly done in other professions. The Advocates Society, for example, connects pro bono duty counsel with solicitors who are facing disciplinary proceedings.

Likewise the College (or the Colleges representing the various practice areas or the Ontario Medical Association) could put a similar program in place. This could be as simple of creating a list or a volunteer committee of physicians who would be prepared to assist re-entering physicians. The College could advertise the need for supervisors on their website and through correspondence with members. I suspect, as is the case in the legal community, physicians who want to make a meaningful contribution to their profession, and act out of a sense of personal ethics and human compassion would answer the call.

Testimonials

I have heard Tracey speak on several occasions. I found her to be an articulate, forceful and entertaining speaker. She had a complete mastery of the subject matter and was able to communicate it in an effective manner.

Robert Solomon Professor, Faculty of Law, University of Western Ontario, London, Ontario

Tracey Tremayne-Lloyd Health Law