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The College of Physicians and Surgeons of Ontario (CPSO) is the
regulatory college Regulatory colleges are legal entities in Canada charged with serving the public interest by regulating the practice of a profession. They function as professional associations that are state-sanctioned occupational closure, to regulate the practic ...
for medical doctors in
Ontario Ontario ( ; ) is one of the thirteen provinces and territories of Canada.Ontario is located in the geographic eastern half of Canada, but it has historically and politically been considered to be part of Central Canada. Located in Central C ...
,
Canada Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...
. The college issues certificates of registration for all doctors to allow them to practise medicine as well as: monitors and maintains standards of practice via assessment and remediation, investigates complaints against doctors, and disciplines those found guilty of
professional misconduct Professional ethics encompass the personal and corporate standards of behavior expected of professionals. The word professionalism originally applied to vows of a religious order. By no later than the year 1675, the term had seen secular applic ...
and/or incompetence. The CPSO's power is derived from Regulated Health Professions Act (RHPA),
Health Professions Procedural Code Health, according to the World Health Organization, is "a state of complete physical, Mental health, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World H ...
under RHPA and the
Medicine Act Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...
. The college is based in
Toronto Toronto ( ; or ) is the capital city of the Canadian province of Ontario. With a recorded population of 2,794,356 in 2021, it is the most populous city in Canada and the fourth most populous city in North America. The city is the anch ...
. In October 2008, the College was named one of "
Canada's Top 100 Employers Canada's Top 100 Employers is an annual editorial competition that recognizes the best places in Canada to work. First held in 1999, the project aims to single out the employers that lead their industries in offering exceptional working conditions ...
" by Mediacorp Canada Inc., and was featured in ''
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'' newsmagazine. Later that month, the College was also named one of
Greater Toronto's Top Employers Canada's Top 100 Employers is an annual editorial competition that recognizes the best places in Canada to work. First held in 1999, the project aims to single out the employers that lead their industries in offering exceptional working conditions ...
, which was announced by the
Toronto Star The ''Toronto Star'' is a Canadian English-language broadsheet daily newspaper. The newspaper is the country's largest daily newspaper by circulation. It is owned by Toronto Star Newspapers Limited, a subsidiary of Torstar Corporation and pa ...
newspaper.


Organization


Structure and mission

The College of Physicians and Surgeons of Ontario (CPSO) is the self-regulating body for the province's medical profession. The College regulates the practice of medicine to protect and serve the public interest. It issues certificates of registration to doctors to allow them to practise medicine, monitors and maintains standards of practice through peer assessment and remediation, investigates complaints against doctors on behalf of the public, and disciplines doctors who may have committed an act of professional misconduct or incompetence. The medical profession has been granted a great degree of authority by provincial law, and that authority is exercised through the College. This system of self-regulation is based on the premise that the College must act first and foremost in the interest of the public. All doctors in Ontario must be members of the College in order to practise medicine in the province. The role of the College, as well as its authority and powers, are set out in the Regulated Health Professions Act (RHPA), the Health Professions Procedural Code under the RHPA and the Medicine Act. The duties of the College include: issuing certificates of registration to doctors to allow them to practise medicine monitoring and maintaining standards of practice through peer assessment and remediation investigating complaints about doctors on behalf of the public, and conducting discipline hearings when doctors may have committed an act of professional misconduct or incompetence.


Council

The College is governed by a council. The RHPA stipulates that it consist of at least 32 and no more than 34 members: 16 physicians elected by their peers on a geographical basis every three years; 3 physicians appointed from among the six faculties of medicine (at the
University of Western Ontario The University of Western Ontario (UWO), also known as Western University or Western, is a public research university in London, Ontario, Canada. The main campus is located on of land, surrounded by residential neighbourhoods and the Thames R ...
,
McMaster University McMaster University (McMaster or Mac) is a public research university in Hamilton, Ontario, Canada. The main McMaster campus is on of land near the residential neighbourhoods of Ainslie Wood and Westdale, adjacent to the Royal Botanical Ga ...
,
University of Toronto The University of Toronto (UToronto or U of T) is a public university, public research university in Toronto, Ontario, Canada, located on the grounds that surround Queen's Park (Toronto), Queen's Park. It was founded by royal charter in 1827 ...
, Queen's University,
University of Ottawa The University of Ottawa (french: Université d'Ottawa), often referred to as uOttawa or U of O, is a bilingual public research university in Ottawa, Ontario, Canada. The main campus is located on directly to the northeast of Downtown Ottaw ...
, and the
Northern Ontario School of Medicine Northern Ontario School of Medicine University (NOSM University; french: Université de l'École de médecine du Nord de l'Ontario) is a public medical university in the Canadian province of Ontario. It is mandated both to educate doctors and t ...
); no fewer than 13 and no more than 15 non-physician or 'public' members appointed by the provincial government for terms decided by the government. Both medical faculty members and public members may be re-appointed at the end of their terms. The College President is elected from and by Council and serves a one-year term. Council members sit on one or more committees of the College. Each committee has specific functions, most of which are governed by provincial legislation. General Council meetings are held four times a year, at which time the activities of the College are reviewed and matters of general policy are debated and voted on. Meetings of Council are open to the public and are held in the 3rd floor Council Chamber at 80 College Street, Toronto, Ontario. The council for 2022 is made up of:


Elected Professional Members


Complaints process

The complaints process regarding physicians begins with a phone call to the Public Advisory Department at 416-967-2603 or 1-800-268-7096, extension 603. A College staff member in the Investigations and Resolutions Department experienced in health care will help the caller. Staff may be able to answer questions about care, clarify which questions to take back to one's doctor, and/or answer questions about how the health care system works. The caller's medical records may be reviewed and a discussion with the doctor in question will be scheduled. Staff will ask the doctor for a response. College staff may also arrange to meet with the individual who initiates the complaints process, and possibly with this individual and the doctor(s) – perhaps even hospital administrators – to communicate and clarify issues. This gives the individual who initiates the complaints process the opportunity to tell the doctor and others about any concerns. This process provides a forum for individuals to have their concerns heard and acknowledged by the doctor and/or hospital representatives, and is done only with both the patient and the doctor's agreement. Occasionally, an improvement to the way in which health care is delivered has come about as a result of these discussions.


COVID-19

On March 24, 2020, the CPSO Executive Council met to discuss the potential impact of the
COVID-19 pandemic The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identi ...
on Council business. The Council declared an emergency under CPSO’s Declared Emergency ByLaw and directed to extend the Council Elections for Districts 5 and 10 which were originally scheduled to be held on June 9, 2020. By May 2020, the CPSO noted they were anticipating a high volume of complaints against senior public health officials, and many related to public health measures and delays in cancer surgeries,
mammograms Mammography (also called mastography) is the process of using low-energy X-rays (usually around 30 kVp) to examine the human breast for diagnosis and screening. The goal of mammography is the early detection of breast cancer, typically through d ...
and the like. On April 30, 2021, the CPSO released a statement on “Public Health Misinformation” accusing Ontario doctors of “using social media to spread blatant
misinformation Misinformation is incorrect or misleading information. It differs from disinformation, which is ''deliberately'' deceptive. Rumors are information not attributed to any particular source, and so are unreliable and often unverified, but can turn ...
and undermine public health measures.” In response, a group of Canadian physicians released a declaration titled the “Declaration of Canadian Physicians for Science and Truth”. They described the CPSO's statement as “unethical, anti-science and deeply disturbing.” As of August 25, 2022, there were 718 signatory physicians and 20,171 on behalf of concerned citizens. The CPSO strongly encourages all eligible Ontarians to receive a COVID-19 vaccine or booster shot(s).


Criticisms associated with the college


Cautions

Between 2007 and 2013 the College issued more than 1,000 "cautions" against practising doctors. Cautions are issued to doctors for transgressions that include providing inadequate treatment, poor record-keeping and raising voices in arguments. However, the college has been criticized in the past for not being transparent to patients as to which doctors have been subject to cautions. The college has been criticized for being more interested in protecting doctors than patients.


Block fees

Between 2004 and 2011 the College prosecuted four physicians for improperly charging block fees to patients. Block fees are annual fees charged by physicians to allow patients to access services. Physicians are permitted to charge block fees to uninsured patients for services not covered by OHIP, but charging block fees to allow insured patients to access OHIP services is considered to be professional misconduct.


The "Transparency Project"

In 2013, in response to some of the above criticisms, the College announced that it would begin its "Transparency Project". The goal of the Transparency Project would be to make it easier for patients to gain more information about doctors who have been accused of wrongdoing. The College Council gave its support to a transparency initiative that had four categories. One, an increase in the transparency of the transfer of patient medical records. Two, a proposal that the Notices of Hearing for the College's Discipline Proceedings be posted to a physician's profile on the public register. Third, a proposal that the status of discipline matters as they are proceeding be added to a physician's profile on the public register. Fourth, that reinstatement decisions in their entirety be posted to a physician's profile on the public register.


Complaint disposal times

In recent years the College has struggled to process an increasing volume of complaints about physicians, probably because patients’ expectations are increasing rather than physicians getting worse. In 2007 it successfully lobbied the Ontario Ministry of Health to increase the time limit for disposal of complaints from 120 to 150 days, and to give itself increased powers to extend those time limits. These proposals were contained in amendments to the Regulated Health Professions Act 1991 which were passed by the Ontario Legislative Assembly in 2007 and came into force in 2009. The time taken to dispose of complaints continued to lengthen until the Ontario Ministry of Health commissioned a report, “Streamlining the Physician Complaints Process in Ontario” which reported in 2016 that “More time and money is spent on a disposition in Ontario than in other jurisdictions, with little apparent benefit to the public in terms of better or safer physician services”, “too many complaints and investigations are in the system too long”, and “the 150 day deadline is not met on many occasions”. Following this report, the College improved the efficiency of its complaints procedures, including routing suitable complaints via an Alternative Dispute Resolution (ADR) process, and disposal times are once again coming down.


“Never reapply” undertakings

A novel solution adopted by the College to the problem of delays in resolving complaints has been to make increasing use of “never reapply” undertakings. A “never reapply” undertaking is an undertaking made by a physician to surrender his or her licence and never reapply for another licence in Ontario or anywhere else in the world. In return, the College promises not to proceed with the complaint, the investigation is terminated and the file closed. These undertakings are probably legally unenforceable both inside and outside Ontario as they would amount to an unreasonable restraint of trade and they are rarely used by other medical regulatory authorities. In the past, such undertakings were only used in the most serious cases, for example sexual abuse of a patient, but they are increasingly being used by the College as a way of disposing of less serious or unspecified complaints. A disadvantage of these undertakings are that they remove physicians from practice who may be able and willing to continue practising but just wish to terminate the investigation. This data was extracted from the CPSO online public register by a combination of electronic and manual searching. 285 physicians were identified who had given undertakings to the CPSO never to reapply for a licence either in Ontario alone, or Ontario plus anywhere else in the world. In each case an attempt was made to identify why the undertaking was given, and the undertakings were allocated into three categories. “Sexual” indicates that there was an allegation of sexual misconduct, either proven or unproven, and involving either patients or co-workers. “Explicable” indicates that the reason for the undertaking was non-sexual, but there appeared to be some other good reason why it was appropriate, for example, gross incompetence, a serious criminal conviction, dishonesty, psychiatric incapacity or a repeated failure to remediate. “Inexplicable” forms the largest category and indicates either that the reason given was vague (”incompetence”, “professional misconduct”, “failure to uphold the standards of the profession” or similar) or that it appeared to be an inappropriately harsh penalty (over-prescribing of opioids, for example, could be easily remedied by placing restrictions on the physician’s licence).


Proposed amendments to the Regulated Health Professions Act 1991

An application is being made to the Ontario Ministry of Health for amendments to the Regulated Health Professions Act 1991 to update the regulations and address some of the above issues.Submission to Ontario Ministry of Health.
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See also

*
Ontario Medical Association The Ontario Medical Association (OMA) is a membership organization that represents the political, clinical and economic interests of Ontario physicians. Practising physicians, residents, and medical students enrolled in any of the six Ontario fac ...
*
Royal College of Physicians and Surgeons of Canada The Royal College of Physicians and Surgeons of Canada (french: Collège royal des médecins et chirurgiens du Canada) is a regulatory college which acts as a national, Non-profit organization, nonprofit organization established in 1929 by a speci ...
*
Collège des médecins du Québec The ''Collège des médecins du Québec'' (CMQ), or Quebec College of Physicians, is a professional organization responsible for setting educational standards for physicians, regulating the practice of medicine, and policing its members at the prov ...


References


External links


College of Physicians and Surgeons of Ontario
- Official web site of the CPSO. {{DEFAULTSORT:College Of Physicians And Surgeons Of Ontario Medical and health organizations based in Ontario Medical associations based in Canada Professional associations based in Ontario Surgical organizations
Ontario Ontario ( ; ) is one of the thirteen provinces and territories of Canada.Ontario is located in the geographic eastern half of Canada, but it has historically and politically been considered to be part of Central Canada. Located in Central C ...