Professional standards
Aviation medical examiners
Many of Canada's 750 civil aviation medical examiners say doctors should have input into the medical standards set for pilots and air traffic controllers. The new Canadian Aviation Regulation Advisory Council, established in 1997, consults with physicians in the course of setting standards, but has no physician members. The medical examiners are forming their own association to lobby for representation. [CMAJ 1999;160(2):174]
Competence test
The College of Physicians and Surgeons of Alberta devised a process to test the competence of physicians every five years. In a pilot study to evaluate the process, researchers asked 308 physicians to assess themselves and to identify colleagues, consultants to whom they refer patients, nonphysician coworkers and patients to assess them. The assessors rated the physicians across roughly 44 statements of performance. Overall, only 28 (9.1%) of the physicians had results that varied more than 1 standard deviation from the peer group for three or more of the five major categories of assessors. Encouragingly, two-thirds considered implementing changes to their practice on the basis of their results. Alberta decided to go ahead with the program. [CMAJ 1999;161(1):52-7]
In an accompanying editorial, an expert in performance indicators cautions against confusing variation with a lack of quality. He concluded that accounting for the expectations of people other than physicians in the assessment tool may prove to be a groundbreaking initiative in the field of assessment. [CMAJ 1999;161(1):44-5]
Legal actions
Most physicians' malpractice fees will drop slightly in 2000 and fewer civil lawsuits against doctors were launched in 1998. Even though legal fees and award settlements cost more than $2,500 for each of the 58,000 members in 1998, that still marked a 13% drop from the peak year of 1996, when legal expenses alone totalled more than $101 million. [CMAJ 1999;161(6):741]
Two years after being hit with a 24% hike in insurance fees, Canada obstetricians are making a concerted effort to reduce their legal risk. In 1997, the Canadian Medical Protective Association hiked dues for obstetrician/gynecologists to $29,280 annually because of a trend toward higher court awards in "bad baby" cases. The numbers of these cases has remained constant over the past decade - about 10 per year - but the court awards have escalated to between $2.5 and $5 million. In response, the Society of Obstetricians and Gynaecologists of Canada set up a two-day intensive ALARM course to reduce risk. [CMAJ 1999;161(5):565-6]
Nurse shortage
Statisticians have predicted a Canadian shortfall of up to 113,000 registered nurses by 2011. [CMAJ 1999;161(1):15]
This year, the harbingers of the nursing shortage were abundantly evident: Newfoundland had to close 15 surgical beds, a Northern Ontario hospital closed and a Saskatchewan health board closed beds. The problem is compounded by the sudden demand for more nurses. Ontario alone promised to hire 7,700; BC and Alberta want 1000 each. [CMAJ 1999;161(1):67-68]
