Date Published | Mar. 20, 2008

Dear Editor,

I wrote yesterday about the winter issue's claim that there is only one geriatrician in Northern Ontario. I said that some physicians might dispute that claim.

On further consideration, I think I should explain my remarks. Instead of this background information being journalistic “homework,” it seems convoluted and not readily accessible.

The article did not define “geriatrician.” You profiled a physician certified by the Royal College of Physicians and Surgeons of Canada in the specialty of Internal Medicine and the subspecialty of Geriatric Medicine.

He seems to suggest (falsely) that no other doctor in Northern Ontario has any specific (or formal) education and training in treating geriatric patients. Your publication's apparent endorsement of his comments implies (incorrectly) that Royal College certification is the only pathway to becoming a geriatrician.

Not all specialist (or subspecialist) recognition comes from certification by the Royal College. Recent changes in policy at the College of Physicians and Surgeons of Ontario (CPSO) provide for recognition as specialists of physicians who are not certified by the Royal College. The current CPSO policy on recognition of specialists can be found at http://cpso.on.ca/Info_physicians/regpol/nonfamspec.htm.

The recent CPSO changes are not yet fully implemented. One problem that remains is that physicians recognized as specialists via one of the new mechanisms are not listed as specialists on the CPSO website (Doctor Search portion).

An Ontario Regulation (on advertising) prohibits calling such physicians specialists, despite the CPSO's officially recognizing them as specialists. The CPSO is preparing a recommendation for the Ministry of Health and Long-Term Care that the Regulation be changed to reflect the current CPSO specialist recognition scheme. Once the Regulation is changed, then the CPSO website can be adjusted.

I am unaware of whether the physicians I mentioned in my message yesterday (at least one of whom completed a U.S. training program) have been through the CPSO process for recognition as specialists or subspecialists.

I am aware that two physicians at my hospital (the Northeast Mental Health Centre, North Bay Campus) have completed that process and are recognized as specialists by CPSO (though in fields other than geriatrics).

My point is that the doctor you quoted, and your publication, misled the public by implying that the previous situation still applies (i.e., that the only way to become a specialist or subspecialist is through Royal College certification).

Perhaps an interesting article could be developed about the changes in specialist recognition by the CPSO. Reducing the confusion about health care credentials in Ontario (especially concerning previously unlicenced practitioners like osteopaths, nurse practitioners, and physician assistants) seems like a worthwhile goal. I'm pleased that there is now a publication dedicated to Northern Ontario health care practice.

Sincerely,
Arthur L. Keith, MD, JD
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Letter from College of Physicians and Surgeons of Ontario in response to an inquiry by the Northern Ontario Medical Journal

To the Editor,

You have asked a number of questions primarily relating to whether there is a difference between Royal College of Physicians and Surgeons of Canada (RCPSC) certification and specialist recognition by the College of Physicians and Surgeons of Ontario (CPSO).

The RCPSC and the CPSO have different roles, and while I will briefly describe the role of the RCPSC, my response will focus on the CPSO.

The RCPSC is a national organization responsible for setting and maintaining the standards for postgraduate medical education, for conducting the certification examinations of specialist physicians and surgeons in Canada, and for promoting their continued education.

The CPSO is the regulatory/licensing body for physicians in Ontario (each province and territory has its own licensing authority). One of the CPSO’s objects is to develop, establish and maintain standards of qualifications for persons to be issued certificates of registration (to allow them to practice medicine in the province).

The qualifications and requirements for registration with the CPSO are outlined in provincial legislation, specifically the registration regulations under the Medicine Act, including the requirement that candidates be certified by examination by either the RCPSC (for specialists) or the College of Family Physicians of Canada (for family physicians). Those who successfully complete their postgraduate medical training in Canada are immediately eligible to sit the relevant national certification examination.

Over the last number of years, new assessment programs for international medical graduates and registration policies that streamline the licensure process have been developed to bring qualified candidates into the Ontario system in direct response to the doctor shortage, in accordance with recommendations made by the College in its 2004 publication, Tackling the Doctor Shortage. Under these programs and policies, several hundred specialist physicians trained in other jurisdictions without RCPSC certification have been granted a license to practice medicine in Ontario.

In February 2004, the CPSO’s governing Council approved a policy entitled Recognition of Non-Family Medicine Specialists. This registration policy was developed, in part, to retain specialists recruited through these new programs and policies.

At the moment, the Doctor Search feature of the CPSO’s website identifies specialist physicians by RCPSC certification only, as the program was developed long before the advent of the registration policy referred to above. We are presently redesigning our website and changes to Doctor Search are under development which we hope will assist and guide the public in determining who should be viewed by them as specialists with advanced training and competence. The CPSO is also presently circulating for feedback proposed amendments to the regulations in relation to the use of specialist titles, including the manner in which titles are used in advertising. Once these amendments are finalized (expected sometime in 2008), the CPSO will submit a regulation amendment request to government for consideration.

In closing, I would direct you to the Ontario Physician Human Resources Datacentre (OPHRD) at (905) 525-9140 extension 23855 or www.ophrdc.org for the number of specialist physicians in geriatric medicine in Northern Ontario. Given that the CPSO website simply reflects the fact of RCPSC certification, it is the OPHRD that has the most accurate data about location of practicing specialist physicians as this agency also receives billing and population data from the MOHLTC, in addition to receiving data from the CPSO.

Kathryn Clarke
Sr. Communications Co-ordinator
Policy and Communications
College of Physicians and Surgeons of Ontario

Editor's note - A document on the website for the Ontario Physician Human Resources Datacentre (OPHRD) shows that in 2006, there were two geriatric medicine specialists in the area covered by the North East LHIN, and one in the area covered by the North West LHIN.

However, when contacted by Northern Ontario Medical Journal, an employee with OPHRD said the names of these geriatric specialists could not be released due to confidentiality laws.

While the geriatric specialist referred to in the North West LHIN is likely Dr. Trevor Bon, who was featured in the December edition of Northern Ontario Medical Journal, one wonders how family doctors are supposed to know who the two geriatric specialists in the North East LHIN are.