I have spent a lot of time thinking about the College of Physicians and Surgeons of Alberta, commonly known as CPSA, and I believe Alberta needs to consider a fundamental change in how doctors are regulated.

My position is simple: the patient comes first. Always.

Doctors are essential to our healthcare system. They deserve respect, fair treatment and appropriate legal protections. But doctors are also human beings, and like anyone else, they can make mistakes, make poor decisions or fail to meet the standards expected of them.

That raises an important question: Should the medical profession ultimately be responsible for regulating itself?

I believe Alberta should consider dissolving the present governing structure and replacing it with an elected civilian board made up of ordinary Albertans, patients and taxpayers.

Doctors would still have an important role. They would provide medical advice to the board and explain technical or clinical issues. But they would not have voting authority over the regulator itself.

An elected civilian board

My proposal would be for Alberta to create a provincial civilian board representing Albertans from different parts of the province.

The board should include representatives from northern, central and southern Alberta, because healthcare experiences can be very different depending on where you live.

It should have an odd number of members so there can never be a tie vote. Members would serve fixed terms and would be elected by Albertans rather than appointed by government.

I believe avoiding government appointments is important. The regulator should be accountable to the public, not to whichever political party happens to form the government.

Doctors and other medical professionals could sit around the table as non-voting advisers. Their knowledge would be extremely valuable. But the final decisions would belong to the civilian board.

This would not be an attack on doctors. It would be a recognition that the people receiving healthcare also deserve a meaningful voice in how that healthcare system is regulated.

Every complaint deserves to be heard

One of the biggest changes I would make concerns complaints.

If a patient takes the time to make a complaint about a physician, I believe that complaint should be heard.

That does not mean every complaint is legitimate. Patients can be mistaken. Patients can misunderstand what happened. Patients can also make unreasonable complaints.

But that is exactly why there should be an independent investigation.

An independent investigator, who is not a physician regulating another physician, should examine the complaint and gather the facts.

If the evidence shows that the complaint has no merit, the investigator can recommend that it be dismissed.

But the recommendation should go to the civilian board for a final decision.

In other words, dismissal should be a decision based on an investigation, not simply a decision that ends the process before the patient has been heard.

What happens when complaints are dismissed?

There is another issue that deserves attention.

Under the current CPSA process, patients can request a review of certain dismissed complaints, but there is currently a non-refundable fee of $200 plus GST.

I question whether a patient should have to pay money simply to challenge a decision that their complaint should not proceed.

If we are serious about putting patients first, I believe there should be a way for a patient to request an independent review without having to pay a fee.

We don’t normally tell someone that they have to pay before they can challenge a decision made within a public justice system.

Healthcare regulation should also provide a fair avenue for review.

What about doctors who repeatedly fail patients?

I also believe the system needs to distinguish between an isolated incident and a repeated pattern.

Doctors sometimes have emergencies. A physician may be delayed because a patient is having a heart attack, because someone has died, or because another serious medical situation requires immediate attention.

Most reasonable patients understand that.

What is different is a repeated pattern of excessive delays, cancellations or failures to communicate with patients.

Imagine arriving early for an appointment and then sitting for 45 minutes or an hour without being told what is happening.

Patients have jobs. They have families. They may have driven several hours to attend an appointment. Some may have taken unpaid time off work.

If a physician repeatedly cancels appointments, repeatedly arrives substantially late or repeatedly fails to communicate with patients, I believe that should be considered a professional practice issue.

The CPSA has reported that a significant portion of complaints relate to practice management, including issues such as physician availability, office management and communication.

There should be progressive discipline when a pattern is established.

That could begin with education or a warning, followed by a reprimand or other measures if the behaviour continues. More serious or repeated conduct could result in stronger disciplinary action.

The point is not punishment.

The point is accountability.

We also have to remember history

There is another reason I believe safeguards are necessary.

Alberta has a difficult history involving eugenics.

The CPSA itself acknowledges that physicians participated in Alberta’s historical eugenics program, including through the appointment of physicians to the Sexual Sterilization Board, which operated from 1928 until 1972.

We cannot change that history.

Nor should today’s physicians be personally blamed for decisions made generations ago.

But institutions should learn from their history.

When an institution has been involved in serious mistakes in the past, one reasonable response is to create stronger safeguards against concentrated power and conflicts of interest in the future.

That is one reason I believe the public should have the final governing authority.

What about professional disagreement?

COVID also raised important questions about professional disagreement.

There were physicians who strongly supported public-health measures, and there were physicians who publicly disagreed with some of those measures.

That does not mean every opinion expressed by a physician was correct.

But it raises an important question: Who decides when professional disagreement becomes professional misconduct?

Physicians have professional obligations. Those obligations matter.

At the same time, medicine develops through debate, questioning and disagreement. A regulator must be careful not to turn legitimate disagreement into misconduct simply because an opinion is unpopular.

The answer should not depend on whether the people making the decision agree with the physician.

There should be clear standards, independent investigation, evidence and an accountable decision-making process.

Doctors deserve protection. Patients deserve protection.

Some people may hear this proposal and think I am suggesting that doctors should have no protections.

That is not what I am saying.

Doctors should have due process. They should be able to respond to allegations. They should have access to legal representation where appropriate. They should not be disciplined without evidence.

If a physician is accused of a criminal offence, the ordinary criminal justice system should deal with the criminal allegation.

But professional regulation is different.

The question is whether a physician has met the standards expected of someone entrusted with the health and safety of patients.

I believe that decision should ultimately be made by a body accountable to the public.

Transparency is essential

If Alberta created a civilian board, I would also want considerably more public transparency.

Albertans should be able to see how many complaints are received, how many are dismissed, how many are investigated, how many are resolved through other processes and how many proceed to disciplinary hearings.

The public does not need confidential patient information.

But we do need meaningful statistics.

If 1,000 complaints are received and 900 are dismissed, Albertans should know that.

If 100 are investigated and 20 result in discipline, Albertans should know that too.

Transparency allows the public to judge whether the system is working.

It also protects doctors because a transparent system can demonstrate when complaints are unsupported.

That is what a fair system should do: protect patients and protect professionals from unjustified allegations.

My proposal

So, what would I like to see?

I would like Alberta to seriously examine replacing the existing professional governing structure with an elected civilian board.

The board would:

• Be made up of ordinary Albertans, patients and taxpayers.
• Represent different geographic regions of Alberta.
• Have an odd number of voting members.
• Have fixed terms.
• Have no government-appointed voting members.
• Have physicians and other professionals available as non-voting advisers.
• Use independent investigators who are not physicians regulating physicians.
• Hear every complaint, while allowing investigators to recommend dismissal when evidence does not support the complaint.
• Provide a meaningful review process without requiring patients to pay a fee.
• Use progressive discipline when repeated problems are established.
• Publish meaningful statistics about complaints and disciplinary outcomes.
• Remain accountable to the people who ultimately fund and use Alberta’s healthcare system.

I am not saying patients are always right.

They aren’t.

I am saying patients deserve to be heard.

I am not saying doctors are always wrong.

They aren’t.

I am saying doctors should not be the only people with governing authority over the system that regulates them.

Doctors bring medical expertise to the table. Patients bring something different. They bring the experience of actually receiving healthcare.

Both perspectives matter.

But when the question is whether the regulator is serving the public, I believe the public should have the final say.

Questions for readers

1. Do you believe Alberta should continue with professional self-regulation, or should ordinary Albertans have the final governing authority over the body that regulates physicians?

2. Should a patient have to pay a fee to challenge the dismissal of a complaint, or should that review be available without charge?

3. Should repeated problems such as chronic cancellations, excessive delays or poor communication result in progressive discipline when a pattern is established?

I would genuinely like to hear what other Albertans think.

Healthcare belongs to all of us. Patients are also taxpayers, and taxpayers ultimately help fund the system.

Doctors deserve respect.

Patients deserve protection.

And above all, the patient must come first. Always.