Highlights from CFPC Board of Directors Meeting, November 9-10, 2015
A. Items approved by the Board:
Strategic Theme 1: Producing family doctors who meet societal needs through a commitment to continuing comprehensive care
· Approval of a business plan to address future requests for expansion of Certificates of Added Competence (CACs). It includes important principles regarding the establishment of CACs, for example the requirement to meet community need, that the competencies not be considered core competencies of the foundational family medicine residency program, that family physicians be involved in the development of the knowledge base for the domain. The preferred route to acquiring a CAC is the practice eligible route in responding to a community need. Board feedback emphasized the importance of changing our terminology to ‘upskilling’, to reflect this preference. It is CFPC’s hope that the acquisition of enhanced skills in family medicine can be supported, not only with availability of PGY-3 positions, but also with facilitation of re-entry PGY-3 positions, and of concentrated experiences in certain domains of care. It will be imperative to obtain support from universities and government to make the proposed changes. Additional resources will be required to implement additional CACs and the expenses will be recovered through the fees for acquiring a CAC.
o Special designations to be used by individuals acquiring and maintaining a CAC in the following domains of family medicine:
§ Care of the Elderly - CCFP(COE)
§ Palliative Care - CCFP(PC)
§ Family Practice Anesthesia - CCFP(FPA)
§ Sport and Exercise Medicine - CCFP(SEM)
§ Emergency Medicine - CCFP(EM)
o ‘Phase I’ of awarding CACs through the Leader and Residency Route in the domains of Palliative Care, Health Care of the Elderly, FP-Anesthesia, Sport & Exercise Medicine and Emergency Medicine: Application submission ends November 15, 2015. On track to award approximately 2,000 CACs.
· Section of Teachers Council Terms of Reference: mandate as a forum for educational consultation and relationship with other committees - three major committees will report to the Section of Teachers Council - Undergraduate Education, Postgraduate Education and Faculty Development. The Council will report to the new Family Medicine Specialty Committee.
· Alternative Route to Certification (ARC): renewed support for the current ARC to sunset as planned, with an end to new registrations on December 31, 2015. Further, that a plan for a new permanent alternative route to certification be developed for approval.
o The current ARC program has had its registration period extended a couple of times. There is concern that the current program was a temporary solution that has served its purpose and needs to be replaced with a process that proves equivalent to certification by examination over the long term.
o New registrations would cease on December 31, 2015 which means the program would need to continue for 18-24 months to give all the candidates time to complete.
o There is a clear ongoing need for a practice-based route to Certification, both for seasoned physicians and for new physicians (e.g. IMGs licensed after Practice-Ready Assessment).
· Support for sharing CFPC member names and emails with the Royal College of Physician and Surgeons of Canada (RCPSC) in order to conduct a survey about emergency medicine training / human resource needs in Canada.
o This survey is part of a CFPC-RCPSC-Canadian Association of Emergency Physicians initiative. It is intended to address perceived or real differences in the abilities of physicians with CCFP(EM) and FRCP-EM certification, to meet clinical and teaching needs. It is also asking for opinions on the effectiveness of the CFPC in achieving the stated goals of the CCFP and CCFP(EM) training programs (as well as the effectiveness of the RCPSC in achieving its stated goals for the FRCP-EM program).
o The survey is complete. No unexpected results.
· Triple C Competency-based curriculum - Commitment of $50,000 from the 2015/16 operating budget to carry out qualitative research necessary to understand the impact of Triple C and inform future educational and policy decisions.
o This qualitative element is in addition to the longitudinal resident surveys as well as the inventory being maintained across the 17 universities. The focus group based qualitative element will focus on the experiences of FM program stakeholders with the implementation of Triple C.
o In addition a Program Evaluation Advisory Group will be established to advise the Director of Education on an ongoing basis. This group is technical and intended to help with the first level of analysis, preparing data to be shared with various groups for their assistance in the interpretation of the data.
· Approval for budget to hire a temporary Director of Accreditation and approval for budget to contract for leadership services in Certification and Assessment.
o The increased workload in accreditation is in large part due to the alignment of accreditation standards. For Certification and Assessment, this is transition time following a Director-level retirement.
Strategic Theme 2: Supporting members in maintaining competence throughout their professional careers
· Approved principles for Mainpro+ Cycle credit reporting compliance, including a six week grace period for all Mainpro+ participants to enter and submit their activities for their most recent cycle and ‘Program Cycle Snapshot business rules’.
· Mainpro+ will be launched June 27, 2016.
· Updated the reciprocal agreement between the CFPC and the American Academy of Family Physicians regarding CPD.
· Committed $44,850 from the CPD Program Development Reserve Fund for Deloitte to assist in the development of a business plan for a CPD Program Development Fund - recommendations expected in Q1 of 2016.
· In recognition of the major public health crisis associated with opioid misuse in Canada, the board committed to supporting mandatory CPD in prescribing drugs of potential misuse and diversion, should licensing authorities move in this direction. We are also committed to developing a coordinated approach involving all relevant organizations and key players.
· The Strategic Initiatives Reserve Fund will be used to support the CPD Regional Educators from January 1 to May 31st, 2016 - this approval amends an oversight in the budgeting process.
Strategic Theme 4: Providing the organizational capacity to meet our strategic goals and objectives
· Approval of audited financial statements for the 17-month period ending May 31, 2015.
· Approval of the 2016-17 member fees, which were subsequently ratified by members at the Annual Meeting. A 2% increase effective 1 June 2016 will be applied.
· Updates to several financial policies: reserve policy (including rolling some reserves into the strategic initiatives reserve and adding new reserves and outlining their opening and minimum balance), capitalization policy (setting that the amortization starts from the date of delivery of equipment and furniture and from the date that software, intangibles and leasehold improvements are actually implemented/put to use), pension accounting approach (decision to adopt a ‘funding method’ which accounts for pensions in a manner that closely approximates a going concern entity), statement of investment objectives and guidelines for socially responsible investing (stipulating that the percentage of the total portfolio invested in equities will be within 35-45%, with a target of 40%).
· Support for the Nominating Committee report naming 11 Board Directors. With the approval of the Members at the Annual Meeting held November 12th, the proposed governance and stakeholder engagement changes were carried. This includes reducing the size of the board to 11 Directors based on skills and attributes, recruited from the full CFPC membership through an open call for interest.
o The 2015-16 Board of Directors:
§ Tom Bailey, MD, CCFP, FCFP, Director-at-Large
§ Guillaume Charbonneau, MD, CCFP, Secretary-Treasurer
§ Cathy Faulds, MD, CCFP, FCFP, Director-at-Large
§ Jennifer Hall, MD, CCFP, FCFP, President
§ Stephen Hawrylyshyn, MD, CCFP, Director-at-Large
§ Yordan Karaivanov, MD, CCFP, FCFP, Director-at-Large
§ Nadia Knarr, MD, CCFP, Director-at-Large
§ John Maxted, MD, CCFP, FCFP, Director-at-Large
§ Garey Mazowita, MD, CCFP, FCFP, Past-President
§ Paul Sawchuk, MD, CCFP, FCFP, Director-at-Large
§ David White, MD, CCFP, FCFP, President-Elect
§ Francine Lemire, MD CM, CCFP, FCFP, Executive Director and Chief Executive Officer (non-voting)
· Terms of reference updates approved for the following:
o Indigenous Health Working Group (including a three year renewal of this working group and a change in terminology from aboriginal to indigenous)
o First Five Years in Family Practice Committee (including a representative from each province as well as a representative from the Sections of Residents and Students)
o Section of Teachers Council (noted above)
o Section of Researchers Council (significant rewrite to align with how the Council is actually functioning - its terms of reference were quite out of date)
o Accreditation Committee
o Governance Advisory Committee
o Finance and Audit Committee
· Committee Chair appointments:
o Roxanne MacKnight – Child & Adolescent Health
o Jennifer Hall – Family Medicine Specialty
o Cathy Cervin - Research and Education Foundation
o Leonara Sara Lalla - Continuing Professional Development
o Francois Couturier - Global Health
o David Ross - Board of Examiners
o Stephen Hawrylyshyn - First Five Years in Practice
o Marc Bilodeau - Patient’s Medical Home
o Kathleen Horrey and Amy Tan - Undergraduate Education
o Nancy Fowler - Postgraduate Education
· Chapter By-law amendments for Quebec, Nova Scotia and Ontario.
Strategic Theme 6: Seizing all opportunities to build capacity in family medicine research
· Support to shift the $40,000 previously approved to hire a post-doc epidemiologist to work at Queen’s University as part of the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) on behalf of CFPC, to support CPCSSN’s application for the Canadian Institutes of Health Research (CIHR) chronic disease patient oriented research (SPOR) funding. In order for CPCSSN to use CFPC’s contribution to “seek matching funds from other sources” as required by CIHR, the $40,000 would go to CPCSSN and it would hire someone to do the above mentioned analysis on CFPC’s behalf. A similar result is anticipated but this shift is a meaningful contribution to help CPCSSN’s bid for funding. If the bid is unsuccessful we will return to the original plan.
Strategic Theme 7: Influencing the health policy environment to promote high quality care in family practice
· A policy paper exploring the concept of Basic Income (income unconditionally granted to all people on an individual basis, without a means test or requirement to work) and examining the evidence for its improvement of population health outcomes, was discussed. Although the issue of poverty is huge and beyond health and our area of expertise, the Board indicated it would like to explore the CFPC focusing on poverty through basic income, through a health lens.
· Support for three Call-to-Action papers developed by the Hypertension Advisory Committee (a group external to the CFPC which we participate on): “Minimizing the influence of commercial interests in healthy public food policies”; “Increasing Food and Nutrition Research, Monitoring and Evaluation”; and “A National Model for Defining Healthy and Unhealthy Foods and Beverages”.
B. Highlights of Board discussions:
Drs. Garey Mazowita and Francine Lemire presented the President’s and CEO’s reports respectively. The take-away messages were about owning our discipline, defining our discipline, re-calibrating and continuing to build on a strong foundation.
Strategic Theme 1: Producing family doctors who meet societal needs through a commitment to continuing comprehensive care
· Importance of seizing deliberate opportunities for the Chairs of Departments of Family Medicine to collaborate with and communicate with CFPC and its Chapters.
· Professor Lambert Schuwirth, an internationally renowned medical educator, was engaged to conduct an external review of CFPC’s certification process. On-site visit completed, report recently received and will be shared with the Board.
· Work of the Advancing Rural Family Medicine: Canadian Collaborative Taskforce is progressing. It produced a “Review of Family Medicine Within Rural and Remote Canada: Education, Practice and Policy”.
· “Fundamental Teaching Activities in Family Medicine: A Framework for Faculty Development” released.
Strategic Theme 2: Supporting members in maintaining competence throughout their professional careers
· CFPC provided feedback to the Federation of Medical Regulatory Authorities of Canada’s consultation process regarding Physician Practice Improvement (PPI). CFPC supports PPI in principle as it aligns with Mainpro+, the Future of Medical Education in Canada-CPD project, and other CFPC initiatives. The following recommendations were shared: that it acknowledge that CFPC’s role as one of the certifying colleges involved in the PPI system, includes our national work supported through the work of all our Chapters; that there be thought given to the challenges of physician self-assessment; that there be clarity on how this will be enforced, how the necessary change management requirements in each province will be achieved.
· Related to practice support, CFPC is collaborating with the Centre for Effective Practice; we are collaborating with the Society of Obstetricians and Gynecologists of Canada to develop educational supports for physicians prescribing mifepristone; Prevention in Hand was officially launched; a whiteboard video and related infographic material for patients are being developed related to Choosing Wisely Canada.
· Discussions with the American Board of Family Medicine of new strategies they are pursuing related to maintenance of certification for family physicians.
Strategic Theme 3: Engaging members throughout their professional careers
· The 2015 honour and awards recipients should be celebrated.
· E-Panel: recent topics have included physician assisted suicide, the federal election, mandatory prescribing related CPD - all topics where we have benefited from a glimpse of what our members are thinking.
· Acart Communications hired to assist in the development of CFPC’s marketing strategy. This firm comes highly recommended from the Royal College. The Marketing Working Group has CFPC and Chapter representatives.
· New online Fellowship application goes live January 1, 2016. Communiques have been sent to members including details about the Fellowship Council opportunity for current Fellows. Excellent response with over 300 replies to one email.
· Discussions with the Canadian Federation of Medical Students and the Resident Doctors of Canada about continued collaboration between our organizations.
Strategic Theme 4: Providing the organizational capacity to meet our strategic goals and objectives
· On target regarding time, scope, and budget, to achieve full PCI compliance by March 31, 2016 with audits and any revisions to be performed between April and the end of May 2016.
· New financial system adopted.
· Policy gap analysis underway.
· Implementation of the capacity review progressing well. Focusing on supporting the new Divisions and Departments.
· Governance Advisory Committee will be shifting its attention to reviewing the alignment of CFCP’s committees. This is a significant undertaking and will involve Chapters and members.