All physicians, physician assistants and medical learners must be registered with CPSA before they provide patient care in Alberta. We review the applicant’s education and qualifications, and assess skills when needed so patients receive the highest quality care. Registered members reaffirm their skills and professional development on an annual basis to renew their practice permit. We have the same expectations of all regulated members, including locums, physicians with Canadian credentials and those with international training to ensure they practice safely and competently.

Physician assessment is an important part of our work, and in 2021 we implemented improvements to our process for assessing the practice readiness of physicians coming into Alberta from outside Canada. We continued working with specialist assessors and, in collaboration with Alberta Health Services, we recruited and trained 18 new Family Medicine Assessors to perform these high-stakes assessments. As a result, our Registration team completed 20 per cent more assessments than during each of the previous two years and cleared a four-month assessment backlog, helping reduce barriers to community-based health care.

2021 also saw the initiation of a summative assessment for physicians who have timed out on the Provisional Register and have not met criteria for the General Register. To transfer to the General Register and continue practising in Alberta, these physicians must pass the summative assessment, which reviews their medical knowledge, procedural skills, clinical decision-making skills, communication and professionalism.

Physician assistants came under CPSA regulation on April 1, 2021. Physician assistants have played an important role in health care for decades, and we’re pleased to welcome them as the newest regulated member of Alberta’s healthcare team. We have added statistics on this growing part of our membership and look forward to updating physician assistant registration statistics annually.

Medicine is an ever-evolving practice and healthcare professionals must commit to life-long learning to ensure they continue to grow and improve, and Albertans continue to receive the best care possible. This is why our Continuing Competence team is committed to working with regulated members throughout their careers. Through innovative programs and educational tools (including the Physician Practice Improvement Program, Group Practice Review, MCC360® and Individual Practice Review), the goal is to provide support and resources that encourage self-reflection and a culture of continuous practice improvement.

As the pandemic continued into its second year, we were flexible with our regulated members, understanding that some needed to reschedule or defer their assessments due to COVID-19. After pivoting to virtual sessions in 2020 to protect everyone’s health and safety, Continuing Competence began slowly reintroducing on-site assessments in 2021. Practice improvement and ongoing competence is a journey, and we are here to empower and support the profession in their commitment to quality medical practice and improved patient outcomes.

2021 also saw our team continue working to prevent the spread of infection in medical clinics. We offered clear, timely guidance on public health measures to help regulated members and medical clinics navigate the third and fourth waves of the pandemic. We prioritized communication with our regulated members and with Albertans, with regular emails to the profession, online FAQs and guidance documents, and recommendations to reduce the risk of transmission within the clinical setting. Our dedicated COVID-19 email account received over 1,500 emails in 2021, with our team providing evidence-based responses to help regulated members and Albertans receive reliable information about everything from vaccinations to mask use. We also aligned our Medical Device Reprocessing (MDR) standards with the province’s standards to ensure a consistent approach across Alberta’s medical settings. The updated MDR standards, along with a host of tools and resources to help medical clinics understand and meet the updated standards, came into effect Jan. 1, 2022.

Research, data analytics and innovation not only help CPSA make evidence-based decisions, they are also crucial in allowing us to provide physicians and physician assistants with reliable, meaningful and updated resources that support high-quality patient care.

CPSA’s Analytics, Innovation & Research (AIR) team is made up of the Research and Evaluation Unit (REVU), the Physician Prescribing Practices (PPP) program and the Tracked Prescription Program (TPP Alberta), Alberta’s prescription drug-monitoring program administered by CPSA.

Much like we encourage regulated members to review data to improve their practice, the AIR team relies on feedback from the profession to improve the educational tools and resources CPSA provides. In the past, physicians expressed an interest in knowing more about their antibiotic prescribing, so in 2021, PPP worked on mobilizing antibiotic prescribing data from TPP Alberta. To support care providers in addressing public health concerns like antimicrobial resistance, individualized MD Snapshot-Prescribing reports were developed for all Alberta physicians. We also produced broad-based reports about antibiotic prescribing trends in Alberta.

PPP’s vision is to actively support patient-centred care, continuous quality improvement and interdisciplinary collaboration, and to empower prescribers to provide the safest and most appropriate care to their patients by using data and evidence-based approaches.

Committed to helping physicians improve their practice and provide excellent patient care through self-reflection and education, the AIR team and the tools and resources they’ve developed provide physicians with individualized information. This identifies opportunities for improvement in their practice, while also supporting greater awareness of their prescribing and medical practice over time.

Also in 2021, members of the REVU team contributed to three peer-reviewed manuscripts, adding to the evidence-based literature on various aspects of medical regulation:

• A review of multi-source feedback focusing on psychometrics, pitfalls and some possible solutions

• Reducing prescribing of benzodiazepines in older adults: a comparison of four physician-focused interventions by a medical regulatory authority

• Exploring content relationships among components of a multisource feedback program

When a regulated member has a health condition affecting their medical practice, our Physician Health Monitoring Program (PHMP) works with regulated members in a confidential and individualized manner to ensure they have the tools and supports needed to take care of themselves—and by extension, their patients. With the regulated member’s consent, we also collaborate with their health providers and the Alberta Medical Association’s Physician and Family Support Program to maximize available resources.

This unique and personal approach allows the majority of physicians working with PHMP to successfully balance their own health with their clinical responsibilities. The vast majority of regulated members in PHMP continue to practise with minimal, if any, disruption to their work.

2021 was another difficult year with COVID-19. We saw Alberta’s healthcare system and care providers stretched to capacity. Not surprisingly, a number of regulated members contacted our PHMP program for guidance, resources and support—and we did our best to listen, understand and respond, knowing our regulated members deserve the same care and compassion they provide to patients. Fortunately, there was no significant increase in health conditions reported in 2021.

Types of Monitoring:

Health monitoring

The regulated member’s care providers periodically provide brief, confidential fitness-to-practise updates to PHMP.

Practice monitoring

A trusted colleague at the regulated member’s workplace provides periodic reports to PHMP regarding clinical performance and professional conduct.

Biological monitoring

Third-party consultants collect and interpret a regulated member’s breath or urine samples. PHMP uses this form of monitoring for those recovering from a substance use disorder.

Practice Conditions Monitoring Program

Our PHMP team lends their monitoring skills and experience to CPSA’s Practice Conditions Monitoring Program (PCMP). PCMP monitors compliance with practice conditions that may be imposed on a regulated member by various areas of CPSA, such as Professional Conduct or by a Hearing Tribunal. Types of practice conditions monitored include, but are not limited to, chaperone or prescribing conditions, restrictions to a regulated member’s type of practice, limits to a regulated member’s maximum weekly work hours or number of patients, restrictions on performing certain procedures, and patient age limits.

The Health Professions Act grants CPSA the authority, with consent, to obtain data such as patient charts and billing information from our trusted partners within the healthcare system to confirm regulated members are compliant with their practice condition.

CPSA recognizes most regulated members want to do right by their patients, and most with a practice condition often have the best intentions when it comes to providing good, safe medical care. Members of our PHMP team work closely with regulated members who have a practice condition to ensure a clear and complete understanding of the condition and help minimize the risk of intentional or inadvertent noncompliance, keeping patients safe.

Chaperone program: how we support positive patient encounters

As part of its practice condition monitoring processes, PHMP administers a chaperone program to use qualified chaperones when required as part of a CPSA-imposed practice condition.

When regulated members need a chaperone present during patient encounters, the program works to outline CPSA’s expectations, chaperone roles and responsibilities, and reporting requirements. Properly trained chaperones work independently to observe examinations and procedures, adding a layer of protection to both patients and regulated members. The program also visits clinics periodically to confirm chaperone compliance and offer additional support and resources.

At some point in their medical careers, most physicians will experience a complaint. CPSA has a responsibility to ensure regulated members abide by CPSA’s Standards of Practice and provide professional, ethical medical care. This means any complaint we receive must be taken seriously.

CPSA is a learning organization and our Professional Conduct team takes an educational approach to complaints resolution whenever possible. The goal is to work with regulated members to identify opportunities for education and growth, resolving complaints informally with the complainants’ permission if we can. Occasionally, a complaint merits a formal hearing where an independent Tribunal can weigh the facts and determine guilt and, if appropriate, a sanction that provides an appropriate deterrent and opportunity for learning.

The Professional Conduct team knows the complaints process can be difficult and stressful for both regulated members and complainants, and is committed to a process that is fair, timely and professional. In 2021, we began a careful review of our complaints policies and procedures to identify ways to streamline the process going forward and make it as straightforward as possible. Towards that goal, we’re working to enhance the mutual understanding between the patient and the regulated member by enabling the regulated member to provide an initial response at the start of the complaints process. This will provide our Professional Conduct team with more information to make informed decisions and initiate an appropriate response at the early stages of a complaint.

We are also further developing a process for early consensual resolution in cases where lengthy and expensive investigations may not be the best approach. In addition, we are investing in our team through focused training and development, ensuring we can meet the demands of managing complaints in an ever-evolving landscape.

Protecting patients means ensuring regulated members are clear on the boundaries and inherent power imbalances that exist in their professional relationship with patients. Alberta’s Patient Relations legislation under the Health Professions Act (HPA) mandates a zero-tolerance policy for any regulated healthcare professional found guilty of sexual abuse or sexual misconduct. For incidents that took place on or after the legislation’s implementation on April 1, 2019, CPSA regulated members found guilty of sexual abuse face automatic, permanent cancellation of their practice permit, while regulated members who are guilty of sexual misconduct receive, at minimum, automatic licence suspension.

In 2021, we introduced part two of our mandatory Patient Relations training module, which regulated members were required to complete to renew their practice permits for 2022. CPSA launched part one of the module in 2019 in partnership with the University of Calgary.

CPSA’s standards on Boundary Violations: Sexual and Boundary Violations: Personal identify our expectations for appropriate conduct during patient interactions, and our advice to the profession documents provide additional guidance for regulated members.

How are patients impacted by the legislation?

Our Patient Relations program supports patients who come forward about situations involving sexual abuse or sexual misconduct by a CPSA regulated member. With the Patient Relations legislation, any patient who comes forward to CPSA can receive support from a third-party counselling service, free of charge.

If you’ve been for blood work, an x-ray or another diagnostic or out-of-hospital medical service, you were likely in a CPSA-accredited facility. CPSA is responsible for supporting these facilities in providing safe, quality care and meeting our high standards so Albertans can be confident in the services they receive.

Our Accreditation team works with committees and experts to develop and apply standards that help facilities create cultures of quality improvement, as well as strong assurance systems to keep their progress on track and maintain patient safety. We assess facilities when they first open or anytime they renovate, move or add a new service. We also reevaluate them every four years and if a complaint or concern is raised.

To adapt to the COVID-19 pandemic, our Accreditation team introduced a hybrid model for diagnostic and non-hospital surgical facility facilitation assessments. Through 2021, we continued combining virtual and in-person elements to reduce the number of assessors and the time they spent on site at facilities. We prioritized patient and staff safety by ensuring high-risk elements were assessed on site, along with activities that required direct observation or validation. Meetings and interviews were conducted virtually whenever possible.

Patient care is at the core of our work. In 2021, our Accreditation team supported facilities in bringing their much-needed skills to help care for Albertans whose health was affected—directly or indirectly—by COVID-19.

We collaborated with Alberta Health and Alberta Health Services throughout the year to expand the role of nonhospital surgical facilities to support the Alberta Surgical Initiative (ASI) and the uptake of services to address the pandemic surgical backlog.

In 2022, we will begin enforcing all accreditation-related requirements in the Health Professions Act (HPA)— specifically, the requirement that regulated members do not refer patients for testing at unaccredited facilities. Through 2021, we worked to accredit approximately 100 sleep medicine diagnostic facilities to align with the HPA, ensuring Albertans have safe, competent care from their sleep medicine diagnostic facilities.

Facilities we accredit and support

• Cardiac Stress Testing

• Diagnostic Imaging

• Diagnostic Laboratory Medicine

• Hyperbaric Oxygen Therapy

• Neurodiagnostics

• Non-Hospital Surgical Facilities

• Pulmonary Function Diagnostics

• Sleep Medicine Diagnostics

Albertans expect safe, high-quality medical care from their care providers at every interaction. CPSA supports patient safety by setting standards for care and holding regulated members to those standards.

CPSA’s Standards of Practice and Code of Conduct, and the Canadian Medical Association’s Code of Ethics and Professionalism are guiding documents that lay out the minimum expectations for ethical medical practice in Alberta. Often referenced in CPSA’s complaints and hearings processes, these documents are enforceable under the Health Professions Act (HPA) and help Albertans feel confident their providers are held to a high standard.

While CPSA’s Standards of Practice set the minimum expectations for professional behavior and conduct, regulated members are encouraged to exceed these expectations in care delivery. In 2021, CPSA had 40 standards of practice and 31 advice to the profession documents to set expectations and provide scenario-based guidance, to support regulated members in their practice. CPSA’s Standards of Practice team also answers questions from regulated members and provides information to Albertans on what to expect during care interactions through advice to Albertans documents, of which there were five in 2021.

In 2021, CPSA reviewed the following standards during two separate consultation periods:

• Cannabis for Medical Purposes

• Continuity of Care

• Episodic Care

• Virtual Care (formerly Telemedicine)

The following updated standards took effect in 2021:

• Advertising

• Cannabis for Medical Purposes

• Closing or Leaving a Medical Practice

• Conflict of Interest

• Job Action

• Practising Outside of Established Conventional Medicine (formerly Complementary and Alternative Medicine)

• Relocating a Medical Practice

Did you know? Now that physician assistants are formally regulated by CPSA, they are held to the same standards as physicians.