Appointment and reappointment of doctors in Canadian hospitals

Abstract

The mechanisms are described by which medical staff are selected and reviewed in an average Canadian hospital. Unlike the United Kingdom, all clinical appointments have a defined term and the onus is upon the incumbent to indicate his suitability for continued appointment. Ultimate legal responsibility for the administrative and medical management of hospitals is that of a lay representative board which delegates authority to doctors nominated by their peers. Thus, the credentials committee is held responsible for the initial investigation and subsequent annual monitoring of all doctors with respect to professional and personal suitability to practise. It is suggested that, despite the differences in provision of health care in Canada, some of these concepts might be worthy of discussion in the United Kingdom. Possible guidelines on several of the issues now being debated in Britain concerning hospital doctors are already incorporated in the Canadian way of medical life. This does not mean that they necessarily provide answers, on either side of the Atlantic, but they may throw some light of experience on the form of contract and on the methods both of appointment and of monitoring the continuing suitability of individual doctors. Obviously there are major basic differences between the provision of health care in the two systems; some of these differences are inherent and inevitable, and others may offerproved alternatives for the National Health Service. For example, Canadian hospitals are run with relative autonomy by individual local boards within guidelines laid down at provincial and federal levels; few have any house staff unless specifically affiliated to a teaching hospital, and the role of the British junior doctor thus falls upon the general practitioners and specialists, who are, almost exclusively, independent contractors. In view of this lack of employment contract between doctors and hospitals, it may seem paradoxical that Canadian doctors are more explicitly regulated than their colleagues inBritain. One example relevant to this discussion is the monitoring of individual doctors. On btaining a postgraduate qualification and leaving a training grade, a hospital doctor in Britain is effectively independent of further review; but in Canada, regular review is a condition of continued practice in hospital. Moreover, since nearly all GPs in Canada work in hospitals as well as in the community, this review involves practically all doctors who havecompletedtraining Although the hospital board is responsible for the overall running of the hospital, considerable authority is delegated to the doctors (referred to as the ‘medical staff’ even if they are not employees) through the medical staff ‘bylaws’.1 This written document, agreed between the doctors and the board, defines what the board expects of the medical staff.