A blog post published on the Canadian Medical Association website last week has made waves among doctors around the country — to the point where the CMA has removed it.
Dr. Louis Hugo Francescutti, a former president of the CMA, authored the March 15 post titled, Medical Professionalism Matters to Me. In it, he suggested doctors review their peers annually and work in salaried positions on one-year contracts that are renewed based on meeting certain performance standards.
"I think what we need to do is stop and take stock of $240 billion or so that Canadians are paying every year on this care system," Franscescutti told Halifax-based CBC Radio program Mainstreet.
"So what we need to say in 2016, are there some places around the world where they do it a lot better than us that we can learn from, and the example that I choose all the time is the Cleveland Clinic."
The Ohio clinic has physicians on salaried, one-year contracts, he says. They work with their peers constantly to measure their work and best practices within the organization.
Francescutti, a preventative and emergency medicine physician and professor in the School of Public Health at the University of Alberta, says he supports a one-year contract and salaried system for physicians in principle, but other changes are needed to make that work.
"Unless our systems are as sophisticated as the Cleveland Clinic, Intermountain or Kaiser Permanente, I would be the last physician in this country that would allow myself to work under a one-year contract," he said.
Using the hashtag #GoodDoctors, Francescutti's post spread like wildfire through the Canadian medical community.
Many physicians reacted angrily to the post, stating on Twitter and other social media that they contacted the CMA to request their dues back. The backlash was so strong that CMA CEO Tim Smith removed Francescutti's blog post and issued a formal apology to members.
The CMA declined an interview with Mainstreet Halifax.
Stepping up to the plate
Francescutti won't speak to the CMA's decision to pull his post, but says the reaction of some physicians is understandable.
"I think what's happened is in Ontario, doctors have been without a contract for two years and the government seems to not want to engage in a reasonable conversation with physicians," he said.
"Physicians are rightly frustrated, the government is not listening to them. I think I just happen to be the lightning rod that when they caught that sentence about one-year contracts and salaries, it invoked an emotional response and after that the Twitter world took over.
"Some physicians voiced their concerns and now we're having a discussion around it."
Enhancing the practise of medicine
In his blog, Francescutti also says physicians should continue to be peer-reviewed quarterly on their work, similar to their time in medical school or residency training.
"At the Cleveland Clinic this is designed not to be punitive — it's meant to enhance the practise of medicine," he said.
"Physicians are used to being peer-reviewed, that's how we got into medical school, that's how we got trained. Unfortunately when we practice, we lose that."
Interviewing patients to find out what they think of a doctor's performance is possible, he said.
Francescutti says he hopes the reaction to his blog post leads to everyone — doctors, governments, the public — thinking about their roles in improving health care.
"Instead of just assuming that it's business as usual, what I'm saying is as a profession, let's step up and be the first ones to say, 'Look, we're not afraid to be accountable, but you've got to give us the authority and the responsibility to make the changes that are necessary,'" he said.
"We know we have problems, we just can't whine about these problems, point fingers at other people. What we do need to do is assume responsibility and say can we do things differently. And that's what the blog was intended to do."
Fancescutti provided his blog post to CBC News. Read it here.