For review only. Surveys must be completed and submitted ...policyconsult.cpso.on.ca/wp-content/uploads/2016/... · A physician’s scope of practice evolves over a practice lifetime

Introduction

Scope of Practice

The College of Physicians and Surgeons of Ontario is currently holding a consultation on physician scope of practice.

The following survey will take approximately 25-35 minutes to complete. The survey is divided into two sections: one that asksphysicians questions about issues related to scope of practice more broadly and another that asks all respondents questions related tothe expectations set out in the College of Physicians and Surgeons of Ontario’s Changing Scope of Practice policy. On the Scope ofPractice consultation page, you can view the information about the College's consultation process along with a copy of the currentpolicy. Please be sure that you have enough time to complete the survey in one sitting as you will not be able to save your progressand complete the survey at a later date.

If you would like to review the questions prior to completing the survey, you can download a copy of the survey here.

Aggregate survey results and a summary of the open ended feedback will be posted on our website at the close of the consultationprocess, in accordance with the College's posting guidelines; however, the identity of all respondents will be kept confidential. All ofyour comments will be carefully considered as these issues are reviewed.

Thank you for your participation in this important initiative.

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For review only. Surveys must be completed and submitted online.

http://policyconsult.cpso.on.ca/?page_id=8292

http://www.cpso.on.ca/Policies-Publications/Policy/Changing-Scope-of-Practice

http://policyconsult.cpso.on.ca/wp-content/uploads/2016/04/SurveyMonkey_Scope.pdf

http://www.cpso.on.ca/Footer-Pages/The-Consultation-Process-and-Posting-Guidelines

About you

Scope of Practice

1. Do you live in...*

Ontario

Rest of Canada

Outside of Canada

Prefer not to say

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About you

Scope of Practice

2. Which province in Canada do you live in?*

British Columbia

Alberta

Manitoba

Saskatchewan

Quebec

Newfoundland and Labrador

Nova Scotia

Prince Edward Island

New Brunswick

Nunavut

Yukon

Northwest Territories

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Who are you...

Scope of Practice

3. Are you a...?*

Physician (including retired)

Medical Student

Member of the public

Other health care professional (including retired)

Organization

Prefer not to say

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About you

Scope of Practice

4. Please tell us which organization you are responding on behalf of:*

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The first part of this survey will be asking physicians questions related to the topic of physicianscope of practice more broadly to inform work that is taking place at the national level.

Scope of Practice - General

Scope of Practice

5. Many organizations have an interest in understanding physician scope of practice (i.e. what a doctor isdoing in their practice). As such, a variety of organizations collect this information for various purposes,using different methods. Please state your level of support for a single mechanism to collect thisinformation, and manage its use, with full consideration of confidentiality and privacy.

*

Strongly support

Somewhat support

Neutral

Somewhat oppose

Strongly oppose

6. Please elaborate on your response above. (Optional)

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Scope of Practice

7. Collecting information about physicians’ scopes of practice (e.g. the types of patients a physician caresfor, procedures performed, treatments provided, etc.) is undertaken by many regulatory colleges and usedfor a variety of activities such as selecting assessors for quality assurance activities. This information, de-identified and aggregated in a national data base, could be valuable to many healthcare initiatives such ashealth human resource planning and physician continuing professional development planning. Howvaluable do you think national database containing aggregate information about physicians’ scopes ofpractice would be?

*

Very valuable

Valuable

Average value

Limited value

Not valuable

Don’t know/not sure

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Scope of Practice

8. If you were asked to define your own scope of practice, how difficult would this be for you?*

Very easy

Easy

Neutral

Difficult

Very difficult

9. Please elaborate on your answer above. (Optional)

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Scope of Practice

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Strongly agree Somewhat agreeNeither agree nor

disagree Somewhat disagree Strongly disagree

A physician’s scope ofpractice evolves over apractice lifetime.

A physician’s scope ofpractice is unique toeach physician.

A physician’s scope ofpractice is determined inpart by training.

A physician’s scope ofpractice is determined inpart by certification.

A physician’s scope ofpractice is determined inpart by experience.

A physician’s scope ofpractice is influenced bythe continuingprofessionaldevelopment activitiesthat a physiciancompletes throughouttheir career.

Scope of practice isinfluenced by therelative amount of timephysicians spendpracticing within aspecific area.

External factors likesystems issues,resources, and paymentsystems impact aphysician’s scope ofpractice.

Non-clinical work (e.g.administration,research) is part of aphysician’s scope ofpractice.

10. Scope of practice can be described in many ways. Please state your level of agreement ordisagreement with the following statements related to scope of practice:*

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11. Please feel free to elaborate on your answers above. (Optional)

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Scope of Practice

12. What other factors influence a physician's scope of practice?*

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Over time, physicians may change the focus of their practice. Changes in scope of practice canoccur within a particular specialty and can also occur from one specialty to another.

Changing Scope of Practice - General

Scope of Practice

13. What is your specialty or subspecialty?*

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Scope of Practice

14. Are there any examples of common changes of scope within your speciality? If so, what are they?

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Over time a physician’s scope of practice may change significantly or may go through a naturalevolution. An evolution in practice may be characterized by the gradual development orprogression of a physician’s practice within a certain area in keeping with the direction of thespecialty. An example of a significant change in scope of practice is when a physician wishes topractice in a different field than that in which a physician was originally trained. A number offactors can cause a physician’s practice to evolve or to significantly change over time. Thefollowing questions will seek to explore the distinction between an evolution of practice and asignificant change in one’s scope of practice.


Scope of Practice

15. Based on the description of “evolution of practice” from above, do you think your scope of practice hasevolved over time?*

Yes

No

I don't know/not sure

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Scope of Practice

16. How has your scope of practice evolved over time?*

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Scope of Practice

17. What has influenced the evolution in your scope of practice?*

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Scope of Practice

18. Are there changes to one’s scope of practice that can be classified as an evolution in practice insteadof a significant change in practice? If so, please provide examples of scenarios that are classified as anevolution in practice instead of a significant change in practice.

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Scope of Practice

19. What are the factors that would suggest a physician has significantly changed their practice instead ofhaving undergone an evolution in practice?

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Scope of Practice

20. If a physician has narrowed their scope of practice would you consider that to be a significant changeof scope, or an evolution of practice? Please explain.

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Changing Scope of Practice- General

Scope of Practice

21. Has your scope of practice significantly changed over time?*

Yes

No


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Scope of Practice

22. What factors motivated you to significantly change your scope of practice?*

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Scope of Practice

23. What steps did you take to effect this significant change in scope?*

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The College’s Changing Scope of Practice policy is being reviewed concurrently with work relatedto scope of practice that is happening at the national level. This policy sets out expectations forphysicians who have changed or intend to change their scope of practice. The following questionswill specifically address content contained in the College’s Changing Scope of Practice policy andresponses will inform the College’s review of the current policy.

Changing Scope of Practice Policy Review

Scope of Practice



A physician’s scope ofpractice is determinedby the patients thephysician cares for.

A physician’s scope ofpractice is determinedby the procedures thephysician performs.

A physician’s scope ofpractice is determinedby the treatments thephysician provides.

A physician’s scope ofpractice is determinedby the environment inwhich the physicianpractises.

24. The definition of scope of practice set out in the CPSO’s current Changing Scope of Practice policyincludes the following: A physician’s scope of practice is determined by the patients the physician cares for,the procedures performed, the treatments provided, and the practice environment. Please indicate whetheryou agree or disagree with the following elements of the current definition:

*

25. Are there any elements of a physician’s scope of practice that are not included in the above definitionthat should be? If so, what are they?

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26. Please elaborate on your answers above. (Optional)

27. Are there any elements of a physician’s scope of practice that should not be included in the abovedefinition? If so, what are they?

28. Please elaborate on your answers above. (Optional)

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Scope of Practice

29. The current Changing Scope of Practice policy requires physicians to report a change in scope to theCollege if they are expanding or changing their area of focus. Is it also important for the College to beaware of physicians who narrow their scope of practice?

*

Yes

No


30. Please elaborate on your answer above. (Optional)

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Scope of Practice



A narrowing of aphysician’s scope ofpractice would requirere-training.

Re-training is onlyrequired when aphysician wants to workin a discipline other thanthe one in which thephysician is certified ortrained.

Working in a practicesetting (hospital, clinic,team-based practice)other than the one thephysician is experiencedin would require re-training.

Working in a differentgeographic setting fromthat in which thephysician is experiencedwould require re-training.

Working with orproviding treatment for apopulation that isdifferent from the one inwhich the physician isexperienced treatingwould require re-training.

31. Often physicians who wish to change an aspect of their practice must undergo training in order toensure they are competent to practice within the new area. Some changes in scope of practice wouldrequire re-training within the new area while others may not. Please state your level of agreement ordisagreement with the following statements:

*

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Working with orproviding treatment for apopulation that isdifferent from the one inwhich the physician isexperienced treatingwould require re-training.



32. If there are any other examples of changes to a physician’s practice that would require re-training thatare not captured above, please state them below.

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Scope of Practice


disagree Somewhat disagree Stronlgy disagree

A narrowing of aphysician’s scope ofpractice would requiresupervision.

Supervision is onlyrequired when aphysician wants to workin a discipline other thanthe one in which thephysician is certified ortrained.

Working in a practicesetting (hospital, clinic,team-based practice)other than the one inwhich the physician isexperienced wouldrequire supervision.

Working in a differentgeographic setting fromthat in which thephysician is experiencedwould requiresupervision.

Working with orproviding treatment for apopulation that isdifferent from the one inwhich the physician isexperienced treatingwould requiresupervision.

Performance ofinnovative techniques orprocedures that are newto the physician wouldrequire supervision.

33. Often physicians who wish to change an aspect of their practice must undergo supervision in order toensure they are competent to practice within the new area. Some changes in scope of practice wouldrequire supervision within the new area while others may not. Please state your level of agreement ordisagreement with the following statements:

*

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34. If there are any other examples of changes to a physician’s practice that would require supervision thatare not captured above, please state them below.

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For the next few questions it is important that you have read the current policy. If you have not readthe current policy, you will not be in a position to answer these questions and as such will beskipped over them. Your answers to all other questions will still be collected and analyzed. If youwould like to take a moment to read the current policy, you may do so by clicking here.


Scope of Practice

35. Have you read the Changing Scope of Practice policy?*

Yes

No

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http://www.cpso.on.ca/Policies-Publications/Policy/Changing-Scope-of-Practice


Scope of Practice



The policy clearlyarticulates physicians’obligations to report anintention to changescope of practice, to theCollege.

The policy is easy tounderstand.

The policy is clearlywritten.

The policy is wellorganized.

It is clear when thispolicy would apply.

The definition of “scopeof practice” is clear.

It is clear when asignificant change inscope occurs.

36. We’d like to understand whether the policy is clear. Please indicate whether you agree or disagree witheach of the following statements regarding the clarity of the policy.*

37. How can we improve the policy’s clarity? (Please feel free to elaborate on your answers above or touchon other issues relating to clarity)

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Scope of Practice

38. Is it clear from the current policy that that a physician must meet certain expectations before they canpractise in a new area?*

Yes

No


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Scope of Practice

39. Do you feel confident that you know what a significant change in scope of practice would be in yourpractice?*

Yes

No


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Scope of Practice

40. What tools would assist you in helping to determine whether you have significantly changed your scopeof practice?*

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Additional Feedback

Scope of Practice

41. If you have any additional comments that you have not yet provided, please provide them below, byemail, or through our online discussion forum.

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mailto:[email protected]?subject=Consultation feedback


Almost done!

We have just a few more questions for you regarding your experience and participation in Collegeconsultations. Your answers to these questions will help us improve our consultation process butare not required.

Consultation Experience

Scope of Practice

42. Would you like to be added to a mailing list to participate in future consultations?

No

No, I'm already on the mailing list

Yes (please provide your email address)

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Scope of Practice

43. How many College consultations have you/your organization participated in previously?

5 or more

3-4

1-2

None

Don't know

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Scope of Practice

44. How did you find out about this consultation? (Select all that apply)

Email from colleague/friend

Social Media (e.g. Facebook, Twitter, LinkedIn)

Dialogue/Patient Compass

College's Homepage

Council Update from the College

Consultation Specific Newsletter from the College

Other (please specify)

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Scope of Practice

45. Which of the following best describes why you/your organization participated in this consultation?(Select all that apply)

The issues were of personal or professional interest

Opportunity to express views directly to those making decisions

Wanted to exchange views with others

Was invited by the organization or someone involved in the issue

Other (please specify)

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Scope of Practice

Strongly agreeSomewhat

agreeNeither agreenor disagree

Somewhatdisagree

Stronglydisagree

I/we would only participate in future Collegeconsultations if the issue has a direct impact onme/my family/our organization.

My/our contribution to this consultation will have animpact on the final decisions made.

I/we appreciate the opportunity to contribute toCollege consultations.

This consultation survey was convenient and easyto complete.

The right questions were asked in this survey.

46. Please indicate whether you agree or disagree with each of the following statements.

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Scope of Practice

Have Already Intend to Will not

Online Discussion Forum (i.e.WordPress)

Email

Mail

47. In addition to the feedback provided through this survey, have you provided feedback through…

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Thank You!

Scope of Practice

Those are all the questions we have for you today. Aggregate survey results and a summary of open ended feedback will be posted onthe Scope of Practice consultation page at the close of the consultation process, in accordance with the College's posting guidelines;however, the identity of all respondents will be kept strictly confidential.

If you think that your friends or colleagues might be interested in this issue or completing this survey, please click here to send them aninvitation email.

The feedback obtained through this survey will be carefully reviewed alongside all other feedback collected through this consultationand will be used to inform national work related to scope of practice and to evaluate the current Changing Scope of Practice policy.

With respect to the policy review, while it may not be possible to ensure that every comment or suggested edit will be incorporated intothe revised draft, all comments will be carefully considered in light of the College's mandate to protect and serve the public interest.Once a draft policy has been developed, stakeholders will be invited to review the revised document and provide further feedbackbefore the policy is considered for final approval by College Council.

The College would like to thank you for your participation in this process.

Please press "done".

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http://www.cpso.on.ca/Footer-Pages/The-Consultation-Process-and-Posting-Guidelines

mailto:[email protected]?subject=Consultation feedback

Documents

For review only. Surveys must be completed and submitted ...policyconsult.cpso.on.ca/wp-content/uploads/2016/... · A physician’s scope of practice evolves over a practice lifetime