Challenges and opportunities to ensure effective physician leadership in Canada

Dennis Kendel, MD

Several thousand Canadian physicians serve in formal leadership roles. Medical leadership positions may be full or part time. They may be based in health authorities, hospitals, medical schools, medical regulatory and advocacy organizations, cancer agencies, health ministries, or community-based health service programs. The titles attached to these positions may be CEO, chief of staff, senior medical officer, VP medicine, medical or academic department head, dean, college registrar, public health officer, or medical director.


Although highly structured medical residency programs prepare physicians for their clinical careers, no standardized educational pathways exist to guide one into medical leadership roles. Some physicians complete master’s of business administration programs, some take PMI courses, and others access a growing array of generic leadership skill development programs. Regrettably, some physicians take on leadership with no explicit educational preparation. Top


Some leadership positions are filled through rigorous recruitment and selection processes. Others are filled through reluctant volunteerism or peer coercion. Once in these leadership roles, some physicians are offered or arrange for ongoing support and learning through mentorship and coaching. Some simply “fly by the seat of their pants.”


Recently, I was asked to offer an opinion about how effectively most physicians are serving in this diverse array of medical leadership roles in Canada. I had to confess that my opinion could be based on little more than anecdotal awareness of some fantastic physician leaders and some who have failed miserably. I am not aware of any mechanism in Canada to measure objectively our profession’s collective performance in formal leadership roles. Top


However, I am aware of evidence that there may be considerable room for improvement in some facets of medical leadership and leadership development in Canada. That evidence has come through dialogue with physician colleagues at the Canadian Medical Protective Association (CMPA), an organization that I very much respect.


The CMPA provides peer guidance and support as well as legal support to physicians who face civil litigation related to their practice as well as investigation or discipline by colleges of physicians and surgeons, health authorities, hospitals, and governmental paying agencies. One might expect that the CMPA would be pleased any time it is able to prevent a physician member from being subjected to any penalty or sanction by any of these agencies. Such a perception would be short-sighted. Top


We need to remember that the CMPA is a medical organization with over 40 physicians on staff and governed by an elected physician council. These physicians are subject to the same CMA Code of Ethics that pertains to all of us. They are no less committed to safe, high-quality patient care than are their clinical colleagues.


Colleagues at the CMPA have shared with me concern about the frequency with which interventions by health authorities and hospitals in response to perceived physician misconduct or incompetence are thwarted or overturned on appeal because of failure to follow procedures set out in health authority or hospital bylaws. Most medical staff bylaws include provisions to ensure procedural fairness and due process in dealing with alleged physician misconduct or incompetence. Physicians in formal leadership roles in health authorities and hospitals seem to overlook or disregard these provisions with troubling frequency. Top


Although this situation enables the CMPA to easily declare “victory” for the implicated physician, it may be a pyrrhic victory. If the physician’s performance or conduct is, indeed, putting patients at risk of harm, the CMPA will find itself engaged in subsequent proceedings, and patients may indeed suffer preventable harm in the interim. The CMPA’s organizational values make it sensitive to preventable patient harm. It is as committed to prevention of patient harm as the Canadian Patient Safety Institute.


My CMPA colleagues note that, with rare exceptions, interventions undertaken by the colleges of physicians and surgeons are not so fraught with failure to adhere to principles of procedural fairness. I am prompted, therefore, to consider what differences in physician leadership at the colleges versus the health authorities and hospitals may account for this variance. Could it be because physician leaders at the colleges serve in full-time positions and deal with such issues daily, whereas physician leaders at health authorities and hospitals are part time and may deal with such cases infrequently? Could it be because physician leaders at the colleges are appointed through competitive and well-structured selection processes, whereas many health authority and hospital leaders are volunteers who may have been reluctant to accept the role, but were pressured to do so because it was “their turn”? Could the variance be attributable to differences in education preparation for the leadership roles and ongoing mentoring/support once in the roles? Top


I believe this issue calls out for some reflection and action by our profession. We may be placing patients at protracted risk of preventable harm if we ignore it. We may also be compromising our profession’s collective leadership reputation.


I expect the CMPA would be very pleased to partner with a number of other medical organizations to study this issue and identify strategies for improvement. This might be an opportunity for the Canadian Society of Physician Executives (CSPE) to step forward to offer to work with the CMPA in addressing this challenge.



Dr. Dennis Kendel became a strategic planning consultant in 2011 after serving for many years as registrar and CEO of the College of Physicians & Surgeons of Saskatchewan. He is a founding member of the CSPE and received its award for Excellence in Physician Leadership in 2010.

Correspondence to: denniskendel@gmail.com


This article has been reviewed by a panel of physician leaders.