The Peer Review Process - General Information
The Atlantic Provinces Medical Peer Review Program is an educational process sponsored co-operatively by the Medical Societies and Licensing Authorities in New Brunswick, Prince Edward Island and Newfoundland & Labrador. The program has been operational since 1993, and has now assessed more than 3500 physicians throughout the region. In the first few years, assessment was confined to Family Physicians. We currently assess physicians in some 26 different areas of practice, and strive to review eligible physicians every seven to ten years.
The Selection Process - Pre-screening
Each year, the Atlantic Provinces Medical Peer Review (APMPR) selects about 200 physicians who will be assessed through the onsite or offsite review process. Because APMPR works from the list of physicians published by the licensing authorities in three provinces, we have very limited information about physicians or their practice. And since the peer review program is confidential, we cannot obtain information from anyone but the physicians themselves. We have, therefore, developed a pre-screening form which provides us with enough basic information to determine if a physician is eligible to be reviewed at that time. If the physician is determined to be eligible, (s)he will be asked to complete a detailed “Physician Questionnaire” to give APMPR and the assessor assigned to the review more information about the physician and the type and scope of the practice.
Example of the Pre-Screening Form
In an onsite assessment, an assessor is named to visit the practice, a process which usually requires about three hours, and includes a review of patient files selected at random by the assessor. Following the file review, the assessor will meet with the physician for about an hour, to ensure that the impressions reached from the review are accurate. Although physicians may be present for the entire process if desired, their presence is only actually required for the interview portion.
Following the assessment visit, a report is submitted by the assessor to the APMPR Assessment Review Committee, a group comprised of physicians representing each of the APMPR member provinces. This committee reviews the report, and makes a decision on whether the practice is satisfactory, or what improvements may be required. Each assessment is categorized as follows: Category 1: practice satisfactory – no further action; Category 2: practice deficiencies identified – reassessment required; Category 3: practice deficiencies identified – interview required. Physicians normally receive the results of the review about three months or so following the onsite visit.
All physicians who are assessed are invited to complete post-visit questionnaires, many of which are returned each year. We have been pleased to observe from those questionnaires that after physicians overcome an initial apprehension about the process, the majority have found peer assessment to be a worthwhile experience
Below are the forms used for onsite assessment. These forms are for information only – physicians being assessed and assessors will access them through the sections of this web site pertinent to them.
- Physician Questionnaire
- Physician Questionnaire for Pathologists
- Assessment Report Forms:
- Management of Specific Disease Entities
- Post-Visit Questionnaire
- Physician’s Evaluation of Peer Review
Note: report forms are used with the permission of the College of Physicians and Surgeons of Ontario. We thank them for their support and generosity.
Offsite assessment is less in-depth than onsite review; it is a process which APMPR has included in its program structure since 2002. In that year, offsite was piloted and statistically proven to be a valid first-level review tool designed for physicians with a previous history of successful peer reviews, and occasionally for new physicians. It is currently limited to a small number of office-based practices including Cardiology, Family Medicine, Internal Medicine, Obstetrics & Gynaecology and Paediatrics. Consideration of demographic factors, along with a chart review, make up the offsite assessment process.
Physicians being assessed are asked to submit a Physician Questionnaire, which includes space for a brief autobiography, and copies of five patient charts, chosen from among patients with specific disease entities relative to the practice. We request the autobiography portion to allow APMPR a brief look at a physician’s life outside medicine, information that – in an onsite assessment – would usually be obtained during the interview with the physician at the end of the visit. APMPR believes it is important that physicians have additional interests outside their professional work. We are conscious that a physician who self-reports working alone with little free time, a heavy on-call schedule and no other interests may be at risk of physician burnout. It’s not that we’re “nosy” about your private life – we just want to know that you have one!
The type of charts to be submitted is noted in the “Instructions to Physicians” below. For example, Family Physicians will be requested to include Hypertension, Chronic Pain and Type II Diabetes. Paediatricians send charts from patients with Autism, Asthma and Seizure Management. An experienced APMPR assessor will evaluate the structure and contents of the charts, as well as the management of the disease entities, to determine if the practice appears to be satisfactory, or whether an onsite visit is required. It is important to note that APMPR does not normally provide physicians with the offsite assessment option each time they are reviewed. It is likely that a physician with a successful onsite review will be offered offsite the next time (s)he is eligible (in 5-7 years), but onsite again the time following.
Below are the forms used for offsite assessment. These forms are for information only – physicians being assessed and assessors will access them through the sections of this web site pertinent to them.