Physicians should never abruptly cease their patients’ access to
opioids, nor should they rapidly taper their patients’ doses
Advice or Remedial Self-Study
Where minor issues are identified, advice will be given
to the physician to improve future practice or the physi-
cian may be required to participate in self-study with
follow-up from the College to ensure the identified
learning needs have been addressed.
If an investigation results in advice, or remedial self-
study, the outcomes will not be available on the public
register.
Mandated Remediation
The College will take a remedial approach, whenever
appropriate, to help physicians practise to current stan-
dards. Our goal, where possible, is to support education
and continued prescribing under supervision, where the
physician’s capacity for remediation is apparent.
The terms of a physician’s mandated remediation are
set out in an “undertaking”, which is a binding and
enforceable agreement between the College and the
physician. In general, undertakings set out an obliga-
tion or restriction that a physician is giving to the Col-
lege (i.e., an agreement by the doctor to participate in
remediation; practise under clinical supervision; cease
to practise medicine; or abide by practice restrictions,
such as no longer being permitted to prescribe narcot-
ics and controlled drugs).
Undertakings to Complete Individualized Education;
Clinical Supervision; Reassessment
The majority of physicians with identified learning
needs have undertaken to participate in and successfully
complete an individualized education plan developed
by the College. The elements of professional education
include completion of the University of Toronto Faculty
of Medicine program in Safer Opioid Prescribing; and
may include the U of T’s Medical Record-Keeping
Course. Additionally, a review of a number of resources
(e.g., College's Prescribing Drugs policy; 2017 Cana-
dian Guideline for Opioids for Chronic Non-Cancer Pain,
etc.) is generally undertaken.
Physicians practise under the guidance of a clinical
supervisor, over a graduated period of time, who oversees
completion of the educational plan. The level of super-
vision is reduced to the next phase only when recom-
mended by the clinical supervisor and approved by the
College. After successful completion of the period of
clinical supervision, each physician is reassessed to gauge
improvement. In some cases, a physician may also receive
a caution from the committee that oversees investiga-
tions, regarding specific aspects of his or her practice, or
professionalism or conduct. Each physician’s undertaking
will be posted on his/her profile on the public register
while the terms of the undertaking remain in effect.
Undertakings Imposing Prescribing Restrictions
In a small number of cases, physicians have under-
taken to no longer prescribe narcotics and controlled
drugs. In some cases, a physician may also receive a
caution from the committee that oversees investiga-
tions, regarding specific aspects of his or her practice,
or pro fessionalism or conduct.
This information is on the public register.
➢Undertakings to No Longer Practise Medicine
In a small number of cases, physicians have under-
taken to no longer practise medicine in Ontario. This
information is on the public register.
Referrals to Discipline
Where a physician has been referred to the Discipline
Committee, the Notice of Hearing, which sets out the
allegation(s), is on the public register. Any practice
restrictions, if ordered pending the outcome of the
hearing, are on the public register.
MD
ISSUE 1, 2018 DIALOGUE
21