This post summarizes some lessons learned from my experience working with physicians on a particularly touchy subject – their performance. This is done to assist those working with physicians in the future, and those who lead performance appraisal (PA) activities for other highly autonomous professions (e.g., architects, professors, lawyers).
Working with physicians is both a joy and a challenge. Physicians are compassionate, motivated professionals with expertise needed for patient care and health system improvement. However, medicine is also a highly autonomous profession, resisting oversight or interference from government, administrators and private interests.
For the last half-century, the mantra “know thyself” underpinned PA approaches for physicians. Professional development and performance management activities were based entirely on self-assessment.  Few Canadian physicians receive feedback about where or how to improve their performance. Furthermore, many physicians have no forum to discuss improvement strategies with colleagues.  Physicians at my organization reported this approach left them “flying blind.” A medical leader reported his only PA occurred when he joined the organization in the 1980s. Another physician was told she had low self-confidence when she asked a colleague for feedback on how to improve her practice.
However, things are slowly changing. The medical establishment is increasingly familiar with the limitations of self-assessment. This includes the Royal College of Physicians and Surgeons, which now values assessment and feedback-related professional development activities at 3:1 maintenance-of-certification hours compared to 1:1 hours for conferences, clinical rounds and journal clubs.  Healthcare organizations have responded, and are providing new supports to assess and enhance physician performance, including multisource (360°) feedback, peer coaching, training, and regular feedback on quantitative performance metrics.
Well-designed PA approaches can capitalize on physicians’ competitive, analytical nature, and their motivation to improve care. While there is plenty of advice in the literature, here are four suggestions:
Ross Graham MSc CHE serves as the Leader, Physician Performance Enhancement at the Vancouver Island Health Authority. Ross is also an active health services researcher and has published on a variety of management and policy topics.
© CSIOP 2019.