I find every day at the Royal College to be pretty exciting and exhilarating. If I were to pinpoint what exactly brought me to work here, I would say it was latent curiosity, on my part, as to what role the College could play in health care overall. This curiosity was happily matched by some perseverance on the part of the recruiters who were looking to fill the CEO position. The next thing I knew, I was moving with my family from Halifax to Ottawa.
In the 10 years that have passed, my most important recollection is not one thing, rather a stream of changes that have taken place. These have been years of considerable change, of growth and of the professionalization of certain Royal College processes — work immeasurably supported by superb volunteers and staff. The Royal College is now interacting in so many important ways with other medical organizations, agencies and institutions across Canada and around the world.
I am now more aware of, impressed by (and, admittedly, sometimes even alarmed by) the complexities of the educational training environment we live in. But I also believe, more than ever, in the Royal College’s important work along with partner organizations, medical schools, hospitals and health authorities. Yes, it’s a complex system but the College’s commitment to excellence, to patient service, to research and scholarship, and to teaching and continuous learning is something all Fellows and Canadians should be proud of.
On the world stage, we may be a small organization from a small country; but we exhibit leadership and the reason our leadership is so good is because we’re building on such a strong basis of expertise and voluntary effort. The uniform recognition of the value of the Royal College as a partner is extremely satisfying. To be recognized in a personal sense as the representative or leader of the College is deeply humbling.
More than 40 years after passing my exams, the Fellowship designation is to me an enduring mark of quality, service, compassion and collaboration — all of the things that are captured in CanMEDS. Why wouldn’t everyone take advantage of the built-in collegiality, specialty affiliations and nodes of expertise that are available through the College? My affiliation with the College has also provided me an opportunity to do what I like doing best, and hopefully do well, and that is to lead a terrific organization supported by a marvelous staff and extended by nearly 4000 volunteers working in behalf of the College and patients.
Thank you for your engagement and support these past 10 years.
2006-2016: Reflections on five areas of effort
In reflecting back on my years as CEO, I’ve provided some brief commentary on the areas where I think the College has really evolved.
- Member outreach: We tried, and we’re still trying, to increase and improve our programs to engage and support you (our Fellows). We want the Royal College to be relevant in both your day-to-day activities and work, and to fortify the long term professional stature that you so deservedly achieve in your practice community. I know most of our Fellows and members have so many affiliations, but I’ve always felt that membership in the Royal College is a bedrock qualification. It signifies the extraordinarily high quality of training and specialist certification our members achieve.
- Competence by Design: In my term as CEO, the College has professionalized many of its services like credentials, examinations and accreditation. More recently, we embarked upon a transformational change of a magnitude that only comes once every few generations to organizations and systems like ours in Canada. That transformation, which we call Competence by Design, has been a marvel of design because of the cooperation and input of so many people from so many jurisdictions. It’s drawn intense interest and commitment in terms of implementation (which is just getting underway). This project is extraordinarily important to the future of the health system because better standards will mean better doctors and better health care.
- International outreach: Our international work stands out for me because when it began it was new and different. It occupies a huge amount of time and is important and more beneficial than many Fellows and staff realize. In my view, the international outreach and collaborations that have been undertaken bring back so many new ideas, so much fresh energy and valuable perspectives to the College and our partners in Canada… it’s a compelling and growing sector of our activities.
- Membership categories: The College has been quite rightly described as being staid and very conservative in its approach to change. Some of that commentary is appropriate since high standards, once established, need not be radically changed on a short time cycle. On the other hand, some of the processes in the College need to be constantly reviewed and regularly updated. In respect to the criteria with which we admit Fellows, we have done a lot because we believe that it’s often better to bring people into the tent and help them rise to reach our standards and then go forth and operate by those standards, than it is to erect barriers or fences that keep people out of the organization. Our work, particularly in the areas or practice eligibility for specialists who are internationally-educated but who are already practising in Canada as specialists, I think has been a very important, timely and ultimately worthwhile endeavor.
- Balancing specialization with generalism: There’s always a dynamic tension between generalism and specialization, and the reality is we need both. Every modern medical system needs access to highly-qualified, narrowly-focused and concentrated expertise in certain areas. But we (the College) identified early on that there’s a limit to the systems-requirement and tolerance to further and further sub-specialization. That’s partly because, in doing so, we tend to remove people from the on-call system and put increasing pressures on those fewer and fewer people who are still open to general referrals and intake. In order to reduce the likelihood of additional subspecialties, while at the same time recognizing that there’s a need for consistent training and pan-Canadian standards for training, we developed the diploma program (a.k.a. areas of focused competence). The AFC (Diploma) program provides recognition of special training while answering the need for national standards. It enables health care professionals to focus on one area without at the same time abandoning the general area of the specialty or subspecialty. So far, we’re quite pleased with the uptake and interest.
Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer