The Professional Practice of Physicians

Diversification of the Practice of Medicine

Under review

Having obtained a diploma from a faculty of medicine and a permit to practice from the Collège des médecins du Québec, physicians may practice their profession in settings as varied as the roles they may play. They may also engage in clinical or non-clinical activities or divide their time between the two.

As was explained earlier, the  medical clinician  practices in institutions such as a hospital centre, a CHSLD or a CLSC, in private practice or in one of the network’s new structures, notably the family medicine group (GMF). The clinician may also practice in spheres not covered by the public plan. In this case, the patient assumes the cost of the medical services provided.

A physician may also engage in activities and assume professional responsibilities of a non-clinical nature. Albeit less known, these are essential, very varied and increasingly recognized.

Thus, a physician may be an administrator. In the public sector, he or she may be a director of professional services or department head of an institution, for example. In the private sector, he or she may be the medical director of a pharmaceutical firm or parapublic agency such as Héma-Québec.

A physician may be a researcher,  either in a university research centre, a clinical research centre or in the private sector, for a pharmaceutical firm. Without being the principal researcher of a research project, the physician may also participate as a clinician in research projects. More and more physicians practicing outside institutions are also asked to participate in research projects.

A physician may also teach, either as a university professor or as a teacher in a facility used for training purposes. He or she may  also teach in other settings, notably by giving conferences in the context of scientific activities or by taking part in continuing professional development activities.

As well, some physicians may opt to work in public health. These are physicians who are specialists in public health or family physicians who have received additional university training in the public health field and in epidemiology. For the most part, they practice in CLSCs, in regional departments of public health, at the National Institute of Public Health or at the Direction de la santé publique of the MSSS.

Others work in medico-legal assessment, as experts in the context of their medical practice, either for a third party designated as principal or as employees of agencies that call upon the expertise of physicians, such as the Société d’assurance automobile du Québec (SAAQ) or the Commission de la santé et de la sécurité au travail (CSST). Thus they may be called upon to act as expert witnesses in court and to present the conclusions of their expert assessment.

A physician may also act as a  medical consultant, using his or her clinical competence to improve the conditions and quality of medical practice in organizations such as medical federations, the Collège des médecins, or various other bodies within the  MSSS.

A physician may also be a medical evaluation officer employed in the health services of a large company or as a consultant for an insurance company. Finally, a physician may have the medico-legal skills required by the Coroner’s office for purposes of investigating the cause of death.

In all cases, the same Code of Ethics and the same laws and regulations serve as a framework for determining good medical practice. The most recent versions of the Code of Ethics of Physicians and certain regulations include sections that specify the obligations of the physician in the practice of certain professional activities, notably those of the research-physician the medico-legal expert and the public health physician.

From the very beginning of their training, medical students and medical residents in their clinical training activities are bound by the same framework of rules and regulations applicable to all medical practice.

Medical practice will continue to diversify as knowledge in the field of medicine evolves and as new social needs emerge.

2011-04-04