What is PPEP? 

The Physician Practice Enhancement Program (PPEP) is a quality improvement program of the College of Physicians and Surgeons of British Columbia. It is not an audit, exam, or disciplinary process. Instead, the primary purpose of this program is quality improvement with an educational focus, designed to identify areas in which physicians meet or exceed expectations and areas of opportunity for to improve their practice. The PPEP supports the College’s mission of serving the public through excellence and professionalism in medical practice. To fulfill that role, the PPEP conducts periodic assessments of physicians, providing practice guidance and ensuring that high standards of practice are met. The PPEP applies to all physicians who have their own practice, practise as part of a multi-physician clinic, and work as long-term and short-term locums.

If a physician receives a letter from the College stating that s/he has been chosen to undergo a review by the PPEP, is participation required?

Yes, participation is mandated by the Health Professions Act, RSBC 1996, c.183, and sections 1-19 and 9-1 of the College Bylaws made under the Act; however, it is not a disciplinary process. Selected physicians are not the subject of a College investigation. PPEP is designed as a quality improvement program with an educational focus.  Feedback from physicians assessed by the program indicates that the majority find their experience worthwhile. Only very rarely (less than 1% of cases in 2015/16) do assessors identify concerns in a practice that require referring a physician to the College Inquiry Committee.

Why would a physician be chosen for an assessment?

All community-based physicians in British Columbia will participate in periodic assessments. Physicians working in an unsupported or isolated environment, as well as physicians over the age of 70, benefit from peer assessments. The College has therefore prioritized these physicians. The majority of physicians are randomly selected and, for reasons of efficiency, all physician colleagues working at the same clinic are assessed at the same time. Any systemic issues identified in the clinic that affect all physicians can be addressed simultaneously.

How often will a physician be assessed?

The assessment cycle is set by the Physician Practice Enhancement Panel of the Quality Assurance Committee. It is based on the review of the initial assessment and may take place at any time every one to ten years. On average, a seven to eight-year cycle should be anticipated. Physicians aged 70 or above are assessed on a three-year assessment cycle, based on the date of their previous assessment.

What evidence does the College have that the peer assessment process has any merit?

The efficacy of peer assessments has been well established in the research literature since the 1980s and 90s. Most physician regulating bodies have adopted some form of the peer practice assessment. The College of Physicians and Surgeons of Ontario implemented its original peer assessment program in 1980. Through evaluation of program data on thousands of physicians, it found that physicians who receive assistance from that College perform better, six years later, compared to a group of physicians assessed for the first time.1

Further studies have demonstrated that providing detailed individualized feedback and optimizing the one-to-one interaction between assessors and physicians is a promising method for further improving physician behaviour.2

  1. Norton, PG, Dunn, EV, Beckett, R, Faulkner, D, Long-term follow-up in the peer assessment program for nonspecialist physicians in Ontario, Canada, Joint Commission Journal, June 1998.
  2. Miller, A., Archer, J. Impact of workplace based assessment on doctors’ education and performance; a systemic review. BMJ 2010;341:c5064

What evidence does the College have that the multi-source feedback (MSF) process has any merit?

Other colleges in Alberta, Nova Scotia and Manitoba, have more than 25 years of collective experience with the Physician Achievement Review Program, which is similar to this College’s MSF component. While it is very difficult to gauge improvement in patient outcomes or complaints, it is apparent that most physicians feel the MSF tool provides information on aspects of the CanMEDS competencies, such as communication and collaboration, which cannot be assessed by a peer review alone. Studies have shown that improvements in physician performance occur after participation in a MSF program.1 The College will continue to gather information to gauge the value of this program to both the public and physicians.

  1. Violato, C., Lockyer, J., Fidler, H. Changes in Performance: a 5-year longitudinal study of participants in a multi-source feedback programme. Medical Education 2008: 42: 1007–1013.

Can a physician opt out of the multi-source feedback component?

The MSF is part of the PPEP assessment. There are, however, situations where certain components of the MSF may not be applicable. Program staff will review applicability on a case-by-case basis.

Why should an experienced physician who has never been subject of a complaint be assessed?

The PPEP does not initiate assessments based on complaints received by the College. The PPEP is an educational and collegial program. The assessment is to be viewed as a tool for learning and gaining greater insight into a physician’s practice.

Is a physician’s participation in PPEP in any way related to an MSP audit?

No. This is not part of an audit by MSP or any other authority that carries out audits. A physician’s billing is not reviewed as part of this assessment.

What happens to information that is collected about a physician and a physician’s practice as part of PPEP?

All information collected through the PPEP is confidential, protected, and will only be used by the program to guide learning and, in some instances, to direct recommended outcome activities. Without a physician’s permission, the information gathered through PPEP cannot be shared with other areas of the College, including any disciplinary processes. The on-site feedback questionnaire and post-assessment feedback questionnaire collected from registrants after the peer practice assessment is completed are viewed only by program staff for data entry and collation. Only de-identified, aggregated data are provided to the Physician Practice Enhancement Panel.


Does the College assess physicians who work in a hospital setting?

At this time, information from quality assurance activities conducted by the hospital cannot be shared with the College and vice versa. As such, the College focuses its activities on physicians who work outside the hospital environment, including private facilities.

While the intent is not to duplicate efforts, it is recognized that a family physician working as a hospitalist or emergency physician is different from that of a community family physician and therefore may require a separate review. Physicians are still required to complete the pre-visit questionnaire should they receive one.  Physicians must indicate where and when they last worked and at which location they wish to be assessed. The information is reviewed by PPEP staff to determine whether an assessment should take place. If there has been little or no community-based work for six to 12 months, the assessment may be deferred or cancelled. 

Does the College assess physicians who work exclusively in the ER?

ER physicians are with full, active practising GP licences and are required to complete the pre-visit questionnaire. If their activity does not include any community-based practice, they will not be assessed.

Is it fair for an assessment to take place in an office that does not belong to the physician subject to participation in PPEP?

The Physician Practice Enhancement Program is a mandatory process. All physicians selected by the College for assessment, including locums, must engage in the PPEP (section 1-19 and 9-1 of the College Bylaws).  The assessor will require a workspace to review charts and conduct the interview. In situations where locum physicians are assessed at multi-physician clinics, PPEP staff will determine whether other physicians at that location will be assessed in order to reduce clinic disruption. The assessor will make every effort to minimize disruptions to the clinic.

Does the College have authority to assess the office and charts in a private location? What about patient confidentiality? Are patients required to give consent before the College can review their records?

The College has the authority to assess these offices and charts wherever physicians engage in the practice of medicine. Patient consent to view records for this purpose is not required; see sections 1-19 and 9-1 of the College Bylaws under the Health Professions Act. It is the responsibility of the physician being assessed to inform those working at the location that an assessor from the College will be visiting the premises.

If a physician does not have an office where s/he regularly works locum shifts, is participation in PPEP still required?

Yes. Physicians will be required to select as the assessment location the clinic where they have completed the most shifts over the past three to six months. Physicians who cannot be present at the selected clinic when the assessor is scheduled to be on site must contact that assessor to make alternative arrangements.

What is the process for the office assessment component of a physician’s review?

When first selected for participation in PPEP, physicians will have completed a pre-visit questionnaire. Solo physicians will have completed a series of office-related questions. If the assessment location is a multi-physician clinic, the medical director is responsible for completing the office-related questions. During the on-site visit, the peer assessor will proceed with the office assessment. Based on the office assessment report, the program staff will determine whether any office-related follow-up is required. With the rollout of the recently enhanced office assessment process, there will be a greater emphasis on the role and responsibilities of the clinic’s medical director to address any office-related concerns.

For physicians who have a narrow scope of practice, how can the College conduct an accurate assessment when a true “peer” cannot be found?

The PPEP endeavors to match an assessor with similar expertise in the area of care to conduct the assessment. Should assessees have concerns regarding the assessor’s scope of practice, they are encouraged to contact program staff.

Physicians should note that by limiting their scope of practice, they may be subject to the requirements outlined in sections 2-3(2)(c) and 2-8(2) of the College Bylaws should they wish to re-enter clinical practice or change the focus of their current practice.

Retirement/part-time work

Do physicians who have no locum/walk-in shifts planned for the future or who only take occasional shifts need to be assessed?

Physicians must complete the pre-visit questionnaire to provide information regarding their practice activity. For example, they will be required to indicate the number of community-based shifts they have worked in the past three to six months, the locum location, and number of days worked. The PPEP staff will review the completed pre-visit questionnaire and determine whether an assessment is deferred or cancelled. Physicians may be reminded of their requirements for currency of practice.

Do physicians who are retired from family practice and now only work as a locum or walk-in clinic need to be assessed?

Yes. All physicians, including locum physicians, are required to complete the pre-visit questionnaire, indicating the areas/clinics that they provide locum or walk-in shifts. The questionnaire asks physicians to select the office where they wish their assessment to take place, which we recommend as being the location where they work most frequently and that reflects their best standard of care (for example, where they have the most charts/patients).

Do physicians who only work in BC part time need to be assessed?

Yes. All physicians who are providing community-based care in British Columbia are required to participate. Physicians who have a full, active practising licence and have signed a waiver with the College to obtain a certificate of professional conduct (CPC) from other jurisdictions on an annual or bi-annual basis are still required to complete the pre-visit questionnaire. PPEP staff will review a physician’s pre-visit questionnaire and determine eligibility. Physicians must indicate where they worked in BC, the frequency of work, and at which location they wish to be assessed. It is also helpful to know the date of their last work shift in BC.