Co-published with the Federation of Medical Regulatory Authorities of Canada and the Federation of State Medical Boards

June 2008

In this report leading regulators of the medical profession in Canada and the United States assess the relationship between quality improvement and the current responsibilities of authorities that license and discipline physicians. The participants in this project are strongly committed to medical regulatory authorities taking a more expansive role in maintaining and improving the quality and safety of physicians’ services. They make provocative and, to us, compelling recommendations to their colleagues and to the medical profession more generally, on the basis of their analysis of the historical and current status of regulation and of a survey of authorities in both countries, which they had planned and analyzed in order to inform their discussions.

This report deserves to be discussed widely among regulators and leaders of the organizations that educate, examine, certify, license, and represent physicians. Many of the points the collective authors make could also be usefully discussed with policymakers in the provinces and the states, and jointly with regulators of other health care professions.

The report began as a conversation between a regulator and a colleague at the Milbank Memorial Fund (MMF), an endowed philanthropic foundation established in 1905 to help decision makers bring the best available evidence and experience to bear on policy for health care and population health. The conversation expanded to include leaders of the Federation of State Medical Boards (FSMB) of the United States and the Federation of Medical Regulatory Authorities of Canada (FMRAC). The federations selected participants in the meetings that led to this final report.

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