The issue
BC healthcare faces increasingly difficult challenges with physician workforce capacity, access to care, resource allocation and financial sustainability.
Health organizations cannot resolve these challenges through administrative action alone. Equally, physicians cannot address them solely through individual clinical excellence.
The system requires a stronger partnership between those who govern and operate healthcare organizations and those whose professional decisions profoundly influence their performance.
Existing structures — including Medical Advisory Committees, Medical Staff Associations, Medical Affairs departments and organizational leadership — provide an important foundation. Physician Citizenship is not intended to replace these structures. Its purpose is to strengthen the relationship that connects them.Why this matters
Why This Matters
The relationship between physicians and health organizations is unlike most conventional employment relationships. They hold considerable professional autonomy while also influencing and impacting clinical priorities, resource utilization, patient access, organizational performance and healthcare expenditures. Yet most physicians in BC practise as independent professionals rather than employees of the health system, and the majority of physicians in BC are still on fee-for-service.
The relationship between physicians and health organizations is therefore largely defined through privileges, contracts, compensation arrangements and professional obligations rather than shared organizational accountability.
This creates a fundamental challenge: physicians influence organizational performance without always having corresponding authority or responsibility for broader system outcomes. Similarly, healthcare organizations carry significant accountability for performance without necessarily having the mechanisms to engage physicians as genuine partners in achieving it.
What leaders should consider
Physician Citizenship begins with the principle that meaningful partnership carries responsibilities on both sides.
Physicians should have opportunities to influence organizational priorities, contribute to stewardship of resources and participate in decisions affecting clinical services and patient care.
In return, healthcare organizations must provide transparent decision-making, meaningful opportunities for participation, appropriate authority and recognition of physician contributions beyond direct clinical service.
The relationship should move beyond engagement as an activity toward participation as an institutional expectation.
This means reconsidering how organizations align:
- Privileges with participation
- Compensation with contribution
- Influence with stewardship
- Professional autonomy with collective responsibility
- Accountability with authority
These are reciprocal commitments, not just additional expectations placed upon physicians, or greater obligations of the health organization.
The practical takeaway
Physician engagement has established important structures and relationships across Canadian healthcare. The next opportunity is to translate that engagement into shared responsibility for organizational and system performance.
This does not require replacing existing governance structures or diminishing professional autonomy. It requires a clearer understanding of what physicians and healthcare organizations should reasonably expect from one another, how those expectations are supported, and how meaningful contributions to institutional performance are recognized.
A way forward
The Cogentis Physician Citizenship Framework (C) is designed to strengthen the relationship between physicians and the healthcare organizations in which they practise.
The framework examines the reciprocal obligations, governance arrangements, institutional expectations and organizational conditions necessary to move from a largely transactional relationship toward a more mature, true partnership.
Our objective is to help health organizations build a physician relationship grounded in mutual accountability, shared stewardship and meaningful participation in achieving healthcare system objectives.
Physician Citizenship is not simply about asking more of physicians. It is about creating the conditions in which physicians and healthcare organizations can achieve more together.
Interested in exploring Physician Citizenship for your organization?
Cogentis Health Group works with healthcare leaders and medical staff to strengthen governance, physician relationships and organizational stewardship.
Contract Cogentis to discus how the Cogentis Physician Citizenship Framework could support the next evolution of your physician-organization relationship.
Astrid Levelt
Founder and Principal, Cogentis Health Group