Most Responsible Physician

In Canada, the legal requirement of any patient admitted to a hospital is that they have a Most Responsible Physician who is responsible for coordinating the entire weight of the system's resources towards enabling them to achieve their personal health goals.

The hospitalist concept, originating from Robert Watcher's article on a new role of physicians created to minimize the inconvenience of community-based physicians having to come in and re-assess patients was the original organizing principle.

In 2008, the Ontario Medical Association Section on Hospitalist Medicine proposed a new funding model for MRP physicains to address the accelerating exodus of physicains from the role. It was argued that the remuneration for this responsibility was disproportionate to the labour required to live up to the ideal. The negotiation process failed, largely because it was centered around a small group of dedicated physicians representing a small minority of those that the Ministry of Health and the Ontario Medical Association were representing. However, the crisis was acknowledged and a E-code premium was devised which aimed to identify Physicians participating in this role and study their activities.

The exodus continued, however, as many physicians refused to be "measured" by the Ministry of Health and Long Term Care out of concerns regarding the assumptions behind productivity = billing, which is generally recognized to be inaccurate. The Ministry felt this was the best "experiment" to analyze the pattern and collect data to inform future models and trends.

From the Ministry of Health and Long Term Care, the definition of MRP was the most appropriate discriminator of the patterns they wished to study, as many physicians practicing as MRP for years had never considered themselves "Hospitalists". The tremendous, largely voluntary leadership efforts of Bob Maloney, Marcel Dore, Mira-Backo Shannon, Kunuk Rhee, Shariq Lodhi served to lay the groundwork for a bold new "envisioning" of the entire concept of MRP Physicains.