As he embarks on his new role, Dr. Rob Gratton is keenly aware of the challenges facing our health care system

When Dr. Rob Gratton talks about Ontario’s health care system and the role of medical regulation within it, one word keeps coming up: trust. It’s a term that sits at the very heart of CPSO’s vision — trusted doctors providing great care. However, as he embarks on his term as CPSO Council President for 2023, Dr. Gratton is keenly aware of the challenges facing our health system, which is stretched to its limits.

Dr. Gratton grew up in a small Ontario community on Lake Huron. His father was a dentist, the sole practitioner in the town. He maintained a busy practice but was also the sort who would jump out of bed at night, head to the office, turn on the lights and provide emergency care. “I had a good sense from him of what it means to be truly embedded into the fabric of a community,” Dr. Gratton says. “He also made a transition in his career to going back to school and earning a teaching degree, and he taught dental students at Western University for many years. That duality — working in the profession, but also guiding future generations — made a real impression on me. It reinforced the importance of education and passing on your knowledge to the next generation of learners.”

In his own medical training, Dr. Gratton specialized in obstetrics and gynecology because it offered the right combination of technical skills and various aspects of family medicine, including close relationships with patients and families. Early in his career, he moved to the United States to do high-risk obstetrics training at a health care centre that delivered some 10,000 babies a year. For a time, it looked like he might not even return to Canada. “This was 30 years ago,” he says, “when there was a real draw to stay in the States.”

Yet, he also saw the glaring inequities of the American health care system, and the blatant racism, and sexism and other forms of discrimination that impact patient care there, leading Dr. Gratton to eventually return to practise in Ontario. He knows those same injustices exist here, but he also knows we are finally having the necessary conversations to address them in the health care sector. Equity, diversity, inclusion, access to care, the patient perspective — these values are all becoming embedded in physician professionalism and the standard of care.

Craig Roxborough, Director of CPSO's Policy Department, said Dr. Gratton’s commitment to professionalism is evident when speaking to learners. “He stresses how aspects of practice, like conduct, connecting with patients and establishing trust, are just as important as any technical skill. And just like with technical skills, those other aspects of care need to be kept current and up to date,” he said.

Because of his sensitivity to the patient perspective, Dr. Gratton was encouraged to get involved in medical regulation. He joined our Inquiries, Complaints and Reports Committee (ICRC) in 2015 and then ran for Council in 2016. “Once you’re on ICRC, it opens your eyes to the importance of regulation, seeing care through the patient’s perspective. Since then, I’ve learned so much more than just the complaints and investigation side. I’ve learned the sheer breadth and mandate of this organization.”

We caught up with Dr. Gratton to ask a few questions about his year ahead as CPSO Council President, as well as record a video introduction 🎥.

You talk about the importance of trust in health care. Can you talk a bit more about that and how it relates to CPSO?
I want to make sure I set this in the context of all the work that has already been done. Under the leadership of CPSO Registrar and CEO, Dr. Nancy Whitmore, the transformation at the College has been remarkable. Meaningful engagement is one of our strategic priorities. Specifically, the College has committed to purposefully involving patients, the public and physicians to inform our decisions, and build awareness of our role and mandate through clear communication.

However, the unprecedented challenges faced by the health care system over the last two years due to COVID-19 has meant even more limited access, longer wait times and unmet expectations. In addition, the doctor-patient relationship has been eroded due to the massive issue of misinformation filling our social media networks — and a general mistrust in science. It’s a serious and dangerous problem that needs to be addressed.

We know that many physicians across Ontario are stressed and unhappy enough by the state of things that they are cutting back on practice hours or leaving the profession entirely. The College has been working diligently to not only address physician supply but to alleviate some of the burden on physicians — and the credit for that should go to the right-touch approach to regulation, which was implemented four years ago. The tenets of that approach are evident throughout all aspects of the College, from registration to complaints and discipline, and everything in between.

Another priority for Council is increasing physician engagement in our policy consultations. Can you address why it is so important to have physicians participate in policy development?
It’s more important than ever that we have this level of engagement, considering the relevancy and timeliness of our recent policy work, including virtual care and social media, and equity, diversity and inclusion as it pertains to our human rights policy.

CPSO has ramped up its efforts in the areas of equity, diversity and inclusion (EDI). Can you speak to why that effort is so crucial?
It’s important in two ways. Organizationally, it’s important to see how we can better serve in the public interest through applying an equity, diversity and inclusion lens to the work we do. It speaks to our role in ensuring that physicians provide quality care to the patients they serve. We need to be seen as leaders in this area to the profession. We know the negative impacts that bias, microaggressions, overt racism and other forms of discrimination have on patient care. Confronting these issues involves a lot of learning and unlearning. It’s a journey and one we’ve only just begun.

What’s your take on the state of health care in Ontario right now?
Well, we’re still dealing with the ongoing effects of COVID, and physicians are not seeing the light at the end of the tunnel. They’re burned out. It is still a very prevalent concern within the profession.

Two major areas of concern are primary

care and emergency care. They are, of course, so intertwined. A shortage of physicians in primary care can impact emergency care, which can then lead to unprecedented wait times in the emergency department, which may be struggling with its own human resource issues. And on it goes.

Given the pressures straining the system and its practitioners, right-touch regulation makes so much sense in ensuring we don’t needlessly add to physicians’ burdens as we fulfil our mandate.

Are you fundamentally optimistic about health care here in Ontario?
I am. I’m incredibly hopeful about the future. We have a lot of exciting opportunities to improve the actual system, continuing to work closely with our health care partners to improve access to care, to improve human resources. It’s not going to happen overnight. It’s going to take us several years to get out from under the impact of COVID. But we need to focus on what we, as the regulator, can do.

Video Introduction

2023 CPSO Council President — Dr. Rob Gratton

My name is Rob Gratton, and I'm really excited to be the 2023 CPSO Council President. I'm an obstetrician-gynecologist from London. I have been practicing at London Health Sciences Centre for the last 25 years. My area of specialty is maternal-fetal medicine.  

How did you begin your journey with the College? 
Seven years ago on the ICRC committee, one of the physicians who was my professor during medicine, knew the trajectory of my career, my interest in medical leadership, my interest in quality of care and patient safety, and asked me if I would consider joining ICRC, and I did seven years ago, and I saw it really as an extension of what I had been doing in quality of care and patient safety, but with a much larger opportunity and a much broader perspective on health care in Ontario. 

After joining ICRC, I then recognized the scope and the importance of self-regulation and in governance, and that interest really propelled me to then seek nomination and election for Council.  

Which projects were the most memorable for you? 
Being on Council, I was part of the 2020 2020-2025 strategic planning, and it has been really rewarding to see that plan come into fruition over the last three years and to see each of those strategies worked out in all of the different areas of the important work that we do here at the College. 

I would say probably the other rewarding thing is just to have the opportunity to work with College leadership, with Dr. Whitmore, and witness the modernization and transformation that's happened at the College.  

We've been able to improve our processes. We've been able to reach out to the membership, and most importantly, with our mandate central, we've been able to engage the public and to work in their interest to ensure quality care and improving quality of care for the public by Ontario. 

The year ahead... 
I would like to send a positive message — positive message to the public, a positive message to the profession, but all the time being mindful of the fact that this continues to be challenging time, that there still are significant difficulties that are experienced both by patients and by physicians providing care. So, I don't want my message to be out of touch. I want it to be aligned with the concerns that are in the health-care system. And I think, with the application of modernization, right-touch regulation, Lean processes, and engagement of the public and engagement of the physicians, we can achieve these objectives. 

I'd like to thank you for this opportunity I've had to introduce myself, and as well, to outline my priorities for 2023. Thank you.