Only in a police state can ordinary citizens face the disruption of their lives and the potential loss of their livelihoods because they fail to satisfy some higher authority that says they must attend conferences, undertake group learning activities or keep a "learning portfolio." Most democracies, except in emergencies, limit authorities' power to interfere with citizens' lives by requiring some form of reasonable cause before they can act against them. The college has abandoned this essential safeguard and arrogated to itself powers greater than those of any police force.

And what is the emergency that justifies ignoring democratic process? There is evidence from the provincial college in Ontario that a few physicians neglect their professional duty to serve their patients by failing to remain in touch with advances in knowledge, but there are procedures in place to address that problem. The Royal College says its polls show that Canadians favour having physicians continue to educate themselves, but does it have evidence that most of us do not? And there is the threat, says the college, that if it does not impose a "voluntary" process a more draconian rule will be imposed.

A hugely expensive program imposed on every specialist in Canada will not, the college assures us, be paid for by its 16% increase in fees. Who then will bear the cost? The specialty organizations that already face recruitment problems? The provincial regulatory bodies, which are facing a budget crunch but are already preparing to conduct "random" practice audits of their own, showing similar disdain for democratic niceties? In the end, of course, it will be the individual specialists who pay for this, in one way or another.

What the college has decreed, without any evidence that we need it, is that we must prove to its satisfaction that we are educating ourselves in ways that the college has decided are best. And we must pay for the privilege.

The college insists that among the many ways to learn, some methods have been proved to change practice patterns more than others, and we will get double time for pursuing them. Meanwhile, other methods will be limited to a total of 20 hours a year. In the end, 1 hour of sleeping through rounds can earn as much credit as 2 hours spent reading journals or preparing a lecture. Yet most research on learning methods is about as sophisticated as the early research on psychotherapy: small projects conducted by partisan researchers over a short time to "prove" that their favourite method works in a particular context. The "evidence" is then generalized to apply to the lifetime learning activities within all specialties.

I have some questions for the college. Has the sustainability of imposed learning styles been studied? Is there any research on how the imposition itself might affect attitudes toward learning? Does the enforcement of a previously voluntary and generally pleasurable activity affect our capacity to continue to do it over a working lifetime? How does the college explain the failure of MOCOMP, its own maintenance-of-competence program? What internal methods does the college use to satisfy itself that it is actually serving the interests of the medical profession or the public? Can cynicism or hypocrisy be measured reliably?

Of course, protest at this late stage is futile. With no more than the threat to delete FRCPC after our names, how does the college propose, in any lawful way, to compel us to pay a massive fee increase, as well as to absorb the cost, in time and money, of a program that takes time away from our patients and more time away from the very learning it claims to be trying to promote?

Like MOCOMP, like the glittering education casinos where our southern colleagues are compelled to spend their money, this program is a hollow sham.