Recommendations for Doctors Nova Scotia:

1. Support training for physician leaders through a specially designed program, in partnership with the Canadian Medical Association.
2. Communicate regularly with all members about health system change and the work of engaged physicians, using the association’s communication tools (website, emails, e-newsletters and doctorsNS magazine).
3. Provide staff support to physician leaders when necessary and appropriate to support their role in engaging in health system decision-making on behalf of the association. This would include consideration and support for physicians around barriers to engagement such as compassion fatigue and negative perceptions by their peers (for example, the idea that physicians are no longer representing their colleagues if they work with the government or the health authority).
4. Assist stakeholders in determining what level of physician engagement is needed for a particular initiative (such as the number, specialty, location or area of interest of physicians), appropriate remuneration, and any other recommendations that will create an environment that encourages physicians’ input and involvement.
5. Actively seek opportunities for physician engagement. Check to make sure particular initiatives are engaging physicians effectively and, if not, reach out to stakeholders to determine if DNS can help them to do so.
6. Remind physicians of the value of engaging at all levels of an organization.
7. Remind stakeholders to engage physicians at all levels of their respective organizations.

Recommendations for health system decision-makers:

1. The Nova Scotia Health Authority (NSHA), IWK Health Centre and Department of Health and Wellness (DHW) and other health system stakeholders should seek early, appropriate and meaningful physician representation through DNS when creating, implementing, maintaining and evaluating health-care and public health services.
2. Engagement of physicians in health system decision-making should be based upon respect for physicians’ autonomy, knowledge and values, as well as the rights of physicians to make recommendations or raise concerns without fear of reprisal when taking part in discussions with stakeholders.
3. Physicians who choose to pursue leadership roles should be provided with adequate resources, training and support.
4. Physicians and other health system leaders should openly discuss and formally commit to clear roles, expectations and accountabilities.
5. The data and information used to make health system decisions should be shared in a transparent manner, to enable the development of a mutual level of trust between stakeholders and physicians.

Recommendations for physicians:

1. Physicians will participate in decision-making when opportunities are presented and will provide feedback whenever possible.
2. Physicians who pursue leadership roles will take appropriate training in order to ensure they are providing quality leadership for their colleagues, organizations and the health system overall. 
3. Physicians at each level of physician engagement, whether front line, service or institutional, will respect, support and value the contributions of their physician colleagues. 
4. Physicians will recognize and respect that other stakeholders are operating within different cultures, expectations and mandates. 
5. Physicians will respect those who choose to become engaged and understand that it is advantageous for themselves, their patients and their professional association to have colleagues actively taking part in decision-making at all levels of the healthcare system.

The physician engagement position paper was shaped by input from physicians from across the province, as well as extensive research and initiatives successfully implemented across Canada.