The Career Development and Compensation Program (CDCP) was created by the Department of Paediatrics at The Hospital for Sick Children, in Toronto, Ontario, to provide clearly defined job expectations, enhance career development and assess performance through two distinct processes: the annual review and the triennial review. Staff are expected to advance the goals of the department and the hospital through activities in clinical care, education and mentorship, and research and are rewarded for excellence through compensation and career advancement. We evaluated the CDCP and conducted interviews with 27 members of the department; these formed the primary basis for our summative evaluation. The study objectives were to evaluate (1) mechanisms to recognize contributions, (2) processes used to ensure staff accountability and (3) opportunities to increase efficiencies. Interviews with members of the department resulted in a broad and comprehensive understanding of the CDCP. It is regarded as a rigorous, transparent and fair program. Concerns about the CDCP stem from the potential negative outcomes of assigning value to particular activities, the inequitable level of support provided to staff across the department and the costs of the review processes. Several recommendations were identified that serve to increase equality and strengthen supports for members of the department, to improve the ability of the CDCP to evaluate the softer aspects of clinical care and scholarship and to adopt a more holistic and integrated approach in the evaluation of staff. These re-formed arrangements build upon past modifications to the CDCP and represent natural progressions in the development of a program that has wide support from members of the department.