Monthly Archives: January 2014

CMA acts on Canadian physician employment worries

The following is a reprint of an article on this subject discussed in an earlier edition of the  CanAm newsletter….

by Pat Rich

January 17, 2014

The CMA has adopted a comprehensive 10-point plan to address all facets of physician health human resources (HHR), including education, training and employment.

The move comes amid growing concern about physician unemployment/underemployment, particularly in some hospital-based specialties such as orthopedic surgery.

“This comprehensive and unified strategy is very timely given recent concerns about graduates of some Canadian residency programs being unable to find full employment,” said CMA President Louis Hugo Francescutti. “We look forward to working with our colleagues in the provincial and territorial medical associations and at CAIR (Canadian Association of Internes and Residents) to implement our plan.”

The plan calls for action on several fronts:

  • a scan of current career counselling services offered at Canadian medical schools will be undertaken;
  • costs related to physician training will be updated;
  • a list of vacant positions across Canada will be produced;
  • the CMA’s policy on physician resource planning (last updated in 2003) will be revised;
  • a policy statement on the impact emerging technologies and models of care are having on HHR planning will be prepared;

The CMA Board, which endorsed the new action plan at its December meeting, also acted on a resolution deferred from the CMA’s August annual meeting by endorsing CAIR’s Resident Principles on Health Human Resources.

The action plan on HHR is part of the CMA’s larger health care transformation initiative to ensure the sustainability of Canada’s health care system.

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MDs avoiding social media in droves: poll

The majority of Canadian physicians are avoiding the use of social media tools such as Twitter and Facebook for professional purposes because they anticipate too many pitfalls and too few benefits, a new CMA poll shows.

The results, from a recent survey involving the CMA’s ePanel, offer a detailed assessment of MDs’ use of social media. They also paint a discouraging picture for those who feel physicians should use these tools to improve their own knowledge of patient care.

The results are based on responses from 885 (24%) of practising or retired physicians, medical residents and students belonging to the ePanel, which was created to provide a rapid response when the CMA needs member input on issues or policy.

The findings, which mirror those from an ePanel survey conducted three years ago, show that almost 90% of respondents believe the use of social media tools in medicine poses professional and legal risks, and almost 40% think social media tools are of little or no use in day-to-day medical practice.

The opinions run counter to social media guidelines published by the CMA in 2011, as well as more recent guidance from the College of Physicians and Surgeons of Ontario. Although both organizations acknowledged the risks related to social media use, they also pointed to the potential benefits, such as improved communication.

The survey revealed that Canadian doctors’ use of social media for professional reasons remains very low, with only 14% of respondents using LinkedIn and 4% using Twitter. (Use of these tools for personal reasons is much higher except for LinkedIn.)

Physicians’ online involvement for professional reasons tells a far different story. Almost 40% of respondents said they had joined an MD-oriented online community, 45% had participated in an online discussion forum on a medical topic, and 96% had used Google when seeking medical information. As well, almost one-third of respondents had recommended a medical app to a patient, reflecting the burgeoning growth of these mobile tools.

There are clear demographic trends in the responses — medical students were not only more aware of the risks inherent in social media but also recognized the potential benefits.

Dozens of individual comments provided with the survey results painted an illuminating picture of current attitudes within the profession.

“At this point, I don’t believe any of these social media are safe enough to protect patient confidentiality and physician privacy,” one doctor wrote.

Another stated emphatically: “I see no value in social media for any purpose whatsoever, but especially not in medicine.”

Another critic responded: “Social media is just another distraction from real patient care. Do not waste our time.”

However, a counterpoint was offered by this respondent: “I think social media is a very powerful tool that cannot be ignored in today’s society. While anything powerful comes with inherent risks, I believe that wise and professional use can mitigate them.”

Another doctor took the middle ground: “I would not feel comfortable using social media to communicate with individual patients, but it may be useful for group communication or educational activities.”

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Reprinted from CMA – January 20, 2014

How much do you make? Nova Scotia doctors want to know

Pilot project hopes to help patients with their finances

Healthcare workers in Nova Scotia may soon be asking patients how much money they earn so doctors can point low-income patients towards support.

The practice of linking poverty and health is already happening in Ontario and Manitoba.

“Patients tell us really personal things all the time. This is one other part of it,” said Dr. Monica Dutt, the medical officer of health with the Cape Breton District Health Authority.

She’s developing a tool for Nova Scotia physicians to use to help low-income patients. It would involve doctors asking about a patient’s finances, and then directing them to get help.

Statistics Canada has reported that growing up in poverty is associated with increased rates of death and illness including diabetes, mental illness, stroke, cardiovascular disease, gastrointestinal disease, central nervous system disease and injuries.

“When your patient can’t afford the medication that you prescribe or they don’t have a stable housing situation or they don’t have income to help support being healthy, it’s really not much use to try to tell them to exercise, or to eat healthy or to take their medications. They really need these other supports in place,” she said.

The Nova Scotia director of the Centre for Policy Alternatives, Christine Saulnier, said she thinks the tool is a good idea.

“If we can have a physician remind somebody to file their taxes — and they do have tax credits for people who live in poverty — and they get money, that can make a huge difference in someone’s life,” she said.

Developers said they hope to have a pilot program implemented in six months.

Reprinted from CBC  – Posted: Jan 20, 2014 6:34 AM AT

Have scalpel, will travel: Alberta surgeons operate abroad to bypass wait times

Patient pays $40,000 to get knee replacement in Turks and Caicos.

Retired nurse Marlene Driscoll spent the holiday season celebrating a different kind of gift: a brand new knee, delivered by her Calgary surgeon at a private hospital in the Caribbean.

The December surgery came with a hefty price tag of about $40,000 for the flights, hospital care and accommodations in the Turks and Caicos.

But it also gave her something not for sale back home — a two-week wait for a procedure with her own Calgary surgeon that would have taken at least seven months in Alberta while she was in so much pain it was difficult just to walk.

Driscoll says she understands the quandaries that surround paying cash for a surgery abroad the way she can’t in Alberta, but says her decision was about more than dollars and cents.“Let’s face it. If you are in pain, if you are desperate to have a procedure like this, then you’ve got to make choices,” she said.

“I’m off the wait list here. Someone else is going to take my place in July,” said Driscoll, who said having a Calgary surgeon made all the difference in deciding to go.

While the debate around medical tourism has raged for years, a new type of practice has begun to emerge in Calgary in which surgeons who work in the public system get licensed to practice medicine in the Caribbean, then, for a fee, actually fly out with their patients to perform shoulder, knee, hip and other operations.

Back in Calgary, they perform post-op care for their patients, only this time, within the public system.

One of the surgeons, Dr. Jim MacKenzie, said his decision to take on a few patients at the Caribbean hospital came down to serious problems back home: too many surgeons, too few operating rooms.

“For the number of surgeons we have and the population we’re trying to look after, we don’t have enough operating rooms. That’s what in my days off prompted me to start looking where else my time could be utilized,” said MacKenzie, 53.

This new kind of health tourism is coming to light even as prominent Calgary surgeon Dr. Robert Hollinshead made the surprise announcement in December that he’s leaving Medicare altogether.

Long waits for patients and scarce jobs for young doctors led him to make the unprecedented decision to opt out of the public system and offer surgeries for a fee right in Calgary, he said in announcing his decision.

As required under legislation, Hollinshead, 65, advised the province of his intentions to opt out in July 2014, after a surgical career spanning more than three decades.

Health Minister Fred Horne said this newest round of “boutique medicine” involves doctors entitled to take on private ventures.

He insisted that within the public system, wait times are going in the right direction — down.

“When it comes to to the public health-care system, there are many, many physicians and others who work in the area of orthopedics who have actually brought down waiting times in the province,” he said.

But health-care observers suggest that if Calgary surgeons are going to such extraordinary lengths to deal with what they say are untenable waits for care in the province, Alberta must ask some hard questions about what kind of access to health care it’s providing residents.

“If it is something that causes Albertans to question whether or not they’re actually having the right kind of access to the kinds of services that surgeons … are providing, that expands the debate,” said Antonia Maioni of the Institute for Health and Social Policy at McGill University in Montreal.

“When that happens, then the government does have to, in fact, weigh in,” she said.In Quebec, one of Canada’s top private orthopedic surgeons offered Hollinshead a piece of advice when it comes to leaving Medicare behind: “Welcome to the political circus.”

Dr. Nicholas Duval helped break new ground in Canada when he opted out in 2002, later setting up a medical clinic with four operating rooms years when Quebec allowed private insurance.

Hollinshead’s complaints about long waits and lack of jobs “are exactly the beliefs I had in 2001 before opting out,” Duval wrote in an e-mail to the Herald.Though he recently began offering jobs to young orthopedic surgeons, Duval said he doesn’t expect private surgical care to take off in Canada anytime soon.

Costs are rising, wait lists for “so-called non-urgent care” are growing, and “the only logical solution is to steadily increase doctors’ salary so they deal with the everlasting same situation and they shut up,” Duval contended.

“That’s what provincial governments do. That explains why after more than 10 years I am still sitting almost alone as a private orthopedic surgeon.”

Calgary shoulder surgeon Dr. Ian Lo, 43, has been to the Caribbean twice since this summer and operated on about 10 patients who came from back home.

Part of the appeal of involving himself in medical tourism is that accompanying patients for surgeries “provides better care,” by allowing proper post-op work to take place back in Calgary.

“You would think it’s the ‘ultra-rich,’ but it’s the people who just don’t have the time to wait anymore,” said Lo, who said he charges the same rates he gets paid by the Alberta government for the Turks and Caicos jobs.

Lo said he also wants the government to pay heed to long wait lists.

“It’s ridiculous that you have to travel to Turks and Caicos to get your surgery done, that’s absolutely ridiculous.”

The head of the Alberta Medical Association said the move by surgeons to find new ways to take on wait lists could mean it’s time for the province to start looking at “different” solutions — including a public, private mix.

“That does not mean American-style pay-as-you-go care. It means, is there is some way of delivering care other than the one that we’re using that would get us good results,” said Dr. Allan Garbutt, a family physician in the Crowsnest Pass.

“If you acknowledge the current system doesn’t work in the sense we don’t get quick care, we don’t get outstanding quality measures, once you acknowledge that, then you can’t automatically exclude something because it has private attached it.”

Medical tourism is already gobbling up dollars from Alberta patients willing to go as far abroad as India for care if they can’t spend it at home, Garbutt noted.

“You can’t call it good care if when your knee goes bad you can spend months until you have a functioning again. You can’t call it good care when a really, really disabling bad back … will take you three years — literally three years — to get it fixed.”

For Driscoll, the pain was sudden, and extreme when it hit in early 2012. A private MRI (ordered in June after her doctor told her she faced an eight-month wait in the public system) revealed her knee had become “an absolute train wreck” and she needed a joint replacement.

Her condition deteriorating, the Calgarian found herself totally reliant on her husband and woozy from pain medication that made it even more difficult to get around.

Driscoll waited another five months to get in to an orthopedic surgeon, MacKenzie.

He told her she was looking at another seven months for the operation.

Then, he mentioned the Turks and Caicos option.

“We immediately said yeah, we’ll go. Two and half weeks later we were in the Turks and Caicos,” Driscoll said.

After a long career as a nurse and many hours still spent volunteering in the health-care system, Driscoll said she’s still a champion of public care but questioned whether authorities really understand the impact long waits can have on a patient.

“I believe we have the greatest system going. The problem is, you can’t get access, it’s very difficult to get access,” said Driscoll.

“There’s an awful lot of pressure on you, and it’s not just the pain.”

NDP MLA Dave Eggen called the recent decisions by surgeons to explore more private care a provocative step and a “red light” over tight capacity in the province’s public system.

“This is an indication of how this PC government has been starving our hospitals for surgical capacity. These doctors are responding to a shortage of capacity that this government has put in place over quite a long period of time,” Eggen said.

“The population has grown and our acute care capacity in the province has not grown. This is a consequence of that. It’s not a positive development.”

According to Horne, the province has already increased the volume of hip and knee operations by five per cent in the last three years. That’s meant wait times have come down by about nine per cent, he said.

While more work remains, Horne said he’s putting resources into the public system and not looking to private enterprises for help.

“Albertans support a publicly funded, universally accessible system that’s based on your need and not how much money is in your pocketbook,” said Horne.

“That’s firmly the position of this government.”

Even if the number of surgeons willing to look outside public health-care is likely to remain small, Alberta is in for some intriguing test cases, said Maioni.

In Hollinshead’s case, she noted, “What we’re looking at now in terms of the kind of opting out … in Alberta is a thin wedge, a very limited niche,” Maioni said, adding that the surgeons need to be able to make a living outside the system.

“However, it will be an experiment, it will be something that people will be watching to see if the demand is there, whether the quality control is there, how the Alberta government reacts to this kind of new player to the health-care system, as well.”

As for Calgary surgeons operating in private clinics abroad and in the public system back home in Alberta, “I’m sure it raises eyebrows in Alberta,” Maioni

© Copyright (c) The Calgary Herald

MDs Fear Pressure to OK Pot Use

Use of medical marijuana expected to explode with rule changes

The organization that regulates physicians in Manitoba is worried recent federal rule changes governing medical marijuana will place more pressure on doctors to authorize its use.

The province’s MDs have generally been resistant to helping patients become registered to legally use a drug most see as having little or no medical value. The number of Manitoba doctors known to be willing to authorize the use of medical marijuana can be counted on the fingers of one hand.

New rules that came into effect last year also allow — but do not require — doctors to dispense cannabis, subject to provincial approval. Manitoba allows physicians to dispense drugs in certain limited situations.

The College of Physicians and Surgeons of Manitoba is concerned by the regulatory change, saying the vast majority of physicians want nothing to do with dispensing medical marijuana.

“It’s a really big issue for the regulatory authorities,” said Dr. William Pope, the college’s registrar.

Across Canada, more than 37,000 persons — including 443 in Manitoba — are currently registered to possess cannabis for severe pain, muscle spasms, nausea and other conditions.

Officials project the number could explode to as many as 450,000 by 2024 after Ottawa recently streamlined the application and approval processes. Under the new regime, applicants are no longer required to submit their personal health information to Health Canada. The government has also simplified the approval process for people with less debilitating diseases and conditions.

New rules coming into effect April 1 will also prevent thousands of Canadians — including hundreds in Manitoba — from continuing to grow their own pot for medical use. They will be required to purchase from federally licensed commercial growers. That has infuriated many registered marijuana users who expect to have to pay $10 a gram instead of the $1 to $2 it costs to grow it themselves, the Free Press has reported.

‘As far as most of us are concerned, there is really no appropriate prescribing’– Dr. William Pope, of the College of Physicians and Surgeons of Manitoba

Pope said the college is concerned the rule changes will cause more patients to press doctors to authorize the use of medical marijuana. It has advised physicians against doing so unless all other medical remedies have been tried.

“As far as most of us are concerned, there is really no appropriate prescribing,” he said in an interview.

That position has caused some Manitobans to seek help out of province. The Vancouver-based Medicinal Cannabis Resource Centre Inc. (MCRCI) will — for a $400 fee — provide a doctor to meet patients via Skype to discuss how medical marijuana can help them and arrange for medical authorization. The centre also assists patients in filling out the necessary federal paperwork.

Terry Roycroft, founder and president of the centre, estimates his organization has assisted as many as two dozen Manitobans in obtaining federal permission to use medical marijuana. It has advised or shepherded thousands of Canadians through the approval process.

Applicants must submit a diagnosis of a qualifying illness from their primary caregiver, be it for cancer, severe arthritis, multiple sclerosis or some other disease or condition.

“They’re pre-diagnosed. All we’re doing is counselling them on the uses and the strains (of cannabis) that would work well with those illnesses,” Roycroft said. “Then we also support them legally with a medical document that allows them to go to the new (cannabis) producers that Health Canada is licensing so they can actually purchase those strains.”

MCRCI has gathered a group of 40 medical specialists and general practitioners from across the country that act as a resource. Its medical staff is also involved in clinical research on a cannabis-based topical cream for patients with rheumatoid arthritis of the hands.

Roycroft said the health benefits of cannabis are only beginning to be tapped. In its dealings with clients, MCRCI outlines alternatives to smoking a joint in obtaining the benefits of the cannabinoids in the marijuana plant. Recent research, including work done in Canada under federal permission, has seen the production of edible cannabis products (which take the body longer to absorb but can provide longer relief), mouth sprays, creams and vapours (in which cannabinoids are inhaled but without the harmful smoke), he said.

Republished from the Winnipeg Free Press print edition January 22, 2014 A4

Concerned about the Future of Healthcare in Canada, Toronto Doctors Create Mywebhealthreport to Empower Consumers

BusinessWire · Jan. 9, 2014 | Last Updated: Jan. 9, 2014 2:01 PM ET

With up to 85% of total healthcare spending consumed within the last few years of life, treating the growing epidemic of chronic diseases will increase the risk of overburdening the Canadian healthcare system as the baby boomer generation gets older and sicker.

Canada’s flawed healthcare system
Mostly geared towards treating sick people, not enough resources are allocated to preventing healthy people from becoming ill and developing chronic disease.

Dr. Walter Heidary and Dr. Eamonn Keane, recognizing this weakness, developed a national web-based platform,Mywebhealthreport, for Canadians to take personal ownership of their health by eliminating or mitigating their risk factors for developing chronic disease.

“Two-thirds of healthcare funding goes to bureaucracy and administrative costs, while only $0.33 of every dollar is spent on actual patient care,” said Heidary, founder, Mywebhealthreport. “With Mywebhealthreport, 100% of funds are spent on the consumer. The future of healthcare must include greater emphasis on prevention in addition to earlier disease detection to improve overall outcomes at a lower cost.”

Empowering consumers and changing lives
“Chronic diseases are the most prevalent and costly health problems of our time,” said Keane, leading doctor, Mywebhealthreport. “They are the leading cause of death, disability and lost productivity. By optimizing personal wellness approaches, many chronic diseases can be prevented or effectively controlled.”

Mywebhealthreport provides evidence-based wellness strategies, with a Health Risk Assessment, biometric testing, and screening for up to 14 types of cancers, heart disease, hormone imbalances and food intolerances.

Not only are consumers empowered and able to take control of their health, but it also creates a gateway for companies to fulfil their responsibilities as employers.

“Signing up our employees with Mywebhealthreport was very important to us,” said Joe Donnell, president, Donnell Insurance Brokers Ltd. “At Donnell, we invest in our employees. The entire process was easy and efficient with a quick turnaround on comprehensive results. I can see that our employees appreciate us investing more into their health. Mywebhealthreport did a great job following up with next steps to improve their health.”

Identifying the struggle to find a family doctor or referral to a specialist, Mywebhealthreport’s Wellness Concierges assist with ongoing wellness advice through networks of healthcare professionals. Mywebhealthreport provides a preventative approach through enhanced health initiatives for the most affordable rates to all Canadians.

Contacts: Media Source: BuzzPR Patricia Lok, 416-777-2899

Reprinted from Healthcare Manager, Jan 14, 2014