Monthly Archives: March 2014

Medical Practice Opportunity at Magazine Landing in Dartmouth

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Canadian patients wait longest to see family doctors

Access to after-hours care, emergency department waits vary between provinces, raise questions

CBC News

Canada ranks last among 11 OECD countries in a new survey in terms of how quickly people can get in to see their regular family physicians, showing “where a person lives does matter,” says the Health Council of Canada.

The finding was published in the council’s final bulletin, based on data from the 2013 Commonwealth Fund International Health Policy Survey of the General Public.

The council, an independent national agency, has been reporting on health-care renewal since its creation in 2003.

The report, titled “Where You Live Matters: Canadian views on health care quality,” focuses on differences across the provinces, comparisons among the 11 OECD countries that took part in the survey between March and June 2013, and changes in Canada’s performance over the past decade.

“What we find is that Canada is really not keeping pace with a lot of these other countries,” Mark Dobrow, the group’s director of analysis and reporting, said in an interview.

“The highest performing province might be looking pretty good in Canada, but be the worst performing if you compared it to all the other countries in the survey.”

Hospital Wait TimesMore than a third of Canadians in a new report said their regular doctor did not seem informed about care they had received in the emergency department, a finding that has not improved since 2004. (Paul Chiasson/Canadian Press)

For example, 50 per cent of respondents in Ontario said that on the whole, the health-care system works pretty well, compared with 23 per cent in Quebec.

The report notes that improvement in reducing wait times has been modest and is often lacking, and concerns Canadians. Only 31 to 46 per cent of Canadians, depending on the province, could get an appointment the same day or the next day, not including emergency department visits.

Since patients who don’t have a primary care provider go to the emergency department, the two waits are related, Dobrow said.

Brantford, Ont., resident Richard Kinsella said he had trouble finding a family doctor when he moved to the city east of Hamilton 15 months ago. Kinsella said people in Brantford commonly turn to the emergency department.

“The emergency, I’ve been twice, and I was there waiting over six hours.”

Dr. Nandini SathiFamily physician Dr. Nandini Sathi’s practice is now able to see more patients within 48 hours of when they call.  (CBC)

People in the U.S. have quicker access to their family doctors, with 48 per cent of those polled saying they could get a same-day or next-day appointment, ranking second last among the 11 countries.

Germany was listed as first in how quickly residents saw their doctors, at 76 per cent, followed by New Zealand at 72 per cent.

Many Canadians don’t have a regular doctor

Dobrow said the report raises important questions about the wide variations among provinces in areas such as access to after-hours care, emergency department wait times, affordability of care, co-ordination among care providers, and uptake of screening programs.

“Do we have the rights goals for our system? Are we looking at better health, better care, better value for all Canadians?” he said.

In September, the council suggested that provinces pay attention to issues such as leadership, having the right types of policies, and legislation and capacity building. For example, overall resources in primary care could be increased by expanding scopes of practice of some health professionals and improving their interdisciplinary training.

At Toronto’s Wellpoint Clinic, the physicians changed to an “open access” system, meaning patients no longer make appointments weeks in advance. Exceptions include people who need to prebook wheelchair transit services or a physical checkup.

“As physicians, we were worried that we would become inundated with patients on a daily basis,” said family physician Dr. Nandini Sathi. “In fact, what’s happened it’s opened up a little bit more time throughout the day for patients who need to be seen.”

Previously, a non-urgent patient may have had to wait up to 10 days or sometimes longer if a doctor was on vacation. “Now it really is 48 hours,” Sathi said. More urgent care slots are also available.

The other findings in the report include:

  • Between three per cent and 15 per cent of Canadians, depending on the province, do not have a regular doctor or clinic.
  • Accessing medical care after hours without resorting to emergency care is difficult for 62 per cent of Canadians, ranging from 56 per cent in B.C. to 76 per cent in Newfoundland and Labrador. In contrast, the U.K. cut its problem in half over the same time period.
  • 61 per cent of Canadians rate their health as very good or excellent.
  • 36 per cent of Canadians take two or more prescription drugs, among the highest use of prescription drugs of the 11 countries surveyed.
  • 21 per cent of Canadians skipped dental care in the past year due to cost.
  • 37 per cent of Canadians said their regular doctor did not seem informed about care they had received in the emergency department, a finding that has not improved since 2004.
  • 20 per cent of Canadians hospitalized overnight left without written instructions about what they should do and what symptoms to watch for at home.
  • Between 23 per cent and 49 per cent of Canadians age 50 or older have never had a test to screen for bowel or colon cancer.

“We still use hospital emergency departments for too much of our primary care. And we show largely disappointing performance compared to other high-income countries, some of which have made impressive progress,” the report’s authors concluded.

Commenting on the findings, Health Minister Rona Ambrose’s office said, “Our government is delivering the tools the provinces and territories need to deliver health care in their jurisdictions,” and reduce health wait times.

The other countries included in the survey are: Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom and United States.

With files from CBC’s Ron Charles and Melanie Glanz


Mobilizing national efforts to improve health workforce planning

Reprinted from Vol. 14, No. 3 — March 2014, the Royal College of Physicians and Surgeons of Canada
The Royal College is mobilizing national efforts to improve health workforce planning and address the growing employment challenges facing Canadian physicians.

This work took a considerable step forward at the first National Physician Employment Summit, which was hosted by the Royal College in Ottawa, Ont., from February 18-19, 2014. The summit, a pan-Canadian meeting of more than 100 attendees, included representatives from government and all of Canada’s major medical organizations, all of whom are committed to ongoing efforts to help highly-trained doctors find work and meet patient needs.

“There are no quick fixes for this complex problem,” said Danielle Fréchette, MPA, executive director of the Royal College’s Office of Health Systems Innovation and External Relations. “This summit brought together major stakeholders to float ideas, share learning and begin to discuss next steps for lasting, sustainable solutions.”

First step in a thoughtful approach

Last fall, the Royal College’s highly-anticipated study, Too many, too few doctors? What’s really behind Canada’s unemployed specialists?, found that 16 per cent of new specialist and subspecialist physicians reportedly couldn’t find work, and 31 per cent pursued further training to become more employable.

The root causes of this are multi-faceted, including limitations to our existing planning models, data on population needs, and learning environments that reflect patient needs. Positively, multiple groups across Canada are conducting research and analysis on this issue.

Figuring out what we know and what we don’t know

The national summit produced three practical steps that will guide the way forward:

  1. Attendees strongly support the current work of the Physician Resource Planning Task Force (PRPTF), supported by the F/P/T Committee on Health Workforce, which brings key stakeholders from across medicine, academia, government, and learner organizations together to determine the right number, mix and distribution of physicians to meet societal needs. Participants will continue to advocate for sustainable funding to continue and expand this work.
  2. The Royal College was seen as the place to collect and coordinate all relevant information regarding specialty-specific data on this issue, and was elected by meeting participants to guide and help inform the PRPTF’s work. Initially, our focus will be on disciplines experiencing the most employment challenges. The National Specialty Societies and Royal College specialty committees will have a strong and active role in developing the information that will support further discussions and decision-making.
  3. The Royal College agreed to host a follow-up event this fall to exchange best practices and share progress reports. This will include a draft action plan to streamline and coordinate efforts to address physician unemployment and underemployment across Canada.

Read the entire joint statement by clicking here.

Strong health workforce planning is about meeting patients’ needs

In an era of lengthy wait times and budget limitations, our health system needs to maximize the efficiency and effectiveness of all health professionals. Together with the national specialty societies and the Royal College’s specialty committees, we must work to collect more information to inform and shape workforce planning to help prevent future “boom-bust” employment cycles.

“Ultimately, we want to ensure that Canada always has the right number of physicians practising in the right areas, supported by the necessary health care resources to meet patient needs,” said Ms. Fréchette. “We will work with all stakeholders in the years to come to help achieve a much-needed, sustainable, pan-Canadian health workforce plan.”

Committed to working together and with others

The Steering Committee of the first National Physician Employment Summit was composed of the Association of Faculties of Medicine of Canada, Canadian Medical Association, Canadian Nurses Association, Canadian Association of Internes and Residents, College of Family Physicians of Canada, Canadian Orthopaedic Residents Association, Canadian Urological Association, Fédération des médecins résidents du Québec, Federation of Medical Regulatory Authorities of Canada and the Royal College.

Short of recruits, not patients: geriatric medicine strives for “critical mass”

by Patrick Sullivan

March 19, 2014

As Canada deals with a sharp increase in the number of frail, elderly patients, the medical subspecialty that was created to care for these patients is proving a hard sell with new physicians.

“There are only 242 certified geriatricians in Canada,” says Dr. Frank Molnar, who represents the Canadian Geriatrics Society (CGS) on the CMA Specialist Forum. “No one knows what the ideal complement is, but the roughest estimate is that we need around 700 geriatricians, and we’re only bringing in 15 to 25 a year.”

So why is recruiting so difficult? Molnar says there are several reasons.

One is that geriatrics has had a hard time “branding” itself because it is a hybrid specialty that deals with complex comorbidities and brittle patients, and is closely linked to other specialties such as psychiatry, neurology and general internal medicine. The difference, says Molnar, is that geriatricians concentrate on patients with multiple conditions: “We’re the ones who provide the ultra-complex care,” he says.

Certification in the field involves three years of general internal medicine training and two years of fellowship training in areas such as neurology and psychiatry.

The CGS thinks medical schools are one of the reasons for its low profile. For instance, students typically receive 300 hours of exposure to pediatrics during their undergraduate years, compared with 80 hours for geriatrics. “This distribution is at odds with societal needs because of the growing proportion of seniors using the health care system,” says Molnar, “and it may help explain why we have 242 geriatricians and 2,500 pediatricians.”

Geriatric medicine also faces challenges during residency training. For example, although training programs in psychiatry include compulsory rotations in geriatric psychiatric, many internal medicine residency programs do not have compulsory rotations in geriatric medicine.

Molnar said the inadequate exposure to geriatrics at both the undergraduate and post-graduate levels contributes to geriatric medicine’s recruiting difficulties.

“There are other factors as well,” says Molnar. “Many of us were actively discouraged from pursuing this career because it has a low profile, is not procedurally based and used to be grossly underpaid.”

Geriatricians in Ontario now earn the same as general internists, but Molnar says geriatricians in many other provinces still earn “far less.”

The demand for geriatricians’ services has been growing rapidly as the number of seniors almost doubled, from 2.7 million to 4.8 million Canadians, between 1986 and 2010. It is now estimated that Canadians older than 65 will account for a quarter of Canada’s population within about 20 years.

The CGS has responded to its low profile and recruitment problems with a series of research publications and commentaries in the Canadian Geriatrics Journal (CGJ),and by raising its issues with bodies such as the CMA Specialist Forum, as Molnar did Feb. 7.

Molnar’s own journey into geriatric medicine began in medical school, which he entered with plans to pursue a career in surgery. “Once there I decided that I liked complex systems and complex cases best, and things seldom get more complex than in geriatric medicine,” he said.

He described the field as a “grinding specialty” that may see him diagnose 100 patients with dementia during a three-month rotation.

“It is a difficult specialty in which you are often dealing with dementia in patients who also have other illnesses,” he said. “But it’s also a very satisfied and satisfying specialty because the work is so important.

“I’m not a salesman for geriatric medicine — I leave that to my peers — but if I was delivering a message to new doctors, it would be this: we deliver the care that you would want for your parents.”

Geriatric medicine’s hopes of reaching critical mass will not happen overnight. One reason is that the specialty is too focused on academic centres — Molnar calls it “hyper-concentrated” — and has little presence outside teaching hospitals. “We definitely need a broader reach,” he said.

The CGS says it also needs the help and support of larger organizations, such as the CMA and Royal College.

“A call to arms has been sounded,” a CGJ commentary stated in December 2013.

“. . .Geriatricians can play leadership roles in providing expertise for system redesign and support strategic health care sectors such as primary care. Now is the time for all health care stakeholders to understand and affirm the importance and relevance of geriatric medicine.”

And medical students may also wish to consider another issue, given the employment problems facing some specialties. “All of our grads find work,” says Molnar. “In geriatrics, there are plenty of opportunities across the country.”

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Foreign physicians moving to Canada are facing more competition from Canadian graduates

Foreign physicians planning on a move to Canada are facing more competition from newly trained Canadian medical graduates – it is time to broaden employment search options beyond Canada’s major urban centres.

The Canadian Institute for Health Information says there were more than 72,500 physicians caring for patients in 2011, a rise of 14% since 2007. The Canadian population grew 4.7% over the same time period.

In addition, according to the Royal College of Physicians and Surgeons of Canada, some recently graduated Canadian trained Specialists are unable to find employment in their chosen disciplines, in some regions of Canada.

Also, in response to the rapidly increasing numbers of Canadian trained physicians, the Canadian federal immigration services are implementing more stringent policy and regulations to ensure that Canadian employers of physicians are making every reasonable effort to employ Canadian physicians first, before offering employment to foreign applicants.

Consequently, foreign physicians intent on moving their medical careers to Canada must now be more strategic when developing their career plans to compensate for the increased competition from their Canadian colleagues.

Canada’s 17 medical schools are located primarily in the country’s major urban centres, which are also the locations of Canada’s largest tertiary care hospitals and healthcare regions. It is these major centres, located in Montreal, Toronto, Calgary and Vancouver that are the preferred practice locations for Canadian trained physicians, particularly clinical specialists and sub-specialists.

Therefore, to reduce the likelihood of being ‘bumped’ by a Canadian applicant, foreign trained candidates must look more closely at the map of Canada to discover the diversity of challenging and vibrant medical careers and lifestyles that are available in the smaller urban centres scattered across the country. These cities all include the same cultural diversity, welcoming Canadian culture and high quality of life of the major urban centres.  Numerous medical opportunities are available in eastern Canada in St. John’s, Halifax, Saint John, and Moncton; in central Canada check out , Quebec City, Peterborough, Barrie, Brampton, Hamilton, London, and Ottawa; and in the west search for Winnipeg, Regina, Saskatoon, Edmonton, and Victoria, to name a few….

For example, to learn more about the active lifestyle awaiting you in the province of Saskatchewan’s capital city of Regina, open this link now!…

To learn more about the extraordinary medical career opportunities and rewarding lifestyle options across our great country, John Philpott, CEO, CanAm Physician Recruiting Inc. highly recommends that that they invest in a professional recruitment firm with a proven record of success in international and Canadian medical recruitment as their guide.

Aging doctors to be put under the microscope in Nova Scotia

College of Physicians wants to monitor doctors working after retirement age

The Nova Scotia College of Physicians and Surgeons is moving ahead with plans to assess the competency of aging doctors.

Recently, a 75-year-old doctor in northern Cape Breton voluntarily gave up her licence after she started to lose her hearing.

In response, Dr. Gus Grant, registrar and CEO of the college, said there may be cases where a doctor can’t handle the full range of services due to an age-related limitation.

“If you look at the large group of physicians who are over the age of 70 —  if 70 is the number and I think 70 seems to be where there’s a line in the sand drawn by other provinces —  if you look at that larger group of physicians it would be worthwhile for the college to help those physicians identify their learning needs, help them tailor their practice to their skills, and to ensure confidence, to ensure public safety,” he said.

Grant said there are hundreds of doctors in Nova Scotia still working in their senior years and advancing age should not, by itself, force a doctor to retire.

He said the College of Physicians and Surgeons takes all complaints seriously, no matter what age the doctor is.

Preventing problems

When Nova Scotia adopts a monitoring program, it will join provinces such as Manitoba where doctors aged 75 years and older are tested every five years.

Dr. Terry Babick, deputy registrar of the Manitoba College of Physicians and Surgeons, said most senior doctors offer adequate care, but occasionally problems arise.

“If in fact there is actually a threat to the public then the entire issue takes on a much more serious note, because these are generally educational in nature but if we perceive that there is a threat to public safety then we inform the registrar immediately,” he said.

In Manitoba, doctors are assessed through a random review of their charts. Babick said when minor problems are discovered the doctor is asked to take additional training.

The Nova Scotia College of Physicians and Surgeons said it hopes to have an assessment program ready sometime this year.

A 2011 study released by the Canadian Institute for Health Information found that a third of physicians 65 and older are still working full time. Also, older doctors who were no longer classified as working full time still carried, on average, 40 per cent of a full workload.

CBC News Posted: Mar 05, 2014 6:55 AM AT Last Updated: Mar 05, 2014 7:31 AM AT