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BC College Urges Aging Physicians to ‘Pull the Cord on Their Golden Parachute’

There are 90 B.C. doctors aged 80 and older, according to the B.C. College of Physicians and Surgeons.

BY PAMELA FAYERMAN, VANCOUVER SUN SEPTEMBER 16, 2014

Older doctors have a duty to retire before declining mental or physical health harms patients, says the College of Physicians and Surgeons of B.C. after receiving about 100 complaints last year from concerned colleagues and patients.

There are 1,724 doctors over the age of 65 practising in B.C., including 174 between the ages of 75 and 79 and 90 aged 80 and over.

“Ideally, every #physician will perform optimally on his or her last day of practice,” says the 2013/14 report from the Inquiry Committee in the College’s annual report.

The committee handles about 1,000 complaints a year on matters relating to doctors’ clinical performance, conduct/ethics, and boundary violations (sexual and other inappropriate relations with patients). There are about 11,500 doctors actively practising medicine in B.C.

“As in the past, the committee investigated a number of complaints alleging deficient performance by older physicians. Many of these triggered … investigations,” according to the committee, which handled about 450 files related to doctors’ clinical performance, including allegations of deficiency on the part of older doctors.

Another 520 files related to conduct, ethics and professionalism, including complaints of poor communication and lack of empathy. There were also 31 files opened about boundary violations, including sexual misconduct, and insensitive or disrespectful behaviour during patient examinations.

The college says experts in occupational performance have shown that older professionals excel when they “stick to familiar tasks and settings.” Yet doctors who are preparing to retire often close their practices and work at walk-in clinics, where they don’t have a history with #patients and make errors they wouldn’t when treating patients they knew well.

B.C. abolished mandatory retirement in 2008 and since then, a growing number of doctors have chosen to continue practising. Dr. Ailve McNestry, deputy registrar of the College, said doctors continue working for the same reasons that others choose to — they derive much satisfaction from it, their identities are wrapped up in their professional lives, and they need or want the income.

The College’s Medical Practice Assessment Committee provides oversight to a program that assesses and educates doctors. The program prioritizes assessment of doctors over age 70, especially those who work in solo offices. While all doctors working in the community (as opposed to hospitals) are supposed to have an assessment every eight years, those in their 70s are assessed more frequently — as are those who have been shown to require ongoing scrutiny.

McNestry said complaints from# medical colleagues as well as patients often reflect a perception that age-related #health concerns — cognition, vision, hearing and mobility — are a factor in declining performance. She is unaware of cases in which doctors with Alzheimer’s or dementia have continued practising. “But symptoms often come on slowly,” she said.

Ageist discrimination exists in medicine, like the rest of society, and McNestry cautions that while the advancing years can be a “high-risk” period for medical errors, “it’s a bit like drivers.

“Just as inexperienced drivers are often high-risk, so too are younger doctors. The (prevalence of) potential risks early in medical careers may be the same as they are late in careers.”

Yet the risks for older doctors have to do with medical conditions, not inexperience. So the college’s assessment program is designed to monitor doctors, especially those working in isolated communities or outside hospitals where they would be continually learning from — and getting scrutinized by — colleagues.

Doctors who are the subject of complaints related to age will be asked to attest to the fact they have a doctor who has deemed them medically fit to practise, much the same as older drivers. Complaints may stem from a formal investigation that can take months as reviewers pore over records to evaluate such things as whether doctors are properly prescribing medications. Some assessments invite input from medical colleagues or co-workers and even patients of the doctor.

McNestry said not all doctors appreciate the evaluations, but “no one practising into their eighties should be surprised about being monitored.”

Dr. Bill Cavers, president of Doctors of B.C., said he agrees with McNestry that some doctors find it difficult to stop practising because “medicine is a lifestyle and identities are often melded to the professional roles.”

Cavers said doctors have an obligation to report colleagues who may not be competent because of advancing age. He’s never called the College himself, but he once spoke to a colleague directly about an age-related practice concern. The associate was a temporary fill-in (locum) for another doctor and he readily agreed to take a leave to pursue remedial courses.

In the 2013/14 fiscal year, 113 doctors participated in remedial education programs, according to the report. Demographics of such physicians are not specified.

Gavin Wilson, spokesman for Vancouver Coastal Health, said about 15 per cent of medical staff at hospitals within the region choose to work past age 65. They “provide an ongoing, valuable service and are in excellent health and want to continue working.”

All surgeons, regardless of age, undergo annual evaluation by their division or department head.

“This evaluation includes a questionnaire regarding practice issues, confirmation that continuing medical education requirements have been fulfilled, a personal interview, and, if necessary, a look at interactions with the other team members and staff,” he said.

The evaluation includes an appraisal of the previous year, including any complaints and outcomes of reviews relating to patients harmed by care. Teaching hospitals also consider whether doctors have contributed academically as instructors or researchers.

From Sun Health Issues Reporter

pfayerman@vancouversun.com

Follow me: @MedicineMatters

Recent Changes by Government to the Temporary Foreign Worker (TFW) Program Deterring the Recruitment of Physicians across Canada

According to Phil Jost, a senior executive and physician recruiter with CanAm Physician Recruitment Inc., recent changes by Customs and Immigration Canada and Service Canada to policies governing the Temporary Foreign Worker (TFW) program may be contributing to unintended and detrimental recruitment outcomes of much needed #physician resources to hospitals, medical clinics and rural health regions across Canada.

When first announced by the government, the changes to the #TFW program were to be directed at preventing the activities of unscrupulous recruiters and Canadian employers from abusing the TFW Program by bringing in large numbers of unskilled temporary foreign workers to work in low skilled resource based industries, such as forestry, agriculture, fish processing, etc. – and displacing qualified unemployed Canadian workers.

To correct this problem the federal government brought in sweeping changes to the TFW program that effectively, and abruptly, stemmed the flow of both low-skilled and high-skilled foreign workers into Canada. According to sources in the immigration law industry, applications for TFWs dropped within weeks by a whopping 74%!

Unfortunately, since these government changes also included high-skilled workers, the flow of needed foreign physicians into Canada has also been seriously compromised. Consequently, communities across Canada must now wait much longer for the arrival of needed physician specialists, including Family Practitioners, Anaesthetists, Obstetrics/Gynecologists, Pediatricians, Surgeons, Emergency Physicians, Oncologists, to name a few….

The recruitment staff of hospitals, medical clinics and rural health regions quickly became overwhelmed when faced with a 300% increase in application fees, large unexpected immigration legal fees, onerous increases in paper work, and a very high applicant rejection rate by apparent over-zealous Service Canada agents.

The inability by #healthcare provider organizations to cope with these arduous government changes has severely taxed their existing in-house recruitment resources, thus compromising their ability to attract Canadian and/or foreign medical graduates. Consequently, employers are forced to cope with increased closures of rural Emergency Departments, delayed elective and urgent surgeries, expectant mothers forced travel greater distances to referral hospitals to obtain maternity care, and cancer patients waiting longer for much needed diagnosis and treatment.

Subsequently, CanAm is experiencing a marked increase in new clients, and increasing demand from our existing clients desperate for solutions to bring some semblance of stability to their community’s physician resources. In response, CanAm is redoubling the efforts of our physician recruitment professionals and certified immigration affiliates to help our Clients to recruit available Canadian physicians, and if necessary, navigate the increased complexities of the revamped government TFW program to expedite the recruitment of foreign physicians.

For hospitals, medical clinics and provincial health regions that have not had to recruit foreign trained physicians since the recent sweeping government changes, a summary of the changes is as follows:

 

 

Government   Policy Changes to the Temporary Foreign Worker Program

1 Employers must now post at least 3 mainstream Physician Job Ads
–            1 ad on the Service Canada online Job Bank or a Service Canada approved provincial website, and the ad must be renewed monthly until the MD vacancy is filled.
–            The other 2 ads must be on media resources ‘acceptable’  to Service Canada, and at the employer’s  expense
–            All ads must run continuously, and unchanged for at least 30 days before an application can be started for a Labour Market Impact Assessment   (LMIA), (formerly known as a Labour Market Opinion (LMO)), which is required for approval to apply to the TFW program to hire a physician.
–            All ads must contain a strict minimum list of prescribed job information details.
–            Failure to meet the above criteria can lead to rejection of the TFW application.
2 Employers can then apply for the LMIA and pay the fee of $1000 (formerly $250)
–            Due to the increased complexity of the new LMIA, and increased incidence of application rejection, the employer is now compelled to hire the services of a certified immigration specialist at industry costs of up to $4500 per application.
–            The LMIA also requires the inclusion a Transition Plan outlining the applicant’s plans to minimize their dependency on foreign physicians in the future.
–            Depending on status of Service Canada’s the processing system, approval time can range from 2 weeks to 2 months.
3 Upon successful completion of the above 2 requirements, the foreign physician is finally approved to apply to Customs and Immigration Canada for approval of a Work Permit in the employer’s place of business. Depending on the foreign physician’s visa status and the efficiency of their certified immigration   professional, approval of the Work Permit can range from a few weeks, to   several months.

 

In summary, we are predicting that without immediate mitigating government policy changes, other countless hospitals, rural health regions, and both urban and rural medical clinics will soon experience physician recruitment hardship. In many cases, the delivery of safe and continuous delivery of critically needed physician services will erode to unprecedented levels.

Readers of this Blog are encouraged to respond with their stories related to this topic…

By Phil Jost, Vice President and Regional Manager, CanAm Physician Recruiting Inc. – phil@canamrecruiting.ca

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Doctors told to pay attention to those controversial rating websites

        Written by JERED STUFFCO         on         September 23, 2014         for The Medical Post

Don’t take it personally—that’s the message from the Canadian Medical Protective Association to doctors regarding physician ratings sites.

get very upset with (online) criticismAmong their recommendations: Take the feedback as “objectively as possible,” the Leader-Post reported here.

And the CMPA added: “Rather than turn a blind eye to these ratings, doctors should consider monitoring what is being said about them, and take measured steps to deal with these reviews.”

While the CMPA says it won’t offer legal protection for doctors who believe their reputations are being harmed by comments, it has prepared a cease-and-desist form to send.

“Physicians tend to get very upset with (online) criticism,” said Dr. Douglas Bell, associate executive director of the CMPA, in the Leader-Post.

“People who go into medicine generally go into it with an altruistic purpose. So when they see criticism they tend not to be objective and look at it (instead) more sort of as an attack on their professionalism.”

New customized page to share examination results with CaRMS for the R-1 Match

For the 2015 CaRMS R-1 Match, applicants will be able to link directly to their physiciansapply.ca account from within their CaRMS application to share their MCC and/or NAC examination results data, in addition to their documents. A link will be available in the CaRMS application and a customized sharing page will help guide the applicant through the sharing process. For more information, please visit the following document: mcc.ca/wp-content/uploads/CaRMS-R-1-Match.pdf

CFPC and MCC Announce New Examination Structure for Family Medicine

Effective January 1, 2016, the College of Family Physicians of Canada (CFPC) and the Medical Council of Canada (MCC) will modify the examination process for family medicine candidates. Upon review, the CFPC has determined that the Certification Examination in Family Medicine, featuring content from both organizations, has not resulted in the anticipated benefits for the Certification decision. For this reason, starting in 2016, the exams will be run as two separate examinations, as they were before 2013. The MCC respects this decision and will work with CFPC to create a transition that is as seamless as possible for candidates. For the joint announcement, please visit the following: mcc.ca/about/news/sept-9-2014

Precision machine offers hope for liposarcoma tumours….

Published Sunday, September 21, 2014 10:10PM EDT by CTV

As Toronto Mayor Rob Ford begins chemotherapy for the liposarcoma tumour in  his abdomen, doctors may need to try several drugs before they find one that  works. But there’s hope of better treatments to come in the future through a new  technology called “precision medicine.”

Cancers are notoriously varied, so even two patients with the very same kind  of cancer will respond differently to the same chemotherapy medications. That’s  because as tumours grow, the genes in the cancer cells mutate in different ways.  For every type of cancer, there are different mutations.

Quickly finding the right drugs that will work on these growing tumours is  critical, since the side effects of chemotherapy can be devastating.

Photos

Chemotherapy drip, cancer treatment

Chemotherapy is administered to a cancer patient via  intravenous drip at Duke Cancer Center in Durham, N.C., in September 2013. (AP /  Gerry Broome)

Now, doctors have found a new way to learn more about the genetics on a  patient’s tumour, to guide them in their search for the right drug.

A research firm in the U.S.  called Champions Oncology developed something it calls Tumorgraft. It takes  a small sample of the patient’s tumour, and implant them into specialized mice  that have been bred without immune systems. The lab then tests different drugs  to see which works best on the mice. Since the mice have no immune systems of  their own, the researchers can be sure it’s the drugs that cause tumours to  shrink in some of the mice.

Toronto resident Yaron Panov has undergone precision medicine for the same  kind of cancer Ford has: pleomorphic liposarcoma. When Panov was diagnosed in  2010, doctors tried surgery, but the treatment failed and after just three  months, the tumour grew back and spread.

Doctors suggested chemotherapy but were not optimistic for Panov’s  chances.

“I was given just a few months to live,” he told CTV News.

Panov’s wife, Dr. Rochelle Schwartz, herself a physician, had heard about  precision medicine treatments being developed at Champions Oncology and the  couple flew to the States.

There, testing on lab mice implanted with Panov’s tumour cells revealed that  the usual chemotherapy drug that would have been given to Panov would not have  worked on him. But a drug developed for colon cancer, on the other hand, showed  excellent effectiveness.

Panov underwent chemotherapy with the drug. While the treatment was  difficult, causing him fatigue, intense nausea and hair loss, it worked to  shrink his tumour.

Panov still has more chemotherapy in the future to maintain the tumour  shrinkage, but for now he is feeling optimistic.

“He had a CT scan 6 weeks ago, and he is tumour-free — to the astonishment  of the sarcoma team,” says his wife, Rochelle. “It helped to save his life.”

The new treatment didn’t come cheap. The lab work on the mice was expensive,  and so was testing each drug. The entire testing procedure can be  time-consuming, taking sometimes several months during which a patient may  become sicker.

Dr. Peter Metrakos, the program leader at McGill University Health Centre’s  Cancer Research Program, says several researchers in both the U.S. and Canada  are doing similar work, using patient-derived cells and grafting them into mice.  But he says the branch of research is still very new.

“There have been dramatic responses by tailoring the therapy with this  approach. But I don’t think it is prime time yet. I think there is still a lot  of work to be done,” he told CTV News.

Nevertheless, Panov and his wife want to bring the approach to Canada so  that Canadians with all kinds of cancer can benefit. They have started the Panov  Program in Precision Chemotherapy, a project with Mount Sinai Hospital in Toronto and Champions  Oncology.  The goal is to raise $1.5 million for a study to validate  the Champions approach.

Schwartz believes targeted therapies would save many cancer patients from  trying difficult treatment drugs that are bound to fail. What’s more, targeted  treatment would likely be cheaper than giving patients expensive medications to  patients that won’t work.

“Isn’t it better to give the patient the right chemo the first or second  time so they don’t suffer from horrible side effects?” she says.

With a report from CTV’s medical specialist Avis Favaro and producer  Elizabeth St. Philip

Read more: http://www.ctvnews.ca/health/precision-medicine-offers-hope-for-liposarcoma-tumours-1.2017829#ixzz3EBfG97Dn

Woman born without a cerebellum baffles doctors

Woman born without a cerebellum baffles doctors

Chinese woman without a cerebellum in her brain.A series of CT scans of the woman’s brains. The black spot indicates where  the cerebellum is normally found.  (Brain, Feng Yu, et al.)

             CTVNews.ca Staff                                       Published Friday,  September 12, 2014 7:57AM EDT

A woman in China has stunned doctors after a trip to the emergency room for  dizziness and nausea revealed that a key part of her brain was missing.

It appears the woman was born without a cerebellum, a small but major part  of the brain that controls such things as movement and balance.

While many people survive being born without certain segments of their brain  or can live after having parts of their brains removed, there have only been  eight other documented of people surviving without a cerebellum. Most died quite  young; this woman has already lived to 24 before receiving her diagnosis.

It’s not clear how the woman had lived this long without a cerebellum, which  is sometimes known as the “little brain.” The brain segment, located underneath  the two main hemispheres of the brain, represents only about 10 per cent of the  brain’s total volume, but it contains a full 50 per cent of its neurons.

The case, her doctors say, highlights just how well the brain can adapt to  deficiencies.

The woman told doctors that she had had problems walking steadily for most  of her life. Her mother reported the woman hadn’t been able to stand without  assistance until she was four, hadn’t learned to walk until she was 7, and had  never learned to run or jump. It has also been impossible to understand her  speech until she was about six.

The discovery was made when the woman, a married mother of one, went to  hospital in Shandong province complaining of intense dizziness and nausea that  had lasted for a month. Doctors did a CT scan and immediately noticed that the  space where the cerebellum should be was empty, filled instead with  cerebrospinal fluid.

The woman’s doctors suspect that the functions that the cerebellum normally  performs had been taken over by the cerebral cortex.

The results of the woman’s initial examination are published in the journal Brain.

As for the woman’s prognosis, doctors are not able to say since her  condition is so rare.

Read more: http://www.ctvnews.ca/health/health-headlines/woman-born-without-a-cerebellum-baffles-doctors-1.2003732#ixzz3EBdbP9gf

Dr. Yang’s surgical navigation device balances revolution with evolution

RCPSC Dialogue Volumn 14, # 9, 2014

Pairing innovation with practicality is perhaps the defining characteristic of Dr. Yang’s surgical navigation device. Conceived and developed by a Ryerson University research team led by Victor Yang, MD, PhD, P.Eng, FRCSC, a staff neurosurgeon at Sunnybrook Health Sciences Centre in Toronto, Ont., and senior scientist at the Sunnybrook Research Institute; the device resembles an unremarkable LED operating room (OR) light — a simplicity that belies its underlying sophistication.

How the device works: Past and present imaging, matched at lightning speed

Dr. Yang’s surgical navigation device uses refined optical information to present preoperative patient data as intraoperative data. In simpler terms, the device — while looking like an OR light — shines a special pattern onto the patient. This pattern is indistinguishable from ordinary light to the operating room team, but the machine sees an accurately-sized, three-dimensional surface of the patient’s anatomy. During surgery, as the patient’s skin is exposed, the machine matches the patient’s current anatomy to his or her preoperative CT or MRI scans, thereby providing that information to the surgeon in real time.

“The system matches all of that imaging within milliseconds,” said Dr. Yang, who is also an associate professor, Division of Neurosurgery, at the University of Toronto, and associate professor and Canada Research Chair (Tier II) in Bioengineering and Biophotonics in the Department of Electrical and Computer Engineering at Ryerson.

“It provides the relevant x-ray type 3-dimensional information that a surgeon needs to perform complex procedures, allowing him or her to see subsurface anatomy in the present tense.”

The case for 7D: Making technology meaningful, relevant and easy to use

Using Dr. Yang’s concepts, the idea to commercialize this technology through 7D Surgical was born out of an apparent need to create a computer-aided surgical device that would be valuable for spinal surgeries.  Studies have shown that computer-aided surgery makes good sense in terms of clinical outcomes and economics; nevertheless, the adoption rate of these technologies for spinal surgeries has been low. If the principle of the technology works, then there must be a problem with the design and the ease with which it can be implemented, Dr. Yang surmised.

“Many of the current computer-aided surgical devices came from innovations in the field of Neurosurgery. Once the basic ‘highway’ configuration was optimized for the brain, companies added software and hardware to adapt it for spinal navigation — but spine surgery has a different workflow and geometry than cranial surgery.”

To accommodate for this, Dr. Yang and his team studied the differences between the two workflows in minute detail, exhausting case studies, personal observations and human catenary studies. Using machine vision, they verified the geometry and timed each element in the workflow with a stopwatch. These efforts confirmed the two values upon which the 7D Surgical concept will be built:

  1. Surgeons are more likely to use new technology that can be quickly and easily integrated into their existing workflows.
  2. Surgeons’ only interest is in knowing the real and present state of their surgeries, not patients’ “before” states.

Dr. Yang in surgeryPhoto Credit: Doug Nicholson

“In medicine, we obviously want revolutionary changes because that’s good for patients; yet, we want things to be implemented in an evolutionary way. The ideal is small changes, on a daily basis, so when you add them all up it becomes a revolution for patient care. Sometimes too great a leap, in terms of technology, may not work out because it may be too far ahead of its time,” he said.

The benefits of surgical navigation: For patients and the OR team

To-date, Dr. Yang’s prototype device has been piloted by five surgeons on 24 patients, as well as by a number of residents and fellows. This clinical trial process will continue for 120 patients, but already the team is seeing benefits in terms of precision, ease of use and time-saved.

Using the surgical navigation system, surgeons can see the position of their instruments, obstructions and surgical materials with incredible accuracy, which facilitates delicate surgical maneuvers. That precision, in turn, reduces the likelihood of patients requiring surgical revisions.

The device also eliminates the need for an intraoperative scan, which requires the use of a bulky machine that is difficult to bring into the OR and time-consuming to set-up; given the technology’s placement in the lighting system, no additional hardware is needed. Moreover, since surgeons are well-trained to keep the surgical area lit, the device has a relatively low impact on current workflows and is intuitive for surgeons to use, with little orientation.

The elimination of intraoperative x-rays (or CT) is also a big benefit to the OR team: nurses are pleased that they don’t have to wear lead vests, anesthetists are pleased with the shorter window between the administering of drugs and the start of surgery, and operating room managers are pleased with the decline in overall OR time.

“If you can do things faster and achieve the same level of accuracy, that’s also cost-effective,” said Dr. Yang.

The final word

While the potential for this device to benefit patients is tangible (and Dr. Yang is hopeful that hospitals will invest in this technology once it is out of clinical trials) he cautions surgeons to avoid a false sense of security with this, or any other, innovation.

“As a surgeon, I recognize my own shortcomings; I understand that no surgeon is perfect. As an engineer, I also understand that no technology is perfect. So, as a surgeon-engineer, I am very sensitive to the high-stakes care that we provide to our patients and also the double-sided blade of technology. Even with a great tool, we still need to be humbly aware that technology is only as good as the surgeons using it.”

Learn more about 7D Surgical from their website: www.7dsurgical.com/news.html

Canadian physician health expert tells colleagues: “Be civil”

Pat Rich – CMA – 9/16/2014

News Body

A senior Canadian physician health expert has urged his colleagues to follow five fundamental principles of civility.

Dr. Michael Kaufmann, medical director of the Ontario Medical Association’s physician health program and Physician Workplace Support Program, took a somewhat lighthearted approach to the serious issue of disruptive physicians at the 2014 International Conference on Physician Health in London, UK.

Having written about his civility framework in the Ontario Medical Review earlier this year, Kaufmann seized the opportunity to present what he admits is a work in progress to an international audience, with a largely favourable response.

“This is just me trying to organize my thoughts on a subject (that) I think matters,” Kaufmann said, noting he wanted to discuss ways of further disseminating his views through a wide variety of media and formats.

Kaufmann explained that he didn’t enter the field of physician health to focus on disruptive behaviour in the workplace; the issue has been brought to his attention by physician leaders since the 1990s.

He said he has dealt with hundreds of “misbehaving – they don’t like being called disruptive – physicians” who are acknowledged to have a significant negative impact on workplace culture, and even on patient outcomes.

While the negative behaviour of disruptive physicians has been characterized in many ways, Kaufmann said civility is an acceptable approach to encourage the desired behaviour these doctors should practise.

In the sense he intends it, Kaufmann said civility goes beyond being nice and polite — although this is a necessary first step.

“It’s not just being Canadian,” he said, in a presentation full of references to both good and bad TV doctors and Canadian icons such as Tim Hortons.

Kaufmann’s five fundamentals of civility are:

  • Respect others and yourself.
  • Be aware.
  • Communicate effectively.
  • Take good care of yourself.
  • Be responsible.

“There’s no rocket science here,” he stated, but added these fundamentals are not always displayed or taught in a deliberate manner during medical training.

Taken together, the fundamentals can foster better behaviour, even when physicians are at risk of demonstrating disruptive characteristics.