Download The Emperor Has No Clothes AMA President`s Message

VITAL SIGNS
COMMUNICATING WITH PHYSICIANS IN ALBERTA
February 2017
ZONE MEDICAL
STAFF ASSOCIATIONS
OF ALBERTA
The Emperor Has No Clothes
AMA President’s Message
Community Focused Health Co-op
Valuing Health Advocacy in Medical School
Moose & Squirrel Medical Clinic Home Palliative Program
Sundre Physician Honoured
PARADime: Alberta’s Resident Physicians Reach Out
A NEW COMMUNITY
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BACKGROUND
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with empathy, and shaped after the kind of service today’s most
service-orientated companies deliver to their customers.
APPROACH
Using principles of co-creation – which in very simple terms, you can
think of as techniques for collaboration and joint problem-solving, we
engaged our employees, physicians, referrers, and our patients to design a future for
medical imaging that we could all rally behind.
Together, we reframed our approach, with patients as our focal point. Instead of
attempting to create an imaging clinic that provides outstanding patient experiences,
we wanted to turn an outstanding patient experience into an imaging clinic. The real
benefit of using this approach is identifying what truly matters to our patients.
RESULT
A medical imaging clinic of the future.
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We’re open Monday to Friday, 8 a.m. to 4 p.m.
APPOINTMENTS
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MEDICAL
IMAGING
REIMAGINED
radiology.ca
A CALGARY & AREA MEDICAL
STAFF SOCIETY PUBLICATION
February 2017
CAMSS EXECUTIVE
President: Dr. Sharron L. Spicer –
[email protected]
President-Elect: Dr. Linda Mrkonjic –
[email protected]
Secretary-Treasurer: Dr. Davinder Sidhu –
[email protected]
CENTRAL ZMSA EXECUTIVE
President: Dr. André van Zyl
Vice-President: Dr. Alayne Farries
Secretary-Treasurer: Dr. Stephen Tilley
EDMONTON ZMSA EXECUTIVE
President: Dr. Shelley L. Duggan –
[email protected]
Vice-President: Dr. Randy Naiker –
[email protected]
Past President: Dr. Robert W. Broad –
[email protected]
Secretary-Treasurer: Dr. Michael Jacka –
[email protected]
NORTH ZMSA EXECUTIVE
Acting President: Dr. Sandra Corbett (in acting role until
ZMSA is set up and ZMSA executive elected)
SOUTH ZMSA EXECUTIVE
President: Dr. Fredrykka D. Rinaldi
Vice-President: Dr. Jessica Abraham
Secretary-Treasurer: Dr. Carl W. Nohr
CONTRIBUTING WRITERS
Dr. Sharron L. Spicer
Dr. Padraic E. Carr
Dr. Emmanuel Gye
Dr. Mackenzie Grisdale and Dr. Noreen Singh
Dr. Vesta Michelle Warren
Jonathan Koch
Dr. Adele Duimering
MANAGING EDITOR: Hellmut Regehr, [email protected]
EDITORIAL ADVISORY COMMITTEE:
Dr. Sharron Spicer – [email protected]
Adrienne Wanhill – [email protected]
Hellmut Regehr – [email protected]
Dr. Tobias Gelber – [email protected]
Dr. Steven J. Patterson – [email protected]
Dr. Alayne Margaret Farries – [email protected]
Calgary & Area Medical Staff Society (CAMSS)
350, 708-11 Avenue SW, Calgary, Alberta T2R 0E4
COORDINATOR: Adrienne Wanhill 403-205-2093
SUBMISSIONS:
Vital Signs welcomes submissions (articles, notices, letters to the
editors, announcements, photos, etc.) from physicians in Alberta.
Please limit articles to 1000 words or less.
Please send any contributions to: Spindrift Design Studio Inc.
Hellmut Regehr, [email protected]
Vital Signs reserves the right to edit article submissions and
letters to the editor.
The deadline for article submissions for the next
issue of Vital Signs is February 17, 2017.
CONTRIBUTORS:
The opinions expressed in Vital Signs do not necessarily reflect
the opinions or positions of CAMSS or CAMSS executive.
Contents:
The Emperor Has No Clothes......................................................................2
AMA President’s Message...........................................................................3
Community Focused Health Co-op.............................................................6
Valuing Health Advocacy in Medical School...............................................7
Moose & Squirrel Medical Clinic Home Palliative Program........................8
Sundre Physician Honoured......................................................................10
PARADime: Alberta’s Resident Physicians Reach Out.............................12
Save the Dates!
CAMSS
Council Meeting
February 8, 2017 | ACH Room B2-200 – 2nd floor – 5:30-8:30 pm
Council Meeting
March 8, 2017 | ACH Room B2-200 – 2nd floor – 5:30-8:30 pm
ZAF
April 12, 2017 | Southport Tower Rm 1003 – 5:30-8:30 pm
CZMSA
Annual General Meeting
February 1, 2017 | Red Deer Hospital, Boardroom 3208 – 3rd floor – 7:00-9:00 pm
Executive Meeting
March 9, 2017 | WebEx
EZMSA
Executive Meeting
February 16, 2017 | Misericordia IN-106 – 5:00-5:30 pm
Council Meeting
February 16, 2017 | Misericordia IN-106 – 5:30-7:30 pm
SZMSA
Council Meeting
February 6, 2017 | Teleconference – 5:30 pm
ADVERTISING:
Please visit http://albertazmsa.com/vital-signs/ to view media kit
or contact Hellmut Regehr at [email protected].
Claims made in advertisements are not verified by CAMSS and
CAMSS assumes no responsibility for advertising accuracy.
© 2017
Vital Signs Subscriptions: Annual subscriptions to Vital Signs are available for $30.00; please contact [email protected] for more information.
ZMSAs – Communicating With Physicians in Alberta
2
President’s Message:
The Emperor Has No Clothes
Over the past year, I have witnessed many things that I never imagined would
come about in my lifetime or medical career: Canada legalizes medically-assisted
dying; access to marijuana for personal “medical” use increases;1 Donald Trump
becomes President of the United States; Alberta faces an impending physician
surplus. WHAT? Does the emperor have no clothes?
Dr. Sharron L. Spicer, CAMSS President
In this era of fake news, we must look carefully to the messages we hear. White House
Press Secretary Sean Spicer (no relation, to
be very clear, though we share a surname and
first initial) asserted that the Trump inauguration was the most-watched ever — then
clarified that “Sometimes we can disagree
with the facts” and reassures the people that
he will “tell you the facts as I know ’em.”2
So, too, we are hearing that Alberta is on
the verge of being over-supplied with physicians. I question this assertion. Certainly
our province — and all provinces — is facing
pressures of rapidly escalating health care
costs; physician-driven costs (not just physician payments but hospital admissions,
surgeries, medications and laboratory tests)
are part of this spiral. And the number of
physicians in Alberta has risen in the past
decade. “The increase in the net new number
of physicians entering Alberta is significant
and unsustainable. The number of physicians
in Alberta has been increasing at a rate of
around 5% per year on average since 2010.”3
Yet the increase in physician numbers does
not necessarily imply a direct cause-andeffect relationship to increased health costs.
Do you remember learning about fluid balance
on the wards during training? Fluid requirement equals insensible losses plus urine output. If you incorrectly estimated insensibles,
though, you would never quite correct the fluid
balance with the calculated fluid requirements.
So it is with determining physician manpower
Do you remember learning about fluid balance on the wards during
training? Fluid requirement equals insensible losses plus urine output.
If you incorrectly estimated insensibles, though, you would never quite
correct the fluid balance with the calculated fluid requirements.
needs. Although “[t]oday, for the most part, the
natural attrition of physicians in the province is
being resupplied by the output of our medical
schools,” we need to better understand whether
our starting position is adequate before we
plan how to limit further growth.3 This will
be a crucial exercise of the multi-stakeholder
Physician Resource Planning Committee
(PRPC), at which Dr. Ruth Collins-Nakai,
past AMA and CMA President, will be the
AMA representative.3
In my editorial and other physicians’ letters in the January issue of Vital Signs, we
expressed reservations about limiting the
entrance of new physicians to Alberta as the
mechanism to limit physician (a.k.a. expenditure) growth. This concern is echoed in my
words — and others’ — in this issue. Certainly
we support rational measures to redirect the
increasing cost curve of health care costs,
and that includes examining how and where
physicians practice. I just hope that rational
does not equal rationing when it comes to
physician services.
FOOTNOTES
1
Health Canada (2016). “Understanding
the New Access to Cannabis for Medical
Purposes Regulations” [Online]. Access:
http://healthycanadians.gc.ca/publications/
drugs-products-medicaments-produits/
understanding-regulations-medical-cannabismedicales-comprehension-reglements/indexeng.php [accessed 24 January 2017].
2
The Guardian (2017). “Trump inauguration
was ‘most watched ever’ Spicer claims again
– video” [Online]. https://www.theguardian.
com/us-news/video/2017/jan/23/sean-spicertrump-inauguration-most-watched-ever-video
[accessed 24 January 2017].
3
Carr P (2017). “No decisions made on
physician supply mechanisms” [Online].
Access: https://www.albertadoctors.org/
services/media-publications/presidents-letter/
pl-archive/no-decisions-made-physician-supplymechanisms [accessed 24 January 2017].
VITAL SIGNS February 2017
3
AMA President’s Message
The following President’s Letter was sent to Alberta Medical Association members on January 13.
Dear Member:
•A needs-based physician resource plan will be developed by a
multi-stakeholder Physician Resource Planning Committee (PRPC).
•Any decisions about how to manage physician supply must consider
the evolving plan.
•No decisions regarding billing number conditions have been made.
As noted in my last President’s Letter, the AMA Amending Agreement
commits the parties to establishing a needs-based physician resource
plan. Using best evidence, the plan will be developed by a multi-stakeholder Physician Resource Planning Committee (PRPC). I am pleased to
announce that Dr. Ruth Collins-Nakai, past AMA and CMA President,
will be our representative to this important committee. (Thank you
to all the individuals who applied to serve on this committee. We are
fortunate to have an abundance of talented physician leaders to help
us with the work of the association.)
I have heard from a number of physicians about the future direction
of this initiative. Specifically, there is a concern that restrictions to
billing numbers are imminent. Before saying anything else in this
letter, let me emphasize that no decisions have been made with respect
to application of billing number conditions.
The Plan Must Inform Decisions and Actions
The increase in the net new number of physicians entering Alberta is
significant and unsustainable. The number of physicians in Alberta
has been increasing at a rate of around 5% per year on average since
2010. The overall trend is an important consideration, particularly
when coupled with Alberta’s difficult financial state.
It makes sense for the parties to consider management of entry, exit and
physician distribution as a contributor to sustainability. However, for
sustainability as we have defined it, the all-important aspects of patient
access and quality of care must be addressed. Additionally, the AMA,
AH and AHS believe that we must continually renew the profession
by incorporating new graduates into Alberta as practicing physicians.
This is why any decisions about how to manage physician supply must
consider the evolving needs-based plan to be developed by PRPC. The
committee stakeholders, including future PRPC members, first met
in October to receive information on physician resources in Alberta,
including trends in physician supply, distribution of physicians in
Alberta, and the costs of physician services. For purposes of gaining
insight and feedback, AH and AHS also presented a draft proposed
regulatory approach, giving AH the authority to issue new billing
numbers only to new physicians who practice in positions identified
in the needs-based plan.
Since that first meeting, AH has held several individual and small group
meetings with stakeholders to further discuss the draft proposal. Any
eventually proposed changes must be approved through the regulatory process, which includes consultation with stakeholders. AH is
consulting and listening to feedback. This engagement will continue;
AH has indicated they are very open to further input. This includes
the PRPC, which involves community-based physicians, primary care
networks, resident physicians, medical students and international
medical graduates. The necessary representation and channels are built
into the design of the PRPC (see page 16 of the Amending Agreement
at https://www.albertadoctors.org/services/physicians/our-agreements/
Signed_AMA_Amending_Agreement_Pkg_Nov_21_2016.pdf).
No Decisions on Future Actions Have Been Made
Again, no decisions regarding billing number conditions have been
made. There are a number of existing tools that could be applied as
needed. Government is naturally looking at all options as part of its
own diligence. They are clear, however, that the PRPC owns the task
of developing a needs-based plan, based on the best current evidence
and involving all the appropriate groups. This evolving plan must
be — and will be — considered as we move forward.
As I have said before: The timing is fortuitous. We are working to meet
an identified need, but we are not under pressure of a crisis. Today,
for the most part, the natural attrition of physicians in the province
is being resupplied by the output of our medical schools. We have
the time and the ability to do things right. We have the knowledge
and expertise to develop a highly refined and effective needs-based
physician resource plan.
Let’s also think about this: We have a significant opportunity with
this new Amending Agreement, because we have a real voice and
influence in all aspects from the fee schedule to clinical appropriateness to physician supply to informatics and beyond. That kind
of influence, though, comes with a price: we must take on some
risk, some responsibility, and willingness to lead by doing things
differently. We need a plan, and that is what the Agreement calls for.
There is a great deal of work ahead for the PRPC. All the necessary
parties will be there, and our Agreement ensures this. We have an
unprecedented commitment for everyone to be guided by the outcome
of the committee’s work — based on best evidence and consultation
with those most affected. This is a unique collaborative effort, and will
set the stage for our future endeavours with government.
I will keep the profession informed as we move forward, including
principles set forward by the Board which will guide our deliberations.
As always, please let me know what you think. Email: president@
albertadoctors.org.
I look forward to working with you in 2017.
Yours truly,
Padraic E. Carr, BMedSc, MD, FRCPC, DABPN
President
ZMSAs – Communicating With Physicians in Alberta
4
Letter
The following is an excerpt from a letter that I sent recently to the AMA President Dr. Padraig Carr. I am grateful for his thoughtful
response and commitment that the AMA ensure that the voices of all stakeholders are heard during the work of the Physician Resource
Planning Committee.
Dear Dr. Carr
Thank you for this note and your other regular communications. I appreciate your service to the AMA and the thoughtful
comments that you and Dr. Cooper have provided in regard to issues of physician stewardship.
I write, in my role as a clinical and academic department head, to express in the strongest possible terms my concern about the
spectre of restricting new physicians in Alberta through restriction of billing numbers or other means. Related to this, I want to
express my concern about the AMA leadership’s lack of clear communication about this matter.
1. In your recent communication to members on December 16, 2016, you stated that, “While the total percentage of members
casting ballots was less than ideal, turnouts are typically low and those who voted did so strongly in favour. Due process was
followed, and the results are binding.” I do not argue with the numerical result of a democratic vote that followed due process.
However, the turnout was much lower than usual (29% versus 38% average since 2003) and while 74% of the votes were in
favour, just 21% of AMA members actually expressed support for the agreement. This low turnout AND the fact that the vote
was for an omnibus agreement that one could only vote all in favour or all against, does not give the AMA unfettered authority
on any of the actions that were voted on. In a civil democracy, elected officials must continue to listen to their constituents
between votes. I am certain that you are willing to listen which is why I am writing today.
2. Restricting new physicians to Alberta would be the most damaging of all possible measures to deal with the issue of the budget
for medical services. Imagine if you were currently entering medical school or completing medical training in Alberta, or
elsewhere in Canada, and you learned that authorities in Alberta (endorsed by the AMA, long time staunch supporters of the
right to independent private practice by licensed physicians) were going to address the issue of the medical services budget
by eliminating (or “restricting”) your ability to practice in Alberta. Moreover, imagine that this was not happening equally
across Canada (except for Quebec (and New Brunswick, to a lesser extent), where harsh measures to control physician supply
have for many years had a detrimental effect on the flow of physicians into that province). The impact could be a rapid loss
of undergraduate and postgraduate trainees from Alberta, a loss of interest by strong physicians from elsewhere, a loss of the
reputation of current Alberta physicians and a loss of morale amongst the thousands of current Alberta physicians who are
involved in the training and mentorship of current and future Alberta medical students and post-graduate trainees.
3. Restricting new physicians in Alberta has the potential to severely, negatively impact academic medicine in Alberta. Academic
medicine in Alberta, clustered around hubs in Calgary and Edmonton, is vibrant and leading locally, nationally and often
internationally in clinical care improvement, research and education. While one can hope that the process of medical workforce
control will be thoughtful and appropriately consider clinical and academic needs, it is not hard to imagine that arbitrary
halts to academic recruitment (to replacement or new positions) would have a rapidly damaging impact on current academic
groups and services. Since 2012, there have been several, ultimately temporary, halts to recruitment to academic departments
in Calgary and Edmonton supported by Academic Alternate Relationship Plans (AARPs). Even these temporary halts in a
handful of departments have been disruptive.
4. That the AMA may endorse restricting new physicians, with the premise of this measure being part of a “needs-based human
resource plan for physicians” is at best naïve and at worst self-serving. I completely agree that we (physicians, medical schools,
government, licensing bodies and medical associations, along with the general public) need to coherently address the issue of
the numbers, type and geographical distribution of physicians to best serve our population. Workforce planning is actually
a significant part of my job as a department head. We need to do better at ensuring that all necessary types of physicians are
trained and that they work in all locations where they are needed. I actually think we have made good progress in Alberta
with this. Speaking for Pediatrics, the area of medicine that I know well, it is pleasing to see that our workforce across the
province (with a few exceptions) is now larger and more expert than it was a decade ago when there were still very significant
shortages of general and subspecialty pediatricians. However, I would argue that the least important aspect of this issue of
resource planning is the actual number of physicians. There is, as I am sure you are aware, limited data to support a relationship
between physician numbers and health outcomes when comparing regions (particularly in the US). Equivalent outcome seems
to happen in regions with very different physician numbers. In addition, I would argue that one way of reducing wait times
VITAL SIGNS February 2017
5
for services would be to double, literally, the number of licensed physicians to improve accessibility. Of course, such a move
would have an impact on individual physician incomes as more physicians would have to be paid from a fixed pool of funding.
I do not think the number of physicians entering practice is unsustainable. What may be unsustainable is existing physicians’
income expectations at a time when the medical services budget is not increasing as much as some physicians would like it to.
This is why I see the spectre of the AMA supporting restriction of new physicians as self-serving.
I have one suggestion and one request. First, I suggest that the AMA leadership develop a clear and transparent statement to its
members on its position of restriction of new physicians. I completely understand that the AMA is supporting the development
of a “plan” by the Physician Resource Planning Committee (PRPC) which includes AH, AHS and AMA. That is fine, but the tone
and statements made in communications from the AMA, including the President’s Letter of December 16, suggest to me that the
AMA leadership favours limiting new physicians, e.g. “…the net new number of physicians entering Alberta is significant and
unsustainable… particularly when coupled with Alberta’s difficult financial state.” It would be disingenuous not to acknowledge
this more clearly. Simply stating that “no decisions have been made” is not reassuring to your well informed membership. In
addition, I suggest that the AMA leadership needs to vigorously canvas the opinions of all AMA members. As stated before, the
results of the Amending Agreement vote did not, in my view, authorize the AMA to take very significant actions without more
consultation of its members.
Second, please provide me with information about how I can provide input to the PRPC and AH.
I want to clearly express that I have very significant concerns about the deliberations around control of physician numbers in
Alberta, and the risks to new trainees in particular and the entire profession in general. In the absence of true information, it is
easy to be worried about what might happen. Thank you in advance for your consideration.
James D. Kellner, MD, FRCPC
Professor and Head, Department of Pediatrics, Cumming School of Medicine,
University of Calgary & Calgary Zone, Alberta Health Services Alberta Children’s Hospital
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ZMSAs – Communicating With Physicians in Alberta
6
Airdrie Physicians Excited to Develop
Community Focused Health Co-op
Dr. Emmanuel Gye
Dr. Emmanual Gye
“I believe that the community needs to be engaged in their health and health care. Physicians cannot
do it alone and that a Health Cooperative, where all in a community are member-owners in ‘owning
their own health,’ is a key success factor.”
This is one of the fundamental tenets within
the Physician Participation Commitment
document that about 25 of my Airdrie colleagues and I recently signed with the newly
formed Airdrie and Area Health Benefits
Cooperative (AAHBC).
Like me, this group of physicians, and many
other local practitioners and service delivery
organizations firmly believe in engaging and
activating all stakeholders in the community to contribute to a healthier lifestyle and
healthier lives while ensuring equity and
fairness in the use of limited resources. If
you think about it, it is a good part of the
reason we chose family practice.
There has been significant change for Alberta
family physicians over the past several years,
and yet more is on the horizon with capitation and new rules for PCNs. This has
caused many of our colleagues to seek other
places to practice. The family practice group
in Airdrie believes we have found a way to
realize these fundamental principles, gain
autonomy to practice the kind of medicine
we desire, and increase our quality of life
with more frequent and predictable time
for our families.
At AAHBC, physicians and other health practitioners will be organized into teams based on
the needs of a segmented community approach
to health, mental health and health care. The
AAHBC could deliver comprehensive, integrated services in various areas of importance
to the community; health and wellness, preventive care, comprehensive primary care,
mental health, social services, urgent care,
outpatient care, linked emergency and acute
care, care in the home, residential care and
end-of-life care.
We will also have the option of providing
episodic services for urgent or ambulatory
care. Moving away from a focus on volume
and fee-for-service, towards a focus on value,
can usher in a new era of innovation, giving
physicians and other health practitioners the
opportunity to better contribute as change
agents in health.
We all know that neither Alberta Health nor
AHS can alone create an integrated, interdisciplinary, comprehensive, and community-directed health and health care system. And
physicians can’t do this alone either. This is
where the cooperative model can help by bringing together all interests; from physicians to
non-profit agencies to individual patients and
families to municipalities to local businesses.
Health co-ops in Canada and around the world
have proven they can successfully meet the
health and health care needs of their members and the entire community in which they
serve. Shared control, shared participation,
and a singular, common focus on health and
heath care needs have proven to deliver better
health and health care services and produce
improved health status of a population at a
lower overall cost.
The first health cooperative in Canada was
formed in 1944. There are now more than 100
in Canada. Health cooperatives have been
able to fill the gaps in health care systems in
countries like Brazil, Japan, Spain, and the
United States.
In all examples, including Airdrie, the health
co-op is a significant part of the broader health
care system. The AAHBC will compliment,
and coordinate with AHS, Alberta Health, and
all other appropriate current and future health
related community organizations.
Emmanuel Gye, MD, PGDip, CCFP
Calgary Suburban RF Delegate
Health co-ops in Canada and around the world have proven they can
successfully meet the health and health care needs of their members
and the entire community in which they serve.
VITAL SIGNS February 2017
7
Valuing Health Advocacy
in Medical School
The First Annual Calgary Medical Students’
Association Advocacy Symposium
Mackenzie Grisdale and Noreen Singh
Mackenzie Grisdale
Encouraging physicians and medical students to prioritize health advocacy is incredibly rewarding,
but comes with its fair share of challenges as well. Arguably, many medical school curricula and
postgraduate programs emphasize medical research and scholarship more than advocacy. However,
our current CanMEDS roles are unequivocal — health advocacy matters. Both students and physicians
need to find ways to value it in the same way as our other, perhaps more traditional, responsibilities.
To that end, we took a new approach, and held
the First Annual Calgary Medical Students’
Association Advocacy Symposium on January 13th, 2017. We made use of structures
with which those in graduate programs are
already familiar — research-style posters, as
Noreen Singh
well as modified three-minute thesis-style
oral presentations. Medical students submitted thirty-nine abstracts,
which outlined the purpose, trajectory, and key challenges of advocacyrelated projects they have been leading.
The projects spanned a huge range of topics. These include an effort
led by Amyna Fidai (with the support of Dr. Ian Walker, Director
of Admissions at the Cumming School of Medicine) to develop a
mentorship program for under-represented populations in medicine.
In that project, students at Forest Lawn High School who are interested in becoming physicians are matched with medical students to
discuss questions regarding the path to medical school. In another
presentation, Lauren Capozzi detailed her team’s effort to provide
cancer patients in Alberta targeted education about exercise. They
plan to introduce interventions such as waiting-room videos featuring
cancer survivors demonstrating exercises to follow along with while
patients await their appointments.
The symposium planning committee’s goal was to create an event
that gives medical students an opportunity to gain presentation
experience, which is an opportunity often reserved for those doing
traditional research. We hope that those presentations will be useful
to the presenters as they progress in their careers, as students who
have invested hundreds of hours of effort into advocacy projects
can now demonstrate on their CVs or on various applications (for
example, grant applications for projects, or residency applications)
that they have completed an oral or poster presentation and submitted
an abstract at a symposium. In the absence of such opportunities,
advocacy projects are often slotted under the ‘volunteer’ heading in
CaRMS applications, which may not convey the depth of leadership
and ingenuity that are required with these projects.
More importantly, the symposium is an opportunity for students to
inspire each other. More than 80 students attended the symposium
to support their colleagues. Those students can now be resources
for each other in future projects because the event has made these
advocates so much more visible within our community.
Organizing this through the medical students’ association gave us a
great deal of latitude to design the event in a way that would be relevant
and engaging to students. The support of physicians was also critical in
ensuring that presenters would walk away with constructive feedback.
We are very grateful to all of the physicians who attended as adjudicators:
Presenter Kyo Farrington
– continued on page 6
ZMSAs – Communicating With Physicians in Alberta
8
– continued from page 5
who printed posters for their presentations. This type of funding
will help make this a sustainable annual event, and is such a moving
vote of confidence in us as students to lead this effort.
We are pleased that a plan is in place for the Calgary Medical Students’ Association to continue hosting this event from year to year
under the leadership of our second-year VP External position. With
the support of the AMA and our faculty, we are confident that this
symposium will continue, and have a keen interest in seeing similar
events introduced at other medical schools, if possible.
Attendees: Harjot Atwal, Julia Iftimie, Meaghan Mackenzie, Rebecca Manion
Dr. Tahara Bhate, Dr. Andrea Hull, Dr. Janette Hurley, Dr. Murray Lee,
Dr. Van Nguyen, Dr. Pam Veale (Associate Dean of Clerkship), and
Dr. Carl Nohr (Immediate Past-President of the AMA). The Dean of
Medicine, Dr. Jon Meddings, also came and expressed strong support
for the event and shared opening remarks with us. Dr. Nohr brought
greetings from the AMA in an opening speech as well, which was just
one of the many ways the AMA assisted us throughout the planning
of this event.
The AMA adopted a resolution in Spring of 2014 to develop a health
advocacy mentorship program for medical students. The symposium
helped the AMA meet that commitment by connecting students to
physician-adjudicators who often had similar interests. Additionally,
the AMA’s Shan Rupnarain helped out by extending an invitation
to delegates of the Representative Forum to adjudicate the oral and
poster presentations. Further, we are so thankful that the AMA
supported the symposium by providing funding for the printing
costs associated with the event, including reimbursing the students
We have already shared key materials that we created for the symposium with medical students at the University of Alberta, thanks to
our relationship through the AMA’s Committee on Student Affairs.
Those students are initiating a similar event there this year, also with
AMA support. We are eager to share our materials (i.e. judging rubrics,
abstract guidelines, as well as oral and poster presentation guidelines)
with student leaders at other medical schools if students have an
interest in hosting similar events elsewhere. We encourage medical
students’ associations across Canada to make use of a “by-students
for-students” symposium model. This approach was important for the
spirit of the event, as we were able to support each other authentically
and to display that we truly value our classmates who do this work.
The abstract booklet from the event will be available at calgarymsa.com.
Mackenzie Grisdale, BA, MA, MD Candidate 2018
Co-chair, First Annual Calgary Medical Students’ Association
Advocacy Symposium; VP External Provincial, Calgary Medical
Students’ Association; Chair, Committee on Student Affairs,
Alberta Medical Association.
Noreen Singh, BSc, MSc/MD Candidate 2018
Co-chair, First Annual Calgary Medical Students’ Association
Advocacy Symposium.
Moose & Squirrel Medical Clinic
Home Palliative Program Two years ago, a
patient with a terminal diagnosis,
Dr. Vesta Michelle Warren
with a wish to die at
home approached
the Moose and Squirrel Clinic. This was
our first experience in navigating the health
care system in an alternative way to honor
patient’s wishes. Being a part of this couples
journey was a humbling and extremely heart
felt opportunity. As her end approached, we
would visit them and find her surrounded
by their dogs and family, a smile on her face.
In fact, her adult children had driven out to
Sundre to take their mom back to their home
in Medicine Hat, feeling that the care offered
there would be superior to what she would
receive here. After the first few days, they
settled in for the duration exclaimed that the
care she received in our rural community
was exemplary — over and above what they
ever thought possible! This family’s simple
request was what ignited our passion for
providing palliative care for patients in their
home rural community.
Palliative care does not mean a terminal
diagnosis with an immediate death. It is a
journey from diagnosis to death — which
can sometimes last years. As Timothy Ihring,
palliative doctor, says in his Ted Talk “Palliative care has been proven with certainty to
allow people to live longer and better.” He also
Dr. Vesta Michelle Warren
asserts that this time is not about dying — It is about living. This is an assertion that the
Moose and Squirrel team strongly believes.
We desire to see the patient as a whole person
and treat any struggles that they are having so
that they can continue enjoying life.
Our palliative program is ever evolving as we
learn more and grow from our experiences.
From our first experience our palliative list
quickly grew as local patients learned that
they could have a very different experience
than the one usually experienced. We began
receiving referrals directly from families,
from other city based palliative programs
and from other doctors to care for patients
with a terminal diagnosis.
VITAL SIGNS February 2017
9
The Moose & Squirrel Medical Clinic Home Palliative program, in
partnership with the existing AHS resources has created a program
that is the only one of its kind in rural Alberta.
In all communities, physicians are often faced
with limited resources in providing high
quality care to their patients and community
members, but in the rural areas this is even
more so. Up until the creation of our innovative team, the local physician together with
the local Alberta Health Services Home Care
program did their best to care for the palliative
patient at home. Unfortunately the work load
for both the physician and AHS services meant
that patients were often not able to stay home
when their care needs exceeded the time that
homecare could provide, and the after hours
needs were often not met at all.
Towards the end of their journey, many
patients were left with two options: admission
to the local hospital to end their days in an
acute care setting or leaving the community
and their friends and family to palliate in a
hospice in the city. Neither of these options
was satisfactory for the families nor patients
when the wishes of the patient were to be
home, for some until death came for them.
Additional barriers exist to both of these
options as well. Often our hospitals’ acute
care beds are full and so patients are relocated
as far away as three hours to other rural communities until a bed opens up back home. For
hospice care, they need to have a prognosis
of 3-4 months remaining… and for many
patients this creates a huge gap in care both
in terms of caregivers, their Medical Home,
and their supports — family and friends.
So our team put their heads together and
came up with a way to help patients remain in
their home community for as long as they, the
patients, choose. This came down to finding a
way to maximize our local resources, as well
as to utilize a multidisciplinary team approach
allowing our members to work to full scope
in partnership with AHS and the family.
To overcome the barriers faced by patients
in remaining in Sundre, we as a team began
to provide additional care over and above
what had traditionally been offered. Our
physicians all committed to providing
24/7 house calls and medical advice to our
patients when needed. Our nurses committed to providing 24/7 access by phone for
our patients and their families, in addition
to providing nurse lead visits to the home
to manage crisis. Our local pharmacists
committed to working with us to get medications needed by patients in expedited
fashion — including after hours and weekend
work when the drugstores are often closed.
Home care services continue to be provided
by AHS and we work with these dedicated
providers. We have an amazing social worker
that we connect patients and families with
early in the course of their diagnosis to help
with the financial and emotional burden the
family faces. The AHS Palliative nurses and
physicians work with our patients and our
team, providing care and assistance/advice
when needed for managing the more difficult
symptoms.
Order
groceries
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We deliver
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Local & organic products.
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The AHS on-call palliative physicians are an
excellent resource for our team, and together
we have been able to overcome palliative emergencies that in the past would have landed
the patient in the local ER or hospital. More
importantly, the patients have been given
back some control and have been able to
enjoy their remaining days where they chose
to be — home.
As news of our program gets out, we find
ourselves with more and more patients
requesting our services. We travel as far as
an hour from our home base of Sundre to
even more remote homes and communities
that offer no local pharmacies, hospitals, nor
physician care — bringing with us the supplies needed to manage their care at home.
The Moose & Squirrel Medical Clinic Home
Palliative program, in partnership with
the existing AHS resources has created a
program that is the only one of its kind in
rural Alberta. We have reached out to other
rural communities with even fewer medical
resources, and have successfully palliated
many people in their homes, allowing them
to have the journey at the end of their days
that they desire. We have overcome barriers by
working together and putting the patient first,
and thinking outside of the proverbial box.
Dr.Vesta Michelle Warren, MD, CCFP, FCFP
Moose & Squirrel Medical Clinic, Sundre
GET $10
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Must live within delivery areas, not to be
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New customers only. Expires Mar 31/17.
Questions?
587-873-8822 or [email protected]
ZMSAs – Communicating With Physicians in Alberta
10
Sundre Physician Honoured for Bringing
Superior Medical Care to Her Community
Jonathan Koch
About 300 people from Sundre and Mountain View County gathered to honour, Dr. Vesta Michelle Warren, the 2016 RPAP
Rural Physician Award of Distinction recipient, at a community celebration sponsored by the Alberta Rural Physician Action
Plan (RPAP), and the Sundre Healthcare Professionals Attraction and Retention Committee.
ment and retention of medical professionals
to Sundre, and the work needed to secure a
new hospital in the community.
RPAP’s incoming Executive Director, Bernard
Anderson, praised the “unsung heroes” of
rural healthcare, lauding local healthcare
professionals for their commitment to the
community, and recognizing the Sundre committee for its tireless work, and vision for the
future of healthcare in Sundre.
“The intention of the RPAP Award of Distinction program is to leave a legacy, forever
honouring the tireless work and dedication
of distinguished physicians, like Dr. Warren,
in the places they call home. This Hospital
Futures Legacy Gala… promises to leave a
legacy that will benefit this area for generations,” said Anderson.
“Great communities make great things
happen, and it’s an honour for myself, and
RPAP to be a part of this event this evening.”
Dr.Warren was presented with a trophy, made
of sandstone and etched glass, that is donated
annually by Mr. Larry Samoil, President of
GRM Business Services.
A packed Sundre Community Centre paid
tribute to Dr. Warren, saying thank-you to
her for her exemplary dedication and service
to the community since 1999. Representatives from the Town of Sundre, Mountain
View County, and Alberta Health Services,
made special presentations to Dr. Warren. A
silent and live auction were also held to raise
funds for a new hospital facility in Sundre.
When it came time to present the 2016
Rural Physician Award of Distinction, RPAP
Board representative, Dr. John Gillett, and
incoming RPAP Executive Director, Bernard
Anderson, did the honours.
“The committee made special mention of
Dr. Warren’s use of nurse practitioners, her
willingness to mentor future generations of
physicians at the Moose and Squirrel Clinic,
and her role as a strong advocate and volunteer within the community, as some of the
reasons for her selection,” said Dr. Gillett.
“[Dr. Warren] is a forward thinking physician
that Sundre should be proud to have.”
The community celebration to honour Dr.
Warren was also the launchpad for the
first-ever Hospital Futures Legacy Gala, a
fundraiser supporting the continued recruit-
The RPAP Rural Physician Award of Distinction was created in 2002 to recognize the contributions of all rural physicians, especially
those ‘unsung heroes’ who provide Alberta
rural communities with outstanding medical
services and who make huge contributions
to medical practice and their communities.
Alberta Rural Physician Action Plan is an
independent, not-for-profit company funded
by the Alberta Ministry of Health. Established
in 1991 by the Government of Alberta, RPAP
supports the ongoing efforts of Alberta’s rural
physicians, their families and communities
to improve the quality of rural health care.
Reprinted with permission
Jonathan Koch, RPAP Communications
VITAL SIGNS February 2017
11
CPSA Introduces New Rules
for Referral Consultation
More timely care is the intent of the amended Referral Consultation standard of practice, which took effect on January 1, 2017
after approval by the Council of the College of Physicians & Surgeons of Alberta (CPSA) last fall. The CPSA has also just released
a new Advice to the Profession document to support physicians in implementing the standard.
The amended standard clarifies the roles and responsibilities of physicians on both sides of the process, promotes better communication
between referring and consulting practitioners (physician and non-physician) and mandates timely response to consultation requests.
Some highlights:
• Referring physicians must include all pertinent clinical information and accurate patient contact information with every consultation
request, to enable timely triage and response from the consultant. Urgent referrals require direct contact with the consultant.
• Consulting physicians are expected to have a reasonably accessible process for receiving consultation requests that is respectful
of the time and resources of referring practitioners.
• New timeframes will reduce unnecessary delays in patient care: Consulting physicians have 7 days to acknowledge a consultation
request and 14 days to inform the referring practitioner (and patient, as applicable) whether the request is accepted.
• Consulting physicians are responsible to contact the patient and arrange the appointment.
Some physicians have expressed concern about meeting the new timeframes for acknowledging and accepting a consultation
request when on vacation or otherwise taking time away from practice. For ideas on how to meet this challenge, refer to the new
Advice document.
Questions? Email [email protected]
HEALTHY PARENTS
HEALTHY CHILDREN
BECAUSE THEY DON’T
COME WITH A MANUAL
Free resources to give to expectant
families and families of young
children.
To order:
https://dol.datacm.com
Username: healthypublic
Password: healthy2013
HealthyParentsHealthyChildren.ca
ZMSAs – Communicating With Physicians in Alberta
12
PARADime: Alberta’s Resident Physicians Reach Out
to Support Some of Alberta’s most Vulnerable
Dr. Adele Duimering
On a chilly February day last year, I had the opportunity to tour the Youth Empowerment and Support
Services (YESS). Since 1981, YESS has opened its doors to provide shelter, food, and support to youth
Dr. Adele Duimering
in need. Myself and colleagues from the Professional Association of Resident Physicians of Alberta
(PARA) had spent the past 10 weeks collecting donations for the shelter in our annual PARAdime campaign, and were
pleased to be able to contribute a van-load of clothing, toiletries, school supplies and food items, generously donated by
resident physicians and health care colleagues at hospitals around the city.
Once again this year, between November 21 and January 31, resident
physicians collected PARAdime donations at 15 hospitals in 6 cities
across the province. In early February, resident physicians in each city
will deliver these items to a local community organization: YESS in
Edmonton, the Calgary Drop-In and Rehabilitation Centre, the Safe
Harbour Society in Red Deer, HIV North in Grande Prairie, Wood’s
Homes in Lethbridge and the Salvation Army Family Support Services
in Medicine Hat.
Why is it important to address social barriers to health? Well, in
short, it makes a difference. We know that preventative health
care is at least as important as disease treatment, and even small
contributions to improving wellness in vulnerable populations can
ripple out to improve health equity — the ability of populations to
achieve their full health potential without being disadvantaged by
such things as age, race, gender, sexual orientation, social class or
level of education.
Now in its eighth year, the resident physician-driven PARAdime
campaign endeavours to support some of Alberta’s most vulnerable
individuals, while increasing awareness amongst health care workers
of the challenges faced by some of their patients. Indeed, resident
physicians encounter social barriers to health every day in practice.
An elderly lady living independently fails to cope with self-care and
neglects to take her medications. A self-employed gentleman from
Grande Prairie hesitates to forfeit income to undergo prostate cancer
treatment in Edmonton. A pregnant 17-year-old girl with no family
support is inconsistent in attending prenatal appointments. A young
intravenous drug abuser presents with infectious endocarditis, but
discharges himself prior to antibiotic completion to care for his dog.
By providing shelter, clothing and meals to a young person who
is living on the streets, he or she is afforded the support to return
to school or seek out a job. From a societal standpoint, by helping
vulnerable individuals bring greater stability and comfort into their
lives, we are promoting healthy communities, and by extension
relieving some pressure on our stressed health care system.
Some of the common challenges in such patient encounters are low
income, unemployment, disability, food or housing insecurity, and
lack of social supports. From medical school we’ve been trained to
elicit a social history, which reveals the more obvious of these social
determinants of health. The subtler — abuse, illiteracy, HIV — may
easily remain in the shadows.
In overseeing one of the PARAdime hospital collections bins, one
unexpected benefit I’ve experienced is how the campaign brings people
together. Our wicker collection basket, decked out in red Christmas
ribbon, is a focal point in our office area, leading housekeepers, nurses,
radiation therapists and even the occasional curious patient to stop
by to inquire what we are up to. This has not only segued into some
interesting discussions on patient needs, but has organically enhanced
workplace collaboration and collegiality. The items we’ve collected have
been thoughtful and diverse — toiletries, new socks and underwear,
winter clothing, and candle and soap gift sets, amongst others. Even
the more unique donations, like Christmas decorations, will surely
bring cheer to a family in need.
VITAL SIGNS February 2017
13
Touring the colourful sun-filled rooms of the YESS shelter last winter, it
was easy to picture how each item collected in the PARAdime campaign
might assist a young person to succeed: an outfit for a job interview,
a backpack to carry to work, notebooks for school, granola bars for
packed lunches, and so forth. In combination with YESS’ programs,
with objectives ranging from helping young people to set and achieve
goals, to building healthy coping skills, it is inspiring to see how these
PARAdime donations may directly benefit those in need in our community. In parallel, via the five other wonderful organizations PARA
has partnered with across the province, PARAdime will continue to
contribute in a small but meaningful way to the wellness of some of
Alberta’s most vulnerable.
As physicians, many of us have never had to worry about lacking
access to basic necessities. It can be easy from this privileged perspective to forget that for those in poverty, taking a medication or
making it to a doctor’s appointment can take a back seat to finding
food to eat or a place to sleep. To properly care for the whole person,
it is essential that we as physicians not only recognize, but seek to
address these barriers faced by so many.
At the core of our residency training are the CanMEDS competencies,
which list “health advocate” as one of the basic abilities that physicians require to effectively meet the health care needs of the people
they serve. As physicians we have the privilege of being entrusted
with our patients’ struggles, and are in a unique position to leverage
this knowledge and our influence to advocate for these needs and
bring about positive change on an individual or population level. I’d
encourage all health care workers to strive to support their patients
and communities, speak on behalf of those who cannot, and call for
change when required. Whether it be through the PARAdime campaign
or by other means, advocacy should be seen as a physician’s duty.
Dr. Lucy Jiang helps deliver donations collected by Calgary and area resident physicians
to the Calgary Drop-In & Rehab Centre as part of the annual PARAdime Campaign.
For more information on this year’s PARAdime campaign, please visit
www.para-ab.ca/paradime-campaign.
Dr. Adele Duimering
PGY 3, Radiation Oncology, University of Alberta
A group of Calgary resident physicians deliver donations to the Calgary Drop-In
& Rehab Centre as part of the annual PARAdime Campaign.
Edmonton Zone Medical Staff Association
CALL out for 2017 Award Recipients
PHYSICIAN of the YEAR | RESEARCHER of the YEAR | PHYSICIAN INNOVATOR of the YEAR
CHAMPION AWARD for YOUNG LEADERS | LIFE ACHIEVEMENTS – Medal of Service (retired or close to retiring)
Any Staff can nominate a physician.
Deadline for submissions: WEDNESDAY FEBRUARY 15, 2017
EZMSA Office, 16940-87 Avenue, Edmonton, AB T5R 4H5, Fax. 780-735-9091 Ph. 780-735-2924.
[email protected]
Award Process: The EZMSA Award Review Committee will be made up of three active members from
the Edmonton Zone Medical Staff Association.
Multiple recommendations get more consideration for awards and/or a letter of nomination signed
by multiple colleagues be considered more favorably than one submitted by one individual.
ZMSAs – Communicating With Physicians in Alberta
14
Rockvyiew General Hospital Medical Staff Association Meeting
December 13, 2016
Internecine (Thanks to Dr. David Kent)
ADJECTIVE:
1. Of or relating to struggle within a nation, organization, or group.
2. Mutually destructive; ruinous or fatal to both sides.
3. Characterized by bloodshed or carnage.
On December 13, 2016 the RGH MSA was honored by a presentation by Guest Speaker Dr. Padraic Carr, Alberta Medical Association, President.
Dr. Carr’s topic was “An Overview of What the Future Holds for Physicians in Alberta”.
On behalf of the RGH MSA Executive, we wish to thank Dr. Carr for taking the time to talk to our group. The discussion that followed was lively
and many different topics were addressed. Dr. Carr was an excellent speaker and we were fortunate that he was able to attend our meeting.
It might have felt at times that the topics would lead to internecine thoughts; but thankfully this did not occur.
Also I again wish to thank all the physicians who have joined the RGH MSA; to date our membership is now at 212 members, the most ever!!!
Best wishes to all in the New Year and we hope to see our members on March 14, 2017 for an interesting discussion regarding ARPs.
Dr. Borys Hoshowsky, President, Rockyview General Hospital Medical Staff Association
Rockyview General Hospital Medical Staff Association
Meeting in Fisher Hall
Tuesday, March 14, 2017 from 6:00 - 8:00 p.m.
Members’ Dinner at 5:30 p.m.
We are delighted to announce guest speakers:
Sarah Konschuh and Kelly Mendes, Program Consultants, ARP PMO
(Alternative Relationship Plan, Program Management Office)
Topic: Clinical ARPs
IL BUONO h IL BRUTTO h IL ARP
The Good, the Bad and the ARP
Focus: Clinical ARPs; who is involved, how they work, how to apply, and recent changes/impacts to ARPs and
Catherine Keenan, Director, Medical Affairs, Calgary Zone
Topic: Academic ARPs
We hope to see you at the Rockyview General Hospital Medical Staff Association Meeting in Fisher Hall,
on Tuesday, March 14, 2017 for this presentation and a terrific dinner. Please RSVP to [email protected]
by February 27, 2017.
The ZMSA Membership renewal process is going on now. Please renew your membership and join the
Rockyview General Hospital Medical Staff Association. To renew or join, contact Stella or the CAMSS office
at (403) 205-2093, email: [email protected]
Many of you have already renewed your RGH MSA Membership for 2016-2017 for which we thank you.
Dr. Borys Hoshowsky,
President, RGH MSA
Best wishes and a big welcome to all RGH MSA Members!! For more information on events that we host,
please go to http://albertazmsa.com/rgh-msa
Dr. Borys Hoshowsky, President, Rockyview General Hospital Medical Staff Association
ZMSAs – Communicating With Physicians in Alberta
16
Foothills Medical Centre (FMC) Parking
Construction Is Underway
Construction of a new parking facility at Foothills Medical Centre (FMC) is underway. This construction, while an essential preparatory step
for building the new Calgary Cancer Centre and updating Foothills Medical Centre infrastructure, has resulted in challenges for patients
navigating the site.
For this reason, I would like to draw your attention to the patient resources that have been developed.
The FMC parking web page contains user-friendly maps and instructions for locating the best drop-off and parking location for patients
visiting the various clinics and buildings on site: http://ahs.ca/fmcparking. A simplified road map and interior map of the facility have
also been developed (see figures 1 and 2).
You may consider making these resources available to your patients to assist them in visiting the FMC site. Additional resources, such as
building-specific maps and enhanced on-site signage, are also in development.
I appreciate your support as we work to improve the experience of all users of FMC during this period. If you have feedback or concerns,
you are welcome to contact me at [email protected].
Dr. Peter Jamieson
Facility Medical Director, Foothills Medical Centre
Figure 1: Road Map of FMC Campus
Figure 2: Interior Map of FMC Campus