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Alberta Doctors'

DIGEST November-December 2016 | Volume 41 | Number 6

Fall Representative Forum/Annual General Meeting A year in review and opportunity ahead

We asked. Here’s what you said.

Reporting on what members told us in two surveys since spring 2016

Award for Compassionate Service

Nominate your colleague

400 schools in four years

AMA Youth Run Club is going and growing strong! Patients FirstÂŽ


Patients First® is a registered trademark of the Alberta Medical Association.

Alberta Doctors’ Digest is published six times annually by the Alberta Medical Association for its members. Editor: Dennis W. Jirsch, MD, PhD

4 From the Editor 20 Health Law Update 26 Dr. Gadget


Co-Editor: Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP Editor-in-Chief: Marvin Polis President: Padraic E. Carr, BMedSc, MD, FRCPC, DABPN

6 Fall Representative Forum/Annual General Meeting

A year in review and opportunity ahead

22 We asked. Here’s what you said.

President-Elect: Neil D.J. Cooper, MD, FRCPC, Dip. Sport Med.

Immediate Past President: Carl W. Nohr, MDCM, PhD, FRCSC, FACS

Alberta Medical Association 12230 106 Ave NW Edmonton AB  T5N 3Z1 T 780.482.2626  TF 1.800.272.9680 F 780.482.5445

34 PFSP Perspectives 38 In a Different Vein 43 Classified Advertisements

Reporting on what members told us in two surveys since spring 2016

28 AMA Award for Compassionate Service Nominate your colleague

31 400 schools in four years

AMA Youth Run Club is going and growing strong!

36 Calling for 2017 TD Insurance Meloche Monnex/AMA Scholarship applicants

January-February issue deadline: December 9

The opinions expressed in Alberta Doctors’ Digest are those of the authors and do not necessarily reflect the opinions or positions of the Alberta Medical Association or its Board of Directors. The association reserves the right to edit all letters to the editor. The Alberta Medical Association assumes no responsibility or liability for damages arising from any error or omission or from the use of any information or advice contained in Alberta Doctors’ Digest. Advertisements included in Alberta Doctors’ Digest are not necessarily endorsed by the Alberta Medical Association. © 2016 by the Alberta Medical Association Design by Backstreet Communications

AMA MISSION STATEMENT The AMA stands as an advocate for its physician members, providing leadership and support for their role in the provision of quality health care.

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COVER PHOTO: Dr. Padraic E. Carr was installed as Alberta Medical Association president on September 24. NOVEMBER - DECEMBER 2016




Oh, nostalgia! Dennis W. Jirsch, MD, PhD | EDITOR

“Things ain't what they used to be and probably never was.” - Will Rogers


erhaps it’s the swollen rhetoric – inescapable – of politicos and pundits south of our border and their hoopla about making their country “great” once again. Or it may be that I am at a remove from life in clinical practice and have the luxury of recalling former halcyon days. Others have suggested there may be a “nostalgia virus” in the air. At any rate I’ve gotten interested in nostalgia, sentimentality about the past.

If much of what we regard as

nostalgia is represented by our wistful memories of the warm smell of, say, Grandma’s kitchen, nostalgia also must be understood as a functioning political tool that can enlist and even mobilize groups in support of political undertakings.

The term itself is an amalgam of the Greek nostos, or homecoming, and algos, or pain.1 Swiss physician Dr. Johannes Hofer coined the term in his 1688 publication, Dissertatio Medica de Nostalgia oder Heimwehe; for the next several hundred years it referred to a debilitating, contagious and occasionally fatal condition characterized by extreme homesickness. The malady often afflicted soldiers, Swiss soldiers in particular, who seemed inordinately susceptible to a particular milking song, “Khue-Reyen,” after which they became melancholic and even manic with longing.


Other features of the affliction: it often affected children sent to the country for nursing, young men in their 20s and women who left home for work. Missing one’s home was but one component of the newly named illness, which seemed to be a psychopathological disorder that could be brought on by many things including travel, unusual food, poor education and masturbation. If nostalgia’s manifestations could be diverse, prescribed treatments ran the gamut of medieval invention. Sending sufferers home worked, but also tried were leeches, vomiting and “warm hypnotic emulsions.” For a time, there was search for a “nostalgia bone,” but to no avail. A French physician, Dr. Jourdan Le Comte,2 thought nostalgia should be treated aggressively, by “inciting pain and terror.” As justification, Le Comte described an outbreak of nostalgia in the Russian army in which a general told his troops that the first one to come down with the affliction would be buried alive. The general evidently kept his word and found his extreme therapy effective. By the 1850s, nostalgia had lost its status as a discrete illness and was considered a form of melancholia that could predispose one to suicide. After the American Civil War, “shame it out of them” replaced “scare it out of them.” Dr. Theodore Calhoun,3 an American military physician of the time, considered nostalgia unmanly and weak, best treated with ridicule and discipline. It continued to be regarded negatively through the First and Second World Wars, as military personnel attempted to stem the tide of troops abandoning the front in droves. Nostalgia’s definition and scope have changed greatly; it has now become a legitimate field of study. A pertinent example4: Greek psychology researcher Constantine Sedikides, PhD, transplanted from the University of North Carolina to the University of Southampton in England, himself felt homesick and decided to study his own plight. He has teamed with Tim Wildschut, PhD, another emigré from Utrecht in the Netherlands and Southampton has become known for its nostalgia research. >

> They and dozens of other contemporary sociologists and psychologists have redeemed nostalgia in their work, which has come to consider nostalgia an important neurological defence mechanism, indeed a protective armor, against negative thoughts and situations through enhanced mood, social connectedness and improved self-regard. Accordingly, much nostalgia may represent positive, grounding experiences which are helpful at life’s major transitions. But if much of what we regard as nostalgia is represented by our wistful memories of the warm smell of, say, Grandma’s kitchen, nostalgia also must be understood as a functioning political tool that can enlist and even mobilize groups in support of political undertakings. Most commonly, missing a fondly remembered time past is the nub of the matter and it is usually personal. Nostalgia can also be collective, however, as when sentimental yearning can be experienced by groups of people, even whole generations and entire nations. Consider the political campaigns of the past hundred years, in which return to a prior “golden age” of perfection has served as the ideological impetus for political movements as diverse as Mao, Pol Pot, Hitler and the Ku Klux Klan. We can recognize it currently in the belligerent crowds that respond to the political thunderings of Donald Trump. In fact, golden age leaders characteristically praise acts of violence and scorn the rule of law in embracing their visions. This new role for nostalgia is a darker one, and as Alan Jay Levinovitz1 has noted, “Fear and insecurity are the disease vector for stories about past and future glory.”

Consider the political campaigns

of the past hundred years, in which return to a prior “golden age” of perfection has served as the ideological impetus for political movements as diverse as Mao, Pol Pot, Hitler and the Ku Klux Klan.

Golden age thinking is characteristic of our species, but it is tantamount to yet another logical bias in our thinking. We generally remember prior times as paradisiacal and perfect, times in which “climates are equally temperate in all times and places, eternal spring for the eskimos, gentle zephyrs for the Greeks. There is nothing new here: Voltaire critiqued the ‘bon vieux temps’ 250 years ago,1 concluding, ‘There are things in which the moderns are superior to the ancients; and others, though very few, in which we are their inferiors. The whole of the dispute reduces itself to this fact.’”


We can recognize it currently in

the belligerent crowds that respond to the political thunderings of Donald Trump.

Our memories of times past do not stand up to re-inspection. We are blind, for instance, to all the early graves that pock the countryside, testament to the harsh realities of economic servitude, absent human rights, and the staggering morbidity and mortality of past times. If we are wary of collective nostalgia, we’re more skittish of crowds now, too. Over 100 years ago, at a time in Europe with striking parallels to ours – churning industrialization and urbanization, talk of global conspiracies and economic elites – Dr. Gustave Le Bon, trained as a doctor, identified the perverse dynamics, the tendency to hostility and the violence of the crowd or “la foule.” Dr. Le Bon felt that ideas floated inside crowds just as microbes do in a human body and warned: “By the mere fact that he forms part of an organized crowd a man descends several rungs on the ladder of civilization. Isolated he may be a cultivated individual; in a crowd he is a barbarian – that is, a creature acting by instinct.”5 Social scientists may have a more temperate view of crowds now; after all, there are crowds intent on beneficence or good works. But it is likely that crowds diffuse responsibility and suspend critical thinking. So there it is. Wistful, warm and passing memories from our past can be healthy, enjoyable things. When our memories are all about loss and the loss becomes a prod, propelling us to march at night with disaffected others, hunting for cruel justice as reparation, we come to know that we must balk. Remember the title of Thomas Wolfe’s classic: “You Can’t Go Home Again.” He was right. Unfortunately, and fortunately too, considering our proclivity to anger, Wolfe was right. We can’t go home again. It’s just as well. References available upon request.




A year in review and opportunity ahead

Professionalism, relationships, patient values and hope for the future

Varying the terms of the contract on one side will result in changes on the other side. We are seeing some consequences to changes in the fulfillment of the social contract across the country. Professionalism, stewardship and integrated high-value care are on the national agenda, and we are participating in these discussions. Like other provincial medical associations, we must decide what our vision is.

Productive relationships

Dr. Carl W. Nohr

Highlights follow from the valedictory address of outgoing President, Dr. Carl W. Nohr. His term began September 26, 2015 and ended September 24, 2016.

Professionalism and the social contract Most dear to me are matters of professionalism, stewardship, integrated high-value care and the social contract we have with the public. On our side of the contract, we provide compassion, availability, accountability, working for the public good and altruistic service. On the other side, we receive trust, autonomy, self-regulation, status and rewards.


A year ago, I talked about preparing for negotiations with the government. Many members of the Alberta Medical Association (AMA) and its staff have worked diligently with our government counterparts to get us to this point. Like you, I have had to work through many concerns. I am satisfied we have come to a place that is good for the patients of Alberta and for the profession. I hope that you will share this opinion when it’s time to cast your vote on the tentative Amending Agreement. Relationships are the key to advancing in any area. We share with the government the goal of an effective system. This common goal has allowed us to develop the positive, respectful working relationship we currently have.

Aligning incentives with system needs and patient values In physician compensation, there are two issues. Equity is one. We need clarification of what our guiding

principles are for relative payments. What should make a difference in the payment rates for different kinds of medical work? It is our collective responsibility to ensure that all physicians receive a reasonable portion of the available dollars. The second major issue in compensation is design. In my view, we should place value for patients first as a design principle, rather than expect it as a by-product of behavior. Preserving intrinsic motivation will be more successful at producing value than modifying behavior through financial incentives. Relationships with patients remain the touchstone of our profession. I have said before that every time we meet a patient, we have an opportunity to increase or diminish the standing of our profession. We must continue to show that we care about them as we care for them. We plan system level changes, but the individual encounter with providers is what the public sees as the system. Compassion is the prevailing principle behind our historical success. The information monopoly model of medical care must change to a patient-valuebased model that incorporates or re-incorporates compassion.

Hopes for the future I have a vision of an integrated high-value system that is so obviously centered on the patient that we don’t need to use that term anymore. We will be working with >

> patients under the terms of the social contract to co-create care that they value in ways that they find convenient and acceptable. Health care is something we used to do to patients. Now it is something we do for patients. The next step is to make health care something we do with patients. When this is done, we will have achieved integration around the patient.

Insofar as we can do that, we will be happy in our work, and we will show ourselves and our patients that it means something very special to be a doctor.

The information monopoly model of

I have a vision of our profession as leaders in a system that supports our work, where precision self-regulation is a welcome and significant part of our professional lives, and where internal motivation and professionalism are driving principles. We can do this. It will take work in health legislation, in regulatory functions and in our association to get there. While policy development is needed, it alone will not create the culture we need. A principled vision of who we are will show us the way. As you know from my President’s Letters, I like to conclude by asking something of you. Be compassionate with your patients, with your colleagues, with those dear to you and with our lovely planet. Remember why you became a doctor, and let the highest principles of our great profession permeate every aspect of your lives.

medical care must change to a patient-value-based model that incorporates or re-incorporates compassion.

With thanks and appreciation I am grateful for the many relationships inside and outside our profession that have sustained and taught me. While there are different perspectives on health care, there are no enemies. Compassion dictates that I wish for others the same things I wish for myself. Adversarial positions express neither strength nor hope and they accomplish little of lasting value. Like produces like; trust and mutual respect produce more of their own kind.

In that context, I appreciate the relationship that has developed between the AMA and Minister of Health, Sarah Hoffman, as well as her team. While the perspectives of government and the medical profession differ on some matters, we have many common goals for the health care system. I have learned much from other medical leaders across the country and from so many of you, my colleagues in our great profession. I also continue to learn from my patients and I am grateful for the trust they give me in allowing me to care for them. I cannot adequately describe how valuable the support and direction from the board members – and from many members – has been. I also appreciate the support of my surgical colleagues and the medical community in Medicine Hat and my long-suffering medical office assistant. Finally, I gratefully acknowledge my dear wife for continuing to believe I am useful, despite occasional evidence to the contrary. My goal during this year was to live and serve with integrity and compassion – to add value to the office of the president of the AMA. You may judge whether I have been successful or not.

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A year in review and opportunity ahead

Incoming AMA president summarizes the fall Representative Forum

occurred. Accordingly, the RF received a presentation on possible approaches to implementation for some of the larger initiatives within the tentative amendments.

Dr. Padraic E. Carr


he fall Representative Forum (RF) proved to be an excellent meeting. As usual, delegates addressed complicated topics, consulted together and emerged with consensus in the form of motions to help guide the Board of Directors. Topics which were addressed included: • The tentative Amending Agreement: As you know, the package of proposed amendments to the 2011-18 AMA Agreement was recently out for a ratification vote. Although the outcome of the vote was not yet determined at the time of this writing, the board felt that due diligence required us to be ready to move quickly if ratification


• Nominating Committee report: Chair Dr. Richard G.R. Johnston updated the RF and the annual general meeting (AGM) regarding the work of the Nominating Committee. This is a regular event, but this year it was notable for announcing a new process to identify candidates for the Board of Directors. The objective is to encourage a larger number of RF delegates to run for board positions, either as a nominee from the committee or from the floor of the RF. Although there is always strong interest in running for board elections, we still want to ensure broad membership and perspectives. • Governance Review Group (GRG) report: The GRG was formed by the RF in fall 2015. Since then, it has done a great deal of detailed work to explore how the AMA might enhance our governance structures to reflect the needs of members. The RF received information about member research that GRG conducted and a list of recommendations to consider for future improvements. • Relationship between Alberta Health (AH) and the AMA: The RF was pleased to host Minister of Health, Sarah Hoffman, who addressed the AGM and

answered questions from delegates. Deputy Minister of Health, Carl Amrhein, PhD, joined the RF for a session about how physicians and government can seek opportunities for collaboration, shared stewardship and shared accountability. • Fee schedule modernization and relativity: The RF received an update on the ongoing work to advance fee relativity by the AMA-AH Physician Compensation Committee and the internal AMA Compensation Committee. • Access to health care: The RF discussed challenges for improving access to physician services and innovative options such as clinical telehealth. Dr. Verna Yiu, President and CEO of Alberta Health Services, also graciously agreed to present to members during this session. • Chronic pain: A panel led by the Section of Chronic Pain discussed issues, particularly the challenge of maintaining access to opioids for those patients who benefit from that therapy, while limiting access to opioids for those who would abuse it. Member input is key to going forward and I am always respectful of our members’ opinions. The greater wisdom of the whole is achieved through individual participation. I look forward to the guidance and insight your correspondence will provide.


A year in review and opportunity ahead

All about your new president and president-elect for 2016-17

Dr. Padraic E. Carr 2016-17 PRESIDENT


r. Padraic Carr, a psychiatrist in Edmonton, became the Alberta Medical Association (AMA) president on September 24. “It is truly an honor to have been elected by the doctors of Alberta as president of the AMA. I am extremely proud of our profession and have the greatest respect for the selfless work doctors do every day. As a practicing physician, and in my role as a member of the AMA Board of Directors, I know that doctors are key to the provision of quality health care for the citizens of Alberta. “We will face many challenges over the next year. In the context of relentless political and economic change, we will be tasked with creating a new master agreement which will define our important role in the health care system. At the same time, we must endeavor to ensure that our patients continue to receive the best care possible and to serve as their advocates. I have every confidence that we will master these tasks admirably. I feel very fortunate to be supported by colleagues whom I hold with the highest admiration and I look forward to all that we can accomplish together.” Dr. Carr received his medical degree in 1990 from the University of Alberta (U of A) and thereafter completed

a rotating internship at Royal Alexandra Hospital and a residency in psychiatry at the U of A Hospital. In 1995 Dr. Carr became site leader/facility chief for Grey Nuns Community Hospital, Department of Psychiatry and remained in that role for 11 years. Dr. Carr has assumed executive roles with numerous organizations, associations and boards on regional, national and international committees. He was president of the Professional Association of Resident Physicians of Alberta, the Grey Nuns Community Hospital Medical Staff and the Alberta Psychiatric Association. He was also a representative to the Assembly of the American Psychiatric Association for western Canada. More recently, he was president of the Canadian Psychiatric Association. Dr. Carr was recognized internationally in 2004 as a Distinguished Fellow of the American Psychiatric Association. For 21 years Dr. Carr has mentored and instructed medical students and residents, currently as a clinical professor in the Department of Psychiatry in the Faculty of Medicine & Dentistry at the U of A. Dr. Carr began his service with the AMA in 1992 as the resident representative on the Committee on Constitution and Bylaws, and has served in a range of roles since then, such as president of the AMA Section of General Psychiatry and a member of the Nominating Committee, Executive Committee and Joint AMA/ College of Physicians & Surgeons of Alberta Executive. He was a member of the Board of Directors from 2006-14 and has been a Representative Forum delegate since 2003. He received the AMA’s Long-Service Award in 2013. In his role as president, Dr. Carr will serve as a member of the AMA Board of Directors and on various internal and external committees such as the Representative Forum Planning Group, Executive Committee and Provincial Physician Liaison Forum. >





Dr. Neil D.J. Cooper

For more than 20 years, Dr. Cooper has also been a consulting pediatrician with the Child Abuse Service at the Alberta Children’s Hospital and the Sheldon Kennedy Child Advocacy Centre.



r. Neil Cooper is a pediatrician and sports medicine physician from Calgary. He graduated from the University of Calgary (U of C) Medical School in 1990, completed his pediatric residency at the Alberta Children’s Hospital in 1994 and earned a sports medicine diploma in 2007. Since 1994, he has had an active community pediatric and sports medicine practice.

Dr. Cooper is the Alberta Medical Association (AMA) president-elect for 2016-17. Dr. Cooper is a clinical assistant professor in the department of pediatrics at the U of C and is regularly involved in teaching medical students and residents.

Dr. Cooper is medical director and vice president for Dreams Take Flight, a charity that takes about 150 challenged children on a one-day adventure of a lifetime to Disneyland each fall. Dr. Cooper has been a member of the AMA since 1990 and has held many positions within the association, including: • Board of Directors • Representative Forum delegate • President and fees representative, Section of Pediatrics • Physician Office System Program: Deployment Committee, Vendor Qualifications Evaluations Committee and Office Systems Evaluation Committee • Relative Value Guide Committee • Physician Compensation Committee (now AMA Compensation Committee) • Fees Advisory Committee

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A year in review and opportunity ahead

Recognizing outstanding achievement in health care


he Alberta Medical Association (AMA) Achievement Awards were created to honor physicians and non-physicians alike for their contributions to quality health care in Alberta. The Medal for Distinguished Service and the Medal of Honor are the highest awards presented by the AMA.

Medal for Distinguished Service The AMA Medal for Distinguished Service is given to physicians who have demonstrated an unwavering commitment to their communities and passion for their work. This year, three recipients have made outstanding contributions to the medical profession and to the people of Alberta. In the process, they have raised standards of medical practice for our province.

Dr. John M. Conly

Dr. Christopher J. (Chip) Doig

Nationally respected and internationally renowned, Dr. John Conly is one of Canada’s leading infectious disease specialists. He is considered to be one of the world’s preeminent experts on antimicrobial resistance and his impact on improving standards of medical practice spans both research and clinical areas.

Dr. Chip Doig’s unwavering commitment to his patients and his profession has earned him the admiration and gratitude of patients, families and colleagues. He is known for his calm, compassionate approach to patient care and his ability to manage the most complex critical cases with skill, focus and the utmost respect for patients. He is also a tireless champion for the medical profession who has undertaken pivotal leadership roles that have advanced the practice of medicine and improved the health care system for all Albertans.

Dr. Conly is currently a professor in the Department of Medicine, Pathology and Laboratory Medicine, and Immunology and Infectious Diseases at the University of Calgary (U of C). He is also medical director of Infection Prevention and Control at the Foothills Medical Centre, medical director of Alberta Health Services (AHS) Antimicrobial Utilization and Stewardship, and co-chair of the AHS Antimicrobial Stewardship Committee. In addition to his expertise in antibiotic resistance, infectious diseases, hospital epidemiology and molecular epidemiology, Dr. Conly is also an expert in health care innovations, particularly the use of technology to enhance health care delivery. In recent years, he has led several health care innovations.

As the ICU medical director in the Department of Critical Care Medicine at the Foothills Medical Centre (FMC), Dr. Doig is known in the ICU for his expertise in resuscitation of the critically ill and his ability to manage patients with severe sepsis and multiple organ dysfunction syndrome. Dr. Doig’s compassionate approach and thorough understanding of medical ethics help him to navigate the delicate task of working with families to manage end-of-life care and, where appropriate, discuss organ and tissue donation. >




> Dr. Charles H. Harley

Dave Colburn

Jocelyn M. Lockyer, PhD

In a career that has spanned almost 50 years, Dr. Charles Harley has had a profound impact on Alberta’s health care system, the patients it serves and the medical professionals who work to ensure Albertans receive the best possible care within the system. A skilled clinician, impassioned teacher and visionary leader, he has dedicated his life to the advancement and improvement of health care for all patients and families.

As a trustee with Edmonton Public Schools from 2004-13, Mr. Colburn took on many issues in order to improve the health of Alberta students, including the fight to give students healthier food choices so that they could become better learners. In 2007, Edmonton Public Schools was the first school board in Alberta to implement a policy that eliminated junk food from school vending machines and since then more than a dozen boards have followed suit.

Dr. Jocelyn Lockyer’s commitment to medical education and to advancing the role of family physicians has had a measurable impact on Albertans. A highly respected leader, scholar and researcher, she has been instrumental in developing educational programs, activities, courses and tools that improve both physician practice and patient care.

Dr. Harley has held several leadership roles throughout his prestigious career, including a teaching career at the University of Alberta (U of A) that spanned several decades and influenced thousands of medical students. He is currently the medical director of the Edmonton Clinical Assistant Program and Acute Care Coverage Program and is co-chair of the AHS Quality and Patient Safety Committee.

As an Edmonton Public School trustee, Mr. Colburn played a pivotal role in championing several other important issues, including working to stop school closures in mature communities like his own. In 2010, Mr. Colburn was elected chair of the Edmonton Public School Board where, under his leadership, the district became the first board in the prairie provinces to create a stand-alone LGBTQ policy. Mr. Colburn spoke publicly and passionately about creating a safe, caring and respectful world in which all people are valued and respected.

Dr. Harley’s leadership has been instrumental in the creation of many important initiatives, including the expansion of physiatrist positions to support stroke and brain injury rehabilitation. His commitment to teaching and leadership is matched by his dedication to clinical practice and his patients.

AMA Medal of Honor The AMA Medal of Honor is presented to non-physicians who have made significant personal contributions to ensuring quality health care for the people of Alberta.


Mr. Colburn worked with the Alberta School Boards Association and the Canadian School Boards Association to add student health to their strategic planning and priorities. He also helped create two provincial health bodies, initiated joint advocacy work between influential provincial organizations and brought key partners together to discuss collaborations on student health. Retired from trustee work since 2013, today Mr. Colburn is a student wellness advisor for the Canadian School Boards Association and a student wellness consultant for the Alberta School Boards Association, where he continues to champion student health and wellness.

Dr. Lockyer received her Bachelor of Arts degree from the University of Waterloo in 1973 and her master’s degree in health administration from the University of Ottawa in 1975. She began her professional career in the Department of Family Medicine at St. Joseph’s Hospital in Hamilton, before moving to Calgary in 1977 and beginning her work with the U of C. There, her first role involved developing and shaping continuing medical education, and she worked closely with family physicians and Royal College specialists to create several pivotal programs. Dr. Lockyer believes in the importance of practice and research being intertwined to ensure quality. Her keen interest in physician assessment also led to her involvement with the development of the College of Physicians & Surgeons of Alberta’s Physician Achievement Review Program. After completing her PhD at the U of C’s Faculty of Education in 2002, Dr. Lockyer’s role became one of teaching and research, in addition to serving as director of Continuing Medical Education. Her passion for research continued, as she undertook several collaborative research projects, including one that led to the development and implementation of the Physician Learning Program for Alberta. In 2012, Dr. Lockyer was appointed senior associate dean, medical education, in the Cumming School of Medicine. >


Recognizing outstanding service Each year the Alberta Medical Association (AMA) and Canadian Medical Association (CMA) bestow awards to a group of dedicated physicians whose service and contributions to the association and the profession have made a significant difference. In the entries below, we highlight the 2016 recipients, along with their personal reflections on the value of service.

disciplines. The AMA is a very supportive organization that is very professionally run, and I have often been proud that our profession is able to navigate difficult and potentially contentious issues in such a professional manner. I have particularly appreciated the opportunity to advocate for access to quality care for patients who are socially disadvantaged and/ or cognitively impaired and have difficulty advocating for themselves.

L to R: Dr. Carl W. Nohr, AMA President, Dr. Mariusz Sapijaszko, Dr. Maureen D. McCall, Dr. Dennis W. Jirsch, Dr. Tobias N.M. Gelber, Dr. Arlie J. Fawcett, Dr. E. Sandra Corbett, Dr. Kathryn L. Andrusky and Michael A. Gormley, AMA Executive Director.

AMA Long-Service Award The AMA Long-Service Award recognizes physicians with 10 years of AMA service who contribute their knowledge, skills and time to the advancement of the profession. Their work, whether on the Board of Directors or its committees, supports and encourages the association’s development. Dr. Kathryn L. Andrusky Family Medicine, Edmonton I have been actively involved with the AMA since medical school and have held many roles, including as a member of the Board of Directors, a board representative to the Primary Care Alliance and a member of the Section of General Practice Executive. I have also served as chair of the Governance Review Group. I hope that I have been able to raise different perspectives and questions on multiple issues through my work on the Board of Directors and the Section of General Practice. Advocacy and leadership are integral roles for physicians – whether for individual patients, the health system or on behalf of our fellow physician colleagues. The AMA provides many positive opportunities to learn, participate and lead.

Dr. E. Sandra Corbett Psychiatry, Fort McMurray My introduction to active involvement with the AMA was with the Rural, Remote, Northern Program Working Group. Since then I have enjoyed working with colleagues in my medical staff association and my section and have served as president for both. My involvement in the Council of Zonal Leaders, the Representative Forum, and serving on the Board of Directors has helped me develop relationships and friendships with physicians all over the province. I learned a lot from both the AMA staff and my fellow board members and came to appreciate that we, who practice in the north, share many issues with our colleagues. Through working with our association, our voice can be heard. We can truly influence and improve the care of our patients. Dr. Arlie J. Fawcett Psychiatry, Calgary I have enjoyed my time of service with the AMA, both in terms of the opportunity to advocate for all of our patients and to interact with colleagues from all medical

I would advise new physicians that your career does not always unfold how you thought it would. Having involvement in different areas of medicine can provide support and perspective that nurtures you through life’s challenging times. Service to your profession can seem difficult when one is very busy, yet it can help you improve the lives of patients and other physicians – and yourself! Dr. Tobias N.M. Gelber Rural Primary Care, Pincher Creek I have been very proud to be part of the primary care network (PCN) evolution, which has led to some significant improvements in how primary care physicians can deliver care. This includes team-based care, creating accurate patient panels and learning to do meaningful measures of clinical practice. Participation on the Primary Care Alliance (PCA) has been particularly rewarding, as it has brought representatives of the major primary care organizations (Section of General Practice [SGP], Section of Rural Medicine [SRM], Alberta College of Family Physicians, universities, PCN physician leads) together to focus on primary care reform, specifically relating to implementation of the Patient’s Medical Home. While a part of SRM and SGP, we developed an overall compensation strategy that supports the care delivery principle of the Patient’s Medical Home. This includes changes to the fee schedule that will better support the Patient’s Medical Home and work on the implementation of a province-wide alternative funding model. Working with the AMA is a rewarding way to give back to the profession that has given me so much. > NOVEMBER - DECEMBER 2016



> Dr. Dennis W. Jirsch Retired General Surgeon, Edmonton My most notable experience with the AMA is being the editor of Alberta Doctors' Digest for the past 11 years. It has been gratifying to select topics of interest to the profession and, every two months, to write a short editorial that sums up my thoughts on the issue. Occasionally I pass someone in the hall who comments on something I have written. Good or bad, comments flesh out my views and make me a better writer. There is no substitute for the AMA in terms of engaging the spirited voice of the membership on developments that keep changing the practice of medicine. It is easier to find one’s voice among a community of peers and the AMA is adept at promoting change that matters to patients and to medical practice. The supportive environment of the AMA is much valued through the various stages of a career in medicine and there is really no substitute. Dr. Maureen D. McCall Family Medicine, Red Deer My most recent work on the Physician and Family Support Program Advisory Committee stands out for me, as this committee works behind the scenes to support our members. Often members struggle with many of the same difficulties as our patients: serious illness, family breakup, addictions and other mental health issues. It is gratifying to know that the AMA provides this program to decrease both the stigma of seeking help and the cost of help, and provides prompt support through confidential peer assessment and excellent professional services.

my medical school training. I represented the Calgary Medical Students’ Association at the Health Issues Council, Committee on Long-Term Care, as well as the Post-Graduate Medical Education Advisory Group. I was passionate about the role of the AMA in shaping medical care of Albertans and saw the promise of physician involvement as a cornerstone of medical care in Alberta. More recently, I was the president and fees representative of the Section of Dermatology and Dermatologic Surgery and am currently a delegate to the Representative Forum. Serving my colleagues and communicating the issues facing dermatology care in Alberta was and continues to be very rewarding. I have been involved in the AMA for over 20 years and am proud that my early work sharing the priorities of medical students helped to shape the AMA vision of the importance of patients’ long-term concerns. I recently joined the Fees Advisory Committee and am eager to contribute the voice of community-based physicians. Involvement in the AMA is paramount, as health care in Alberta is constantly changing and a strong physician voice is critical in fostering quality patient care and timely access to preventative and acute services.

AMA Member Emeritus Award The Member Emeritus Award recognizes significant contributions to the goals and aims of the AMA, seniority, long-term membership and distinguished service (20 years) based on criteria determined by the Board of Directors. Members Emeritus enjoy all the rights and privileges of a full member, but shall not be required to pay annual dues. Dr. Fraser W. Armstrong Family Medicine, Edmonton My AMA work started by representing physicians in the pursuit of more widely available medical knowledge resources through electronic sources. From there I moved to working directly with health regions and the ministry of health on linking existing clinical patient laboratory, X-ray and text report result databases – eventually leading to Alberta Netcare. Perhaps most rewarding was my association with the Physician Office System Program (POSP) initiative. I was involved from the first expressions of interest through to the completion of its mandate, serving as the AMA co-chair for much of that time. POSP spread otherwise unattainable/ unaffordable information technology infrastructure to clinical care delivery in an amazingly expeditious fashion, increasing utilization rates from 10%-80% in less than six years.

The AMA has been invaluable in providing support during political ups and downs in our province during the 30 years of my career. AMA support to primary care networks has translated to excellent new programs in my community. Dr. Mariusz Sapijaszko Dermatologic Oncology, Edmonton My involvement with the AMA started in the early 1990s during


> L to R: Dr. Carl W. Nohr, AMA President, Dr. Eric A. Wasylenko, Dr. Christine P. Molnar, Dr. Gerhard N. (Gerry) Kiefer, Dr. Steven W. Chambers, Dr. Daniel J. Barer, Dr. Allan L. Bailey, Dr. Fraser W. Armstrong and Michael A. Gormley, AMA Executive Director. Missing from photo: Dr. Gordon H. Johnson.

> Working with the AMA allowed me to meet exceptional, dedicated folks, committed to the betterment of the profession of medicine and patient care. This involvement has and continues to infuse my clinical practice with renewed passion and insights for improving the care I provide to my patients, who are our profession’s life-blood – something I learned from my father. Dr. Allan L. Bailey Family Medicine, Spruce Grove Getting primary care network physician leadership at the Representative Forum and the establishment of the Primary Care Alliance Board both rank high for me. Although not yet completed, I have enjoyed the work to offer family physicians an alternative payment option under a blended capitation-funding model. I’ve also enjoyed working to establish a physician managed “data co-op,” enabling research and evaluation of the primary care system. Over the last 30 years, primary care physicians have achieved a stronger voice within our association and with other key stakeholders. We have improved fee and income equity, and provided many family physicians with an improved work life, ensuring a sustainable and high quality primary care system for Albertans. The friendships, acquaintances and experiences I have acquired are a priceless gift of my service to the profession and the AMA. Developing in leadership and better understanding the politics of health care has been a rewarding process of growth and learning. Dr. Daniel J. Barer Emergency Medicine, Edmonton I most enjoyed my six years on the AMA Board of Directors, establishing relationships with other members and appreciating the diverse points of view and backgrounds around the table as we worked through complex issues. My work within the Section of Emergency Medicine has been especially rewarding as our section found its voice in the medical community. This was made possible through the hard work and dedication of my colleagues

in Alberta’s emergency medicine community. Together we’ve made a positive impact on patient care through advocacy, both within the AMA and in the public sphere. Overall I have found my involvement at the AMA to be both enriching and fulfilling. I feel that gaining perspective on the “big picture” enhances a physician’s ability to function well within the public health care system. I especially value the hard work of the presidents of the AMA – before, during and after their year as president. Our organization is better for having those fine individuals serve in that capacity. Dr. Steven W. Chambers Family Medicine, Edmonton My decades of caring for patients and families from “womb to tomb” is, of course, the main joy of family practice. What a privilege to be invited into the lives of these people who became friends over the years. My time as president and on the Board of Directors of the AMA and Canadian Medical Association (CMA) will always be special to me. The highlight would be my many years central to evolving primary care in the province, from helping develop the ground-breaking 2003 agreement to serving as co-chair of the Primary Care Initiative Committee while the first several dozens of the primary care networks were born. It has been an honor to get to know so many colleagues from all specialties and all locations. I truly appreciate the invaluable contributions to society they each make. Dr. Gordon H. Johnson Cytopathology, Edmonton My recollection of dates is hazy, but involvement with AMA began in the early 1980s when I worked with the Fees Committee of the Alberta Society of Laboratory Physicians (ASLP) back in the day when there was a Pathology Fee Schedule. This led to becoming a member of the AMA Fees Committee and I continued with this group for many years. I will not forget the many challenges that were dealt with, including the early efforts of dealing with intersectional fee disparities. While on the Fees Committee we

initiated the efforts to make the fee schedule more equitable and introduced use of a relative value guide to enable this. Working with the AMA is an open opportunity to become familiar with all of the non-medical aspects of our work and to develop contacts/friends across the province. I was always impressed with the superb abilities of the AMA staff on the committee. Their skills made the very large amount of work involved manageable. Dr. Gerhard N. (Gerry) Kiefer Pediatric Orthopedics, Calgary One of my most significant contributions was involvement in the selection of our current executive director, Mr. Gormley. His guidance has helped shape our organization and the entire health care service delivery model in Alberta. Then, as president in 2006, I helped negotiate and implement our Physician Services Contract financial agreement, which resulted in recognition of overhead differences (Business Costs Program), the stress of isolation (Rural, Remote, Northern Program) and the Retention Benefit, resulting in income supplements outside of the regular fee schedule. I have learned that the collective wisdom of the group and physician professionalism are the foundation for this outstanding organization that represents us. An effective AMA is essential to our role as advocates for our patients and improved health care delivery. Physician involvement provides individual physicians an opportunity to influence the decision making process, health care resources and the entire health care system. Dr. Christine P. Molnar Nuclear Medicine, Diagnostic Radiology, Calgary The opportunity to serve our profession during my two terms on the AMA Board of Directors has been one of the most meaningful professional experiences I have had in my career. Hearing the voice of Alberta physicians, understanding their needs for strong professional integrity, autonomy, fairness and their true devotion to achieving >




> the highest quality of medicine possible for Albertans is a powerful experience. It is uplifting to be part of that team. Working on the AMA board to develop strategic directions and enabling change that will support our goals as a profession and an organization is an honor. Through my participation over the past 30 years in AMA service through my section, the Representative Forum and the Board of Directors, I have grown personally and professionally. I have developed skills like active listening, collaboration, strategic thinking and decision making, and leadership. I have truly enjoyed my connections with other physicians from across the province. I think it is important to realize that we are part of a very large team and by working together we can accomplish so much more than if we go it alone. Work hard, but have fun! Find something that makes your heart sing. Dr. Eric A. Wasylenko Palliative Care, Applied Clinical Ethics, Okotoks, Calgary Working on rural initiatives in the 1980s and then helping lead the development of co-operative physician workforce planning provincially and nationally in the 1990s were terrific opportunities to better understand the complexities of organized medicine. Political, economic, professional, academic and human considerations were all in play. Those experiences helped prepare me to contribute as an AMA representative to the CMA in several capacities, including chairing the core Committee on Health Policy and Economics. The accumulated experience and connections with passionate leaders in medicine stimulated my interest in helping to address big system issues. That led to roles helping to develop palliative care and ethics programs that hopefully have made a difference to patients and colleagues. Learning from committed and skilled leaders has served me well at all stages of my career. The AMA has long been committed to developing leaders and lives the language of supportive, cooperative engagement. Being an active part of this organization will have a profound impact on any physician’s service to patients and colleagues. AMA - ALBERTA DOCTORS’ DIGEST

Canadian Medical Association (CMA) Honorary Members Dr. Robert W. Broad Neurosurgery, Edmonton What stands out the most for me was work on the Joint Subcommittee on Alternate Payment Plans, which was the predecessor to the alternative relationship plans (ARPs). This work extended over a number of years, and the committee created the principles and established the initial alternate payment plans to fee-forservice. I was a member first and eventually became chair. Being involved in those initial steps helped set us in the right direction toward establishing ARPs. Over the years, I have also been a member and later chair of the AMA Committee on Financial Audit, and for a number of years was head of the Section of Neurosurgery. Through the AMA I became a member, and eventually chair, of the CMA Audit Committee. There is a personal satisfaction that comes with this kind of professional involvement, which is a reward in itself for supporting a member organization like AMA. Having an organization of us and for us is tremendously important for us as a profession and as individuals. The strength is in people stepping up and taking on roles as they arise and getting involved. Dr. Eugene J. (Sean) Cahill Family Medicine, Sherwood Park Over the years I have served the AMA as a member of the Board of Directors and as a delegate to the Representative Forum and CMA General Council. I have also served on the executive of the Section of General

Practice, which brought into closer focus the competing interests within a section and how harmony is achieved. Being on the AMA board afforded me insight into the complexities of health care delivery. Serving as a delegate to the CMA General Council allowed me to experience the shared interests of delegates on common ground and to witness how the CMA interacts with government. The AMA and CMA offer the opportunity for members to enhance and expand their skills in the practice of medicine. Effectively delivering health care to the community requires the involvement of physicians at both the planning and the delivery phase. Membership in the AMA offers the company of dedicated caring physicians, with an energizing influence that brings to one’s life. The AMA has kept the profession united and been a source of support when the profession has been underappreciated. It welcomes and facilitates the growth of individuals within its membership as a means of strengthening the organization for all. Dr. William S. Hnydyk Family Medicine, Edmonton I’ve had the unique opportunity to experience service to the AMA as a senior staff person for nearly 13 years and lead or be part of numerous programs, committees and projects. While they were all rewarding, providing senior staff oversight of the Physician and Family Support Program (PFSP) stands out for me. When PFSP was one of the benefit stream programs threatened with loss of funding during one round of stalled negotiations, it was heartwarming to see how the general membership rallied around the program and sent a very strong message to government that it was imperative that the program be preserved. For me it demonstrated that membership truly valued a program that provided assessment and treatment for colleagues in times of need. >

> My experience at the AMA has reinforced my belief that AMA is a wonderful organization to learn and develop leadership skills that will help you in both clinical and administrative medicine. Dr. Lyle B. Mittelsteadt General Practice/Administrative Medicine, Edmonton My first experience with the AMA was as a member of the Government Affairs Committee, and I enjoyed the opportunity to interact with political and medical leaders to discuss issues. Another highlight was working with International Medical Graduate physicians practicing under limited licenses to establish a section within the AMA. My recent work in supporting the sections of the AMA involved in mental health and addiction care delivery has also been very gratifying, as has supporting individual physicians when they are in need of advocacy. As a young boy, I dreamed of being a physician and I am grateful to have achieved that dream. This vocation is often hard, with long hours and time spent away from friends and family. It also carries rewards – the smile on a young mother’s face as she holds her newborn baby or seeing a family through life’s challenges. Being a physician is a gift. Like most gifts in life, you get the most joy when you can use that gift for the benefit of others. Working with my colleagues to make our health care system work a little bit better has been tremendously rewarding.

Dr. Sandy J. Murray Family/Occupational Medicine, Red Deer I am fortunate to have served the profession on a variety of committees, the Board of Directors, and the Executive Committee including a year as president in 1988-89. Subsequently I served on the board and committees of the CMA. During my year as president-elect, the AMA formed a Committee on Environmental Health and, as chair, I presented an AMA position paper to pulp and paper development hearings. I encourage the CMA and AMA to continue pressing forward on issues of environmental health. I am known as a hard-working journeyman who stands up for my fellow physicians, and I have gained more from the profession than the profession has gained from me. I have learned much from my colleagues, and I am very grateful for the opportunities the AMA and CMA have provided me. "I have always believed that a well-trained, sensible family doctor is one of the most valuable assets in a community, worth today, as in Homer’s time, many another man." – Sir William Osler Dr. Wendy L. Tink Family Medicine, Calgary Springboarding from teaching to medicine was one of the greatest decisions of my life. I am both humbled and proud to have cared for three generations of families, shared in their greatest joys and sorrows, and every day learned something new.

It has been fun to work with learners of all levels to incorporate the science and art of medicine into improving the lives of patients and families. Advocacy for integrated, patientcentered care and a strong effective physician voice to shape local and provincial programs and services has been an integral part of my career. The AMA started me on my the leadership journey. Thank you for the leadership development and the opportunities to work with visionary physician leaders and staff within and external to the AMA. Wisdom created by increasing perspectives and collaborative initiatives led to profound personal and professional satisfaction. I am pleased to have served on the CMA Council on Medical Education, Physician Resource Workforce, Section of General Practice Executive and the Representative Forum. It has been heartening to see meaningful change in health care and be part of the AMA learning organization.

AMA Award for Compassionate Service The AMA Award for Compassionate Service honors a physician who, during his or her career, has served as an inspiration to others with outstanding compassion, dedication and extraordinary contributions to volunteer or philanthropy efforts to improve the state of his or her community. Dr. Annalee Coakley Dr. Coakley has dedicated her medical career to caring for marginalized and vulnerable patients, including refugees. As the medical director of the Mosaic Refugee Health Clinic in Calgary, she provides compassionate care to new Canadians and advocates for her patients locally, nationally and internationally. >




> Dr. Coakley is committed to not only the medical care of her patients, but to all aspects of their social and economic wellbeing, including helping them connect to employment opportunities and other community supports. Dr. Coakley is a passionate advocate for programs that are crucial to her patients’ health and wellbeing. She was part of a team who spoke out about cuts to the Interim Federal Health Program and spent countless hours working directly with patients who had been declined status or lost their health care privileges. She advocated for patients’ reinstatement and met directly with government officials to negotiate on their behalf. On April 1, 2016, the Liberal government reinstated the program. Her concern for vulnerable patients transcends borders and has led to her involvement with a charitable organization that provides medical care to a refugee camp in Kenya. She has pursued additional training in tropical medicine and teaches about immigrant and refugee health at the U of C. Most recently, Dr. Coakley marshaled the community to welcome and care for the influx of Syrian refugees coming to Calgary, establishing satellite clinics and caring for those who arrive battling illness, injury or trauma.

PHYSICIAN(S) REQUIRED FT/PT Also locums required

Dr. Coakley has dedicated her life and career to caring for vulnerable patients and showing them kindness and compassion – something far too many have never experienced before.

ALL-WELL PRIMARY CARE CENTRES MILLWOODS EDMONTON Phone: Clinic Manager (780) 953-6733 Dr. Paul Arnold (780) 970-2070






Employees, contractors, partners, the government You have obligations to all of them MaryAnne Loney and James Lingwood | ASSOCIATES,


hysicians are very well educated, but that education does not necessarily prepare them for the business and legal considerations of operating their own practice. While some will work as employees, many doctors will find themselves alone or as part of group operating their own office and running a business.

Doctors can, and most do, hire office managers, accountants and others to help them. But as owners, ultimate responsibility rests with them. The following is a list of some of the legal issues facing doctors as business owners and some suggestions that could help you avoid problems.

Determine if your workers are independent contractors or employees Your legal obligations to your employees are very different than your obligations to contractors. There are specific employment and tax obligations imposed on employers that are typically not contemplated in a contractor/payer arrangement. Under both tax law and employment law, whether someone is an employee or a contractor is based on the nature of the relationship, focusing on such factors as control, ownership of tools, integration into the workplace and the workers’ chance of profit and risk of loss. Tax and employment law typically supersedes what the contract actually says, so a judge or an arbitrator could decide that a person you thought was your contractor is actually your



employee, and you are significantly liable because of this mistake (both in employment and tax obligations). The Canadian Revenue Agency (CRA) regularly reassesses and disgruntled former employees regularly sue or seek employment insurance on these grounds. Worse, even if the agreement is found to create a contractor relationship, a court or tribunal may find that the contractor is dependent upon the employer. In such cases, employment standards legislation will apply to the relationship, creating significant burdens that were not anticipated or intended by either party. Therefore, before entering into the relationship, it would be prudent to consult with a tax or employment lawyer to ensure the conditions indicate a contractor relationship and will avoid a finding of dependency, both in the written contract and in the actual circumstances of the relationship.

Know your obligations as an employer Beyond the obvious requirements regarding minimum wages, vacations and statutory holidays, employment standards legislation creates a bevy of rights to employees including rights to leaves of absence, restrictions on pay corrections and limitations on the right to terminate. Additionally, it is an implied term of an employment agreement that the employee receive notice (or pay in lieu/severance) where he or she is dismissed without cause. It is possible to contract out of this obligation, but employers must be careful to draft legally valid limitations on these rights that meet the minimum requirements of legislation. Court decisions are replete with examples of invalid attempts to limit severance, so clear and limiting language must be used to effect such a limit. The severance obligation can change significantly where there is a fixed-term contract. Additional care and attention is required to avoid large exposure. >

> Restricting competition You may wish to set up your employment relationships in a manner that restricts competition by employees if they leave their employment. Unfortunately, restrictions on competition are presumptively invalid, but there are ways to draft agreements to effectively protect your business for a limited period following dismissal. This can include restricting competition within a limited area for a limited period and restrictions on soliciting patients/clients.

Record your agreement with your business partners While your relationship with the other doctors you work with may not have the same risks associated with failing to meet your obligations to an employee, a properly drafted agreement between you and the other doctors will help reduce the chance of disputes arising, assist in resolving any disputes that do arise and even limit your tax liability. There are several possible ways to structure your relationship with the other doctors at your office, including a partnership, a cost-sharing arrangement and contractor agreements. All of these can be personalized so that the specific conditions suit you and your business partners. However, more important than limiting your tax liability, putting into writing each party’s rights and obligations will make sure everyone knows what those rights and obligations are, which means they will more likely be respected. While saving some money in taxes is great, saving yourself the cost and hassle of having to find new business partners can be even more important.

Know your tax obligations There is no creditor like the CRA. Fighting the CRA can be frustrating, time consuming and expensive. While you are legally presumed to know your tax obligations, many people do not. There are three main areas small business owners, including doctors, get themselves in trouble.

phones, vehicles and home offices are particularly prone to being denied. An accountant can help you with this. Finally, meet your trust obligations. Source deductions, which are tax withholdings from employee salaries and GST are considered trust funds that you collect on behalf of the CRA. If you fail to properly collect and remit trust funds, the CRA can take collective action immediately, even if the assessment is under appeal. If the CRA cannot collect it from your business, they can seek collection from directors or anyone who has received dividends from the corporation directly. This is another reason it is important to know whether your worker is an employee or a contractor and if you should be collecting GST. While medical services are usually exempt from GST, if your office is selling other property or services, you may still have GST obligations. An accountant or tax lawyer can help you resolve this question. In summary, while legal and accounting advisors are happy to help you with your business issues once they arise, contacting them beforehand may prevent legal problems from developing in the first place.

More than data entry. We apply our proven financial process to your business. It’s not data entry, it’s a partnership.

First, keep your business financials separate from your personal financials. Do not use your business account or credit cards directly to pay for personal items and assume your accountant will catch it and fix it later. Even if you haven’t actually done anything wrong, auditors are much more likely to reassess a shareholder a taxable benefit when they have trouble following the transactions. Second, know what you can and can’t deduct. You can only deduct expenses which are for the purpose of earning income, and there are several rules that limit that. Expenses which may offer personal benefits, like cell

T 403.986.5321





We asked. Here’s what you said. Reporting on what members told us in two surveys since spring 2016


t’s our usual practice to share the results of member surveys in Alberta Doctors’ Digest. In this issue, we are reporting on the 2016 Tracker and Readership Surveys. Both surveys were conducted in June. The Tracker Survey is the second of the three this year. The Readership Survey is conducted every two years. The results of both surveys are enlightening.

Tracker Survey highlights: Holding the course The Tracker Survey was in the field from June 27 to July 10 in a random sample of 3,000 members. Responses were received from 356 members (12%). The data is valid 19 times out of 20 with a margin of error of +- 4.88%.

Who responded Years in practice



0% 5% 10%




Student Resident 1st year in practice 2-5 years 6-10 years

4% 1% 6%




What zone are you in?


11-15 years 16-20 years 21-25 years 26+ years No Response




No response Family physician/general Specialist: Family medicine Specialist: Other


42% 8%

No response Zone 1 - Southern Zone 2 - Calgary Zone 3 - Central Zone 4 - Edmonton Zone 5 - Northern

Members continue to agree that they are satisfied with Alberta Medical Association (AMA) benefits and services (89%). Most members agree that they feel informed about news and the activities of the AMA (82%). The lowest level of agreement comes around the idea that financial and other incentives for physicians are aligned with timely system access to quality care for patients. Just over a third agree, but almost as many are neutral. Among those who disagree, there is an opinion that incentives give priority to simple and high-volume services. There was a significant improvement in belief in the fairness of the AMA-Alberta Health Physician Compensation Committee. Beginning at 48% in February, that result is now 53%. Support was strongest among specialists (non-family medicine specialists), rising from 36% in February to 47% in June. >


> Summary of findings, benchmark questions Questions 1. The AMA is effectively supporting the Patients FirstÂŽ vision where physicians positively influence a health system built around patients and families.




5. The Physician Compensation Committee process for defining and administering physician compensation is fair. 6. In our system, incentives and financial/compensation supports for physicians are aligned with the system objectives of timely access for patients to quality care. 8. The AMA is effectively contributing to efforts to promote system-wide efficiencies and savings. 9. An integrated provincial electronic medical record (EMR) strategy that includes seeking value from existing infrastructure is essential for improvement of the health care system. 10. Patient-physician confidentiality and safeguarding of that private information remains a requirement for effective patient care.






























37.3% 60




32.3% 0



34.5% 0










85.0% 0





94.9% 0








30.4% 20





34.3% 0



31.3% 0




61.1% 40







82.1% 0




29.7% 0





55.0% 60





67.1% 0






18. Physicians are being supported by the AMA in maintaining their own health and that of their families.


56.3% 0


17. I am able to effectively share my opinion with the AMA when an issue or change will impact me.



12. The AMA is creating and sustaining opportunities for physicians to play active leadership roles within their communities (e.g., leadership development, Many Hands™, Youth Run Club, etc.).

16. I feel well informed about the news and initiatives within the Alberta health care system.


35.3% 0


15. I feel well informed about the activities and news from the AMA.


83.5% 0

11. Primary Care Network (PCN) evolution toward the medical home model will improve access, quality and continuity of care.

13. The AMA is effectively building and managing the partnership with Alberta Health and Alberta Health Services.


70.2% 0

3. Physicians are shifting their practices to support partnering with patients in the delivery of care. 4. The AMA is making progress in supporting fair allocation of compensation based on relative value.





Category percentages 0

2. The AMA is an effective advocate for physician members by providing leadership and support for their role in the provision of quality health care.










24 >



19. I feel the Representative Forum is able to understand and receive feedback from physicians to support their governance role.


20. I am satisfied with the benefits and services provided by the AMA, e.g., insurance, continuing medical education (CME), Physician and Family Support Program (PFSP), etc.


Readership Survey highlights: The future is looking digital

The exception was a number that may be of interest to readers of this magazine. For the first time, a majority of respondents said they would prefer to read Alberta Doctors’ Digest in electronic format (53%). We will be exploring this option in the months ahead. Printing and mailing costs could be reduced, but if we go this route, it should be to make the content more accessible and usable for members. Potential cost savings will not be the preeminent decision factor. Let us know what you think about moving to digital format. Please email if you have comments to share.

Benchmark trends Responses to the benchmark questions had significant increases in agreement from the findings in 2014 and 2012. All mean scores are above four on a five-point Likert agreement scale and 86% or more are in agreement. 2016


The AMA keeps me informed about important issues that affect me in my professional practice.

92% 89% 90%

The AMA keeps me informed about important issues that affect me personally as a physician.

86% 81%

AMA communications provide timely information about issues affecting physicians.

91% 87% 90%

AMA communications use clear language that explains complex issues and makes them easily understood. AMA communications help me feel connected to the association.







55.2% 20







88.8% 20





Topics of interest

Every two years since 2010, the AMA has conducted a special all-member survey to assess the quality and effectiveness of our communications and publications. This year’s Readership Survey results continued the generally positive results, with only minor changes in ratings.

Trends (percent of agreement)



Editor's note: Questions 7 and 14 were comment questions, so they were not included in this summary of findings.


Category percentages


Overall averages


90% 86% 86% 86% 82% 84%

Family physicians, specialist family physicians and other specialists find most of the same topics important. While the most important topics or issues for all groups are similar, the response to lesser issues is more diverse. Specialists, for instance, are less likely to find programs (e.g., Business Costs Program, Rural, Remote, Northern Program), uninsured services or primary care activities relevant to them. Physicians’ preferences for topics have not changed in the last four years. The top five topics receive over 80% agreement. They are the ones that would directly affect physicians and their practice the most. I am interested in AMA communications about the following topics: (Top five - percent of agreement) Benefits (negotiated)


Physician fees, fee equity, Physician Compensation Committee


Alberta Health Services activities that affect physicians


Alberta Health/government activities that affect physicians


Billing tips



Ranked the highest, at 95% agreement is the AMA as an information source, the same high level achieved in 2014. Ranked the second highest, at 89% agreement – a 3% increase over the response of 2014 – was the College of Physicians & Surgeons of Alberta as a source of information. >

> I rely on information, about issues that affect physicians,

• 35% report reading the entire letter.

from the following sources: AMA


College of Physicians & Surgeons of Alberta 53%

Alberta Health Services


• The same as 2014, 48% agree that they know they can comment online and participate in discussions with other physicians.


Word-of-mouth Vital Signs

• At 59% agreement, an 8% increase from 2014, members believe the President’s Letter makes it easy to provide comments to the AMA president.



Alberta Health

• 75% feel the letter is the right length; whereas approximately 24% feel it’s too long.

48% 24%

MD Scope

20% 5%

• 53% report reading MD Scope “usually/always,” an 8% increase from 2014.

I am aware of the following AMA publications: (select all that apply) President's Letter

• 59.5% agree that articles are interesting and informative, while 38% of physicians are neutral about the articles’ content.


MD Scope


Alberta Doctors' Digest


Section News


Billing Corner


News for Docs/News clipping service


All of the above


Online @ your service membership guide


None of the above

• 21% report reading the classified ads attached “usually/always,” an increase of 8%.

• 67% of physicians find the billing tips useful, a 5% increase from 2012.

Alberta Doctors’ Digest (ADD) • 49% report reading Alberta Doctors’ Digest “usually/ always,” a 5% increase from 2014. • The top feature is the cover story selected by 62% of respondents, with Health Law Update and From the Editor both having more than 40% of respondents.


Summary of communication channels

• 77% of respondents agree that the specially themed issues were noticeable.

Frequency of readership (%): President's Letter MD Scope







Alberta Doctors' Digest



Section News




Billing Corner







Section News • 50% report reading Section News, a 14% increase in readership since 2014.


Readership useful (%): Section News AMA Membership Guide

5% 56%


AMA @ your service membership guide


• Ranked the least frequently read at 37% “usually/ always,” still had a 4% increase from 2014.


74% Strongly agree/agree

• 56% of physicians are finding the information timely and useful, almost a 10% increase in agreement from 2012.



Billing Corner

• 43% of physicians believe that ADD should continue with a print version which is supported by 7.5% fewer respondents than in 2014.


25.5% Strongly disagree/disagree

Below are the highlights from each of the AMA’s internal publications for members.

President’s Letter

• 86% of physicians refer to the AMA website for information about benefits and services (75% of physicians in 2014).

Billing Corner

• 65% report reading AMA President’s Letter “usually/ always,” a 5% increase in “always” from 2014.

• Significantly more physicians report reading Billing Corner than in 2012 and slightly more than in 2014. Currently 48.5% of respondents report reading it, “usually/always.”

• 90% read the President’s Letter in the email message.

• Of the physicians who read it, 74% find it useful.





The power of the whiteboard Wesley D. Jackson, MD, CCFP, FCFP


he CanMEDS Physician Competency Framework is an educational framework first developed by the Royal College in the 1990s and revised in 2005 and 2015. It “ ... describes the abilities physicians require to effectively meet the health care needs of the people they serve. These abilities are grouped thematically under seven roles. A competent physician seamlessly integrates the competencies of all seven CanMEDS Roles.”1 Expertise in each of these roles naturally varies from physician-to-physician, and technology allows for rapid and relatively simple distribution of great ideas and tools. At least three of the roles outlined in this framework highlight our need as physicians to educate ourselves, our patients and our peers. I would like to highlight two educational tools using whiteboard animations that are readily available to all physicians. Dr. Mike Evans is the founder of the Health Design Lab at the Li Ka Shing Knowledge Institute. While an associate professor of family medicine and public health at the University of Toronto, he developed a significant library of engaging, evidence-based and informative patient education videos on YouTube2 using whiteboard animations. His first video, highlighting the importance of exercise, was called “23 and 1/2 hours: What is the single best thing we can do for our health?” It was uploaded about five years ago and has garnered over five million views. Since that time, he has published many other videos addressing topics ranging from hip and knee replacement to advice for those taking opioid medication. The quality of his work has not gone unnoticed; he recently has been recruited to work with Apple in California. I have prescribed his videos, such as 23 1/2 hours, What’s the best diet? and What is the single best drink for your health? to my patients as homework. I have also shown in my office, videos on concussion and PSA testing. I leave my iPad with the patient, with guided access mode enabled, while


I leave the room for a few minutes and then return to answer any questions. These videos have also been enjoyed by my family, with the talk on flatulence rising to the top (pun intended) as their definite favorite.

I would like to highlight two

educational tools using whiteboard animations that are readily available to all physicians. is a website that was launched in July that is “ ... designed for medical school students and practicing physicians to learn and review the fundamentals of clinical medicine.”3 It is the product of the collaboration of more than 180 leading medical professors from around the world, led by Dr. Sanjay Sharma from Queen’s University in Kingston, Ontario. This website uses a combination of whiteboard animations, video lectures, SOAP notes and online discussion boards to help students and doctors learn in a fun and engaging way. Topics are arranged in courses ranging from cardiology to urology. Modules within these courses are short, engaging and meant to support the flipped classroom approach now used in many medical schools. Currently, there are about 100 modules available, with 100 more to be added in the next few months. While other, more traditional lecture-based video educational tools available on the Internet continue to be helpful, the techniques in the above resources use pedagogically sound principles to efficiently teach key points while offering the consumer more detail as time and need permit. As a practicing physician, I am constantly looking for ways to improve efficiency while maintaining or even improving quality in my clinical and teaching practice. Efficient use of technology allows me to easily tap into the talents and skills of these great teachers to benefit the patients and learners in my practice while helping me maintain competence and continue to enjoy my profession. >

> Reader tip Thanks to Dr. Lawrence Farries who replied with the following in response to the previous Dr. Gadget article: “Do I need a medical calculator?” “I enjoyed your article and have downloaded and have been playing with MDCalc. For surgeons, the ACS NSQIP-based Surgical Risk Calculator is online only but has been of great utility in both reassuring and talking patients out of surgery as appropriate. Actually, one of the fascinating things for me with the ACS Surgical Risk Calculator was that when you discuss the complications and outcomes predicted by the calculator, most patients are not too dismayed by the thought of death or of horrible sounding things like pneumonia or venous thromboembolism. However, if you tell an independent 78-year-old that following his esophagectomy he has a prediction of one in seven, or 14%, for “discharge to nursing home or rehab facility,” he may run like a rabbit. A discussion with this evidence-based information often goes differently than I would have guessed.” References available upon request.


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AMA Award for Compassionate Service Nominate your colleague

• A letter of support. • The nominee’s curriculum vitae. The nomination form is on the AMA website at Alternatively, you may fax the documents to the attention of Ms Meredith at 780.482.5445.

Deadline for nominations is February 1, 2017.


he Alberta Medical Association (AMA) Award for Compassionate Service honors a physician who is an AMA member and during his/her career has demonstrated outstanding compassion, philanthropy and/or volunteerism to improve the state of the community in which he or she is giving back.

Compassionate service is viewed as: • Demonstrating a significant and extraordinary contribution to volunteer or philanthropic efforts. • Enhancing the reputation of physicians as compassionate members of the community by giving back locally, nationally or internationally. • Going outside of one's normal duties and practices to care for others who would otherwise not receive care or support.

Nomination Please submit the following to the chair of the AMA Committee on Achievement Awards, c/o Janice Meredith, AMA Public Affairs by email to • Completed nomination form (must be typed as hand-written submissions are not accepted).


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Makes me feel

(Comments from YRC members, Mee-Yah-Noh School, Edmonton)

… “healthier and happier.” (grade 4) … “more less stressed.” (grade 6) … “welcome and needed.” (grade 6)

Favorite thing

(Comments from YRC members, Mee-Yah-Noh School, Edmonton)

“I feel that running club is my family.” (grade 6) My favorite part of run club is “running with my friends.” (grade 6) My least favorite part is “that it’s only once a week.” (grade 6)

THE AMA YOUTH RUN CLUB is a place for students to be physically active, have fun and learn about good nutrition and other healthy lifestyle habits. The YRC closed out its 2016 spring/summer season with a record-breaking 383 schools and close to 22,000 kids, handily surpassing the goal of 350 schools. This growing program needs support and as a Youth Run Club Champion, it’s a great opportunity to make a connection with your community. ConTaCT Vanda Killeen, aMa Public affairs 780.482.0675 YRC PARTNERS





400 schools in four years AMA Youth Run Club is going and growing strong! Vanda Killeen, BA, DipAd/PR | SENIOR


The bigger picture: More than just running In its role as the Many Hands™ flagship project, the YRC has always offered opportunities for physicians, residents and medical students to get involved with the program’s primarily elementary school participant communities on a volunteer basis. However, based on the program’s description as the Youth Run Club, there’s been a perception that these opportunities have mostly been in the form of running with or helping coach a club.

Post-run, Dr. Padraic Carr joins the “Kool Gang” at Edmonton’s Prince Charles School.


eading into its fourth year in 2017, the AMA Youth Run Club (YRC) has developed into a popular Comprehensive School Health (CSH) program under the guidance of program partners the Alberta Medical Association (AMA) and Ever Active Schools (EAS). CHS links health and education in the school setting through its support and encouragement of physical activity, healthy eating and positive social environments. With the wrap-up of the spring/summer 2016 season in June, with 383 schools and close to 22,000 children and youth participants, EAS and the AMA set a goal of 400 schools and 25,000 students for June 2017. Typically, school participation gets off to a gradual start in the fall, with the shorter season and cooler weather. Then it builds to peak participation with the warmer temperatures and better running conditions of the spring/summer season. But with 370 schools already on board in October, the YRC began its fourth year with a bang!

But as those physicians and medical students who have been involved with the YRC have discovered, the club has a strong school health advocacy component, as EAS and the AMA connect physicians and medical students with schools to facilitate the delivery of a school health advocacy talk. Talks are supported with seven Health Advocacy Talk tip sheets posted to the AMA website. These tip sheets cover topics including the value of physical activity and good sleep, plus the hazards of too much screen time. Second-year University of Alberta medical student and YRC CHAMPion Savanna Boutin was able to fit two school health advocacy talks at Edmonton’s St. Teresa School into her busy schedule and found the brief amount of preparation and presentation time required very manageable. “I did prepare a PowerPoint presentation for one of my talks,” says Savanna. “And I used the tip sheets on the AMA website to prepare my speaking points for both.” She added information from personal experience to her talks, which focused mainly on the importance of being physically active and on nutrition. “They’re both subjects I’m familiar with, which also reduced prep time. All told, I probably spent 45 to 60 minutes preparing for the 10 to 15 minutes of actual speaking time.” She adds, “I really enjoyed the whole experience! The kids asked great questions and it was good to acquire that school health advocacy experience. I’d definitely do it again.” >


Have you seen it?


The new AMA-sponsored Comprehensive School Health/Youth Run Club video premiered on September 23 at the AMA Fall 2016 Representative Forum (RF). Presented at the RF by Dr. Kimberley Kelly, AMA CSH representative, the four-minute professional video was conceived and produced by Dr. Kelly, AMA Public Affairs and Jason Gondziola. Jason is a producer, cinematographer and youth media educator.

Dr. Padraic Carr and YRC leader and teacher Ms Karla Loberg-Walter (green t-shirt) gather with a sea of smiles after the YRC fall launch run at Prince Charles School.

> Another YRC CHAMPion who looks forward to his next volunteer opportunity with the AMA YRC is Dr. Padraic E. Carr, AMA President. Dr. Carr brought greetings from the AMA to the Calgary and Edmonton fall 2016 launches. And the grin on his face said it all. “What a fantastic experience! I thoroughly enjoyed myself. The energy of the kids is amazing. I’d like to bottle some of that.”

Featuring interviews with AMA physicians, the video illustrates the mutual relationship between CSH and the YRC, with the AMA/EAS partnership program serving to unite health and education in the school setting. As a platform for school health advocacy, the YRC promotes community engagement by doctors and the well-being of students. View the video on the AMA website:

Dr. Carr’s greetings to over 500 French Immersion students from St. Gerard School and Prince of Peace School in Calgary on September 27 were followed the next day with greetings to over 300 students at Prince Charles School in Edmonton. These enthusiastic students ranged from kindergarten to grade six. “Seeing the enthusiasm and the joy of the kids, outside running around, laughing and playing with each other, was a special thrill,” says Dr. Carr. “The added involvement and support of the teachers and principals, as well as the attendance of family members, tells me the AMA and Ever Active Schools are onto a good thing.” Health advocacy opportunities: Become an AMA Youth Run Club CHAMPion. Find out more about how you can get involved with the AMA YRC. Contact: Vanda Killeen, AMA Public Affairs T 780.482.0675


It was all about “Peace, man!” at the St. Gerard/Prince of Peace Schools’ YRC launch in Calgary on September 27.

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Medical professionalism and social media: Danger or opportunity? Sara Taylor, BSc, MD, CCFP | ASSESSMENT



o start the conversation on medical professionalism and social media, I would like to share this ideal tweet from Dr. Carl W. Nohr, the Alberta Medical Association’s (AMA’s) Immediate Past President: "There is a linkage between physicians and society and that linkage is professionalism."

Online medical professionalism

We tend to use the general term of professionalism throughout medical training as a standard to guide both conduct and behavior. One would argue that it is not always used in a positive vein once in medical practice with the incidents of unprofessional behavior or misconduct rising to the surface. However, we must duly recognize the professional behavior that so many physicians display. In every sense, professionalism is the basis of what it means to be a physician.

The Canadian Medical Association (CMA) has devised a policy to guide and define medical professionalism. In part, they state: “The medical profession is characterized by a strong commitment to the well-being of patients, high standards of ethical conduct, mastery of an ever-expanding body of knowledge and skills, and a high level of clinical independence.”

For a moment, I urge you to pause and reflect on what professionalism means to you as a physician. I imagine that if we were to poll the answers, we would see varying interpretations. But the over-arching themes would be the same. Now, what if you were to consider what professionalism means in the context of being a physician online. Does a difference exist between medical professionalism in-person versus online? Taking it a step further, can social media engagement and medical professionalism coexist? Let us first look at how we are defining professionalism and social media to examine the potential dangers and opportunities of this combination. Given that this is a vast topic, we will aim to focus on some of the more salient points.


The main concept of online medical professionalism is that we should use the same principles that guide our professional conduct and behavior in-person.1 So how do we define medical professionalism? The literature supports many frameworks of medical professionalism, but for the most part they are aimed at identifying what it is to be a “good doctor” by integrating physician, physician-physician, physician-patient and physiciansystem relationships.

They also state that: “… as members of the medical profession they (physicians) are expected to share and uphold those values that characterize the practice of medicine and the care of patients.”2 This CMA policy also outlines medical professionalism as the “social contract between physicians and society.” In essence, our professional identity exists within us as physicians, regardless of the environment we present ourselves in. This applies to any physical or online space.

What is social media? For purposes of this discussion, it might be worthwhile to provide a brief overview of what is meant by social media. For some physicians, the words “social media” may be terrifying or uncertain – or terrifyingly uncertain. For others, it may be part of everyday life. Overall, personal and professional use of social media by physicians is increasing.3 >

> The following categorization according to social media purpose is useful:3


• social networking (Facebook, Twitter) • professional networking (LinkedIn) • media sharing (YouTube) • content production (blogs, microblogging) • knowledge/information aggregation (Wikipedia)

Why do physicians need to consider social media? According to Pereira et al.,4 physician colleagues from Ontario, “If professionalism is a social contract between medicine and society, and society is increasingly using social media, is it a professional responsibility of physicians to consider the rewards and risks of social media in the care of patients, society and themselves, as well as the education of learners?” In fact, social media offers the opportunity for the medical profession to connect with society in another meaningful way. Interestingly, the peer-reviewed literature pertaining to social media in medicine began with cautions followed quickly by recognized opportunities.1 In fact, “social media is so pervasive today the question is no longer whether physicians will participate but rather how they can best use social media to advance the health of the public.”5

What are the dangers for physicians using social media? The dangers can be summed up quickly by outlining four types of unprofessional behavior: • Violating a patient’s privacy – it is very difficult to maintain confidentiality even when it appears to be non-identifying. • Engaging with a patient’s direct concerns – social media is not the place to interact with patients directly. • Violating your own privacy – posting unprofessional content, for example, venting, foul language and intoxication, can damage your reputation. • Misrepresentation – falsifying credentials or not identifying conflicts of interest are unprofessional offline and online.

Like a drop in a river, your words and images on social media can disseminate to places unknown. So be professional in every way.

• Education – social media can be a valuable way to share and receive information. It offers an excellent way to keep current on medical literature. • Connection – many medical professionals are on social media already, especially Twitter, so it is an excellent way to engage with other physicians and organizations. These connections can translate to real-life connections. This ability to connect can also reduce feelings of isolation associated with specialized practice or geographical location. • Supplemental medical training – students are provided with a voice and access to experts who use Twitter to supplement their traditional medical school experience.6 • Public health messaging – social media is an effective way to disseminate public health information such as the upcoming flu season and vaccinations. • Conference enhancement – whether or not you are attending a conference, associated hashtags can enhance the experience and learning (e.g., #icph16 is the hashtag for the recent International Conference on Physician Health in Boston). • Creating an online presence (probably the most important point of all) – having a reputable social media profile will allow you to create your own image of how you want to be seen online. I hope this information leaves you with the inspiration to consider using social media as a physician or the confidence to continue if you already are. References available upon request.

One of the other primary dangers to consider is that when you post anything online, even if it is perceived to be among friends, it can be shared without your awareness. Always remember, social media is a public space no matter what privacy features may be in place.

What are the opportunities for physicians using social media? The opportunities for physicians using social media far outweigh the dangers. Here are some of the opportunities:



FEATURE Calling for 2017 TD Insurance Meloche Monnex/AMA Scholarship applicants


he Alberta Medical Association (AMA), in conjunction with TD Insurance Meloche Monnex, is providing $20,000 in scholarship funds for 2017. By committee selection, four deserving applicants will each be awarded $5,000 to put toward their additional training in clinical areas of recognized need in Alberta. If that fits your situation, apply for the TD Insurance Meloche Monnex/AMA Scholarship by March 31, 2017. Scholarship applicants must be: • Seeking additional training in a clinical area of recognized need in Alberta. • An AMA member.

• Enrolled and accepted in a clinical program of at least three months duration in a recognized educational facility. The proposed program must be supplementary to completion of a Royal College of Physicians and Surgeons of Canada or College of Family Physicians of Canada certification program, or the physician may be in an established practice and wishing supplemental training. To request a scholarship application form, please contact Janice Meredith, Administrator, Public Affairs, AMA:, telephone 780.482.2626, ext. 3119, toll-free at 1.800.272.9680, ext. 3119, or visit the AMA website at

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IN A DIFFERENT VEIN Does Hercules really need to slay the Hydra? Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP | CO-EDITOR


o I had to give a talk in November to a meeting of employers and insurance company benefits blokes – people negotiating employee benefits plans. They wanted to understand how a new drug is approved and funded in Canada. It’s the kind of talk you get to do when you’re no longer fit to talk to residents about molecular biology. Drug insurance is yet another of the Hydra’s heads that bites a hole in “universal access.” My first experience with the insurance industry was unhappy. It was in London, England, and I had to buy a house on a meagre resident’s salary to shelter my pregnant wife. I was studying with friends at The Hand & Shears public house one evening near St. Bartholomew’s Hospital, and who should appear but a school acquaintance, Scot Lockhart, complete with old school tie. I bought him a pint of bitter. He spoke with an Edinburgh Morningside accent.* “Ay hear you’re thinking of b-eying a house, Seh-ndy. D’you hev laife insurance? It really helps getting a mortgage,” he said.

The Canadian health care system

now seems to belong to dyspeptic union leaders, envious medical economists, control-freak administrators, career policy planners and bland sheepish followers of the delusion of equality waving banners saying “No two-tier medicine” or “No American-style health care.”

By the second pint, I’d bought his stupid Whole Life Policy, then later found that the mortgage company not only had little interest in his policy but had their own, which I had to join. I’ve been allergic to insurance ever since.

They’re all clamoring for no change

or change that will feather and protect their own nests and which boils down to more of the same.

Insurance as part of patient social history As a clinician, one usually asks about additional insurance coverage during the social history part of a consultation. It’s an important part of history taking, and I’ve always liked William Osler’s assertion: “It is much more important to know what sort of patient has a disease than what sort of disease a patient has.” He was talking from times when disease processes were fuzzier than they are today and so, with a nod to molecular biology, I’d modify his dictum: “It’s as important to know what sort of patient has a disease as it is to know what sort of disease a patient has.” My dear colleagues chuckle and sometimes roll their eyes at this old-fashioned interest in a patient’s social history. They are surprised that I spend valuable time finding out that this old person in front of me remembered as a child being bombed in Rotterdam first by the Germans then by the Allies, or that this middle-aged Asian woman escaped to London from Uganda from the monster Idi Amin in 1972, or that this man’s daughter was murdered in Red Deer two years ago. But lately, that part of the social history which only 10 years ago I often forgot to ask – “What insurance do you have?” – has become an important segment of the social history. Most had Alberta Blue Cross, which was fine. Patients would get what was needed and if it wasn’t funded on the public system, it wasn’t worth losing any sleep. >


> No longer. While health care spending as a percentage of Gross Domestic Product is falling (Figure 1), the share of private sector spending on insurance is rising (Figure 2).1 Needed drug coverage has become yet another head of the multi-headed Hydra rearing in front of Hercules, Defender of Government Monopoly Medicare. It is just another example of the complex, multi-tiered Canadian Medicare industry. It joins the Mounties, Workers’ Compensation Board patients and guests of Her Majesty as preferential care accessors together with private radiology clinics and surgical centres, dentists, physiotherapists, chiropractors, psychologists, nutritionists, other “–ists” and the whole USA medical system. These are accessible to those with cash or insurance. Even teachers access second opinions in the USA covered by their union. Yet those wishing to take out insurance and privately consult a simple Canadian doctor who works in the Medicare system are given the bird.


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Figure 1: Total health expenditure as a percentage of GDP, Canada, 1975 to 2015

Mauro Castellanos, B. Comm t: (780) 707-4241




Share of GDP


ArTeam Realty




6% 1975











Year Actual


Source: National Health Expenditure Database, Canadian Institute for Health Information.

Figure 2: Share of private-sector health expenditure by source of finance, Canada, 1988 to 2013 70% 60% 50%


40% 30% 20% 10% 0%







Year Household (out of pocket)

Private health insurance


Source: National Health Expenditure Database, Canadian Institute for Health Information.





> Canada stands out as a proud and unique global oddity that outlaws medical staff who labor within Medicare from working privately after contract hours and forbids the sale of insurance for medical purposes. To compensate for this weird loss of freedom of practice and to avoid a stethoscope-swirling uprising, we are (on average) paid well. The system is designed to reward volume and mediocrity.

And let me also tell you that some

of my friends who are the most avid supporters of the current system are also the first to come looking for inside information as to how to access things faster.

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Drug coverage costs and access Now to add to this cornucopia of codicils to the Canada Health Act, we can add access to expensive life-prolonging drugs and biologics. There are Canadians with employee benefits who may or may not have this access depending on the insurance company’s coverage rules. And there are those, like me and my family, who do not have access. The proportion of private health care spending allotted to private insurance is about to take a big jump with “targeted” agents and “bio-similars” coming to an outlet near you. “Bio-similars” are broadly similar-ish to the original molecule, but not even close to being a generic form of the original biological entity. And buying these life-saving agents from labs in India and China without high standard clinical trials will be reckless for a 15% to 20% cost saving. The path of access to new active drugs is long and lonesome. Low-priced it is not. For cancer drugs, for example, the struggle from the inception and development of a promising agent even before an application to Health Canada for a Notice of Compliance (NOC) >

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> requires in-vitro studies, animal toxicity testing, excellent manufacturing standards and phase one, two and three clinical trials. An NOC then allows marketing to commence. The steps after a Health Canada NOC to provincial funding for the individual patient is again tortuous and can now take as long as two years. Why? Drug costs have risen (“sky-rocketed” as the tabloids say). Some of this is corporate greed, but a lot is due to increased costs and risks of bringing a drug to market. The slog of the post Health Canada process now involves an excess pricing review, the Common Drug Review, a pan-Canadian oncology drug review with a pan-Canadian expert review, a pan-Canadian pricing review, then the Provincial Clinical Programme Review with application to the Provincial P&T committee and finally ministerial approval. All stages come with the back-and-forth of requests for more information, referral to a sub-committee for further study, tabling items until the next three-monthly meeting, all brought in with the best of intentions of thorough, thoughtful study of the data with cost-benefit analyses. This extensive process has led to the unintended consequence of an opportunity for insurance companies to provide private access to these expensive drugs/biologics after Health Canada approval for those with generous company drug plan coverage. In a free society, this is entirely rational and entrepreneurial, but for new drugs that are life-extending, there is now delayed access for those without these plans. Pharma companies make arrangements and deals with insurance companies to provide coverage of their drugs for their clients. These arrangements are private and the insurance company may or may not actually pay the projected retail cost of the drug. In return, the insurance company takes the risk that their high drug costs may continue longer than projected before the patient can shift from private drug access to the public system. Companies with “life” somewhere in their names tend to provide the best coverage plans. And when some patients are already accessing and benefitting from the drug, there is an obvious whip on the provinces to hurry up and stump up. And you closet Medicare conservatives who are now bridling and saying this must be stopped should remember it’s just another example of the patchwork of compromises making up the Canadian health care system, yet another beautiful hypocrisy where the illusion of equal access meets the reality of preferential treatment for everything except the work of a qualified, highly trained physician or surgeon. But even there, preferential access exists. Consider the patient with a long list of questions taking time from those easy-going souls whom our system depends on, the demand for second or third opinions and the unfairness of funding targeted surgeries which then becomes a game of

whack-a-mole with delays in other surgical procedures. Then there’s the inside information as to who is good at what. All these mean the intelligent, articulate patient jumps Joe McBlow in the cue.

One tier or two? That brings me to the Vancouver court case brought forward by Dr. Brian Day. He is arguing that for governments to make it illegal for Canadians to insure against illness and access private medical care (but not dental, pharmaceutical, optical or orthotic) is a violation of the Canadian Charter of Human Rights. From a legal perspective, I can’t see how he can lose his case no matter how far the BC government takes it or how many patients with botched knee jobs that the Friends of Medicare bring forward. Why? Because this is not about end results but about an individual’s right to try to access a service reasonably soon and a physician’s right to spend their free time as they please. I chuckle when I hear the slogan “two-tier” implying that one tier of medical care is higher quality than another. My experience of private practice in Britain was that the quality of care in Harley Street was a good bit below the quality in the National Health Service, though you did get to sit in a waiting room with comfy cushions. The Canadian health care system now seems to belong to dyspeptic union leaders, envious medical economists, control-freak administrators, career policy planners and bland sheepish followers of the delusion of equality waving banners saying “No two-tier medicine” or “No American-style health care.” They’re all clamoring for no change or change that will feather and protect their own nests and which boils down to more of the same. But they’ll have to do better than that because “the times they are a-changin’!”2 I’d suggest slogans something like: “Keep it as it is!” or “Private practice for all except MDs!” or “Don’t criticize what you can’t understand!”2 Even the joyless Andre Picard, of the Toronto mouthpiece “The Grope and Flail” agrees: “Allowing some private provision of care and broader use of private insurance does not mean the death of Medicare. On the contrary, if the proper regulatory safeguards are put in place, and public health dollars deployed for a wider range of services (as in most European countries), we should emerge with a Medicare system that is more universal and fairer.” In a country where basketball players, entertainers, lawyers and bankers can earn multi-millions without a squeak from the population, it seems churlish to blow the whistle on a few highly skilled, experienced clinicians who take in a million. And let me also tell you that some of my friends who are the most avid supporters of the current system are also the first to come looking for inside information as to how to access things faster. >




> Look, personally I’m fine with things as they are now. But I’m under no illusion that the system is fair or “one-tiered.” Canada has a pretty good health care system, not at all coming to its knees, thanks to devoted front-line physicians, surgeons, nurses and support staff. But it is missing out on worthwhile funding available from people who want to pay privately, which will reduce wait times whatever certain medical economists say. And the best brains do not necessarily move into private practice. We now have a system that tends to reward mediocrity. Those doctors who walk the extra mile are paid much the same, sometimes less, than those who do a so-so job. Much health care money now drains into the USA. Allowing some regulated private medical practice will allow a slowing of the increase in physician’s incomes, provide a bit of competition and improve the country’s

GDP. It should ease off (but not stop) the whinging about wait times. “That big fat moon is gonna shine like a spoon. But we’re gonna let it. You won’t regret it.”2 In the meantime, we can continue to live under the delusion that we have a one-tiered system when we have a patchwork – a centrally planned, muddle-through system with gaping holes of unfairness. “Ain’t it hard when you discover that?”2 Hercules should sheath his sword and come to terms with the Hydra. * Visitors to Scotland should become familiar with four distinct dialects: Glesca, rural Lowlands, Choochter and Morningside/Bearsden. This last is an attempt in districts of Edinburgh and Glasgow to sound cultivated. References available upon request.

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PHYSICIAN WANTED CALGARY AB An exciting opportunity is available for family physicians and specialists to join Revolution Medical Clinic. We are located in the bustling Signal Hill Shopping Centre. Come and join the most modern and innovative clinic in southern Alberta. We offer a very competitive fee split in exchange for a superior patient-focused approach. Part- or full-time, flexible hours to accommodate work/life balance, very competitive fee split. Possible partnership opportunity available to committed members of our team. Contact: Dr. Riyaan Hassen C 403.688.7867 CALGARY AB Pain specialist Dr. Neville Reddy is looking to recruit physicians (general practitioners and specialists) to join his team of dedicated health care professionals. Innovations Health Clinic has two locations (southeast and southwest), favorable 30% expenses offered. Contact: Neville Reddy, MB ChB, FRCPC (Anesthesia) T 403.240.4259 C 403.689.4259 CALGARY AND EDMONTON AB Retiring? Semi-retiring? Want someone to take over your panel? Imagine Health Centres (IHC) is growing and welcomes semi-retired and/or retired physicians who want to ensure continuity of care of their patients. Come work part-time or full-time and allow us to introduce ourselves to your patients. Imagine Health Centres are multidisciplinary family medicine clinics with a focus on health prevention and wellness. IHC prides itself in providing the best support

for family physicians and their families in and out of the clinic. Health benefit plans and full financial/tax/accounting advisory services are available to all IHC physicians. Do you want your patients to be cared by a team that collaborates with other health care professionals for enhanced patient care? If so, contact us. Contact: Dr. Jonathan Chan to submit your CV in confidence EDMONTON AB Oxford Medical Clinic is looking for a part- or full-time family physician/ general practitioner to join our team; very attractive deals and incentives. Contact: T 780.475.1966 F 780.475.1997 EDMONTON AB Office space available for specialty and family physicians. New graduates welcome. Join a group of established physicians in a family practice setting who would be happy to encourage and mentor new physicians. Challenging clinical medicine. Busy northeast clinic in a well-equipped and modern professional building. No capital investment or management responsibilities. High income, medical teaching facility and part of the North Edmonton Primary Care Network. Contact: Thomas Bray

EDMONTON AB Two positions are immediately available at the West End Medical Clinic/M. Gaas Professional Corporation at unit M7, 9509 156 Street, Edmonton AB T5P 4J5. We are also looking for specialists, internist, pediatrician, gynecologist and orthopedic surgeon to join our busy clinic. Full-time family physician/ general practitioner positions are available. The physician who will

join us at this busy clinic will provide family practice care to a large population of patients in the west end and provide care to patients of different age groups including pediatric, geriatric, antenatal and prenatal care. Physician income will be based on fee-for-service payment and the overhead fees are negotiable. The physician must be licensed and eligible to apply for licensure with the College of Physicians & Surgeons of Alberta (CPSA); their qualifications and experience must comply with the CPSA licensure requirements and guidelines. We offer flexible work schedules, so the physician can adopt his/her work schedule. We also will pay up to $5,000 to the physician for moving and relocation costs. Contact: Dr. Gaas T 780.756.3300 C 780.893.5181 F 780.756.3301 EDMONTON AB Parsons Medical Centre (PMC) and Millbourne Mall Medical Centre (MMMC) want you. To meet the growing needs, we have a practice opportunity for family physicians at PMC and MMMC. Both clinics are in south Edmonton. PMC and MMMC are high patient volume clinics with friendly reliable staff for billing, referrals, etc., as well as an on-site manager. Enjoy working in a modern environment with full electronic medical records. PMC and MMMC serve a large community and wide spectrum age group (birth to geriatric). Both clinics have on-site pharmacy, ECG machine, lung function testing and offer a large array of specialist services including: ENT, endocrinologist, general surgeon, internist, orthopedic surgeon, pediatrician and respirologist. PMC and MMMC are members of the Edmonton Southside Primary Care Network which allows patients >





to have access to an on-site dietitian and mental health/psychology/ psychiatry health services. Overhead is negotiable, flexible working hours and both clinics are open seven days a week. Contact: Harjit Toor T 587.754.5600 F 587.754.8822 EDMONTON AB Windermere’s newest clinic is looking for physicians to start as soon as possible. Imagine Health Centres (IHC) newest clinic opened in January in the Currents of Windermere. This top-notch, high-profile retail development is within the proximity of Riverbend and McGrath. A multidisciplinary family medicine clinic with a focus on health prevention and wellness, IHC prides itself in providing the best support for family physicians and their families in and out of the clinic. Health benefit plans and full financial/tax/accounting advisory services are available to all IHC physicians. We are looking for part- and full-time family physicians. Imagine Health Centres has an excellent opportunity to take over existing patient panels at our Edmonton locations. Do you want to be part of a team that collaborates with other health care professionals for enhanced patient care? Do you want to make a difference in your patients’ care and take a proactive instead of a reactive approach to health care? Compensation is fee-for-service and inquiries are kept strictly confidential. Only qualified candidates will be contacted. Contact: Dr. Jonathan Chan to submit your CV in confidence


EDMONTON AND FORT MCMURRAY AB MD Group, Lessard Medical Clinic, West Oliver Medical Centre and Manning Clinic, each with 10 examination rooms, and Alafia Clinic, with four examination rooms, are looking for six full-time family physicians. A neurologist, psychiatrist, internist and pediatrician are required at all four clinics. Two positions are available at the West Oliver Medical Centre in a great downtown area, 101-10538 124 Street and one position at the Lessard Medical Clinic in the west end, 6633 177 Street, Edmonton. Two positions at Manning Clinic in northwest Edmonton, 220 Manning Crossing and one position at Alafia Clinic, 613-8600 Franklin Avenue in Fort McMurray. The physician must be licensed or eligible to apply for licensure with the College of Physicians & Surgeons of Alberta (CPSA). For the eligible physicians, their qualifications and experience must comply with the CPSA licensure requirements and guidelines. The physician income will be based on fee-for-service with an average annual income of $300,000 to $450,000 with competitive overhead for long term commitments; 70/30% split. Essential medical support and specialists are employed within the company and are managed by an excellent team of professional physicians and supportive staff. We use Healthquest electronic medical records (paper free) and we are a member of a primary care network. Benefits and incentives of being part of our clinics include the convenience to work at any of our locations, part- or full-time available, attached to a primary care network, nurse for physician’s patients provide one-on-one, on-site diabetic management care and comprehensive medical follow-up visits. Therapists at our clinics provide one-on-one consults. Seminars and dinner workshops credit go toward their licence. Flexible hours, vast patient circumference looking for family doctors, continuing care and learning opportunities for accredited doctors.

Full-time chronic disease management nurse to care for chronic disease patients at Lessard, billing support and attached pharmacy are available at the Lessard and West Oliver locations. Work with a nice and dedicated staff, nurse available for doctor’s assistance and referrals. Also provide on-site dietician and mental health/ psychology services. Clinic hours are Monday to Friday 8:30 a.m. to 8:30 p.m., Saturday and Sunday 10:30 a.m. to 5 p.m. Contact: Management Office T 780.757.7999 or T 780.756.3090 F 780.757.7991 SHERWOOD PARK AB Synergy Medical Clinic is seeking the services of a physician interested in accepting new patients. The successful candidate must commit to building a patient panel and providing on-going comprehensive care to his/her cohort of patients. The clinic is located in Sherwood Park at the Synergy Wellness Centre and is part of the Sherwood Park-Strathcona County Primary Care Network. We offer physicians a collegial and collaborative environment where one can provide care to a wide range of patients. Physicians are supported by a tremendous team and the clinic uses Wolf electronic medical records for enhanced patient care. Physician compensation is based on fee-for-service payment. The interested physician must be licensed and eligible to apply for licensure with the College of Physicians & Surgeons of Alberta (CPSA); their qualifications and experience must comply with the CPSA licensure requirements and guidelines. Relocation reimbursement is available for interested out-of-province physicians. Contact: Mel Snihurowych Chief Administrative Officer T 780.400.3303 msnihurowych@ >


PHYSICIAN AND/OR LOCUM WANTED CALGARY AB State-of-the-art brand-new clinic, Zamin Medical Centre has opportunities for locums and partor full-time physicians. If you are an experienced family physician or a new medical graduate, we can help you build your practice in a supportive team environment. Excellent location, flexible hours and free underground parking. Contact: or CALGARY, EDMONTON AND RED DEER AB Imagine Health Centres (IHC) is currently looking for family physicians and specialists to come and join our dynamic team in part-time, full-time and locum positions in Calgary, Edmonton and Red Deer. Physicians will enjoy extremely efficient workflows allowing for very attractive remuneration, no hospital on-call, paperless electronic medical records, friendly staff and industry-leading fee splits. Imagine Health Centres are multidisciplinary health clinics with a focus on preventative health and wellness. Come and be part of our team which includes family physicians, physiotherapists, psychologists, nutritionists, pharmacists and more. Imagine Health Centres prides itself in providing the very best support for family physicians and their families in and out of the clinic. Health benefit plans and full financial/tax/accounting advisory services are available to all IHC physicians. There is also an optional and limited time opportunity to participate in equity opportunities in IHC and related medical real estate. Enjoy attractive compensation with our unique model while being able to maintain an excellent work-life balance. We currently have three Edmonton clinics. The clinics are near South Common, west Edmonton and our brand new clinic opened in January in the Currents of Windermere.

We currently have two clinics in Calgary. The clinics are located downtown and south Calgary. We also have compelling opportunities available in Red Deer. All inquiries will be kept strictly confidential. Contact: Dr. Jonathan Chan to submit your CV in confidence EDMONTON AB A west end of Edmonton medical clinic is looking for part- or full-time and locum physicians to join our team. Must be eligible to be licensed by the College of Physicians & Surgeons of Alberta. Well-equipped facility with trained staff and we use TELUS Med Access electronic medical records. Physician offices and plenty of examination rooms available; competitive fee split 75/25. We have day or evening shifts as desired. If you have any further questions or are interested in this opportunity, please contact. Contact: T 587.987.8002 SHERWOOD PARK AB Dr. Patti Farrell & Associates is a new, busy, modern family practice clinic with electronic medical records. We require locum coverage periods throughout 2017. Fee split is negotiable. Current clinic hours are Monday to Friday 8 a.m. to 4 p.m. are negotiable. Dr. Farrell is a lone practitioner (efficient clinic design built for two doctors) looking for a permanent clinic associate. Contact: C 780.499.8388 SHERWOOD PARK AB The Sherwood Park Primary Care Network is looking for several physicians to cover a variety of locum periods in a variety of Sherwood Park offices. Practice hours vary widely. Majority of practices run electronic medical records. Fee splits are negotiated with practice owners. Some practices are looking for permanent associates. Contact: Dave Ludwick T 780.410.8001

SHERWOOD PARK AB Well-established busy clinic with five family physicians seeks a locum or associate part- or full-time to replace a departing physician who has relocated to another city. We are located in a professional building with lab and X-ray on site, primary care network nurse support and excellent office staff. Clinic has been using Med Access electronic medical records for 10 years. Contact: Dr. Lorraine Hosford T 780.464.9661 SHERWOOD PARK AB Nottingham Medical Clinic is looking for part-/full-time family physicians. Locums welcome. Clinic has a modern appearance. Pharmacy and dietitian services in the clinic, on-site laboratory and diagnostic services are also available. We currently have five family physicians and are looking for at least another three. Appointmentbased practice, flexible schedule and clinic uses Med Access electronic medical records. Moving bonus, 70/30 split. Contact: Dr. Steve Denson T 780.298.6109

SPACE AVAILABLE CALGARY AND EDMONTON AB Medical offices available for lease in Calgary and Edmonton. We own full-service, professionally managed medical office buildings. Competitive lease rates, attractive building amenities and turn-key construction management available. Contact: NorthWest Healthcare Properties Lindsay Hills, Leasing Manager, Calgary T 403.282.9838, ext. 3301 Shelly Fedorak, Leasing Manager, Edmonton T 780.293.9348 >





EDMONTON AB A west end of Edmonton medical clinic is looking to rent out one or two examination rooms. Rent would include one physician desk, examination room(s), staff and waiting rooms. The clinic uses Telus Med Access electronic medical records. We are open Monday to Saturday. If you have any further questions or are interested in this opportunity, please contact: Contact: T 587.987.8002

PRACTICE FOR SALE EDMONTON AB Edmonton medical clinic with minor surgery room for sale. This established medical clinic equipped with a surgical room for minor surgeries is a newly built facility that has been operational since 2012. The clinic is thoughtfully and beautifully designed with a spacious patient waiting and receptionadministrative area, one lunch room with a half bath, five ample-sized and fully-equipped patient rooms, one minor-surgeries room, one doctor’s office and one sterilization/computer room. Medical and surgical equipment are included. The configuration of the patient rooms and of the overall clinic is very versatile and suitable for diverse types of medical practices. The practice is in a prime central location in Edmonton with ease of access and ample free parking for patients and staff. The clinic has previously been used for a medical dermatology practice with a limited scope in cosmetic dermatology and is complemented by a very experienced and loyal clinical team consisting of one nurse and one clinic manager, both of whom are ready to be transitioned to the next medical team. The clinic, currently operating at four days per week, boasts about 265 new patients and about 200 follow-up patients a month. This is a ready-to-operate, full turn-key clinic. All prospective buyers need to provide proof of qualification as physician registered in Canada and sign a confidentiality agreement prior to accessing further information.


Training and support are available. Seller financing is available. Contact: Simon Roa T 780.906.8933 canadian/edmonton-medicalclinic-with-minor-surgeries-roomfor-sale.aspx

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Alberta Doctors' Digest November/December 2016  

November - December 2016 | Volume 41 | Number 6

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