Alberta Doctors' Digest May/June 2017 by Alberta Medical Association

Alberta Doctors'

DIGEST May-June 2017 | Volume 42 | Number 3

AMA Advocacy Night Providing frank advice to medical students on getting involved with tough issues

Distribute electrons, not atoms

Alberta Doctors’ Digest is going all-digital

Danger, Will Robinson! Danger! It's just a matter of time before our current health care e-commun¡cation methods fail

What new tax rules could mean for incorporated physicians Patients First®

CONTENTS DEPARTMENTS

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 10 Health Law Update 12 Insurance Insights 18 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 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 amamail@albertadoctors.org www.albertadoctors.org July-August issue deadline: June 12

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.

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FEATURES

6 AMA Advocacy Night

Providing frank advice to medical students on getting involved with tough issues

8 Distribute electrons, not atoms

Alberta Doctors’ Digest is going all-digital

15 Tartans, kilts and slippery surfaces

2017 Interprovincial Medical Curling Bonspiel was a great place for fun and camaraderie

16 Danger, Will Robinson! Danger!

It’s just a matter of time before our current health care e-communication methods fail

20 AMSCAR promotes student wellness and collegiality 23 Youth Run Club – Live Active Community Fun Run

We ran, we saw, we conquered

26 The Wallaces of Wainwright and the Battle of Vimy Ridge

Recognizing the 100th anniversary of the Battle of Vimy Ridge

32 What new tax rules could mean for incorporated physicians

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.

To request article references, contact:

daphne.andrychuk@albertadoctors.org COVER PHOTO:

Finola H.W. Hackett says medical students heard frank advice at AMA Advocacy Night. MAY – JUNE 2017

FROM THE EDITOR

Inequity and our discontent Dennis W. Jirsch, MD, PhD | EDITOR

aul Ryan, Speaker of the USA House of Representatives, recently withdrew a new health care plan for the country after years of Republican disgruntlement with the Affordable Care Act. There’s been widespread relief, since the hasty submission offered little or no savings or structural reforms and it was estimated the plan would fail to cover another 24 million people.

In The Price of Inequality,

Nobel Prize-winning economist Joseph Stiglitz argues that the only way to achieve durable prosperity is to build shared prosperity. In general, the excesses of the present system must stop.

American health care is in trouble. A recent World Health Organization ranking placed the USA at number 37, behind nearly all developed countries.1 It now spends more on health care than any other country, over one-sixth of its gross domestic product, yet it fails to provide care to all citizens and has worse outcomes than other countries, with investigators noting a “strikingly consistent and pervasive” pattern of poorer health at all stages from infancy through old age. Physicians, hospitals and drug and medical-device companies all charge more than their counterparts elsewhere. Economists have a term for this: rent-seeking. That implies that the powerful (political, corporate or otherwise) are gaming the social and political environment in search of more resources than can be reasonably justified.

AMA - ALBERTA DOCTORS’ DIGEST

Former presidential candidate Bernie Sanders has been tireless in pointing out that most of the income gains in the last 20 or 30 years have gone to a very small elite at the top of the population pyramid. Last year, for example, the average CEO garnered 335 times the pay of the average worker,2 a 10-fold increase since 1980. Over the same time, the median incomes of the bulk of the middle class have fallen in real purchasing terms. Winners continue to accumulate ever more assets, while the poor face the grim prospects of job insecurity and downward mobility. It is difficult to consider that this ever-moredistorted social enterprise represents a true democracy. The effects of inequality have been well described in recent decades. Recall the Whitehall studies,3 set up in Britain in 1967 to investigate the prevalence of heart disease and other chronic illness in civil service workers. Expecting to find the greatest risk of heart disease in men in high status jobs, investigators found instead an inverse relationship: men in the lowest grade jobs had a death rate that was thrice that of high grade administrators. The social gradient as it pertains to health has held up to repeated study.4-6 We now know that economic and social conditions and their distribution affect individual and group differences in health status and are greatly important in health affairs. There are many aspects to the association of ill health and poverty. The poor tend to be more obese and more violent, and often bear greater burdens of chronic illness. They tend to be imprisoned more and die earlier. Their children are likely to be unhealthier, and their social mobility – the ability to rise in circumstances a lá Horatio Alger – tends to plummet. As if this weren’t enough, richer folks – yes, the richer folks! – are often worse off than would otherwise be the case under more equitable circumstances. Since, in this sense, everybody suffers, it is not a big jump to contend that the more equally wealth is distributed, the better the health of society-at-large is. These are, no doubt, fighting words, but let me quote Sage of Omaha, Warren Buffett: “There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning.”7 >

> In the face of mounting inequity, government has done little. The wealthy and the super-wealthy in the USA continue to pay taxes that are low, given their resources, and they and their lobbyists have succeeded in rallying general cries for lower taxes all round, hobbling any attempt at reparation. Recall for a moment, former presidential-hopeful Mitt Romney admitting to a 14% tax rate when he ran for office some years ago. Recall, too, Warren Buffett’s amazement to find that his personal tax rate was lower than his secretary’s.

Travelling old pathways will

burden us all with poorer health than need be, and gated communities are a poor sanctuary from the anger fomenting on the inequity train.

Perhaps the most egregious example of profiteering has been the ability of the financial sector to take advantage of the poor and the poorly informed. The Great Recession of 2008 can be traced back to a bubble of subpar mortgages and a flood of mortgage-derived instruments that ultimately held little or no value. Again, hear the candor of Warren Buffett, who has repeatedly referred to these exotic and opaque inventions as “financial weapons of mass destruction.”8 The ultimate fix, when the music finally stopped, was government funding. Mega-insurer AIG received more than $180 billion US, an amount larger than the total spent on America’s poor from 1990 to 2016.9 No one went to jail. Globalization and its proponents merit a good chunk of blame, too. Despite the assurances of politicos that all would benefit from NAFTA, this has not been true. Wherever possible, unskilled work has been moved offshore to realize cheap labor costs, and domestic job losses for these workers have been extreme. At the same time that multi-national companies have been able to cut costs with cheap labor, they have been able to move income offshore to low-tax jurisdictions. In The Price of Inequality,10 Nobel Prize-winning economist Joseph Stiglitz argues that the only way to achieve durable prosperity is to build shared prosperity. In general, the excesses of the present system must stop. • Banks and others in the financial industry must curb their appetites for risk, and their products must become more transparent. At the same time, the institutions need to become more competitive, severing their reliance on the usurious rates charged, for example, with credit card purchases that become debtor nightmares at rates of 24% per annum. Off-shore banking should not be available as a hiding place for income.

• The tax code should be rejigged so that corporations, well-off individuals, indeed all, must pay their fair share. Required dismantling: the plethora of loopholes, tax subsidies and special arrangements that have grown steadily over years. • Health care needs comprehensive reform. Health care costs remain the number one reason for personal bankruptcy in America, and the health spending juggernaut will not be reined in short of universal coverage, which will in turn require a single-payer system. • Globalization may be unstoppable in a digital world, but its success cannot rest on the economies of laid-off workers. Active labor market policies, rather than attempts to thwart the bargaining power of workers, are vital, as are robust social protection programs. • Education is paramount on several fronts. Workers who find they are inadequately skilled for new technologies need facilitated training responsive to their needs and to those of the marketplace. For the young, education costs continue to soar, loading college and university graduates with stultifying debt. We need to fund post-secondary education. These are blue-sky notions that some would call fanciful. They’re up against narrow self-interest, so I wouldn’t bet on them. In addition, many – and here I include most professionals: physicians, engineers, lawyers, etc. – have found themselves in reasonable shape, on the winning side of things. It may be a counsel of moral perfection to expect self-abnegation and support of the common good more than the individual.

We would do well to remember that the cost of inattention to inequity has historically been social upheaval and violence.

Some benefit might come, however, from acknowledging this skewed state of affairs. Owning up to it, especially in the middle, but-often-parallel world we inhabit north of the American border, might prompt us to consider other possible futures. Travelling old pathways will burden us all with poorer health than need be, and gated communities are a poor sanctuary from the anger fomenting on the inequity train. We would do well to remember that the cost of inattention to inequity has historically been social upheaval and violence. Should this happen, though, we’ll be able to explain it, if nothing else. References available upon request.

MAY – JUNE 2017

COVER FEATURE

AMA Advocacy Night

Providing frank advice to medical students on getting involved with tough issues Finola H.W. Hackett | STUDENT,

CLASS OF 2019

FACULTY OF MEDICINE & DENTISTRY, UNIVERSITY OF ALBERTA

n February 6, outstanding physician leaders joined University of Alberta students in an evening of celebration and mentorship in health advocacy and leadership in medicine. The first-ever Alberta Medical Association (AMA) Advocacy Night took place at Bernard Snell Hall on campus. Around 50 students and seven physicians attended. These physicians included AMA President Dr. Padraic Carr, who gave an opening address highlighting how delighted he was to continue supporting student leadership endeavors after his involvement began as a trainee when he was the Professional Association of Resident Physicians of Alberta (PARA) representative to the AMA.

Students expressed gratitude

for the chance to hear frank advice and guidance on their current and future endeavors from doctors with such a wide range of experience.

The physician mentors made up this all-star cast: • Dr. Allan Bailey, family physician in Spruce Grove and a leading advocate for primary care in Alberta • Dr. Helly Goez, pediatric neurologist, physicianship course coordinator and advocate for patients with orphan diseases and for diversity in medical education

AMA - ALBERTA DOCTORS’ DIGEST

• Dr. Tracey Hillier, radiologist and associate dean of the MD program, involved in faculty and student engagement in the curriculum • Dr. Kimberley Kelly, family physician passionate about prevention and improving student and community health in Alberta • Dr. Melanie Lewis, pediatrician and associate dean of learner advocacy and wellness who has worked extensively in medical education and physician health • Dr. Ameeta Singh, infectious diseases specialist involved in sexually transmitted infection prevention and improving care for marginalized populations In the first portion of the evening, students engaged in roundtable discussions with the physicians. Students heard about each physician’s career and leadership experiences and followed up with any burning questions they had for the speakers. Students expressed gratitude for the chance to hear frank advice and guidance on their current and future endeavors from doctors with such a wide range of experience. The second portion of the evening was a poster presentation session celebrating students’ existing advocacy projects. Students presented these 10 fantastic projects: • Structuring success: Student government in medical education by Miranda Mengyuan Wan • Can MEDs teach healthy living? Developing interactive lessons for youth by Marya Aman, Shauna Regan, Jennifer Weekes and Aran Yukseloglu • Innovative organ donation curricula for undergraduate medical education by Calvin Tseng, Teresa Li, Jessica Luc, Betty Wang, Hollis Lai, PhD and Dr. Helly Goez • Collaborative care and dementia by Kristin Pon >

> • Sexual harassment of Canadian medical students by Tanis Quaife, Jenna Webber, Stephan Imbeau, Deanna Hagan, Dr. Susan Phillips, Dr. Rachel Ellaway and Dr. Jacques Abourbih

• PedsCases: Pediatrics for medical students by Amarjot Padda and Larissa Shapka • AMSCAR: Promoting medical student resilience, health and wellness through an interactive weekend by Krista Ingram, Swati Chavda, Carly Yim and Ivanna Kruhlak • Medical Students' Association leadership retreat: Integrating leadership competency training into student governance by Fatemeh Ramazani • HealthLINC: Health literacy and information for newcomers to Canada by Karl Narvacan, Christine Patterson and Shez Kassam

The Advocacy N¡ght student representatives said they were very grateful for the AMA's strong support of mentorship initiatives.

• Integrating LGBT competencies into undergraduate medical curricula by Derek Fehr, Julianna Deutscher and Hollis Lai, PhD The seven physician mentors were delighted to hear the students present their projects and to offer feedback. Following compilation of the judging rubrics, the winners of the outstanding poster prizes were announced: • Collaborative care and dementia by Kristin Pon • Sexual harassment of Canadian medical students by Tanis Quaife, Jenna Webber, Stephan Imbeau, Deanna Hagan, Dr. Susan Phillips, Dr. Rachel Ellaway and Dr. Jacques Abourbih This evening was a great opportunity to celebrate students’ ongoing work in community health advocacy, medical education, governance and leadership. On behalf of the AMA, Dr. Carr congratulated the poster presenters on their fantastic work.

The poster presentatlon session celebrated students' existing advocacy projects.

The student representatives said they were very grateful for the AMA’s strong support of advocacy mentorship initiatives. The stage has been set for this inaugural Advocacy Night to be followed by future collaboration, building the next generation of leaders in medicine.

Students presented 10 fantastic projects at the poster presentation.

MAY – JUNE 2017

FEATURE

Distribute electrons, not atoms Alberta Doctors’ Digest is going all-digital Marvin Polis | EDITOR-IN-CHIEF

n our last readership survey, a majority of Alberta Medical Association (AMA) members indicated they would be interested in digital distribution of Alberta Doctors’ Digest (ADD). We looked into it and, wow, this makes a whole lot of sense! So we’re going to give it a go, starting early next year.

With six printed issues annually, we consume almost three million pages of paper. Not to mention the envelopes, postage and fossil fuels required to ship all these atoms to members’ offices. I’m not sure how many trees that represents, but it’s probably not prudent in the age of digital, especially when our readership surveys report that the majority of members cherry-pick articles of interest and then dispose of the publication (hopefully recycled). With digital distribution, we’ll be able to enhance ADD beyond the printed word. We are exploring the possibilities of rich media such as video, audio and greater use of photography. After all, pictures and sound are often a great way to tell a story! At the same time, we recognize that some members will always prefer reading, so that option will remain. You will be able to read ADD on screen. If you prefer, you’ll be able to print the entire issue (or just certain stories) if you want a tactile experience. Hey, some people still like the feel and smell of paper. We get it. So, we’ll send you electrons. You can still print the atoms if you want to. As we plan the transition to a digital format, we are inviting AMA members to assist by participating in small focus groups by phone, video or email. We want your feedback to ensure we get this right. So if you’re interested, please contact Daphne Andrychuk at daphne.andrychuk@albertadoctors.org. Marvin Polis Editor-in-Chief Alberta Doctors’ Digest

AMA - ALBERTA DOCTORS’ DIGEST

MAY â&#x20AC;&#x201C; JUNE 2017

HEALTH LAW UPDATE Should BC residents have the right to purchase health insurance to fund privately secured medical services? Cambie Surgeries Inc. et al vs. British Columbia is a truly Sisyphean effort

Jonathan P. Rossall, QC, LLM | PARTNER,

he Greek gods punished Sisyphus, the king of Ephyra, for his self-aggrandizing craftiness and deceitfulness by forcing him to roll an immense boulder up a hill, only to watch it come back down time and time again. Through the adaptation of this myth into modern culture, tasks that are laborious and futile are described as Sisyphean. Almost two years ago, this space featured a column entitled “BC constitutional challenge will have its day in court.” It was optimistically reported at that time that the case would commence in November 2015. In point of fact, the case commenced in September 2016 after several delays arising from the late production of documents by the defendant, the BC Government, and the last-minute addition of the federal government as a co-defendant. Now, the case is delayed further until September this year. At this stage, the plaintiffs have not completed putting their case fully before the courts and, needless to say, the defendants have not even started the defence.

The challenge relates to the right of BC residents to purchase health insurance to fund privately secured medical services.

Readers will recall that the challenge relates to the right of BC residents to purchase health insurance to fund privately secured medical services. Essentially, it is a challenge to the ministry of health’s monopoly on the provision of public health services. The plaintiffs are Cambie Surgeries Inc., four of its patients and another private medical clinic.

AMA - ALBERTA DOCTORS’ DIGEST

MCLENNAN ROSS LLP

According to recent reports, the plaintiffs have found themselves mired in a series of procedural issues and applications, many revolving around their efforts to have expert evidence on the impact of wait lists and other relevant issues put before the court. According to Dr. Brian Day (the representative of Cambie Surgeries Inc., and an outspoken advocate of the need for private medical resources), the government has deliberately used stall tactics and has erected artificial barriers to the efforts of the plaintiffs to complete their case.

Essentially, it is a challenge to the ministry of health’s monopoly on the provision of public health services.

More recently, Dr. Day states the plaintiffs are also running out of funding. He has indicated that the initial budget for legal fees anticipated a six-month trial, which has already been surpassed. According to Dr. Day, the plaintiffs have spent more than $2 million (which includes privately donated funds and money donated from the Canadian Constitutional Foundation). An example of the roadblocks allegedly placed by the government is their objection to the plaintiffs’ attempt to admit evidence from Dr. Bassam Masri. Dr. Masri is the head of orthopedic surgery at the University of British Columbia and the Vancouver General Hospital. He holds several senior administrative positions in the health industry. A large part of what Dr. Masri does is oversee the allocation of surgical resources. The province allegedly questioned Dr. Masri’s qualifications to give an opinion on the impact of wait times on patient care. Dr. Masri believes that current wait times are unsustainable, that the availability of private >

> health care provides competition to the public system and that private health care would serve as a valuable alternative. The purpose of expert opinion evidence in the context of a trial is to provide insight from a qualified individual on areas of evidence that the court itself does not have and which cannot be gained merely from the introduction of evidence. So although it would be possible to introduce evidence from patients regarding their individual experience with wait lists, expert evidence is required to get a broader view and form an opinion of the impact that wait lists might have on health care generally. Strangely, the trial judge agreed with the province and held that while Dr. Masri is entitled to his personal opinion on such issues, that opinion was not supported by any research or other evidence. Based on even a cursory review of Dr. Masri’s background, it is difficult to envisage a physician better qualified to venture an opinion on wait lists and the availability of resources, but such are the vagaries of the judicial system. Similar objections have apparently been raised (and upheld) in relation to numerous experts sought to be admitted, which has resulted in the passage of time and ever-increasing costs. And so the case creeps on, with the plaintiffs using the time off to raise funds, locate other experts, re-group and generally continue pushing the boulder up the hill.

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Swing a club in support of medical student bursaries! Register today for the 90th Annual North/South Doctors’ Golf Tournament Don’t miss out on the best doctors’ golf tournament of the year!

Monday, June 26 | 8 AM shotgun start | Red Deer Golf and Country Club Register online at http://bit.ly/90northsouthregister OR contact Jennifer McCombe at jennifer.mccombe@albertadoctors.org, telephone 780.732.3359 or toll-free 1.866.714.5724, ext. 5359. Your registration fee of $275 includes a buffet breakfast, a round of golf with a powered cart at the renowned Red Deer Golf and Country Club and a BBQ lunch. You’ll get free use of the driving range and practice facility, a fantastic souvenir and the opportunity to win great prizes! This stroke-play tournament, co-hosted by the Alberta Medical Association, the College of Physicians & Surgeons of Alberta and The Canadian Medical Foundation, raises funds for medical student bursaries and physician health programs. Support Alberta’s next generation of physicians by sponsoring the 90th Annual North/South Doctors’ Golf Tournament: http://bit.ly/90northsouthsponsor

MAY – JUNE 2017

INSURANCE INSIGHTS

Mystery solved! How property insurance is calculated Jessica Gallant | RELATIONSHIP

nsurance companies consider many factors to estimate the likelihood that you will make a claim and what that claim will cost. Here are some of the main things that will affect the cost of your property insurance.

Location, location, location Where your home is located can make a big difference. Using your postal code, insurance companies can track claims made in that location and use that information to adjust premiums. Based on past experience in your neighborhood, they can determine how likely it is you will need to make a claim. If you live in an area with a high incidence of break-ins or vandalism, for example, your rate will be higher than what you would pay in an area where those things are rare.

Premium tip Bundle your home and car insurance with TD Insurance.

Emergency services proximity How close you are to a police station or fire station are indicators used to adjust premiums as well. Because fire is a major concern, it’s an advantage to live near a fire hydrant or a fire station. The closer you are, the better the chances of saving your property in the event of fire. In urban areas, proximity usually isn’t a problem, but in more remote or rural areas, the distance may be greater, which influences the cost of your insurance.

Premium tip Tell us if you have a fire alarm system, smoke detectors, carbon monoxide detectors or other security features.

Amount and types of coverage The higher the amount of coverage you purchase, the higher your premium will be. The type of package you AMA - ALBERTA DOCTORS’ DIGEST

MANAGER, AFFINITY MARKET GROUP, TD INSURANCE MELOCHE MONNEX

choose – gold or platinum – will also affect the cost of your insurance. Insurance coverage for a condo owner will cost more than coverage for a tenant. With a condo, your policy may have to cover your liability exposure for shared or common areas of the structure, which adds to the cost of insuring it. Optional coverage for specific items like a bicycle or jewellery will also mean a higher premium.

Premium tip Let us know if you’ve paid off your mortgage.

Replacement cost Your premium is also dependent on the amount required to rebuild your home in the event of a total loss. This includes the cost to rebuild the structure, replace the contents, replace the out buildings and cover additional living expenses. Any renovations can increase the value of your home, but they will also increase the cost to rebuild it.

Premium tip Maintain your home for the long term to avoid making small claims that will increase your premiums.

Age of building, roof and insured person As a building ages, the risk associated with it increases and so does the premium. As the overall infrastructure ages, so does the risk of a faulty or leaky pipe and potential for water damage claims increases. Newer homes generally pay lower premiums, and the premium increases as the homes age. However, the effect of the building aging becomes smaller as you make necessary updates and renovations such as roof replacement. It is also important to know that as you age, your capacity to maintain the home may diminish. This means that your home may be at a greater risk for damage, so your premiums may increase. >

> Heating, electricity and/or a wood stove Heating, electricity and/or a wood stove in your home may affect your premiums in the following ways:

Trying to make sense of your medical billing?

• With oil heating, you may have to pay more than you would with a forced-air gas furnace or electric heat. • The risk of leaks with oil tanks increases the potential for damage to your property and for environmental hazards. Depending on the age and condition of your oil tank, you may be encouraged to replace it. • A variety of factors associated with your electrical system can affect the risk of fire and, with it, the cost of insuring your property. Breakers pose less of a risk than fuses. If the flow of electricity into your home is less than 100 amps, it increases the risk of overloading and fire. Older types of wiring can also raise the level of risk, particularly if the wiring has deteriorated. • Wood stoves can pose an increased risk of fire. Older models are a common source of house fires and carbon monoxide poisoning, especially if they have not been correctly installed or maintained.

Premium tip If you choose a higher deductible, your insurance company may reduce your premium.

Finished basements

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Basements are no longer used primarily for storage and laundry. As homeowners look for more living space, many more basements are finished and used for entertainment and recreational purposes, often with expensive furnishings and equipment (which make for more expensive claims). As such, having a finished basement will lead to an increase in the amount of insurance. Although it is true that having a finished basement will likely increase the premium, it is important to ensure we have the most accurate information in the event a claim occurs. Customers do not always think to call us when they finish their basement.

Need more information? As a trusted partner of the Alberta Medical Association for over 30 years, TD Insurance Meloche Monnex is dedicated to helping members get access to preferred rates and dedicated advisors who are committed to helping you choose quality insurance products.

For more information, please contact one of our analysts by calling the AMA direct line toll-free at 1.844.859.6566 or visit www.tdinsurance.com/ama.

MAY – JUNE 2017

AMA - ALBERTA DOCTORSâ&#x20AC;&#x2122; DIGEST

FEATURE

Tartans, kilts and slippery surfaces 2017 Interprovincial Medical Curling Bonspiel was a great place for fun and camaraderie Jeffery M. Patterson, MD, FRCPC

“M

ay your slide/stick be straight, your turn be perfect, your weight be true and your sweeping effective. But if not, remember – have fun.” These were the welcoming words at the 2017 Interprovincial Medical Curling Bonspiel at the Granite Club in Edmonton from March 15-19. St. Patrick’s Day costumes mixed with tartans and kilts as participants “hurried hard” and fought for the title of “A” event champions. In the end, the Patterson rink, skipped by Dr. Jeffery Patterson, with third Dr. Brian Taylor, second Dr. Brendan Lett and lead Dr. David Pickle, took the Anderson Trophy home. Dr. Edward Papp won the Ross Wheaton Award in recognition of a person from a league who has contributed substantially to the ongoing success of this beloved bonspiel. The educational events featured fun interactive sessions on diagnostic imaging and laboratory medicine. Dr. Fung and Dr. Rennie combined lost objects, laboratory lunacy and laughs.

“A” event champions are (L to R) Dr. David Pickle, Dr. Brendan Lett, Dr. Brian Taylor and Dr. Jeff Patterson.

If all this fun and camaraderie sounds good to you, consider joining a curling league starting in fall. The medical curling leagues begin in October as follows: • Tuesday nights at the Granite Club, Edmonton Contact Jeff at jeffreyp@ualberta.ca • Sunday nights at the North Curling Club, Calgary Contact Sylvain at coderre@ucalgary.ca Join us for the next bonspiel in Saskatoon March 15-17, 2018. Curling combines fitness, fun and fellowship. It’s all about the work-life balance, isn’t it?

Dr. Edward Papp won the Ross Wheaton Award in recognition of a person from a league who has contributed substantially to the ongoing success of this beloved bonspiel.

MAY – JUNE 2017

FEATURE

Danger, Will Robinson! Danger! It’s just a matter of time before our current health care e-communication methods fail Andrew Binne | COMMUNICATIONS COORDINATOR, MICROQUEST INC. Vanda Killeen, BA, Dip Ad/PR | SENIOR COMMUNICATIONS CONSULTANT,

uality and efficiency are key elements of professional patient care and because many patients receive care from two or more providers, physicians need to communicate and consult quickly. When e-communicating, however, the last thing you want is for your message, often containing confidential patient information, to be “Lost in Space.” (If you're under the age of 50 you might want to look up this campy 1960s television sci-fi on Wikipedia). Yet, it’s extremely rare to see a health care professional or medical clinic that isn’t using email and text messaging via smartphones and tablets – despite the serious security risks. In the words of that famous robot from Lost in Space, “That does not compute!"

While email led the health care e-communications charge, smartphone and tablet use has been rapidly increasing, making text messaging as popular as email, if not more so. For physicians, smartphones and tablets mean you don’t have to go back to your desk to respond to that email, send that message or conduct other online activities, such as referencing drug data, researching or carrying out clinical calculations, or making prescribing decisions; you just pull out your phone or tablet and conduct your business.

The improper securing of health care

e-communications leaves patients vulnerable to personal health information security breaches, resulting in liability issues for physicians.

Oops! Wrong address! Every day, physicians use digital devices to manage the coordination and transition of patient care. The problem is that all the convenience and accessibility comes at a price: the security and protection of patients’ personal health information (PHI). Unfortunately, the improper AMA - ALBERTA DOCTORS’ DIGEST

AMA PUBLIC AFFAIRS

securing of health care e-communications leaves patients vulnerable to PHI security breaches, resulting in liability issues for physicians. As so often happens, it’s only after breaches occur that security measures are reviewed. It isn’t difficult to find examples of PHI breaches where the use of email was the culprit. An SC Magazine1 post describes how an employee at Massachusetts General Hospital emailed the PHI (names, lab results and social security numbers) of 648 patients to the wrong email address. In another American example in 2015,2 Georgia’s Department of Human Services reported that a community care employee emailed the PHI of over 3,000 patients to the wrong recipient.

Risky storage Smartphone and tablet use introduces another area of privacy concern for physicians: the secure storage of PHI on their devices. Consider what would happen if your device was stolen. Is the risk of a breach of patients’ PHI stored on your stolen device and the resulting issue of liability worth the convenience? On the Office of the Information and Privacy Commissioner (OIPC) of Alberta website, you can find numerous investigative reports and news releases that describe instances of the theft, loss or unauthorized access of partially or completely unsecured systems and portable devices containing PHI. In its 2014 Healthcare Breach Report,3 Bitglass, an American data protection company, analyzed health care data breaches from the past three years and found that 68% of breaches since 2010 occurred because devices or files were lost or stolen; only 23% were due to hacking. The report also found that more than 76% of all breached records were the result of loss or theft. It’s clear that the theft and unauthorized access of unsecured, private information from electronic and digital devices is not lessening and that the solution is to exchange and store information with a secure messaging system. The increasing incidents of PHI data theft and the resulting security breaches undermine public trust in our health care system and our health care providers. >

Shaken faith A USA based Black Book consumer survey from December 2016 (“Healthcare's digital divide widens”) reported some surprising responses from consumers to questions of privacy in the health care sector. According to the survey, “57% of consumers are skeptical of the overall benefits of health information technologies, mainly because of recently reported data hacking and a perceived lack of privacy protection by providers.” Additionally, 89% of respondents reported withholding health information during visits. 4

It’s clear that the theft and

unauthorized access of unsecured, private information from electronic and digital devices is not lessening and that the solution is to exchange and store information with a secure messaging system.

While these are USA statistics, Canada demonstrates similar numbers. In a Canadian Medical Protective Association (CMPA) article,5 the results of a 2012 Canada-wide survey revealed that 43% of respondents “would withhold information from their care provider based on privacy concerns.” A 2015 news release from the Office of the Privacy Commissioner of Canada6 shows no waning of that concern. In a telephone poll, nearly half of respondents said they were extremely concerned about what might happen to their personal information stored on a mobile device if it was lost or stolen, and 78% of respondents have become “less willing to share their personal information.” The health care sector should find these statistics alarming. Trust is essential in successful doctor-patient relationships, yet the prevailing public attitude is one of distrust and a lack of faith or belief that personal information is safe and secure in the hands (and devices) of others, to the point where patients are choosing privacy and security over the disclosure of potentially vital PHI.

The solution: Encryption and off-device data storage Yes, email, texting and instant messaging are unquestionably quick and convenient ways to e-communicate. And in most everyday situations and layperson exchanges of information, they’re secure enough. But that’s not the case with health care. As a physician, you’re obligated by legislation, regulations and standards of practice to safeguard and respect your patients’ PHI.

There is a solution. AMA dr2dr Secure Messaging is as quick and convenient as email and texting, while providing 256-bit data encryption. With patient data stored on a central website, you’re guaranteed that a stolen device will never create an opportunity for a data breach. Secure communication isn’t the future of health care; it’s the NOW.

The false security of messaging apps Messaging apps provide transmission encryption; that is, text messages you send are encrypted until they reach the recipient’s phone (e.g., iMessage7 and WhatsApp8). Transmission security, however, is not the same as on-device encryption. Transmission encryption occurs between devices, not on the device. What would happen if your phone was lost or stolen? Someone with access to your device could simply open your messaging app and view all the PHI you sent via text. As for accessing your device, that’s simpler than you think. Protecting access to your phone or iPad with either a password or PIN is absolutely a first step in securing PHI on your device, but it’s not enough. A University of Pennsylvania study9 tested smartphones and found multiple instances where the oil left by the users’ fingers created a visible smudge pattern on the screen. This smudge pattern shows not only where on the screen the user has touched, but also the direction of their swipes across the PIN entry screen, which indicates the order in which keys were touched. The high probability of theft or loss of devices, the lack of on-device encryption and relatively visible PIN patterns (as an example of just one method of password hacking) illustrate why password protection of devices is not the only security measure that must be taken. Along with passwords, encryption should be used on devices where PHI is stored. Section 60 of the Health Information Act requires that reasonable steps be taken to protect health information. In their 2007 “Investigation report concerning stolen laptops containing health information,” the OIPC of Alberta concluded, “It is well known that theft of laptops or other mobile devices is a foreseeable threat” and that practitioners using mobile devices must “use encryption to protect the data – password protection alone is not sufficient.” References available upon request.

MAY – JUNE 2017

DR. GADGET

Made-in-Alberta consumer health websites Wesley D. Jackson, MD, CCFP, FCFP

n April 2017 Google search showed that WebMD is the most popular consumer health website, with an estimated 80 million unique visitors each month. This is not surprising as this excellent, well-marketed USA based website includes a symptom checker, top stories, a message board, news and health tips relevant to many Americans. It also features information and articles from experts on medication, common medical conditions, healthy living, family and pregnancy. Unfortunately, a significant amount of the information may not apply to Canadians in general or Albertans in particular.

Alberta alternatives emphasize local conditions and resources Fortunately, several less well-known but equally excellent websites are available specifically for Albertans. MyHealth Alberta (myhealth.alberta.ca), developed by the Government of Alberta and Alberta Health Services (AHS), provides all the WebMD features with an emphasis on Albertans and local conditions and resources. It also includes patient handouts, a large video library, a list of AHS advisories, current wait times in hospitals and urgent care centres, travel health advisories, information about tests and treatments, and a health care locator. The site is maintained by health care experts across the province and it is adding new information regularly. It will also soon house a patient-managed personal health record, which will have the ability to track height, weight, allergies and medical conditions, and the ability to retrieve personalized information from the pharmacy network to more effectively track medications. These features and others make this website an excellent recommendation to our patients.

AMA - ALBERTA DOCTORSâ&#x20AC;&#x2122; DIGEST

Health sites fill education gaps for parents No matter how well educated we think we are, almost all of us feel overwhelmed when our first child graces our home. This insecurity results in many visits to health care providers in an effort to understand the complex psychological, social and physical effects introduced by that noisy, smelly and wonderful bundle of joy. Healthy Parents Healthy Children (healthyparentshealthychildren.ca) is a well-designed website which includes decision-making tools around pregnancy, labor and delivery; clinical calculators; and summaries of information on parenting, immunization, feeding babies and small children, family health, common childhood health concerns, safe infant sleep and developmental milestones. Webisode and video topics include connecting with baby, learning to be a parent, when baby canâ&#x20AC;&#x2122;t stop crying, safe sleep for baby, the power of play, returning to work and breastfeeding, nutrition, tobacco-free pregnancy, immunization and healthy pregnancy weight gain. This website was developed and is continually updated by AHS to fill the educational gap. It is an excellent resource to recommend to new and seasoned parents.

As physicians, we need to make our

patients aware of the excellent local resources and tools available to them.

Childhood immunization has been the center of controversy for many Albertans for several years, generating many questions for parents which can result in sometimes prolonged visits to their health care providers. Immunize Alberta (immunizealberta.ca) contains the current immunization schedule, vaccine information sheets and detailed answers to common questions such as the >

> difference between native immunity and vaccine immunity or the persistent but unfounded rumors of a possible link between vaccines and autism. The website, which was developed by AHS based on insight and feedback gathered from Alberta parents, states: “Whether it's a simple question about the childhood immunization schedule or what to expect after your child gets immunized, uncertainty about the real risk of diseases, or concerns about immunization safety: immunizealberta.ca has the info you need.” Links to Immunize Canada (immunize.ca) and the excellent app

associated with that website are also provided. Those who use the app (available on iOS and Android) will find an outbreak tracker as a new feature, along with other tools. These excellent local resources do not come up as the first choice in a typical Google search, and they may not even make the top 10, yet they provide valuable context-based information for Albertans. As physicians, we need to make our patients aware of the excellent local resources and tools available to them.

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MAY – JUNE 2017

FEATURE

AMSCAR promotes student wellness and collegiality

(L to R) Wade Coutinho, Kenji Miner, Michelle Young, Isabella Tu, Evelina Tijunelyte and Aran Yukseloglu.

he 13th annual Alberta Medical Studentsâ&#x20AC;&#x2122; Conference and Retreat (AMSCAR) was a huge success and a wonderful experience for medical students from University of Calgary and University of Alberta. This year, it occurred in Banff over the weekend of February 10-12. The Alberta Medical Association (AMA) was a gold sponsor for this event. Students arrived on Friday evening, when they had the opportunity to socialize with other students and begin a weekend promoting medical student resilience, health and wellness. They engaged in a bingo ice breaker exercise and enjoyed light refreshments. The evening culminated with options to attend a meet-and-greet party at a local pub, enjoy some board games or wind down with a paint night led by a second-year medical student. >

AMA - ALBERTA DOCTORSâ&#x20AC;&#x2122; DIGEST

(L to R) Keon Ma, David Fung and Alex Wong.

> On Saturday, students engaged in diverse sessions, from massage therapy, to clinical skills, to a hike at Tunnel Mountain. Dr. Padraic Carr, AMA President, gave a succinct and inspiring speech at lunch, during which he reminded us to recall the root motivations of why we entered the profession. A gala dinner included a keynote speech from Dr. Kathryn Dong, director of the Addiction Recovery and Community Health program at the Royal Alexandra Hospital in Edmonton, who discussed the importance of harm-reduction policies. Each session gave students raffle tickets for prizes from gift cards to gift baskets to chefs’ tables. Winners were announced at the end of the gala dinner.

Sunday provided an opportunity to either visit the mountains or the Banff Upper Hot Springs. Students returned in the afternoon refreshed and then returned (albeit reluctantly) on shuttle buses to their respective schools. The weekend fostered student wellness and collegiality. In a post-AMSCAR feedback survey, students reported that Banff was an amazing venue and that they appreciated the weekend as a break to enjoy non-academic activities with their classmates. AMSCAR would not be possible without the support of organizations like the AMA. Student feedback has been incredibly positive and we look forward to the 14th annual AMSCAR next year! (L to R) Marya Aman, Vivian Nguyen, Deborah Adesegun and Ethan Kutanzi.

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MAY – JUNE 2017

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)

Survey says … healthy students are better learners AMA Youth Run Club supports physician health advocacy in schools Evidence shows that active children are physically, mentally and socially healthier and happier, and they’re also better learners.

ImPRovINg CommuNITY hEAlTh ThRough PhYSICIAN lEAdERShIP ANd AdvoCACY (394 schools and 23,000 students)

The AMA is proud to partner with Ever Active Schools on the AMA Youth Run Club, a school-based program that through organized activities (running, walking, hiking, snowshoeing and more) and School Health Advocacy Talks helps children and youth develop lifelong, healthy habits. How can you get involved with the AMA Youth Run Club? Be an AMA YRC CHAMPion! Run with or help coach a club, help school staff set up and manage a YRC, or give a School Health Advocacy Talk (talking points for seven suggested topics are available on albertadoctors.org/YRC). For more information, contact: Vanda Killeen, AMA Public Affairs vanda.killeen@albertadoctors.org / 780.482.0675

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FEATURE

Youth Run Club – Live Active Community Fun Run We ran, we saw, we conquered Vanda Killeen, BA, Dip Ad/PR | SENIOR

COMMUNICATIONS CONSULTANT, AMA PUBLIC AFFAIRS

n a rainy-then-sunny Saturday morning in April, 140 Alberta Medical Association (AMA) Youth Run Club supporters and participants gathered in Edmonton’s William Hawrelak Park for the Live Active Community Fun Run, hosted by the Youth Run Club.

Even if the rain clouds hadn’t been chased away by sunshine just in time for the start of the run, you wouldn’t have been able to dampen participants’ spirits, fueled as they were by boisterous tunes pumped over speakers and an energetic, happy warm-up led by Chesa Corsiatto of Ever Active Schools (EAS). Participants in the three runs (1.5, 3 and 6 kilometers) included students from 16 AMA Youth Run Club schools, their teachers, parents and siblings; AMA and EAS staff and families; staff and families from AMA Youth Run Club sponsors (Alberta Blue Cross and MD Financial Management); North Edmonton Primary Care Network staff; and several AMA member physicians.

(L to R) Dr. Kimberley Kelly and her sons, Dr. Padraic Carr and Dr. Lucy Jamieson and her son, daughter and family friends.

The volunteers were also big contributors to the supreme success of the event. They set up the run routes, equipment and start/finish area, registered runners and marshalled the run routes, and did many more behind-the-scenes chores. The AMA Youth Run Club was grateful for the cheerful and efficient support of staff from Ever Active Schools, the AMA and YRC sponsor MD Financial Management. Staff from Alberta Blue Cross accompanied their big, blue, plush mascot, who was a bright, cheerful hit with the kids. “It’s a great way to spend a Saturday morning!” enthused Dr. Padraic Carr, who welcomed and then cheered on the runners. “This is the fourth or fifth Youth Run Club event I’ve been involved in and they’re an absolute blast!” Joined by her son, daughter and friends, Dr. Lucy Jamieson was attending her first Youth Run Club event. “It was a great event and is a really good initiative to get kids active and running,” she commented. “As a runner, doctor and mother, I love seeing kids run.” Dr. Jamieson also appreciated that the run was free. “That allows families to participate who may not normally be able to afford the entry fee.” And, she added, “The healthy snacks (apples, oranges, granola bars and bottled water) were an excellent idea.” >

AMA President, Dr. Padraic Carr, with AMA Youth Run Club sponsor mascot ("Blue Cross") and two Alberta Blue Cross representatives.

MAY – JUNE 2017

> Already interested in volunteering with the AMA Youth Run Club at his son’s school this spring, Dr. Marc Bibeau commented, “It was really encouraging to see so many friends, old and new, lace up and hit the trails! It was a chilly morning,” he continued, “but we were warmed by the enthusiasm of the AMA Youth Run Club team and the many volunteers. Luc and I both look forward to participating in future Youth Run Club events.”

As Dr. Kimberley Kelly visited with her fellow physicians after the run, she observed: “It was such a great event! I can sense the momentum building in the physician community for the Youth Run Club.” If you’re interested in getting involved with the AMA Youth Run Club, email AMAYRC@albertadoctors.org.

Dr. Marc B¡beau and his son, Luc.

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FEATURE

The Wallaces of Wainwright and the Battle of Vimy Ridge J. Robert Lampard, MD

he 100th anniversary of the World War I Battle of Vimy Ridge occurred from April 9 to 12. Many Canadian historians believe Canada came of age on that cold, muddy, snowy, Easter weekend in 1917, when our army forced the entrenched German army to retreat. Both the British and French armies had previously failed to take the ridge. The Canadian success proved that a united, well led army of volunteers could achieve what others had failed to do at 10 times the cost. Of the 100,000 Canadian troops, 10,000 were killed or injured. An estimated 10% were Albertans in the 10th, 31st, 49th and 50th Battalions, as well as the 8th and 11th field ambulances that supported the 3rd and 4th divisions. Dr. Harry Wallace was the regimental medical officer for the 49th. Dr. Ashley Cooper-Johnson covered the 50th.

Shortly after the Battle of Vimy Ridge, Dr. Wallace’s unit was given a short respite. On April 24, the unit was ordered back into the line, which was then located three miles over the ridge. With three others from his battalion, he was guided forward under the cover of darkness, until halted by a sergeant. The sergeant indicated the Germans had moved an artillery battery up into position. Suddenly there was a flare that lit up the sky, followed by intense shelling from both sides. Shells began landing nearby. Dr. Wallace dove into a small, water-filled shell hole with one of his colleagues. The shelling kept getting closer. “I’m getting down into the water to get my head undercover,” Dr. Wallace said, with water now up to his lips. “That’s not a bad idea, doc. I am go …” his colleague responded. A 5.9 shell exploded eight feet away.

The battle started with an unprecedented rolling barrage at 5 a.m. Most of the Canadian troops reached their objectives by 8 a.m. Casualties (Canadian and German) began arriving at Dr. Wallace’s regimental first aid station at 7 a.m. They were triaged to the nearest advanced dressing station for assessment, analgesics, transfusions and transfer, if necessary, to the casualty clearing station behind the lines, as it had an operating room.

Dr. Wallace’s account continues: “I could feel a weight on me, then a cold stream of water on my back. I’m tired but I feel no pain. Then I hear voices. My batman pulls me out. I hear the splash, splash, splash and know it’s blood. I’ve only a few seconds to live. Then a change comes over me. My mind clears. I say to my bearers ‘it’s no use boys, I’m finished – beat it out of here.’ I think of my wife and little son. Hoping they will not grieve too much. I wish I could tell them how easy this thing is.”

By 3 p.m. the 8th Field Ambulance alone had triaged 2,000 casualties. The greatest bottleneck was the lack of stretchers. The German stretcher-bearers had not been ordered to return them. So everyone improvised using corrugated iron and blankets; 2x4s and canvas; bed rolls with poles; and blanket hammocks.

“The splash, splash ceases although the warm blood trickles down my back. Time passes. I feel stronger. My pulse is racy but steady. Shells are bursting nearby again. Another concussion. My wound is painful. At the station I see the major’s wounds are dressed. They tell me my colleague is dead. Never knew what hit him. One second late getting down. That explains the splash, splash … it was his life blood not mine.”

So intense was the fighting, with everyone isolated from the news, it wasn’t until the third day that the front line troops learned of the brilliant success that had been achieved – from the London Daily Mail. Recently, the notes Dr. Wallace wrote on April 29, 1917, while he was recovering from his injuries, have surfaced. They include the period from the Battle of Vimy Ridge until April 24, 1917, when he was seriously injured and evacuated to England. Dr. Wallace vividly describes the event. AMA - ALBERTA DOCTORS’ DIGEST

Evacuated and recovered, Dr. Wallace worked in British hospitals until 1919. Eventually, he heard from a fellow officer that Wainwright was short of doctors, so that’s where he headed. He became the Alberta town’s solo physician for decades. >

> His young son, Douglas, didn’t have to read his father’s “in case I don’t come back” letter. It was to have been given to him on his 15th birthday. It read, in part:

“My dear son Douglas: Always let your dear mother be your first thought. Go to her for guidance and sympathy. Follow her example – always do what you know to be your duty. I would consider myself a coward if I did not do what I know to be my duty. The greatest test of bravery is in always doing what you know to be right, for it is better to have a good name and be honorable than it is to be rich. Let your aim in life be – to be a man. Goodbye. Your father, H. Wallace.” Doug Wallace, like his father, entered medicine and became a World War II Royal Canadian Air Force Medical Officer. After the war he joined his father in medical practice and became the mayor of Wainwright. Moving into medical management, Doug became Alberta’s acting deputy minister of health, CEO of the University of Alberta Hospital and CEO of the Toronto General Hospital before becoming the general secretary of the Canadian Medical Association in 1970. All of us have been saved from having to write such a war-time letter or to receive one. We have much to be thankful for because our forefathers fought in both world wars. It has become too easy to forget that the freedom from conflict has been passed down to us – at a price. References available upon request.

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MAY – JUNE 2017

RESIDENTS' PAGE

Burnout: Is it happening to you? Shannon M. Ruzycki, MD | PGY

Dear Colleague:

hope you're doing well. No, really. I’m worried about you. Evidence consistently demonstrates that about half of resident physicians will suffer from some form of burnout during training.1,2 The main symptoms of burnout are emotional exhaustion, depersonalization and a reduced sense of accomplishment.2 Though not unique to medicine, physicians are much more likely to suffer from burnout than professionals in other high-stress careers such as law or business.2 In fact, higher education is generally protective against the development of mental illness – in every field except medicine.2 Physicians are more likely to suffer from depression and other types of mental illness than the general public. Though first-year medical students have similar depression and burnout scores to students entering other professional programs, by the beginning of residency training, these rates are much higher than those of other students in advanced degree programs.2 Burnout and depression peak during residency with rates nearing 60% and reach a low point of just under 50% of all practicing physicians.2 These numbers worry me.

About half of resident physicians

will suffer from some form of burnout during training.

Medical students and resident physicians are amazing individuals who are ambitious, goal-directed, intelligent and altruistic. We start medical school like most other students, but something happens the longer we are immersed in the culture of medicine – many of us develop emotional exhaustion and self-doubt that dramatically reduce our satisfaction from our work. AMA - ALBERTA DOCTORS’ DIGEST

4, GENERAL INTERNAL MEDICINE; UNIVERSITY OF CALGARY

What can we do about burnout? Evidence suggests that the most effective interventions to reduce burnout are at the systems level.3 Examples include scheduling changes, increased physician autonomy and “no-page” time periods at night for residents.3 We need to work with our colleagues and our training programs to make changes that enhance wellness. Fortunately, the University of Alberta and University of Calgary, along with the Professional Association of Resident Physicians of Alberta (PARA), recognize the stress of residency training, and they are actively working to help resident physicians recognize burnout and prioritize well-being. But there is still much we can do as individuals. We need to support ourselves and one another. If you recognize burnout in yourself, please invest in yourself. Purchase some free time by hiring a cleaning person, having your groceries or meals delivered, or hiring someone to do any task that is not making your life better. Use your newfound free time to exercise. Find an activity you enjoy. Encourage your partner or best friend to attend with you. Force yourself to go. Avoid the reduced sense of accomplishment by celebrating your successes, no matter how insignificant they feel. Consider taking a flex day and seeing a movie or going for a hike. Consider a journal. Look out for your colleagues and role model a culture where we prioritize our own wellness. Do not complain if a colleague takes vacation or a flex day during your rotation. Send a congratulations card to a colleague to celebrate accomplishments. Be kind. Do not berate. If you think a colleague is struggling, reach out. PARA is actively working with our partners on resiliency training and wellness initiatives. We also provide presentations on fatigue management during academic half-days. PARA’s Community and Wellness Committee is a group of resident physicians from across the province that organizes activities to promote resident physician well-being as part of its mandate. From runs and bowling to hockey games and dinner theatre, PARA sponsors social and recreational events throughout the year, supporting resident physicians in spending time outside work with friends and family. In addition, one week each year is designated Resident Physician Wellness Week (RWW). This year it was held from May 14-20. >

> Each year, RWW provides opportunities for resident physicians to partake in well-being activities and serves as a reminder to staff and resident physicians of the importance of finding the right balance between our personal and professional lives. Less explicitly, it broaches the often swept-under-the-rug issues faced by resident physicians – stress, burnout, relationship strain, depression and anxiety, amongst others – and helps resident physicians recognize that they are not alone in these experiences and that support is available in addressing them.

Evidence suggests

that the most effective interventions to reduce burnout are at the systems level … But there is still much we can do as individuals.

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You deserve to enjoy your life. If you are so far into burnout that you cannot imagine mustering the energy to re-invest in your well-being, please tell someone. You can contact the AMA Physician and Family Support Program toll-free at 1.877.767.4637 or www.albertadoctors.org/services/ pfsp/pfsp-services. I am thinking about you. I hope you are doing well. Sincerely, A colleague For more information on the annual Resident Physician Wellness Week, visit para-ab.ca/news-events/residentphysician-wellness-week/. References available upon request.

MAY – JUNE 2017

PFSP PERSPECTIVES

Medical assistance in dying

Caring for ourselves and our colleagues in changing times Terrie E. Brandon, MD, CCFP | CLINICAL

ying is a difficult process to witness. Death and dying should not be trivialized. Every death, even the most expected, is unsettling. It is an event that defines us as humans.1

As I write this, 97 Albertans have been granted medical assistance in dying and another 48 who requested the service were found not to have met the criteria. Given the number of physicians involved in the care of a seriously ill patient, it’s safe to say that the issue of medical assistance in dying (MAiD) has personally touched hundreds of Alberta physicians. The passing of Bill C-14 initiated a sea change in the practice of medicine. In our training, we prepared to relieve suffering and preserve life. That we are now expected to participate in ending life is unsettling to many physicians, even to some who support the concept.

Issues with MAiD What about MAiD is distressing us? The types of stories we’re hearing reveal a variety of stressors within this issue. • A physician opposed to MAiD on moral and religious grounds feels silenced by his peers who support the practice. • A family doctor experiences unexpectedly severe grief after losing a long-time patient while dealing with the emotional impact of having participated in ending his life. • A medical practice is divided when one physician decides to provide MAiD while the others are opposed. • A physician calls the assistance line from her car while on the way to provide MAiD. She believes she is doing the right thing for her patient, but she needs to sort out her thoughts and emotions.

AMA - ALBERTA DOCTORS’ DIGEST

DIRECTOR, PFSP

• A physician fears the legal consequences of providing MAiD to a patient whose family is opposed. • Having promised a patient assistance in dying, a physician is distressed that he was unable to complete the application process in time to give the patient the type of death she was hoping for.

The passing of Bill C-14 initiated a sea change in the practice of medicine. In our training, we prepared to relieve suffering and preserve life. That we are now expected to participate in ending life is unsettling to many physicians, even to some who support the concept.

Physician support Stories like these are a part of our new reality. So how do we deal with our own emotions and with those of our colleagues? Many jurisdictions have some form of support for health care teams providing MAiD. In Quebec, an interdisciplinary support network has been built into the process. The Netherlands has specially trained consultants to support and educate physician providers and to consult with every provider before and after each event. Here in Alberta, a supportive review is completed after each assisted death, allowing the team members to discuss their perspectives and experiences should they wish to do so. Initiatives like this acknowledge the emotional impact on those involved. For more information about the review process refer to albertahealthservices.ca/assets/info/hp/maid/if-hpmaid-supportive-review-process.pdf. >

> Dr. James Silvius, the Alberta Health Services (AHS) lead for Medical Assistance in Dying Preparedness, says there is significant variability in the emotional impact on providers; some seem to take it in stride, while others have unexpected emotional responses. He also acknowledges the difficulties caused within teams when the issue provokes friction between physicians or between physicians and other health care providers. AHS continues to explore ways to assist those involved in MAiD through education and direct support.

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In my own experience of discussing MAiD with physicians, I’ve been impressed with the deep level of thought that they’ve given to this issue. In sharing their stories and emotions, they’ve shown remarkable empathy for the experiences and feelings of their colleagues, even those with opposing views. I have been struck by the ability of these physicians to understand, respect and accept perspectives other than their own. A study in Oregon confirmed that MAiD is emotionally intense and stressful for physicians. The sources of their discomfort included concerns about adequate management of symptoms and suffering, not wanting to abandon their patients, and having an incomplete understanding of their patients’ preferences. Although they recognized their stress, few sought support from colleagues or their professional organizations, with most turning to their spouse for support.2 While reaching out to family is natural during times of stress, our profession will be healthier and stronger if we also reach out to each other. MAiD is just one of the challenges we face in the shifting landscape of medicine. Our support for each other will help us develop the resilience needed for our journey into new and challenging territory. Share your feelings and experiences. Reach out to your colleagues. In addition, the Physician and Family Support Program (PFSP) assistance line will connect you with a fellow physician for confidential support (1.877.767.4637). We don’t need to walk alone. References available upon request.

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Voting is your privilege! 2017 CMPA Council Elections The Canadian Medical Protective Association (CMPA) is governed by an elected council. Members are invited to vote in the 2017 council elections. Election information will be sent to CMPA members in Areas where elections are being held. Election period is May 10th to June 14th, 2017. Take part in selecting council representation in your Area! www.cmpa-acpm.ca/elections / elections@cmpa.org / 1-800-267-6522 Ext. 483

MAY – JUNE 2017

FEATURE

What new tax rules could mean for incorporated physicians Christina Kuruliak, CFP® | SENIOR

FINANCIAL CONSULTANT, MD FINANCIAL MANAGEMENT LTD, CALGARY

ecently, the federal government’s changes to tax rules for professionals (including physicians) who practice in some complex corporate and partnership structures became law.

As a financial consultant with MD Financial Management Limited, I work with incorporated physicians, many of whom are in group practices. The new rules can affect their eligibility for the small-business tax deduction and many of my clients have questions about this. Here are the answers to some of the most common questions I’ve been receiving.

What are the new tax rules? Under the previous legislation, each incorporated physician in a group structure could claim the small-business deduction on up to $500,000 in active business income. Now that the new tax rules are in place, incorporated physicians in a group structure may need to share this $500,000 small-business deduction among them. If these changes apply to your medical practice, your corporate taxes could increase and you may need to adjust your financial plan.

Will these new rules affect me? About 20% of incorporated physicians will be affected.

No impact Negative impact Potential negative impact

Sole-ownership MPC No impact if you are the sole shareholder in your medical professional corporation (MPC).

2 MPCs owned separately by physician spouses No impact if you're a dual physician family where each spouse owns his/her own corporation - as long as these corporations provide little or no service to each other.

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Incorporated

Cost-sharing arrangement No impact if you are sharing costs (e.g. office space, medical equipment, supplies and staff) with other physicians but provide services to your own patients and bill the government directly.

Partnership

Negative impact in a partnership group practice. Partnerships share income, expenses, personal liability and medical liability. The small business deduction would be split based on the proportionate share of income from the partnership.

Group corporation Negative impact in a group corporation where each physician is a shareholder. The small business deduction would be shared.

Multiple sources of income Fees for services derived from a partnership or a group corporation could be impacted, but any revenue billed directly by your MPC or earned through other sources should still be eligible for the small business deduction. >

> Incorporated physician income that is channelled through an affected structure (a partnership or certain group corporations) could now be subject to the general corporate tax rate, since access to the small-business deduction must now be shared. Depending on your province of residence and other factors, including your method of compensation, this could more than double your corporate taxes. However, the corporate tax increase might be offset by reduced personal taxes. Ultimately, the combined changes to your personal and corporate tax rates will depend on your situation.

What will these changes mean for my financial plan? If you are affected by the changes, in essence this means you will not be able to defer as much tax. You will be left with less after-tax money in your corporation, which can affect your financial planning strategies. Some financial tools and strategies will become more attractive, and others less so. Your MD advisor can help you determine what effect losing the small-business tax rates might have on your financial plan.

I think these changes will affect me. What should I do? Start by doing these three things: 1. Speak with your physician group. Determining what, if anything, your physician group will do in response to the legislation should be your priority. Be aware that changes to the group structure might impact your income as well as your corporate tax.

2. Meet with your lawyer and tax advisor. They can help analyze your situation, determine the potential impact and make recommendations. For example, you may be able to eliminate the tax consequences by adjusting only a portion of your income. 3. Meet with your MD advisor. He or she may be able to help reduce the effects of these changes and can offer insight into how your retirement goals may be affected. If you’re an incorporated physician, getting the right advice tailored to your particular situation is critical. Christina Kuruliak is a Senior Financial Consultant with MD Management Limited in Calgary. Contact Christina at christina.kuruliak@cma.ca.

authorized to make any determination of a client’s U.S. status or tax filing obligations, whether foreign or domestic. The MD ExO® service provides financial products and guidance to clients, delivered through the MD Group of Companies (MD Financial Management Inc., MD Management Limited, MD Private Trust Company, MD Life Insurance Company and MD Insurance Agency Limited). For a detailed list of these companies, visit md.cma.ca. MD Financial Management provides financial products and services, the MD Family of Funds and investment counselling services through the MD Group of Companies. MD Financial Management Inc. is owned by the Canadian Medical Association.

MD Financial Management provides financial products and services, the MD Family of Funds and investment counselling services through the MD Group of Companies. For a detailed list of these companies, visit md.cma.ca. The information contained in this document is not intended to offer foreign or domestic taxation, legal, accounting or similar professional advice, nor is it intended to replace the advice of independent tax, accounting or legal professionals. Incorporation guidance is limited to asset allocation and integrating corporate entities into financial plans and wealth strategies. Any tax-related information is applicable to Canadian residents only and is in accordance with current Canadian tax law including judicial and administrative interpretation. The information and strategies presented here may not be suitable for U.S. persons (citizens, residents or green card holders) or non-residents of Canada, or for situations involving such individuals. Employees of the MD Group of Companies are not

MAY – JUNE 2017

IN A DIFFERENT VEIN

In the red corner … personalized medicine. In the blue corner … realistic medicine. Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP | CO-EDITOR

illie goes to the doctor, and after a full discussion of the patient’s priorities, the doctor prescribes Viagra. “The dose is important, so follow my instructions carefully: Monday, take one tablet then skip a day. Wednesday take two tablets then skip a day. Friday three tablets then skip Saturday and Sunday.” (personalized medicine) A week later, the doctor meets Willie’s wife in the street. “How’s Willie doing?” he asks.

Alice, “When I use a word, it means just what I choose it to mean – neither more nor less.” So, to me, personalized medicine is about care and attention to clinical detail, personalized but not slavishly patient-centered, since much clinical contact is patient education. Indeed, the word “doctor” derives from the Latin for teacher. Sometimes you have to save patients from their own gullibility through discussion and education.

Medicine, art and economics

love fuzz-words and buzz-phrases purporting to encapsulate the path ahead.

“Oh, he died,” she says. “I’m terribly sorry… How awful. What happened?” “It must have been all that skipping,” she says. (realistic medicine) Medicine, art and economics love fuzz-words and buzz-phrases purporting to encapsulate the path ahead. These are passwords, codes for those in the know, who are part of the group-think. Those not keeping up with the lexicon are left to wonder what’s going on, and what they mean. Thus, “supply-side economics,” “pre-Raphaelite art,” “evidence-based medicine,” and so on. So when Bob sent me a document published by the Scottish Health Office realistically called “Realistic medicine,”1 I thought, “Not another medical buzz-phrase, please. We’ve had evidence-based medicine, productivity-based medicine (time-and-motion based or Taylorism or lean medicine), patient-centered medicine, personalized (precision) medicine, and now… drum roll… personalized medicine’s surly cousin: realistic medicine.” Medicine is full of these buzz-phrases. They always push an agenda. The interesting thing is that they mean quite different things to different people. As Humpty Dumpty in Lewis Carroll’s Alice Through the Looking Glass says to AMA - ALBERTA DOCTORS’ DIGEST

However, this is not the meaning of personalized medicine to others which might be the right drug/ procedure at the right dose/technique at the right time and place. And to the researcher, precision medicine means something quite different – simply put, precision oncology is the endeavor of tailoring your cancer treatment, specifically designed and targeted to your unique form of cancer. But that’s a research definition and after a few minor successes this approach has yet to prove its worth. I spent an enjoyable Friday in April at a conference on “Precision oncology and experimental therapeutics,” euphonically abbreviated to POET, run by my friend Gwyn. There was an air of innocence to the meeting – yet mixed with healthy scepticism. Speakers either ignored the question of what precision medicine actually was – as if it were self-evident, presenting their own research data jazzed up with correlations of clinical data, for example, with a “targetable genomic mutation.” Or they labored to show how a future of vast quantities of data might transform lives – though their presentations looked like a cornucopia of packets of mini-information that might show a treatment path in a patient in the vainglorious hope that laying open the human genome, epigenome, proteome and any other-ome will lead to a targeted drug. >

> Admirably, at the POET meeting, the terminally weary buzzword “innovation” was rarely used. It’s now a bleat left to pseudo-innovators – politicians of the Trudeau/ Morneau stripe (“innovation” was mentioned 17 plus times in the March 2017 federal budget). This word is also still used by inventors of useless gadgetry like the horn that goes off in a car when a non-existent thief is stealing it and by the designers of software programs who like to present your email or bank statements in confusingly different colors and formats. There was, however, little discussion of two impatient, pachyderms outside the room. The first elephant, an increasingly noisy fellow (usually fronted by nursing and support staff not unreasonably looking for bigger roles in patient care) was pushing for patient-centered medicine and patient-related outcome measures. And the second Big Boy was the much more threatening shadowy presence of Silicon Valley with its $6 billion/ annum investment money, its insatiable need for disruption, pushing the Obama message of big data, big outcomes and big profits. For that is what much of personalized medicine is really about – selling mobile apps, telemedicine, IT equipment, automated diagnosis software, wearable sensors, and gear for measuring genomes, transcriptomes, proteomes, and other-omes to unsophisticated funding providers promising them multi-billions in savings, logarithmic improvements in health and scads of patient satisfaction. Digitizing health care is a huge business opportunity but, despite Silicon Valley’s outrageous hype, it will not improve patient care one iota. This will always depend on clinical expertise, listening to patients, a careful one-on-one physical examination with attention to detail, judicious choice of investigations, common sense and experience, communication, and as much a degree of compassion as the provider can muster at the end of a heavy clinic. So what is realistic medicine? Well, it seems to be a gestalt description embodying the changes occurring for the last 30 or more years with a couple of newish outcome measurements. This is a summary of realistic medicine: • The emergence of teamwork, with a need to integrate more with social workers in view of the huge influence of social ills in medical ailments. • A need to reduce unwarranted variation in medical and surgical practice coupled with the need to reduce harm. • Better, smoother, more respectful communication between players. • The need to measure outcomes relevant to patients (“Did the doctor invite discussion of your priorities?”), together with the incessant bleat for “innovation.” This last point was the weakest plank of an interesting document.

The document does not deal with the bad dude offspring of each of these – neither the increasing care fragmentation (“Who’s in charge?”) nor the following: • Costly overlap of roles between team members (especially family doctors and pharmacists). • Increased time required for group case discussion detracting from direct patient care (try attending an interdisciplinary clinic). • Tension between what a patient wants and what the doctor perceives to be in their best interest. • Gullibility of many patients • Dismal communication skills between caregivers (though I do like one dentist’s description of my dentition: “You have summer teeth” – some are teeth). • Massive increase in costs for recording patient related outcomes when we barely record objective data such as disease and treatment outcomes. Realistic medicine is what good doctors have been practicing for decades – only some brilliant, benighted Doc Martin or Gregory House characters have missed this culture shift, although at the end of a heavy clinic, most of us find the standards of realistic medicine dropping like a guttering candle and one resorts to robotic medicine and how-do-I-get-out-of-this-room medicine.

We’ve had evidence-based medicine,

productivity-based medicine (time-and-motion based or Taylorism or lean medicine), patientcentered medicine, personalized (or precision) medicine, and now… drum roll… personalized medicine’s surly cousin: realistic medicine.

For pretty much all of my career, the profession of medicine has been under change. Some might call it evolution, others siege and attack – from armchair critics, lobby groups, rival guilds and professions who believe they can do bits of what we do better than we can – without the necessity of going through the mill of night call, residency, examinations and bitter experience. It’s the on-going division of health care labor. So we now have a document some 30 years after discussions began, formalizing this process of change, published by the chief medical officer for Scotland. This is relevant for Canada since much of the tradition, practices and processes of medicine in Canada have followed the British (and especially Scottish) tradition of medical practice with its influence of practical surgery, the importance of taking a full history and a skilled physical >

MAY – JUNE 2017

> examination, the judicious use of investigations, the ethic of First Do No Harm, the central role of the family doctor as gatekeeper and the banishment of the witch doctor (though not the placebo effect). Starting out as a resident, you were expected to do pretty much everything: taking histories and examining patients; drawing blood and examining it under the microscope; putting in endotracheal tubes; setting up IVs and cut-downs; doing cardiac resuscitations, bone marrows and lumbar punctures; prescribing drugs and explaining the side-effects; counselling; and participating in clinical trials. In most of the above fondly recalled scenarios, there is now someone specialized in the area that does those tasks better than I did, which leaves me with what? A diminished role, and yet, care pathways have become so fragmented that neither the right boot nor the left boot know (or care) where the football is.

A quarterback is always required. Treating a

disease is now a complex interaction of teamwork. It’s astonishing how well it actually is done and amazing that we can actually cater to individual foibles, requests and demands.

A retreat I attended in 1980, complete with paper pinned on the walls summarizing all the haverings of the day, discussed all the issues in realistic medicine: Do all patients have to see a physician? The answer was no. But the argument was made by Dr. Neil McDonald (a careful thinker) that in any team there must be a quarterback, a team captain, who has the overall picture and strategy, who can steer the boat in a storm. I once went to a concert starring the late Chuck Berry in Edinburgh, Scotland. He was backed by a local rock band and received his usual cash in a brown envelope before he would go on stage. The show was a gas. Chuck started off amiably enough, but halfway through the third number, as the excited lead guitar of the local band was in the middle of an uninvited bit of solo work, Chuck pigeon-strutted over to the lead’s amplifier and turned his volume down. Hoots of laughter from the audience. Yes, we’d come to see Chuck Berry, not Bertie Dishington of the Edinburgh Athenians. And so with health care. You go to see the doctor when you’re really unwell, not the pharmacist, the clinic nurse,

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the chiropodist or the physiotherapist. And yet the essence of teamwork is the passing of the ball to the most appropriate player at the time who may run with it for a bit – but not for too long – and they must pass it before they run into trouble. A quarterback is always required. Treating a disease is now a complex interaction of teamwork. It’s astonishing how well it actually is done and amazing that we can actually cater to individual foibles, requests and demands. There must be an attending staff who acts as overall case manager. In most instances, this should be the family doctor, but at times it must be a specialist if the case is complex. With division of labor there occurs costly overlap. For example, there is an emerging problem with community pharmacies. Physician dispensaries were dispensed with a few decades ago, with the argument that there was an inherent conflict of interest if the prescriber and the dispenser is the same person. But pharmacists now consult, order blood tests and X-rays, prescribe and dispense – with an obvious inherent conflict of interest. A family doctor also does this but now does not have the luxury of a pharmacy from which to dispense. The pharmacist orders in generics, choosing the company giving the best deals; they now sit down with the patient and for $108 review their meds annually. They can also phone the patient any day for a follow-up chat: “How ya’ doin’, Mrs. Bruin?” and charge a fee. There’s a fee for injections. Pharmacy chains are rubbing their hands about this with a cut going to overall company profits and the taxpayer paying. Meanwhile the family doc does the same thing, throwing in a physical examination. I shall be reporting this inefficiency to somewhere in Alberta Health, if I can only figure out where. And while we’re talking about teams and division of labor, my friend Tony sent me an article from California2 demonstrating that pigeons can read pathology slides and X-rays. As one of the many who has been defeated at tic-tac-toe by a chicken at the Calgary Stampede, I can well believe a pigeon can diagnose a large cell lymphoma at least as well as a pathology resident. But it does need proper assessment before determining an avian fee schedule. So the contest between realistic medicine and personalized medicine is a tie, both valuable in their place. It’s like trying to understand the success of Njinski, the famous Canadian-born racehorse, by trying to measure his molecular biology and the millions of interacting molecular pathways at one moment in time. You also have to take in the beauty of the whole animal, surging from behind six horses on the final furlong to win the Epsom Derby in 1970 by two-and-a-half lengths. References available upon request.

CLASSIFIED ADVERTISEMENTS

PHYSICIAN WANTED CALGARY AB Med+Stop Medical Clinics Ltd. has immediate openings for part-time physicians in two of our Calgary locations. Our family practice medical centres offer pleasant working conditions in well-equipped modern facilities, high income potential, low overhead, no investment, no administrative burdens and quality of lifestyle that is not available in most medical practices. Contact: Marion Barrett Med+Stop Medical Clinics Ltd. 290-5255 Richmond Rd SW Calgary AB T3E 7C4 T 403.240.1752 F 403.249.3120 msmc@telusplanet.net CALGARY AB Are you a specialist or family physician looking to set up your own practice or relocate your existing panel? We can help. We provide you with a turn-key space to provide your services, which means that you will not be working for someone else. We take care of the day-to-day management. It is your practice, so you decide on your schedule and style of practice. We have different overhead structure, including fee-for-service split (25%), fixed-cost consulting room rental and partnership arrangement. Are you planning to retire soon? We can help with the transfer of records and patients to a new doctor. Why work for someone else? Contact: pristinehealthclinic@gmail.com

CALGARY AB Nuwest Medical Centre seeks family physicians and specialists. This is a newly built modern exciting location in Calgary. Physician owned and managed, well known for its high level of efficiency and great service. One block north of the Kirby C-station in the affluent west end neighborhood of Calgaryâ&#x20AC;&#x2122;s downtown, a busy residential and commercial location, making it an ideal location to build a busy practice. We are expanding our clinic hours in a few months and will need part- or full-time physicians with an interest in family practice or walk-in practice. Other specialties such as internal medicine and pediatrics will be considered as well. We provide Accuro electronic medical records and a well-managed practice. Competitive overhead split will be offered to help build and establish your practice. Contact: Dr. Nabil Elkabir T 403.993.6442 nabilelkabir@hotmail.com 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 25% expenses offered. Contact: Neville Reddy, MB ChB, FRCPC (Anesthesia) T 403.240.4259 C 403.689.4259 nreddy@innovationshealth.ca www.innovationshealth.ca

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 rhpc@shaw.ca 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 for their patients. Come work part- 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 corporate@imaginehealthcentres.ca www.imaginehealthcentres.ca >

MAY â&#x20AC;&#x201C; JUNE 2017

> CARSTAIRS AB Snowy Owl Medical Clinic is thrilled that patients and physicians alike love our model of delivering high quality health care. We are located in the small town of Carstairs, just 30 minutes north of Calgary. Our clinic provides a modern, friendly and supportive environment for practicing primary care medicine. We are looking for a bright and caring family physician to join us this fall. Contact: www.snowyowlclinic.com for more details EDMONTON AB Capstone Medical Clinic is a brand-new family medicine clinic in west Edmonton. It is in close proximity to an assisted-living facility, diagnostic imaging and multiple pharmacies. This is an ideal location for family doctors looking to build a new practice, as well as physicians with an existing panel. Both part- and full-time positions are available. Clinic hours are flexible and payment is fee-for-service. We use TELUS Health Solutions (Wolf) electronic medical records. We are part of the Edmonton West Primary Care Network (PCN) and have access to a PCN nurse on site. Interested physicians must be licensed with the College of Physicians & Surgeons of Alberta. Contact: Dr. Christopher Gee T 780.708.3012 info@capstonemedicalclinic.com EDMONTON AB MD Group Inc.’s Lessard Medical Clinic and West Oliver Medical Clinic, each with eight examination rooms, are looking for full-time family physicians and specialists. West Oliver Medical Clinic, located in a great downtown area, 101-10538 124 Street and Lessard Medical Clinic in the west end at 6633 177 Street, Edmonton. Clinic hours are Monday to Friday 8:30 a.m. to 8:30 p.m., Saturday and Sunday from 10 a.m. to 5 p.m.

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The physician must be licensed with the College of Physicians & Surgeons of Alberta (CPSA). Qualifications must comply with the CPSA license requirements and guidelines. The physician income will be based on a fee-for-service arrangement with an average annual income of $300,000 to $450,000. MD Group can offer you competitive overhead splits for long term commitments. 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 and maintain membership with the local primary care networks. Benefits and incentives to the employment within our group include the convenience of multiple locations around Edmonton to support your living arrangements, part- and full-time schedules available, staff familiarized with primary care programs and promotion, support staff including nurses for physicians patients to provide one-on-one care, on-site diabetic management care and comprehensive medical follow up visits. Therapists within our clinic provide priority consults and on-site respiratory lab. Seminars and dinner workshops are well documented and monitored for CME credits. Flexible hours, vast patient populations at both locations, continuing care and learning opportunities for accredited physicians. Full-time chronic disease management nurse to care for co-morbidity patients, billing support staff and attached pharmacy are available. Work with friendly and dedicated staff, nurses available for doctor’s assistance and referrals as well as on-site mental health and psychology services. Contact: Stephanie Harris Operations Manager MD Group Inc. T 780.756.3090 F 780.756.3089 mdgroupclinic@gmail.com

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); 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 westendmedicalclinic@gmail.com

EDMONTON AB To meet our growing needs, we have a practice opportunity for a pediatrician at the Parsons Medical Centre. The clinic is in south Edmonton and is a high patient volume clinic. You can enjoy working in a modern environment with full electronic medical records, friendly reliable staff for billing, referrals, etc., as well as an on-site manager. Parsons serves a large community and wide spectrum age group (birth to geriatric). The Parsons Medical Centre has a pharmacy on-site, ECG machine and offers a large array of specialist services. >

Parsons Medical is a member of the Edmonton Southside Primary Care Network which allows patients to have access to an on-site dietitian and mental health/psychiatry health services. Overhead is negotiable, flexible working hours and open seven days a week. Contact: Harjit Toor T 587.754.5600 manager@parsonsmedicalcentre.ca EDMONTON AB Windermere’s newest clinic is looking for physicians to start as soon as possible. Imagine Health Centres (IHC) newest clinic, Currents of Windermere is a top-notch, high-profile retail development 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 corporate@imaginehealthcentres.ca www.imaginehealthcentres.ca

HIGH RIVER AB Pediatrician wanted for Charles Clark Health Clinic. High River is interested in adding a pediatric service within its LEED certified building that currently includes 13 family physicians. An additional nine family physicians and two obstetricians are also practicing in the community of 13,500 located 30 minutes south of Calgary. Leasehold improvements are included and there are opportunities to share the space. Contact: Dr. Ron Gorsche Charles Clark Health Clinic T 403.652.2929 rgorsche@telusplanet.net PINCHER CREEK AB Seeking a general practitioner surgeon to join the Associate Clinic in Pincher Creek. The Associate Clinic is seeking a full-time GP surgeon to join our dynamic family practice. Our current nine-physician team includes two GP surgeons, two GP anesthetists and one endoscopist. Our entire physician team practices obstetrics and work together as a cohesive group both in clinic and hospital. The Associate Clinic in Pincher Creek is a rural primary care clinic that strives to provide excellence in primary care and urgent care for the community and to enable patients to be partners in the management of their health care. Our clinic is co-located with the local hospital in rural southwestern Alberta. We serve Pincher Creek and the surrounding communities, including many residents of the nearby Piikani Reserve, Cowley, Lundbreck and Waterton Park – approximately 10,000 patients. We also operate a satellite clinic on the Piikani Reserve and provide service to Vista Village (a Good Samaritan designated assisted living facility) and Crestview Lodge. Services are provided through the clinic by a team comprised of nine physicians, registered nurse, licensed practical nurses, medical office assistants, social worker, dietician, pharmacist, respiratory therapists, receptionists, resident physicians and medical students. Administrative supports include on-site billing, medical transcription, third-party billing and an IT database expert. Our physicians enjoy practicing in an environment that has low physician attrition and potential for high income in a clinic which has been secured through a favorable, long-term lease.

The right person to join our team will be a family physician with enhanced surgical skills/GP surgery skills. Family physicians with the desire to complete enhanced surgical skills training may also be considered. Responsibilities will include performing Caesarean sections and other low-risk surgical procedures, assisting visiting orthopedic and general surgeons, as well as providing surgical and emergency on-call services for our rural community. Contact: Jeff Brockmann T 403.632.2100 jbrockmann@pinchermedical.ca ST. ALBERT AB Congenial, established family practice in desirable St. Albert has rooms available for a family medicine associate, psychiatrist, psychologist, pediatrician, dermatologist or other medical professionals. Flexible hours are possible. Split fee or negotiable fixed rate. Hospital privileges are an option but not necessary. Stable long-term staff, excellent primary care network support with on-site access to pharmacist, chronic disease nurse and mental health specialist. Contact: Nikki Office Manager T 780.419.3690 F 780.419.3565 STRATHMORE AB Excellent practice opportunity for a family physician in a rural setting less than 50 kilometers from Calgary. Join a true family-practice based team at the newly renovated Valley Medical Clinic with on-site physiotherapy, dental, pharmacy, audiology, podiatry, specialty services and a fast-paced walk-in component. “Where quality of life is the way of life” is the town motto for this growing community of nearly 14,000. Active community hospital with admitting and emergency privileges available if desired. Excellent collegiality and mentorship with a dynamic group of eight rural physicians. On-site resident teaching for over 30 years. Those interested in team work and the joys of rural family practice, please contact. Contact: Dr. Ward Fanning Valley Medical Clinic T 403.934.5205 fanninga@telus.net >

MAY – JUNE 2017

PHYSICIAN AND/OR LOCUM WANTED CALGARY AB Innovative multidisciplinary medical clinic is offering a rare opportunity for a family physician to take over a patient panel and practice in vibrant downtown Calgary. 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. 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 are also limited time opportunities in our other locations in Calgary, Edmonton and Red Deer. As a family physician, Imagine Health offers an opportunity to build your practice in an environment that emphasizes physician happiness, well-being, and work-life balance. To us, that means a few things such as exceptional spaces, unique and innovative technology, top-notch support staff, industry-leading staff-physician ratios, well-managed administration, work flow and billing optimization, attractive compensation package, medical business/ investment opportunities and flexible schedule. In summary, our people, technology and spaces are designed to let you focus on being an effective clinician first and foremost. Donâ&#x20AC;&#x2122;t miss the opportunity to join our talented and friendly team.

AMA - ALBERTA DOCTORSâ&#x20AC;&#x2122; DIGEST

The successful candidate must possess the following: effective interpersonal skills and the ability to work in a team environment; current license to practice medicine from the College of Physicians & Surgeons of Alberta or active license in any Canadian province. All applicants will be considered. We offer a competitive remuneration. If you are interested in this great opportunity with Imagine Health Centres, please send your resume along with any other credentials you may have and label the subject line: Physician/family doctor position. Contact: Dr. Jonathan Chan to submit your CV in confidence T 403.910.3990, ext. 213 corporate@imaginehealthcentres.ca www.imaginehealthcentres.ca 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 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 corporate@imaginehealthcentres.ca www.imaginehealthcentres.ca EDMONTON AB To meet the growing needs, we have a practice opportunity for family physicians to start as a locum (with an option to join part- or full-time) at Parsons Medical Centre (PMC) and Millbourne Mall Medical Centre (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 manager@parsonsmedicalcentre.ca >

> MAYERTHORPE AB Permanent physician or locum required. We are a very busy clinic in a small rural community and serve a very large outlying area. Clinic and hospital work are both available, no obstetrics. We use Wolf TELUS Health Solutions electronic medical records. If you choose to work at the hospital, the on-call schedule is one in three-to-four days and you would be on-call for a 24-hour period. Mayerthorpe is 1.25 hours from Edmonton on a divided double-lane highway. Contact: Dr. Mary Aird or Dr. Zahir Jamal T 780.786.2358 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 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 terrypurich@me.com 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 davel@sherwoodparkpcn.com

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 hosford6@telus.net

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 Regional Leasing Manager T 403.282.9838, ext. 3301 lindsay.hills@nwhreit.com Michael Lobsinger Leasing Manager, Edmonton T 1.877.844.9760, ext. 3401 michael.lobsinger@nwhreit.com EDMONTON AB Space available for a specialist medical practice in the busy and vibrant south Edmonton community, close to South Edmonton Common. New, modern and easily accessible building with latest amenities for a medical practice at attractive rates and electronic medical records are available. Building houses multiple specialists and general practices. Contact: edmontonspecialists@gmail.com for further details

FOR SALE

EDMONTON AB Collection of 150 historical medical books, majority of the books are on obstetrics and a few on medical instruments. Contact: Dr. John J. Boyd T 780.434.1869 jjboyd@shaw.ca

PRACTICE FOR SALE CALGARY AB Established family physician office based practice in south Calgary. You will you be working in a stateof-the-art freestanding medical building with heated sidewalks and free parking, sharing space and expenses with three other family physicians. Wolf electronic medical records in place for the past decade. You will have access to a large office, two examining rooms and share a procedure room. You will share receptionist and have access to a nurse as required. You will be assuming the care of a diverse group of patients ages 0 to 97. Hospital privileges not required. You will be part of the South Calgary Primary Care Network. Interested applicants will be CCFP certified and ideally will be interested in teaching medical students part-time in a clinic setting. You will be willing to take over the practice and related overhead expenses by November 1. The seller is willing to provide locum and backup services for up to six weeks per year for the next five to 10 years, if desired. Asking price: $1 Contact: occdoc@telus.net >

MAY â&#x20AC;&#x201C; JUNE 2017

EDMONTON AB Family medical practice for sale. Very well-established family medical practice with over 40 years of history. Located on the southside of Edmonton directly across from the Grey Nuns Community Hospital at the Tawa Medical Centre, 3017 66 Street. There is plenty of on-site parking for patients. Public transport is readily available and will be easily accessible when construction of the new “Grey Nuns stop” of the Valley Line LRT adjacent to the building is completed. Tawa Medical Centre is primarily health care and other tenants include: internal medicine, gastroenterology, neurology, obstetrics and gynecology, pediatrics, pulmonary medicine, several surgical specialists, diagnostic imaging, laboratory and pharmacy. This 1,100 sq. ft. prime space consists of three large examination rooms, substantial sized doctor’s office which will accommodate two physicians, large reception area/waiting room, air conditioning and corner location with large windows. The office has been recently renovated. The medical office is electronic medical records compatible. The long-term friendly staff is very personable and knowledgeable, and will continue working for the new owners. Current lease is in place until September 2019. The lease also includes one underground parking stall with an option for more. This is a ready-to-operate, full turn-key clinic. Physician is available for transition period and locum as needed. All prospective buyers need to sign a Confidentiality Agreement prior to accessing further information. Contact: Ronan RK Consulting T 780.908.7772 medicalpracticeforsale2017@gmail. com for more information

COURSES CME CRUISES WITH SEA COURSES CRUISES • Accredited for family physicians and specialists • Unbiased and pharma-free • Canada’s first choice in CMEatSEA® since 1995 • Companion cruises FREE

AMA - ALBERTA DOCTORS’ DIGEST

WESTERN MEDITERRANEAN CME AWAY™ CRUISE July 22-August 3 Focus: Sexual health, men’s health Ship: Holland America Ms Westerdam WESTERN CARIBBEAN CME AWAY™ CRUISE August 13-20 (Featuring: Kids summer camp at sea) Focus: Family medicine, vaccines and geriatrics Ship: Celebrity Equinox ALASKA CME AWAY™ CRUISE August 20-27 Focus: Infectious diseases and dermatology Ship: Celebrity Infinity RHINE AND DANUBE RIVER CME AWAY™ CRUISE September 1-16 (Sold out, wait list only) Focus: Cardiology, sport medicine and dermatology Ship: Avalon Illuminations ADRIATIC AND AMALFI COAST CME AWAY™ CRUISE September 6-16 Focus: Family practice and chronic pain: Update on 2017 pain guidelines Ship: Azamara Quest JAPANESE EXPLORER CME AWAY™ CRUISE September 24-October 5 (Limited space) Focus: Cardiology, internal medicine and endocrinology Ship: Celebrity Millennium TUAMOTUS AND SOCIETY ISLANDS TAHITI CME AWAY™ CRUISE October 18-28 (Bucket list destination) Focus: Cardiology and emergency medicine Ship: Paul Gauguin EXUMA, BAHAMAS CME AWAY™ RESORT November 5-12 (Book early – sold out quickly last year!) Focus: Family medicine Resort: Sandals Emerald Bay (adults only) Resort

CHILE, PATAGONIA, CAPE HORN AND ARGENTINA CME AWAY™ CRUISE November 25-December 2 Focus: Neurology and infectious diseases Ship: Stella Australis LAS VEGAS CME AWAY™ RESORT November 26-30 Focus: Chronic pain and pain management Resort: The Cosmopolitan of Las Vegas SINGAPORE TO HONG KONG CME AWAY™ CRUISE December 5-17 Focus: Rheumatology and pain management Ship: Regent SS Voyager EASTERN CARIBBEAN CME AWAY™ CRUISE December 30-January 6, 2018 Focus: Male/female sexual health and endocrinology Ship: Royal Caribbean: Harmony of the Seas AUSTRALIA AND NEW ZEALAND CME AWAY™ CRUISE February 3-17, 2018 Focus: Pain management, chemical dependency, rheumatology and endocrinology Ship: Celebrity Solstice RIVIERA MAYA MEXICO CME AWAY™ RESORT February 4-11, 2018 (Voted best Sea Courses resort in 2016) Focus: Save the date – CME AWAY™ Resort Resort: UNICO Riviera Maya (adults only all-inclusive) PUNTA CANA, DOMINICAN REPUBLIC CME AWAY™ RESORT March 10-17, 2018 (Voted best Sea Courses resort in 2016) Focus: Save the date – CME AWAY™ Resort Resort: Hard Rock (family friendly all-inclusive) >

> INDIA AND SRI LANKA CME AWAY™ CRUISE March 23-April 7, 2018 Focus: Endocrinology, neurology and dermatology Ship: Celebrity Constellation AUSTRALIA GREAT BARRIER REEF CME AWAY™ CRUISE March 30-April 11, 2018 Focus: Cardiology, obstetrics, pediatrics and cultural anthropology Ship: Celebrity Solstice MARQUESAS – TAHITI CME AWAY™ CRUISE April 14-28, 2018 Focus: Save the date – CME AWAY™ Cruise Ship: Paul Gauguin HAWAII CME AWAY™ CRUISE May 3-13, 2018 Focus: Endocrinology and cardiology Ship: Royal Caribbean Radiance of the Seas ITALY AND CROATIA CME AWAY™ CRUISE May 28-June 10, 2018 Focus: Save the date – CME AWAY™ Cruise Ship: Celebrity Constellation AMSTERDAM AND NORMANDY CME AWAY™ CRUISE June 7-17, 2018 Focus: Gynecology and psychology Ship: Azamara Journey BORDEAUX RIVER CME AWAY™ CRUISE June 10-17, 2018 Focus: Neurology and infectious disease Ship: Uniworld River Royale MEKONG RIVER CME AWAY™ CRUISE October 16-31, 2018 Focus: Neurology and endocrinology Ship: AmaWaterways – AmaDara For current promotions and pricing, contact: Sea Courses Cruises TF 1.888.647.7327 cruises@seacourses.com www.seacourses.com

SERVICES

SAVE THE DATE

ACCOUNTING AND CONSULTING SERVICES

PRACTICAL PRACTICE FOR PRACTITIONERS

Independent consultant, specializing in accounting and tax preparation services, including payroll and source deductions, using own computer and software. Pick up and drop off for Edmonton and areas, mail or courier options available for rest of Alberta.

Edmonton AB September 30

Contact: N. Ali Amiri, MBA Consultant Seek Value Inc. T 780.909.0900 aamiri.mba1999@ivey.ca aliamiri@telus.net

algo+med algo+med are a medical billing service submitting to both Alberta Health and Workers’ Compensation Board Alberta. We provide timely submissions, detailed reports and advanced analytics of billing data. Our processes are secure, ensuring privacy and confidentiality of both physician and patient information. Our rates are competitive and new clients receive their first month free. Contact: T 1.866.218.8041 www.algo-med.com

Royal Alexandra Hospital, division of gastroenterology will be hosting a one-half day workshop for family physicians. More information to follow in the July-August Alberta Doctors’ Digest.

DISPLAY OR CLASSIFIED ADS TO PLACE OR RENEW, CONTACT:

Daphne C. Andrychuk Communications Assistant, Public Affairs Alberta Medical Association T 780.482.2626, ext. 3116 TF 1.800.272.9680, ext. 3116 F 780.482.5445 daphne.andrychuk@ albertadoctors.org

DOCUDAVIT SOLUTIONS Retiring, moving or closing your practice? Physician’s estate? DOCUdavit Solutions provides free paper or electronic patient record storage with no hidden costs. We also provide great rates for closing specialists. DOCUdavit Solutions has achieved ISO 9001:2008 and ISO 27001:2013 certification validating our commitment to quality management, customer service and information security management. Contact: Sid Soil DOCUdavit Solutions TF 1.888.781.9083, ext. 105 ssoil@docudavit.com

MAY – JUNE 2017

MD GIVES FINANCIAL ADVICE THAT EVOLVES WITH

MY LIFE. Dr. Edward Kucharski, Family Physician

Trust your MD As a CMA company, we understand physiciansâ&#x20AC;&#x2122; finances better than anyone. For personalized advice, call 1 800 267-4022 or visit md.cma.ca. MD Financial Management provides financial products and services, the MD Family of Funds and investment counselling services through the MD Group of Companies. For a detailed list of these companies, visit md.cma.ca.