Alberta Doctors' Digest September/October 2017 by Alberta Medical Association

Alberta Doctors'

DIGEST September-October 2017 | Volume 42 | Number 5

Our #GOATs are doing great things to promote physician wellness An interview with Dr. Sue Reid Over $69,000 raised for medical student bursaries 90th Annual North/South Doctorsâ&#x20AC;&#x2122; Golf Tournament was a huge success!

Taking it to the community

AMA Youth Run Club ends fourth year on a high note

Income for the soul

Project Outreach brings medical care and learning to children in need

Patients FirstÂŽ

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 Co-Editor: Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP Editor-in-Chief: Marvin Polis President: Neil D.J. Cooper, MD, FRCPC, Dip. Sport Med. President-Elect: Alison M. Clarke, MD, CCFP, FCFP Immediate Past President: Padraic E. Carr, BMedSc, MD, FRCPC, DABPN 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 November-December issue deadline: October 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. © 2017 by the Alberta Medical Association Design by Backstreet Creative

4 From the Editor 14 Letters 16 Health Law Update

24 Dr. Gadget 34 In a Different Vein 38 Classified Advertisements

FEATURES

6 From the Editor-in-Chief

Put on your own oxygen mask first and what's up with eADD?

8 PFSP: Our #GOATs are doing great things to promote physician wellness

Interview with Dr. Sue Reid

1 1 PFSP: Anxiety in our children

What do they have to worry about anyway?

19 Over $69,000 raised for medical student bursaries

90th Annual North/South Doctors’ Golf Tournament was a huge success!

20 Closing the gap between primary and specialist care

Primary Health Care Integration Network launched to address integration challenges

22 Income for the soul

Project Outreach brings medical care and learning to children in need

23 Creating life-changing results

Calgary medical residents bring their skills and knowledge to Vietnam

26 Taking it to the community

AMA Youth Run Club ends fourth year on a high note

30 Private corporations and tax planning under review

What you need to know

32 Emerging Leaders in Health Promotion grant program

CALL ME – Canadians Alleviating Loneliness and Longing by Mingling with the Elderly

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:

Dr. Sue Reid, Director, Office of Staff Wellbeing, Faculty of Medicine & Dentistry, University of Alberta and Resident Wellness Rounds Coordinator SEPTEMBER – OCTOBER 2017

FROM THE EDITOR

When breath becomes air Dennis W. Jirsch, MD, PhD | EDITOR

spend a fair bit of time in bookstores and like to think I forage widely, but I approach books written by medical doctors with certain trepidation. Many of these books promote a particular therapy regarding diet, drugs, creams or other potions. In spite of this, I recently picked up a small book that has been on non-fiction best-seller lists and finished it in an evening. I’ve been missing out. It’s a must read. When Breath Becomes Air1 was written by Dr. Paul Kalanithi, a young Stanford neurosurgical resident about to complete six years of training. Kalanithi found that he was losing weight – two notches on his belt – at the same time he was experiencing night sweats and intermittent back pain. He feared the worst. Indeed, investigation revealed Stage four lung cancer, unrelated to cigarettes and his world turned upside down. Kalanithi’s plan before this had been to combine his interest in literature and writing with clinical neurosurgery, and he sent his best friend an email revealing his dire circumstances, adding, “The good news is that I’ve already outlived two Brontes, Keats and Stephen Crane. The bad news is that I haven’t written anything.”

I’d argue that Paul Kalanithi’s vigorous

and full involvement in life make his memoir more of a guide to living than an aid to dying.

His email reflects a sense of humor that would serve him well. Cancer killed him 22 months later, but Kalanithi was able to pen his memoir in the interim. There is wide agreement that he produced a small masterpiece.

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Dr. Abraham Verghese, author of the recent fictional best seller, Cutting for Stone,2 and also a physician at Stanford, provided an introduction for Kalanithi’s book. “Finishing this book and then forgetting about it is simply not an option,” Verghese said. Kalanithi begins his story with the diagnosis that overturned his world, but he reminisces regarding earlier years. At age 10, his family moved from New York to Kingman, Arizona so that his cardiologist-father could establish a practice. The schools in Kingman were subpar, so Kalanithi’s mother urged him to read classic literature, which initiated his appreciation of the written word and led to further studies in literary theory at Stanford. Though the young Kalanithi obtained several undergraduate degrees and a master of arts in English literature, at some point he began to question whether literature held the answers to life’s big questions, so he began to take the prerequisite courses for medical school. He spent a year studying medical history at Cambridge before beginning medical school at Yale, where Lucy, his wife-to-be, was also a student. Post-graduation, they returned to California and to Stanford to begin residencies in neurosurgery and internal medicine respectively. Things ran on plan until Kalanithi was near the end of his neurosurgical training and his diagnosis of advanced cancer was received. His memoir was written in the last 22 months of his life. In the aftermath of his diagnosis, Kalanithi grappled with the diagnosis he’d been given and sought answers that would give his life meaning. He read anything he could find pertaining to man’s mortality, including Heidegger’s Being and Time, C.S. Lewis’s Mere Christianity and Alexander Solzhenitsyn’s Cancer Ward. He wrote an essay, How Long Have I Got Left?3 that was published in the New York Times in January 2014. The work was an immediate sensation. His cancer responded, for a time, to medication and Kalanithi-as-author was launched. >

> Kalanithi is nothing if not honest. The relationship with his wife Lucy foundered under the weight of plans gone awry and together they sought counselling and therapy. They decided to have a child, even as his cancer continued its inexorable march. On chemotherapy, Kalanithi was even able to resume some of his duties in the operating room, but not for long. He succumbed to his tumor and died at the age of 37 on March 19, 2015. Lucy found the manuscript on his computer. She completed and edited it from his notes and added an epilogue in which she describes his last courageous hours.

So go to the bookstore.

Buy this book. Read it. You will find it unputdownable – and more, you will live more fully because of it.

The book he wrote is profoundly sad and even heartbreaking, but its most notable feature is its honesty – the candid reaction of a physician brought up short by looming death. He tackled the big questions: What makes life worthwhile in the face of looming calamity? What does one do when the future vanishes and there is only a perpetual present? What does it mean to have a child as one prepares to die? He’d read and incorporated the best of the great authors, but found that all answers are at best incomplete: “I began to realize that coming face-to-face with my own mortality, in a sense, had changed nothing and everything.” And then the line from Beckett that would become the motto or byword for the truncated life he led thereafter: “I can’t go on. I’ll go on.”

He pushed on, yielding only when there were no alternatives. He wrote even though he was exhausted and knew he would fail, after the operating room, late at night, even during chemotherapy. Kalanithi’s memoir is spare, even austere, but it is strong, clear and unambiguous. Sprinkled throughout are quotations from authors he found compelling. As Verghese had noted, his writing is a joy to read and has at times the cadence and rhythm of poetry. His authorial voice is so assured and deft that the reader expects it to go on forever, describing what happens to friends and family after he’s gone. Then the voice stops and his death, like all deaths, though anticipated, came suddenly, a surprise. The magic here – and there is magic! – has to do with Kalanithi’s resilience and grit in the face of such insuperable odds; he triumphed by continuing to live fully, investing the short time he had left with full commitment to Lucy and Cady, the daughter born just months before he died. As a reader and physician, I have little choice but to recall the long and diverse tragedies I was privy to in clinical practice: the multiple miseries and the sudden or protracted deaths that constitute the human condition. Forever, it seems that we have talked and worried about “a good death.” I’ve read about the Ars moriendi,4 two Latin texts from the 15th Century which offer advice on the protocols and procedures of a good death, perhaps the first in a long tradition of guides to death and dying. I’d argue that Paul Kalanithi’s vigorous and full involvement in life make his memoir more of a guide to living than an aid to dying. So go to the bookstore. Buy this book. Read it. You will find it unputdownable – and more, you will live more fully because of it. References available upon request.

SEPTEMBER – OCTOBER 2017

FROM THE EDITOR-IN-CHIEF

Put on your own oxygen mask first and what's up with eADD? Marvin Polis | EDITOR-IN-CHIEF

he Physician and Family Support Program (PFSP) is one of those very important Alberta Medical Association (AMA) programs that keeps powering along in the background of the association. Year-after-year, it supports our colleagues when they are in crisis and it provides education and support for us and our families to stay healthy and balanced day-to-day.

In this issue of Alberta Doctors’ Digest, we are featuring two useful and inspiring PFSP articles. First, we launch a series of profiles about the GOATs of physician wellness. What’s a GOAT? Read on and find out! Then, we learn about anxiety in our children and what we can do about it. PFSP encourages you to put on your own oxygen mask first and don't be afraid to ask for help! So here’s to the PFSP, everything it has accomplished and will continue to accomplish. We hope you will enjoy these special features! ln other news, we recently announced our intention to transition Alberta Doctors' Digest (ADD) to an all-digital format. I'm pleased to report that the transition is underway and we are on schedule to launch the new format early next year. This is very exciting because with digital distribution we'll be able to enhance ADD beyond the printed word. We are exploring rich media such as video, audio and greater use of photography. We will have more tools at our disposal to bring you great stories about Alberta's doctors! Some members have offered the feedback that they prefer reading a paper publication, so that option will remain. You will be able to read ADD on screen. lf you prefer, you'll be able to print the entire issue on your own printer (or just certain stories) if you want a tactile experience. As we continue to plan the transition to an all-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

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COVER FEATURE/PFSP PERSPECTIVES

Our #GOATs are doing great things to promote physician wellness

hrough the years, we in the Physician and Family Support Program have been impressed by physicians who are supporting the wellness of their colleagues and the various ways they are creating a more open, supportive and compassionate culture for Alberta physicians. So in this and future issues of Alberta Doctors’ Digest, we will acknowledge the work of some of these students, residents and physicians. We’ll give you a glimpse of who is doing what on the ground to promote physician wellness. In our eyes, each of these individuals is a #GOAT (Greatest Of All Time). Our first Physician Wellness #GOAT to be profiled is Sue Reid, MBBS, FRCPC, Director, Office of Staff Wellbeing, Faculty of Medicine & Dentistry, University of Alberta and Resident Wellness Rounds Coordinator. To get her perspective on physician wellness, we caught up with her fresh off vacation and preparing to host her podcast series Real People in Anesthesia.

Dr. Sue Reid gets our physician wellness #GOAT What three words describe the current state of physician wellness? Burnout. Depression. Imbalance. What three words (or statements) describe your goals for physician wellness? Leadership. Institutional and cultural change. Sharing of challenges and solutions.

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What are you currently working on? In addition to creating my very own podcast, I’m working on next month's Wellness Newsletter, a talk for our residents and a wellness presentation for the Alberta Anesthesia Summit conference. Plus, I’m eagerly anticipating the Canadian and US physician wellness conferences in the fall. As a physician yourself, what is something you do intentionally to take care of your mental health? I meditate. I start. I stop. I start again. (I wholeheartedly recommend the Headspace app.) What is your cue that an area of your own wellness needs your attention? Losing self-confidence. Feeling overwhelmed. Emotional eating. What area of your wellness do you find the most challenging to look after? Physical health and exercise. How are the challenges of your wellness different now than earlier in your career? Earlier in my career I didn't have the tools to support my mental health. I became burned out and depressed, but fortunately PFSP was there to help. What can your colleagues expect from you as the chair of the wellness of anesthesiology? Passion, enthusiasm, commitment and humor! If you had the magic wand for physician wellness, what would you do? I would disable our perfectionism, activate our self-compassion and make self-care the norm. What one thing do you want your colleagues to know? We are all human; we are in this together. Put your own oxygen mask on first and don't be afraid to ask for help. Also don't believe everything you think! >

> With respect to physician wellness, who (or what) gets your #GOAT? My #GOAT goes to Dr. Gigi Osler, President-Elect, Canadian Medical Association (CMA), who is committed to making the CMA a leader in physician health. She also tweets cute pictures of her adorable dog!

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Got #GOAT? We know many students, residents and physicians are doing good things for their colleagues’ wellness. Let us know who gets your physician wellness #GOAT, by emailing pfspadmin@albertadoctors.org. Editor’s Note: Throughout her campaign, Dr. Osler promised to address physician health, ensure work-life balance and promote leadership development for all physicians. Excellence in medicine runs throughout her family, as Dr. Osler is the great-great-great niece-in-law of Sir William Osler, one of Canada's most famous physicians and former CMA president.

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COVER FEATURE/PFSP PERSPECTIVES

Anxiety in our children

What do they have to worry about anyway? Sharron L. Spicer, MD | ASSESSMENT

hysician health has gained a lot of attention over the past decade in the professional and lay media. We are recognizing the paradox that some of the traits that make good doctors may also pose risks to physicians’ own well-being. It has become widely known that many physicians struggle with underlying perfectionism and anxiety that can contribute to depression, anxiety disorders, addictions and other mental health conditions. Not surprisingly, many of our colleagues’ children also demonstrate some of these same tendencies. This observation is borne out in my conversations with other physicians. I am amazed by the number of times that a coffee or lunch with colleagues has led us to mutually confide about our children’s struggles with mental health issues, school and learning difficulties, and the social demands of today’s world. As we begin another school year, it seems a good time to reflect on the challenges that our children face with managing stress within the school context. School is the workplace of children and youth. Along with gathering the usual back-to-school supplies to fit in their backpacks, let’s consider how to equip them for the anxiety they may face.

What contributes to childhood anxiety? Stress is a normal, even healthy, part of life for all of us. Yet for some, anxiety can be overwhelming. There is an epidemic of anxiety in young people of our society. About 8% of youth have a diagnosed anxiety disorder. That’s about two per classroom. Or, put another way, if you know more than 12 kids, chances are good that at least one of them struggles with anxiety. The face of anxiety is not always a worried child. Anxious kids can be inattentive, have emotional lability, resist change, struggle with social interactions or have trouble sleeping. Some may externalize with disruptive features,

PHYSICIAN, PFSP

while other may show more internalizing features. Children with other emotional or learning issues, such as attention deficit disorder, giftedness or learning disabilities, may be more susceptible to anxiety. As with many characteristics, psychological features are affected by a multitude of biological and social or environmental factors; both “nature” and “nurture” impact personality. I am not a behavioral researcher per se, other than being an observer of human behavior as a pediatrician, a physician leader, a parent and an active community member. My own observations have led me to wonder about the social influences that have contributed to the dramatic rise of anxiety in youth. Twenge et al. (2010) points out that within the social environment, the individual family unit is less predictive of individual variation than cultural influences. They further suggest that a cultural shift over the past half century toward extrinsic goals (such as money, status and narcissistic pursuits) over intrinsic goals (such as competence, affiliation and autonomy) is strongly correlated with the increase in psychopathology among high school and college-aged youth. Here are some of my observations about the stresses that youth face more than ever before.

The stress of competition From a young age, many of our children’s pursuits are achievement-oriented: lessons, performances, tournaments and competitions. These pursuits have roles in shaping character and promoting delayed gratification. Yet we need to be sure that enjoyment comes from engaging, not just achieving. As kids move into adolescence, competition can become more subtle but more powerful; social media can intensify their perceptions of their social status based on body image, number of friends or followers and the exploits described or exaggerated by other teens. With adolescents developing their own sense of self, they usually compare themselves unfavorably to their peers or celebrities when they use social media as their reference. >

SEPTEMBER – OCTOBER 2017

> The stress of overload Children have long days at school; many attend pre- or after-school care or have long bus rides. They often have many extra-curricular activities, homework and other academic demands. If you feel frazzled driving them from place-to-place, think about whether they have the same degree of stress from participating in those activities.

The stress of isolation Our children’s social worlds are more fragmented than I recall from my own childhood. It is less common for children to have close connections with grandparents or extended family; for those families who do, it can ease child care in the younger years and add a layer of social connection. It seems that groups such as schools, teams and clubs are now spread out and draw from larger pools of people. No longer is the neighborhood the natural meeting place for social connections. Families are smaller and young people may spend more time at home without parents or siblings. Connections via social media do not replace relational connectedness.

The stress of social consciousness Children are introduced early to social causes. When my daughter was in kindergarten, one of the classroom assistants brought in her father for Terry Fox Day. Like Terry, he had had a leg amputated after a cancer diagnosis. Demonstrating his prosthesis to the wide-eyed youngsters no doubt made the experience real for them – so real, in fact, that for the next year, my daughter’s bedtime prayers included, “Please, God, don’t let me get cancer.” Not long afterwards, the girls of her Brownies unit were introduced to an animal fostering program. Their naïve hearts were torn by the thoughts of poor abandoned puppies needing rescuing. Yes, we are raising a generation of children with a social conscience – but is it at the cost of burdening them early with too much knowledge of what is bad in the world?

Managing anxiety Whether a normal degree of worry or one severe enough to have a diagnosis, some of the tips for managing anxiety are the same. 1. Promote good sleep habits. Nobody does well when sleep deprived, kids especially. Shut off the electronics one to two hours before bedtime. Keep phones and devices out of the bedroom. Make reading a part of the bedtime routine. Ensure your child has enough time for sleeping, especially when academic and extra-curricular activities may consume many of the after-school hours. Caution teens about the use of caffeine; it is not a substitute for sleep and its side effects can mimic or increase the physical manifestations of anxiety. 2. Ensure good nutrition. If your household is anything like ours, breakfast is a rushed affair. Smoothies are a great morning option. Easy to make with some AMA - ALBERTA DOCTORS’ DIGEST

yogurt, frozen fruit or green vegetables, a spoonful of nut butter and a bit of milk or soy, they’re acceptable to kids for their taste and to parents for their nutrition. School lunches are a challenge. You need to find nutritional choices, ensure it stays cool (or hot) until lunch, is easy to unwrap (first-grade fingers might have trouble opening certain containers), complies with peanut-free polices and isn’t too weird for a kid to eat in front of their friends. Plan with your kids about what works for them. If an evening meal is the only time your family eats together, make it a time to have a good protein source and add those healthy fruits and vegetables. Maybe the leftovers can go in their and your lunches the next day. Involve the family in menu selection, food prep and clean up. 3. Keep time for children (and you) to play. We need to be sure that our kids have time to relax, play, explore and satisfy their curiosity. The benefits of exercise, laughter and imagination are not just for kids; you will benefit, too. 4. Use online resources. A plethora of web-based material is available for children and youth. One reliable source of information is AnxietyBC® (youth.anxietybc.com). Many online games and apps coach kids in the basics of cognitive behavioral therapy. 5. Don’t be shy about seeking professional help. Just as we physicians can benefit from the objective advice of health professionals, so can our kids. Your family doctor or pediatrician is a good place to start. Other therapists, such as psychologists, have advanced training in cognitive strategies to help children with emotional regulation and they can also offer in-depth testing to identify factors such as learning and attention difficulties, giftedness, depression and anxiety disorders. The Physician and Family Support Program (PFSP) offers services to eligible physicians’ immediate family members (albertadoctors.org/ services/pfsp/i-need-help-now). 6. Work with your child’s school and teacher to identify strategies to use when stress is mounting. For example, they might arrange that the student can seek a quiet place, listen to music or have a burst of exercise to manage stress. Academic demands or test environments might be altered. Open communication with the teacher about their observations and concerns is important. When anxiety becomes a significant issue, an individual program plan created by the school with student and parent input might be helpful. 7. Help kids find their “tribe.” Giving kids opportunities to connect in meaningful ways with peers and trusted adults can be very enriching. This can help them develop a sense of individuality and self-esteem while being connected to something broader than themselves. Many clubs have opportunities for youth to teach younger members or provide community service. These opportunities can add to the intrinsic rewards that foster fulfillment. >

> 8. Seek out supportive adult role models for your children. It’s good for kids to have positive adult influences apart from their parents. Grandparents or other extended family, coaches, teachers or youth leaders can provide positive influences and may give credibility that teens don’t seem to find in their parents.

Dr. Spicer is a pediatrician in Calgary. She is a recent alumnus of the CanREACH Primary Paediatric Psychopharmacology Program. References available upon request.

9. Share your challenges with sympathetic and like-minded parents. Having the suggestions and support of other parents can be very supportive. Just be careful to keep the details of your kids’ lives private, especially as they get older. 10. Be patient with your kids and yourself. Believe it or not, their anxiety is not just a means to push your buttons. Take consolation that while your parenting has not likely caused their anxiety, it is an effective tool to help them manage it.

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LETTERS Dear Editor:

lease let Dr. Alexander Paterson know that I absolutely love his humor and witticisms. As a fellow Scottish immigrant from '75 (general practitioner surgeon in Canmore now retired), I look forward to his erudition and perspicacity and tongue-in-cheek politicizing. Lang may yer lum reek Sandy. Yours truly, T. Wally Bryson, MB, ChB, FRCS (Glas.) Canmore AB

mobilization networks.” Look at Alberta: • A closed state: (Alberta Medical Association and government) – partly. • A growing state crisis: (finances: provincial, federal and now professional) – yes! • Elite divisions: (special interest groups) – yes! • Tensions – yes! • Rapid educational expansion: (young doctors needing jobs) – yes! • Popular grievances aligned with mobilization networks – yes!

Dear Editor:

“T

he peasants are revolting” in the Ontario Medical Association (OMA)!

Apologies to Brant Parker, author of “The Wizard of Id,” for using his classic line, to which the King sourly responds, “You can say that again!” The introduction makes light of a very serious problem in the OMA. One article, The Doctors' Revolt (Toronto Life, September 29, 2016) has a section headed Ontario doctors are engaged in civil war. Revolution is driven by hopelessness that comes from overpowering change and inadequate representation. Eventually people take up the modern equivalent of the pitchfork and torch … and revolt! Ellens noted revolution has “… necessary factors: a closed state, a growing state crisis, elite divisions or tensions – frequently coupled with rapid educational expansion – and popular grievances aligned with

AMA - ALBERTA DOCTORS’ DIGEST

The Alberta Medical Association (AMA) is experiencing similar stressors to the OMA. To avoid war, we must first ensure the health of our democracy and representation. The biggest problem with democracy in the AMA is member apathy. Some will use the ratification vote on the Amending Agreement (AA) as an example; I believe that showed member confusion because the AA was complex and ill defined. The Schedule of Medical Benefits (SOMB) Rules Savings Initiative would change fee codes later, making the AA impossible to assess. The 74% in favor came from 29% voter turnout – so four of five members were silent or opposed to the agreement. What organization makes drastic changes on the mandate of only 30% of its members? Is that a democracy which all of us will continue to support? If fees and benefits keep going south, the majority will not remain silent forever.

A really bright point in the AMA is the diversity in the Representative Forum (RF), which is the governing body of the AMA. It has delegates from every section and zone with students, residents, universities, etc. One difficulty is how slowly the RF works as there are only two regular meetings a year. Now I hear some sections are trying to pack extra delegates into RF through other channels such as zonal delegates. If so, they are acting like special interest groups. Part of trust in an organization comes from transparency. AMA members should be able to review the work done by our representatives. Until recently, direct access to previous RF motions was restricted to RF delegates! I was assured that by September, all members will have direct access to RF motions. The excellent broad-based representation at RF does not correlate with balanced representation at the board of the AMA level. For example, there has never been an AMA board member from Central Zone! Even if a rural nominee is guaranteed every rural vote, the nominee would only have approximately 30% of the total so would depend on urban votes to succeed. Dr. Padraic E. Carr, AMA President (now immediate past president), said this is democracy … maybe, but it is not good representation. When he was speaker, Dr. Carl W. Nohr taught me that debate is a cornerstone of democracy. The lack of debate means the minority loses the opportunity to persuade the majority of the validity of their cause. He wisely noted that – sometimes – each of us will be in the minority! >

> It is important not to waste time on trivial motions, but what happens when important motions are crippled and not debated? There are many effective tactics to cripple a motion: “refer to the board,” “table” the motion or indeed “table indefinitely,” as happened to the most important motion I ever submitted to RF (curiously making AMA history as the only “table indefinitely” motion since 1996, when the AMA started electronic tabulation of motions.) Motions are also hobbled when they are relegated to the end of a meeting where they receive limited

discussion or die from lack of time. This occurred at the Spring 2016 RF when five motions on medical assistance in dying (MAID) came to the floor in the remaining 20 minutes of Members’ Hour, at the end of that one-and-a-half day meeting (and after over 40 hours of RF meetings since Carter). I dare anyone to tell me that 20 minutes for five motions on any issue profoundly affecting the profession – and our patients – is democracy in action. There is truth in the phrase “divide and conquer!” Some bureaucrats

and politicians will be happy with the AMA gong show as we struggle with fees, remuneration and serious issues like MAID. If we do not correct the internal weaknesses in our representative processes, we will see the peasants are revolting in the AMA. And sadly, having been treated like a peasant, I am tempted to act like one. Yours truly, Kevin M. Hay, MB, BCh, BAO, MRCPI, CCFP, FCFP Wainwright AB

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SEPTEMBER – OCTOBER 2017

HEALTH LAW UPDATE

High times ahead

How will cannabis legalization affect physicians? Jonathan P. Rossall, QC, LLM | PARTNER, MCLENNAN ROSS Nathaniel Brenneis | ASSOCIATE, MCLENNAN ROSS LLP (R)

LLP (L)

Some highlights of the legislation include the following: • Bill C-45 will prohibit anyone from selling cannabis to any person under the age of 18. • Adults will be permitted to possess up to 30 grams of dried cannabis in a public place.

his past April 13, the federal government finally released Bill C-45, the “Cannabis Act,” to considerable fanfare and buzz. Bill C-45 proposes a regulatory framework for legalizing cannabis for recreational purposes in Canada. The federal government has indicated that it expects Bill C-45 to receive Royal Assent no later than July 2018. In the meantime, researchers, entrepreneurs and policy-makers across Canada are scrambling to prepare for the effects of this new law.

Many uncertainties and potential

dangers still surround the use of cannabis. As a whole, the medical community remains divided and non-committal to using cannabis as a form of treatment.

What’s in the Bill? Bill C-45 generally adheres to the recommendations that the Task Force on Cannabis Legalization and Regulation published in its final report in December 2016. We have previously written on the Task Force’s recommendation in the January-February 2017 issue of Alberta Doctors’ Digest in our story: I get high with a little help from my … prime minister. The predominant themes of Bill C-45 are to promote and protect public health and safety, to prevent youth from accessing cannabis and to deter cannabis-related criminal activity.

AMA - ALBERTA DOCTORS’ DIGEST

• Adults will also be permitted to cultivate up to four cannabis plants per residence. • Bill C-45 contemplates the sale of cannabis in a variety of different forms including dried cannabis, cannabis oils, fresh cannabis, cannabis plants and cannabis plant seeds. Cannabis edibles are currently prohibited, but these have been flagged for regulation. • Licensed cannabis producers under the current medical regime will be automatically grandfathered in as licensees under Bill C-45. Bill C-45 will not be the conclusive word on cannabis regulation, however. The statute is designed so that it requires individual provinces and territories to enact legislation to fill in the gaps and address the public health and safety objectives across the country. Provincial and territorial governments will also be responsible for licensing and overseeing the distribution and sale processes. This includes the abilities to increase the minimum age requirement, lower the amount of cannabis permitted for personal possession within their jurisdiction, create additional rules and requirements for the growth of cannabis plants at home and restrict locations where cannabis may be consumed.

How will the bill affect doctors? What does Bill C-45 mean for physicians? At first glance, not a whole lot. As recommended by the Task Force, the current regulatory regime will remain in place. This means that the Access to Cannabis for Medical Purposes Regulations (ACMPR) will continue to govern the production, distribution and sale of cannabis for medical purposes. The role of health care practitioners is unchanged by the introduction of Bill C-45 and physicians will essentially continue to serve as the sole gatekeepers for patients who want to use cannabis to treat their ailments. >

> As with the previous regulations, an individual who requires cannabis for medical purposes must first get a medical document from an authorized health care practitioner. Specifically, under the ACMPR, the medical document must contain similar information to a prescription, including: • the patient's name and date of birth • a period of use of up to one year • a daily quantity of dried marijuana expressed in grams • the authorized health care practitioner's license information

Recent reports suggest, however,

that Alberta doctors are becoming increasingly open to the idea of prescribing cannabis to their patients.

While the pending legalization has not brought any new policy developments, it may be signaling a cultural shift amongst physicians. Many uncertainties and potential dangers still surround the use of cannabis. As a whole, the medical community remains divided and non-committal to using cannabis as a form of treatment. Recent reports suggest, however, that Alberta doctors are becoming increasingly open to the idea of prescribing cannabis to their patients.

According to the latest stats published by the College of Physicians & Surgeons of Alberta (CPSA), the number of doctors prescribing cannabis in the first four months of 2017 increased 50%. At the end of 2016, 329 doctors in Alberta were registered to authorize cannabis use as a treatment for 5,254 patients. By April of this year, 495 doctors were filling prescriptions for close to 10,000 Albertans. Regardless of what motivated these newly registered physicians to start prescribing, this trend is likely to continue as legalization nears and cannabis becomes a larger part of everyday Canadian life. The Canadian Medical Association, Alberta Medical Association and CPSA encourage physicians to maintain a cautious approach while policymakers come to grips with how the new regime will affect the old regime. After all, many unanswered questions remain. For example, how will the relative percentages of CBD and THC be regulated? Will cannabis be covered under patients’ health insurance? Will it be included on Alberta’s hospital formulary systems? Will it be monitored by the CPSA Triplicate Prescription Program? We will be closely tracking these issues as the July 2018 deadline approaches.

CORRECTION In the July-August issue of Alberta Doctors’ Digest, an incorrect link was provided in Health Law Update to a Canadian Medical Protective Association reference about CME risk management. The link should have been www.cmpa-acpm.ca/static-assets/pdf/adviceand-publications/risk-management-toolbox/com_ electronic_records_poster_11x17-e.pdf.

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FEATURE

Over $69,000 raised for medical student bursaries 90th Annual North/South Doctors’ Golf Tournament was a huge success thanks to generous sponsors and donors!

hysicians and health care leaders from across the province teed off June 26 at the Red Deer Golf & Country Club. Together with sponsors, they raised over $69,000 for medical student bursaries – the largest amount raised in the tournament’s history. Best of all, the proceeds will be matched dollar-for-dollar.

Thank you to our

sponsors

Participants enjoyed a great day of golf, breakfast, lunch and prize draws. World Long Drive Champion (2014), Vinny “The Pasta Man” Ciurluini wowed guests and helped raise more money by accepting donations in exchange for taking golfers’ first drives on a tough par 5. Eleven medical students and residents were sponsored by the College of Physicians & Surgeons of Alberta (CPSA) to join in the fun. They got a chance to show off their golf skills and network with CPSA and Alberta Medical Association staff.

Presenting sponsor

Eagle sponsors

Birdie sponsors

Thank you to all participants and sponsors for making this year’s tournament a success. See you on the links in 2018!

The Annual North/South Doctors’ Golf Tournament is co-hosted by the College of Physicians & Surgeons of Alberta, Alberta Medical Association and the Canadian Medical Foundation.

(L to R) Dr. Padraic E. Carr, Dina Baras and Cameron Plitt

(L to R) Dr. Rachel Delacretaz-Jaunich, Julianna Zenke and Terry Godbout

Par sponsors

(L to R) Colleen Turner and Mauricio Vizconde

SEPTEMBER – OCTOBER 2017

FEATURE Closing the gap between primary and specialist care Primary Health Care Integration Network launched to address integration challenges

ne of the most substantial challenges for physicians is system integration between primary care clinics, Primary Care Network (PCN) services and the rest of the health care system, according to Dr. Brad Bahler. Dr. Bahler believes there is a solution. He is the senior medical director of the newly launched Primary Health Care Integration Network (PHCIN), which was established to broker connections to advance initiatives that improve transitions and integration of care.

“Primary and specialty care physicians are faced, on a daily basis, with a difficult system that is poorly coordinated and creates challenges for our patients,” said Dr. Bahler, adding that when patients can’t access the services they need such as specialty procedures or diagnostics, primary care physicians are the ones closest to the issues. “We designed this network to work locally with partners on real life challenges of integration,” said Dr. Bahler. “That’s important rather than working conceptually at a higher level.” Dr. Bahler said improving these challenges can’t be done well unless there is an organized group of both primary and specialty care physicians working together to solve the problems. “Also, this only works if you keep the patient experience and journey top-of-mind during the entire process.” The PHCIN is a customized Strategic Clinical Network™ (SCN) within the Alberta Health Services (AHS) Provincial Primary Health Care Program. Working closely with several key partners including patient/family advisors, AHS zones and provincial programs, PCNs, the Alberta Medical Association, the Primary Care Alliance, other SCNs, Alberta Health and academic partners, the PHCIN will work to improve transitions of care at every level. Several system integration initiatives were already underway even before the PHCIN officially launched. Dr. Bahler outlined the challenges in central Alberta

AMA - ALBERTA DOCTORS’ DIGEST

involving COPD and heart failure patients who were transitioning out of the hospital. “How do we work collaboratively with specialty and acute care to make sure? First, every one of those patients has a medical home. Secondly, those family physicians get the right information when their patients are discharged. Finally, when patients are back in the community, they have good access to advice and medical care to keep them from being readmitted to hospital.” These are the types of initiatives the PHCIN will tackle. In addition to its many partners, the PHCIN receives guidance from a coalition for integration. Dr. Bahler co-chairs the coalition, along with a patient representative. “This is an independent think tank to bring knowledge, ideas and connections to integration challenges.” The structure of the PHCIN will align with the new zonal councils that were recently announced as part of the new governance framework for PCNs. Physicians, clinics and PCNs will work collaboratively through the five zonal councils to identify challenges in realizing high-functioning medical homes for patients in the system and to pursue solutions to address them. Anticipated benefits to primary care physicians and teams for strengthening the patient’s medical home include the following: • Improved and appropriate access to specialist physicians for advice and patient referrals. • Improved ability to participate in care planning for patients in other parts of the health system. • More comprehensive and timely information about patients who are transitioning from acute care into the community, resulting in better continuity of care. • Opportunities to provide leadership in provincial initiatives that improve integration and advance other aspects of health system transformation in alignment with PCN evolution plans. • Improved access to care pathways, guidelines and other tools that enable better care for patients.

FEATURE

Income for the soul Project Outreach brings medical care and learning to children in need

ediatric anesthesiologist Dr. M. Ruth Connors had been in Calgary for only a year when she did her first medical mission to the developing world in 1992. “It was an eye-opening experience,” she recalls. Inspired by the mission, she decided to form an organization that could take Calgary-based medical professionals where they were needed most. Together with her colleague, Dr. Roger Galbraith, Project Outreach was established in 1993 with dual goals: to provide much-needed medical services to children in the developing world and to increase medical capacity within the communities they visited. For the organization’s first mission 24 years ago, staff from Alberta Children's Hospital traveled to Danang, Vietnam, where they worked with a local pediatric surgeon, Dr. Phung, to perform cleft lip and palate reconstructive surgery. As the first medical mission allowed into Danang after the Vietnam War, it was an incredible experience for all involved. “We did have to jump through a few hoops in 1993 to get in,” says Dr. Connors, who, along with the Project Outreach team, was invited to Danang by Dr. Phung. “We were working in a former US Army hospital, complete with those quintessential green stretchers, like you see in the movies.”

AMA - ALBERTA DOCTORS’ DIGEST

Project Outreach has since conducted several other missions, including additional trips to Vietnam, as well as to Ecuador and Peru. They have expanded their focus to include pediatric eye surgery, urology and oncology. In Ecuador, the team focused on pediatric orthopedic surgery and in Peru, they undertook reconstructive burn surgery.

Project Outreach

was established in 1993 with dual goals: to provide much-needed medical services to children in the developing world and to increase medical capacity within the communities they visited.

On each trip, they also hold teaching days for local medical teams on topics of interest. “We want to share skills and knowledge so that we can all learn from each other,” comments Dr. Connors. In 1999, as part of that commitment to learning, the organization sponsored three pediatric nurses to spend a month at Alberta Children's Hospital. A year later, with the support of the College of

Physicians & Surgeons of Alberta, they obtained educational licenses for two physicians from Vietnam to spend three months studying their specialties at Alberta Children’s Hospital. That same year, the organization also sponsored a pediatric anesthesiologist to spend six weeks in Calgary. In addition, Project Outreach members from Alberta Children's Hospital taught at the Institute of Paediatrics in Hanoi, Vietnam from 2000 to 2005. While the Project Outreach teams have changed over the years, Dr. Connors notes that all physician volunteers donate their time and cover their own expenses to travel to the missions. “We do hold fundraising events, including galas,” she explains. “We use the monies raised to cover the costs for nurses and other non-MD team members, and support our commitment to ensuring each child can live a healthy, productive life.” Project Outreach returned to Danang, Vietnam this past April to again help children with cleft lip and palate defects and hypospadias. Another trip to Vietnam is planned for 2018 and further missions will be made to Peru. As long as the need is there, Dr. Connors intends to continue the organization’s work. “It’s an incredible blessing and a privilege to do work in the developing world,” says Dr. Connors. “When you’re able to give in this way, you get so much more in return. It really is income for the soul.”

FEATURE

Creating life-changing results Calgary medical residents bring their skills and knowledge to Vietnam

or Dr. Becky L. Hartley, a fourth-year plastic surgery resident at Alberta Children’s Hospital in Calgary, the chance to travel to Danang, Vietnam to deliver medical care to people in need was too good to pass up. As members of Project Outreach’s most recent medical mission, Dr. Hartley and fellow resident, Dr. Valerie A. Hurdle, spent almost two weeks assisting with plastic surgeries. The two residents joined a multi-disciplinary team of medical professionals at Tam Tri Hospital in Danang. There, the team performed a number of complex cleft lip and palate surgeries, and hypospadias repairs on children and adults who might not otherwise have received medical care.

We know that quality of life, including

eating, breathing and speech – and employability – can be dramatically improved through surgical repair. And that can completely change the trajectory of people’s lives.

“I’m so grateful for the opportunity to be a part of this,” exclaims Dr. Hartley, who had never travelled with a medical mission before and was impressed with the efficiency and effectiveness of the processes. “It was an incredibly busy schedule. We saw more than 100 patients for assessments on our first day,” she says. Surgeries were scheduled for the remainder of the week, with each team tackling four cases each day. “We had Saturday and Sunday off, then operated Monday and Tuesday again before doing follow-up and heading home. From what I understand, that’s a pretty typical schedule for this type of work.” Dr. Hartley notes that while the conditions they worked in were somewhat different than what they were used to in Canada, many of the mission members who were experienced internationally were impressed with Tam Tri Hospital and all were very pleased with what they were able to accomplish. “We brought a lot of our own supplies and equipment,” says Dr. Hartley. “We also brought along our own post-op nurses, to emulate Canadian post-op care.” “We really meshed together well and the OR was so collegial,” she continues. “As a resident, cleft palate surgery is quite a high-level skill and we were able to do really good work for our patients, work that was greatly appreciated by the patients and their families.”

“People were so incredibly grateful and it was really rewarding to see what a difference this could make to them. We know that quality of life, including eating, breathing and speech – and employability – can be dramatically improved through surgical repair. And that can completely change the trajectory of people’s lives.” Both Dr. Hartley and Dr. Hurdle credit Project Outreach plastic surgery lead, Dr. Frankie O.G. Fraulin, Project Outreach developer, Dr. Ruth Connors and the Vietnamese Quang Duc Charity Association – led by Nam Nguyen – for making the experience so positive. “It was so smooth and so efficient. I wouldn’t hesitate to go back.”

(L to R) Dr. Fraulin (plastic surgery lead), Dr. Hartley (plastic surgery resident) and Dr. Hurdle (plastic surgery resident)

To find out more about Project Outreach visit projectoutreachcalgary.org.

SEPTEMBER – OCTOBER 2017

DR. GADGET

The best gadget is the one that’s with you Wesley D. Jackson, MD, CCFP, FCFP

s I considered the topic of this article, it occurred to me that I hadn’t talked about gadgets here for quite some time. My next thought was: Which gadgets should I highlight? Should I focus on artificial skin transplants designed to treat diabetes or power prosthetic devices? Maybe I could review Bluetooth cochlear implants or an artificial iris that responds to light much like the natural eye? What about smart shoe insoles or battery powered clothing? Or contact lenses that monitor blood glucose? Maybe a vibrating pen that makes it easier for Parkinson’s patients to write? Or, perhaps tissue nanotransfection which uses a small coin-sized silicone chip that "injects" genetic code into skin cells, converting them from one type to another?

Flashlight Most smartphones incorporate a flash module that you can quickly access as a flashlight to allow for better visualization in the exam room.

Magnifying glass The camera feature can double as a magnifying glass when you are looking for that corneal foreign body (with no slit lamp available) or need a better look at a skin lesion. However, the latest versions of iOS has a setting that produces a lighted magnifier through a triple-click of the home button. You can find it by following this path: Settings – General – Accessibility – Magnifier (on).

Photocopier

While all of these are interesting, I came to the conclusion that the best gadget I own, and is actually working well, is my smartphone. With that thought in mind, I would like to highlight a dozen uses of this tool in medical practice.

Some of my patients bring in lists of concerns or personal health readings such as blood pressures or glucose readings on paper. Rather than take time to transcribe these documents, I quickly use my phone to take a photocopy, and if my EMR allows it, attach it directly to the chart.

Communication device

Mirror

First and foremost, our smartphones allow us to be in contact with the rest of the world by voice, email or text. Some physicians use encryption software such as Canadian-developed ShareSmart to take clinical photos and discuss patients with their colleagues using text messages in a secure environment.*

I have used the patient’s phone as a mirror using the front facing (Skype or FaceTime) camera in the exam room when the real item is not available.

Camera All modern smartphones have a built-in camera that allows physicians to take high-quality pictures. I often use a different app that allows photo input such as Notes on iOS (iPhone) so that these photos do not go into my photo library. Many electronic medical records (EMRs) use this capability through a dedicated app to allow direct private communication with the patient record.

AMA - ALBERTA DOCTORS’ DIGEST

Timer Your phone helps you easily maintain your schedule by setting timers and alarms.

Personal assistant All modern smartphones understand simple commands to help manage calendars, set reminders, do web searches and even send text messages through Siri, Cortana or Google. This personal assistant function sometimes saves a considerable amount of time. >

> Notepad

Specialized diagnostic tool

Note-taking capabilities are available on all smartphones. Notes can be entered in the usual manner using the keyboard, but most devices also allow for dictation, which I have found generally quite accurate. I have used this as a reminder to follow up with learners on an assignment or to do more in-depth research on a particular patient concern. Most note-taking apps allow you to add photos, web links or soundbites.

Your phone can become, for example, a dermatoscope, an ultrasound viewer, an ophthalmoscope, a sphygmomanometer, a colposcope or a heart monitor using dedicated attachments and their associated apps.

Audio recorder

Like most gadget geeks, I enjoy the thrill of learning about and playing with the newest and best tech toys. I doubt this will change, but I will make a concerted effort to understand and utilize all the power of the best gadget I own – the one that is always with me.

Smartphones are excellent audio-recording devices. It is very possible that your patients are using this feature during your interaction with them. Perhaps in the future, we will be able attach sound files to the patient file, saving considerable charting time.

*Editor’s Note: If you intend to use secure messaging to communicate patient information, even if encrypted, a privacy impact assessment is required for submission to the Office of the Information and Privacy Commissioner of Alberta.

Clinical resource Many medical apps transform our mobile devices into incredibly useful resources. Some of these apps have been reviewed in previous Dr. Gadget articles, and I expect many more will be developed in the future.

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SEPTEMBER – OCTOBER 2017

FEATURE

Taking it to the community AMA Youth Run Club ends fourth year on a high note with 27,000 kids, 455 schools and 154 Alberta communities Vanda Killeen, BA, Dip Ad/PR | SENIOR

COMMUNICATIONS CONSULTANT, AMA PUBLIC AFFAIRS

he Alberta Medical Association (AMA) Youth Run Club (YRC) took its 2016-17 season-end event on the road May 25, as AMA President Dr. Padraic E. Carr joined AMA and Ever Active School (EAS) staff at MacDonald Island Park in Fort McMurray for the club’s second community Fun Run event. “For four years, the AMA Youth Run Club has been expanding, as it introduces hundreds … well, actually thousands, of young Alberta students to this infectiously energetic, school-based, physical activity program that is such a source of joy and satisfaction to all who get involved,” said Dr. Carr, as he brought greetings to the 200-plus Fort McMurray students, teachers and families attending the combined YRC Fun Run/ParticipACTION 150 event. Following on the heels of the YRC’s first community Fun Run, held April 8 at William Hawrelak Park in Edmonton, the Fort McMurray event marked the first time the club has ventured to a northern Alberta community and the second time we’ve hosted a community Fun Run. While the focus is still on the student members of AMA Youth Run Clubs, the Fun Runs in parks – particularly those during non-work hours (evenings, weekends) – seem better-suited to the schedules of students’ families and AMA physicians, residents and medical students.

Advocate for health at your local school As the flagship program of AMA Many Hands™, the YRC provides member physicians, residents and medical students with opportunities to volunteer in schools by delivering School Health Advocacy Talks or helping coach and/or manage a school’s YRC, or to get involved by attending a run and bringing family and friends. During the 2016-17 season, 12 YRC CHAMPions (volunteer physicians, residents and medical students), sometimes in teams of two, visited a dozen schools across Alberta to give School Health Advocacy Talks, using the tip sheets on the AMA website. Youth Run Club CHAMPions are impressed with the positive,

AMA - ALBERTA DOCTORS’ DIGEST

welcoming environment of the students, teachers and the AMA Youth Run Clubs. Strathmore family physician Dr. Ben Sader has worked with teacher Lori Clarke to coach and manage the Brentwood Elementary run club for several years. Commenting on his work with the YRC, Dr. Sader said: “We now have 70 students from grade three to six who join us at lunch twice weekly in fall and spring sessions. Our club has grown in size and we continue to pursue new ideas. Our junior coaches program enlists dedicated grade six students to help with our warm-up and cool-down sessions.” Dr. Sader and Ms Clarke have hosted annual Brentwood Fun Runs (two- and four-kilometer races) and invited other Strathmore and area schools. Dr. Sader has involved residents in the family medicine program as run club coaches and has found the online and consultative resource support of the AMA and Ever Active Schools very helpful.

For four years, the AMA Youth Run

Club has been expanding, as it introduces hundreds … well, actually thousands, of young Alberta students to this infectiously energetic, school-based, physical activity program that is such a source of joy and satisfaction to all who get involved.

“We’re enthusiastic supporters of improving children's physical activity,” added Dr. Sader. “I’m happy to share our story of how far our program has come.” >

> Of his visit and presentation of a School Health Advocacy Talk to the Good Shepherd Elementary School’s Youth Run Club, Calgary pediatric resident Dr. Phil Quon, a frequent YRC CHAMPion volunteer, commented, “The visit went great! The resources and website you referred me to were excellent as well.”

Thank you! The AMA and EAS thank our generous sponsors, Alberta Blue Cross and MD Financial Management Limited for helping to keep YRC on the road! We also thank all of our 2016-17 YRC CHAMPions for their kind and generous contribution of time and support to the AMA Youth Run Club. We look forward to working with our existing and new CHAMPions in 2017-18, as we implement new strategies to increase our partnerships between schools, physicians, residents and medical students.

It's a family affair at the AMA Youth Run Club Live Active Community Fun Run in William Hawrelak Park.

Fort McMurray Youth Run Club participants trek in MacDonald Island Park.

SEPTEMBER – OCTOBER 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

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

YRC PARTNERS

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amayouthrunclub.com

FEATURE

Private corporations and tax planning under review: What you need to know Christina Kuruliak, CFP® | SENIOR

couple of months ago, I wrote about the federal government’s new tax rules for professionals in complex corporate and partnership structures. Specifically, I looked at what the rules could mean for incorporated physicians. The government has said that it wants to bring greater fairness to the tax system and close what it considers to be tax loopholes for private corporations. On July 18, the government followed up with further proposed legislative changes and it has invited public input until October 2, 2017 (“Tax planning using private corporations” fin.gc.ca/activty/consult/ tppc-pfsp-eng.asp). These proposed changes have elicited questions from my physician clients. With the help of my MD colleagues who specialize in taxation and incorporation, I’ve provided answers to some of the most common questions here.

In a nutshell, what are the proposed changes about? The government wants to ensure that corporate tax advantages exist to help Canadian businesses reinvest and grow without providing personal tax advantages to shareholders. The government also believes that when wealthy Canadians use private corporations to gain unfair tax advantages, it comes at the expense of other Canadians. The three proposed changes would either eliminate certain tax strategies or reduce their effectiveness, which could ultimately result in incorporated physicians paying more tax. The proposed changes target three areas: • income splitting • accumulating investments in a corporation • converting regular income into capital gains AMA - ALBERTA DOCTORS’ DIGEST

FINANCIAL CONSULTANT, MD FINANCIAL MANAGEMENT LTD, CALGARY

Income splitting Many incorporated physicians pay dividends to their spouse and/or adult children. These family-member shareholders would now be subject to a new “reasonableness” test that would consider their actual financial contribution to, or time spent working for, the corporation. If the reasonableness test is not met, the family member may be taxed on their dividend income at the highest marginal tax rates. In this scenario, income splitting in many family situations would no longer be advantageous and ultimately incorporated physicians could pay higher rates of tax on dividend income. Accumulating investments in a corporation The government is exploring a new concept of taxation on the income earned on investments held in a private corporation (called passive income). This new concept would effectively eliminate the tax deferral benefit presently available when physicians invest through their corporation. Converting regular income into capital gains Certain tax strategies in use today convert what would be regular income, such as dividends, into capital gains income, which is taxed at a lower rate. The government’s proposed changes would eliminate this kind of conversion.

I’m an incorporated physician. What could these proposed changes mean for my financial well-being? If the proposed changes become law, you may be left with less after-tax money in your corporation and in your pocket, which could affect your financial planning strategies. Your financial advisor can help analyze your situation and discuss the potential implications of these proposed changes. >

> If I am not yet incorporated, is incorporation

off the table for me? This is a personal decision, as it depends on each physician’s circumstances and their objectives in incorporating. It may make sense to delay the decision until it is clear whether the tax benefits of incorporation will be available in the future.

I’ve been paying my spouse a salary for services performed for my practice. Do these proposed changes impact me? Paying a spouse or adult family member a salary for services performed has always been subject to an assessment of reasonableness. Unreasonable amounts paid by a corporation for services are not deductible by the corporation and can result in application of other punitive tax rules. These proposed changes do not impact or change the payment of a reasonable salary in any respect. Read a summary of the issues on MDs website (mdm. ca/md-blogs/tax-planning-using-private-corporationswhat-s-next-a-summary-of-finance-announcements) and details about the Canadian Medical Association’s advocacy efforts (cma.ca/en/pages/tax-issues.aspx). Please remember that these are only proposals and public consultations at present, so no tax laws have changed yet. These proposals are complex, so we recommend that our clients speak with their tax advisors before implementing any changes to their current financial planning or corporate structures in response to these proposals and consultations. Christina Kuruliak is a Senior Financial Consultant with MD Management Limited in Calgary. Contact Christiana at christina.kuruliak@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 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.

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Need confidential advice dealing with patient advocacy or intimidation in the workplace? Call the Zone Medical Staff Association. ZMSA operated.

PRACTITIONER ADVOCACY ASSISTANCE LINE (PAAL)

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The PAAL is a 24-hour confidential service you can call to share the issue and obtain advice from your ZMSA. All calls are answered by Confidence Line, an independent provider of confidential reporting lines.

The PAAL service has been transferred out of Alberta Health Services and is now operated at arm’s length by ZMSAs.

For more information visit albertadoctors.org/paal

SEPTEMBER – OCTOBER 2017

FEATURE Emerging Leaders in Health Promotion grant program CALL ME – Canadians Alleviating Loneliness and Longing by Mingling with the Elderly Vanda Killeen, BA, Dip Ad/PR | SENIOR

COMMUNICATIONS CONSULTANT, AMA PUBLIC AFFAIRS

The ELiHP grant program The Emerging Leaders in Health Promotion (ELiHP) grant program provides funding to help medical students and resident physicians conceive and implement health promotion projects in support of the development of their CanMEDS/ FM core competencies, particularly health advocacy.

The study also reported other positive results, such as participating adults feeling that “life was worth living; that they had a sense of support and that their loneliness and anxiety were alleviated …” This contributed to the prevention of many related areas of potential long-term sequelae.

Jointly sponsored by the Alberta Medical Association’s Health Issues Council and the Canadian Medical Association, the ELiHP grant program facilitates the growth of physician leadership and advocacy skills in a mentored environment while enhancing the well-being of the general Alberta population through education, advocacy and community service.

Dr. Nabeela Nathoo

“Currently, the Canadian literature in this area is sparse,” said Dr. Nathoo. “We hypothesized that the implementation of a telephone befriending service here, in Calgary, would enable the development of personal skills and supportive social environments, ultimately alleviating feelings of loneliness and its related numerous adversities.” Beginning in May 2016, Drs. Nathoo and Damji recruited 12 adults, 65 or older, from Calgary’s Alex Seniors’ Health Centre. They paired each participant with a volunteer medical student from the University of Calgary’s Faculty of Medicine 2017-18 class. For a one-year term, students made calls lasting approximately one hour once a week, at pre-scheduled times. >

The UK study (Cattan et al., 2011) examined the effect of this telephone befriending service “on social interaction among older people and their self-defined general sense of well-being.” In their paper, the UK team noted the short-term, positive effect the service had on the “state of loneliness in older adults.” Dr. Omar Damji

AMA - ALBERTA DOCTORS’ DIGEST

preliminary results, our data suggests that a telephone befriending service to combat loneliness and isolation in the elderly is feasible and may reduce loneliness in the elderly.

Could it be that simple? Telephone + medical student + elderly person = less loneliness

Text me on my cellphone … Better yet, just CALL ME ith their CALL ME (Canadians Alleviating Loneliness and Longing by Mingling with the Elderly) ELiHP project, co-leads Dr. Nabeela Nathoo and Dr. Omar Damji put a Calgary spin on a UK-based study of the positive effects of a telephone befriending service on the physical and mental health of older adults (65 and older).

Based on our

> In their ELiHP project final report, Drs. Nathoo and Damji concluded: “Based on our preliminary results, our data suggests that a telephone befriending service to combat loneliness and isolation in the elderly is feasible and may reduce loneliness in the elderly.” The project co-leads plan to extend the project “in order to recruit more participants to further elucidate the effect …” They’d also like to “delineate if there is any biological secondary benefit that relates to experiencing less loneliness and overall feeling a greater degree of happiness and belonging in society.”

This project taught us to consider the social

and psychological aspects within the bio-psychosocial model and tease out a primary intervention that is not derived solely from pharmacology.

“Dr. Fruetel’s years of commitment to geriatric medicine and her vast network of fellow physicians and allied staff were invaluable to our ability to network with the other essential partners in this project,” commented Dr. Damji, adding: “Dr. Fruetel was instrumental in guiding us through project design and feasibility and connecting us with the Alex Clinic. She also helped us delineate between immediate and long-term clinical correlation at the completion of the study.”

Project and leadership value For the two young physician project leads, this landline telephone-based project was an eye-opener with respect to the ability of simple and rather archaic methods that have been in society for many years (i.e., the use of a telephone) to act as a source of intervention. “This project taught us to consider the social and psychological aspects within the bio-psycho-social model

and tease out a primary intervention that is not derived solely from pharmacology,” said Dr. Nathoo. While they received valuable mentorship from Dr. Fruetel, Drs. Nathoo and Damji exercised and developed their leadership skills as they mentored other medical students participating in the project and guided their research coordinator. They also acknowledge the health advocacy skills the project required, as they needed to be “approachable and empathetic towards elderly individuals … to be an advocate to individuals in society who experience loneliness, which is often undermined as a serious issue leading to medical sequelae.” “This project is a stepping stone for us,” concluded Dr. Damji. “We’re optimistic that our experience with this project will give us the confidence to pursue more advocacy projects in our future careers as physicians.”

Mentorship Mentorship is a key component of the ELiHP grant program, as mentors help guide the planning and implementation of the projects with their experience and knowledge. Mentors help connect project leads with the people and places/ facilities they need to liaise with to carry out many of their projects. For their CALL ME project, Drs. Nathoo and Damji received guidance and assistance from Dr. Karen Fruetel, a geriatrician and vice-chair of education for the Department of Medicine at the University of Calgary’s Cummings School of Medicine. Dr. Fruetel is also a master teacher in the Undergraduate Medical Education program.

SEPTEMBER – OCTOBER 2017

IN A DIFFERENT VEIN

Doing good in Minute Particulars Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP | CO-EDITOR

ur medical world is full of phonies blabbing about what should or should not be done to improve cost, efficiency and outcomes. Yet they somehow avoid or find an excuse to avoid seeing the difficult patient, the dying patient or the demanding patient and family. Someone else can deal with these awkward problems. The great visionary William Blake called these people out: “He who would do good to another must do it in Minute Particulars; general good is the plea of the scoundrel, hypocrite and flatterer.” I recently met three doctors who each in their own way are quietly doing good in Minute Particulars by following their medical passions. Although several of these doctors have been featured in past issues of Alberta Doctors’ Digest, many Alberta doctors like them do not make the pages of the general media. But these champions deserve our full support.

Dr. Annalee Coakley The waiting room in the Refugee Clinic in Calgary’s Marlborough Professional Building is full: a pram, babies, children, women in headscarves and long dresses, sullen men. There’s an international feel with time zone clocks on the wall and a world map with flags showing where refugees have come from. Dr. Coakley (MD Queens, with a London School of Tropical Medicine diploma and, last year, recipient of the Alberta Medical Association Medal for Distinguished Service) is the clinic medical director. She showed me the clinic rooms and the venesection station. “It’s more efficient taking blood here. You can’t just hand a requisition form to a refugee who’s never been in a real clinic and expect them to make appointments. They get completely lost. Nothing happens,” she said.

AMA - ALBERTA DOCTORS’ DIGEST

Dr. Annalee Coakley at the Calgary Refugee Clinic

A warmly decorated teaching room with objects from around the world – a pair of wooden elephants, a colorful shawl – is where counselling sessions are held; mental trauma is a critical aspect of the work here. “Following the surge of Syrian refugees earlier this year, we’re now dealing with a very different group of 70 Yazidis, heavily traumatized, tortured victims of Daesh. Many are illiterate, so communication is hard. We have a Calgarian of Yazidi descent who helps with interpretation and navigation. We’re seeing conditions not commonly seen in our refugee population: conversion disorders, pseudo-seizures, severe manifestations of post-traumatic stress disorder (PTSD). We’re expecting 200 Yazidis by December. Even when they sit next to our harmless Muslim Syrian patients in the waiting room, it can be frightening for them given what they’ve been through with ISIL.” The Yazidi people of Northern Iraq are a monotheistic, peace-loving sect worshipping “the blue peacock.” They’ve been targeted by the Islamic State, the women submitted to loathsome, hideous atrocities: burying or burning alive, their babies murdered in front of them, even unconfirmed reports of mothers being forced to eat their babies’ flesh. >

> “Refugees are the ultimate copers,” said Dr. Coakley. “They’re quick learners with great resilience and adaptability, better than many of our local social problem families in my clinic in Forest Lawn. They’ve been through so much – they know they have to adapt.” Alberta Health Services (AHS) has stopped funding the smaller Edmonton refugee clinic, the idea being that refugees can be integrated into community family practices. Although this may be possible in some instances with educated, literate, Englishspeaking Syrians, it won’t work with re-settling others less fortunate, such as the Yazidis. You need smart, trained medical office assistants who can cope with incoherent communication and understand the limits of giving instructions. The refugees need ready access to a language line, translators and social workers. Even transportation is hard.

“It’s just a job – a well-paid job. You’re no

different to any other profession,” the disparagers say. This downplays a physician’s or surgeon’s role, but I believe a calling is needed to sustain the life of a medical doctor.

“We used to give taxi chits, but that didn’t work. You need a cab driver who doesn’t just drop them off but must deliver them to their appointment.” Having had difficulty finding my way around the Foothills Medical Centre after 27 years with passable English, I get this.

“I bridle at that term. The term ‘bogus’ refugee was applied to some refugee claimants – a different class than refugees from the Middle East. Claimants are vetted by the Immigration Review Board. No refugee is provided better resources than Canadians. The Middle East refugees have gone through a security screen by the Canadian military, actually better than the United Nations screening process. We have a good process.” How did she get into this work? Would she call it a vocation? “After completing my diploma of tropical medicine, I wrote the Refugee Clinic to see if I could work with newcomers to maintain my skills in tropical medicine. Once I met the patients, it became a vocation.” And you don’t hear that word “vocation” used much now. It’s unfashionable, a bit coy, to say that becoming a physician or a surgeon is a calling. “It’s just a job – a well-paid job. You’re no different to any other profession,” the disparagers say. This downplays a physician’s or surgeon’s role, but I believe a calling is needed to sustain the life of a medical doctor. You must always walk the extra mile – or it is indeed a nine-to-five job that could be done by anyone with smarts.

Dr. Jeffrey C. Way Dr. Way is a surgeon who believes in the vocation of medicine/surgery. He’s not the first Alberta surgeon to work in dangerous, bleak, behind-the-front line areas, but he is possibly the latest. In February and March of this year, he and his daughter, Emily, a nurse, travelled via Erbil to Bartella, a small mainly Christian town 20 kilometers from Mosul. The town was liberated from ISIL in October 2016. It’s close to the Iraqi/Kurdish advance on east Mosul, the biblical city of Nineveh. >

The Calgary Refugee Clinic started as a Community Medicine Residency Project in 2003. It’s now largely AHS independent with funding from Mosaic Primary Care Network which is responsible for clinic operation. From April 2016 to June 2017, the clinic has seen 1,757 new patients and what started with two family docs per day now requires three to four. Prior to coming to Canada, refugees are screened for TB and HIV. In Canada, they are screened for hemoglobinopathies, hepatitis B/C, strongyloides, varicella, diabetes, cancers and other chronic diseases. In children, stools are screened for organisms/parasites. But mental health issues are most prevalent: PTSD, grief, anxiety, depression; these are best managed by forming a trusting relationship with a health care provider. “Funding? We lurch from crisis to crisis. We have costs of $40,000 a year now for drugs and rely on donations. Our teaching fees go into the pot.” I asked Dr. Coakley about the “bogus refugee” fuss a few years ago from press reports that some Mexican refugees weren’t real refuges and they were receiving better treatment than Canadians.

> Dr. Jeffrey Way and his daughter, Emily

SEPTEMBER – OCTOBER 2017

> The World Health Organization (WHO) established a field hospital that was flown in from North Carolina in January with major support from Samaritans’ Purse, a Christian humanitarian aid organization. After a day’s training in security from a private security company, the pair were dropped at this field hospital surrounded by 16-foot blast protection walls and given bunk beds in a tent. They got down to work and would not to leave this five-acre area until they were transported out. The flow of mortally injured and dying patients (Kurdish Peshmurga and Iraqi fighters, but also innocents of all ages caught in the strife) was peculiar in that although mortar bombs exploded all night, night admissions were infrequent due to the danger of night travel. This allowed the luxury of a few hours rest. At dawn, snipers, small-arms fire, landmine explosions, mortar and car bombs would start, and casualties would arrive. This influx of dying and severely wounded would continue through the day and then stop a few hours after sundown.

You must always walk the extra mile –

or it is indeed a nine-to-five job that could be done by anyone with smarts.

Fifty-four beds for all ages were filled with the severely wounded – a six-year-old shot in the belly, a teenager with a sniper bullet to the back of the head, dying children and adults. Two other general surgeons and an orthopedic surgeon were in attendance. Two operating areas were active round the clock dealing with burns and penetrating wounds that only the modern international arms industry can provide – legs, arms, hands, parts of heads blown off; shrapnel and bullets in eyes, brains, chests and abdomens. “I’d seen many of these kinds of bullet wounds, though in a more civil setting in Canada, but not others. On one occasion I had to look up how to enucleate an eye,” said Dr. Way. Pain killers were mainly anti-inflammatories (Ibuprofen, IV Tylenol, some Tramadol), but in contrast to our own flush access, narcotics were in shorter supply. Antibiotics were available. This was not a free-for-all mobile army surgical hospital (MASH) set-up. Formal ward rounding, careful decision-making on who could be surgically helped or transferred or who would be palliatively nursed, charting and case reviews were carried out. The WHO provided oversight by reviewing, documenting and recording all cases admitted.

AMA - ALBERTA DOCTORS’ DIGEST

I asked Dr. Way if he would go again: “Yes, of course. You go where your skills are needed.” The contrast between the safety of an albeit busy surgical life in Alberta and the comfort of returning to a family and Millarville acreage compared to the desperate morass of war in the Middle East is part of the meaning of having entered surgery. His daughter Emily was so inspired that she’s taking a Master’s degree in Humanitarian Affairs in Britain. We agreed that entering the medical profession has got to be a vocation, a requirement to help others, or else it becomes a mere job with a good chance of burnout after your 189th cholecystectomy. One further word of advice from Dr. Way: if you volunteer, make sure it’s with a well-backed organization like Médecins Sans Frontières, Samaritans’ Purse or the Red Cross.

Dr. Bill Hanlon A plaque in Mandarin on the office wall of my colleague, Dr. Jackson Wu, translates to: “Distance reveals the strength of the horse. Time reveals the heart of Man.” And if this Chinese aphorism is true, then Dr. Bill Hanlon, a family doctor in Cochrane, may have been a Centaur in times past, for in February this year, he hauled a 70-kilogram sled for 720 kilometers over frozen Lake Baikal in Siberia supporting the Basic Health International Foundation (basichealthinternational.com). He trudged for three weeks, eating freeze-dried food. His day’s organization: 10 to 12 hours hiking, six hours of tent handling (hammering pegs into ice thwarting high winds), eating, visiting and bringing sustainable medicines to locals and sleeping when he could. Dr. Hanlon is 62 and fit as an Irish fiddle. You can picture him out-jigging a teenager at a ceilidh. One older patient who berated him for being away when she was ill is now one of his biggest supporters after learning he wasn’t on a Palm Springs golf course but hiking across northwest Afghanistan with a couple of donkeys and an interpreter, seeing villagers who’d never seen a doctor. Despite problems with the Taliban on entering and leaving the area (they confiscated medicines and were reluctant to hand them back. Me? I wouldn’t have quibbled about that), Dr. Hanlon is a determined, thrifty traveller. Among his exploits are a 24-day ski-hike across Greenland following Nansen’s route, a 47-day ski-trek to the South Pole, climbing Mount Everest and the Seven Summits in Nepal and Tibet (the first Canadian doctor to do that). He still has some climbing to do: his bucket list includes climbing the highest peak on all seven continents plus Oceania! These are physical extremes but also spiritual journeys during which he’s never lonely (connecting with nature, chatting to himself, animals and tent), hiking the world’s great pilgrimages, for example, the Path of the Saints in Ireland. >

harnessed local herbal remedies, Dr. Hanlon holds some scepticism of Big Pharma – with its minimal contribution to remedies for the world’s poor. He’s worked in Central America, Ethiopia, Peru and Tibet. In northeast Afghanistan and Tajikistan, he’s treated nomadic Kyrgyz herders living at high altitude where TB and cysticercosis are common. It’s a tough journey to poorly equipped health posts, so local remedies are essential. He’s promoted droma (silverweed) an anti-spasmodic herb found in Tibet, but which is also a protein that counteracts malnutrition when added to the diet. He’s also recommended sunbathing for these people wrapped as they are in sun-protecting garments.

Dr. Bill Hanlon makes tough journeys to poorly equipped, remote health outposts.

> Dr. Hanlon was born in Wexford and attended medical school in Cork, a city I visited with my parents in the 1950s. As a four-year-old from Edinburgh, I saw a shoeless ragamuffin running and burling a hoop through the muddy street in central Cork. This poverty, I think, has affected Dr. Hanlon more than he admits. He was a pharmacist in Dublin before studying medicine, paying his fees by working part time. He also holds a diploma in tropical medicine. These early days molded his life and personal motto: “Health, Hope and Healing” – bringing education (especially maternal and child health) with sustainable remedies to remote, isolated peoples. He now gives talks, often to village schools.

Dr. Hanlon loves to return to remote villages that he’s visited – a favorite is a village in northeast Pakistan where an old farmer (in his 90s) is tending his fields when he arrives, immediately recognizing him with warm greetings. Practicing in Cochrane allows connection with communities. Some 10% of the Cochrane practice is indigenous, as the Morley Reserve is nearby. But remote travelling requires understanding colleagues and good locums. We discussed burnout, a condition often creeping up on doctors after years in practice. It can affect anyone, but particularly specialists and general practitioners without a community connection. Dr. Hanlon’s advice: always have a second passion, whatever that may be and liberally indulge it. So there we have three doctors – all with a passion, a vocation – each travelling a different path to a fulfilling life in medicine.

Influenced by a Tibetan friend, Tampa Thonduc, who practiced in Tibet with few Western resources but

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PHYSICIAN WANTED CALGARY AB TruCare Medical Center is an ideally located family and walk-in clinic close to Lions Park LRT Station and North Hill Mall. This opportunity will suit partor full-time physicians looking to build a new practice or with existing panel. Flexible hours with competitive fee split. Contact: Dr. Farhan Khan T 587.315.6838 drfarhankhan@hotmail.com www.trucaremedical.ca CALGARY AB Start practicing right away. Westside Medical Clinic, a collaborative family medical centre, is seeking general practitioners to join our new clinic and team. Weâ&#x20AC;&#x2122;ve been operating for over 10 years but recently moved to a beautiful new clinic at 1923 17 Avenue SW. This clinic offers an ideal location for physicians wanting to build a patient panel, or for established doctors that would like an ideal, central location from which to expand their practice. With over 45,000 vehicles a day passing by, we are getting many calls from the community. We also have a highly diverse patient demographic, offering a truly urban practice opportunity. Brand-new equipment, modern design; our clinic strives to provide both patients and doctors with a terrific environment and experience. Westside Medical provides the opportunity that you need to be most efficient in your practice. We offer shared access to primary care network collaborative health care professionals, two surgical suites and

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

ample well-trained staff. We are one kilometer from Sunalta C-train and the #2 transit stop is right in front of our building. Richmond Diagnostic Centre is two blocks west. Contact: Rob Filyk T 403.815.8488 robfilyk@shaw.ca to arrange a visit with our doctors and learn more CALGARY AB Forest Lane Medical Clinic in an exciting location in a busy mall close to 36 Street SE and Deerfoot Trail is seeking part- and full-time physicians and specialists to join their brand-new clinic in a densely populated area. Fully supported practice is managed by a highly experienced clinic administrator with competent physician assistants. Med Access electronic medical records, higher take-home income, low overhead, respectful and professional environment. Physicians with panel are welcome. Contact: Kulwinder Rajewal T 403.930.6505, ext. 105 k.rajewal@forestlanemedical.ca CALGARY AB Sante Medical, an established medical aesthetics centre in Calgary, is looking for an experienced MD injector/dermatologist to join its practice and must be licensed with the College of Physicians & Surgeons of Alberta, fellow of the Royal College of Physicians and Surgeons of Canada, or eligible for fellowship with experience in dermatology/ cosmetic injectables. Our clinic offers flexible clinic hours, competitive compensation and benefits, and tremendous opportunities for growth. Contact: careers@santemedical.ca to send email inquiries/resume/CV

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 Pristine Health is looking for family physicians and specialists to join our clinic. We offer Med Access electronic medical records, competitive overhead split (75/25) and opportunity for partnership. We have a branch each in north and south Calgary. We can help with transitioning from another clinic and provide relocation assistance. Contact: T 403.402.9593 pristinehealthclinic@gmail.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 Silver Springs Medical Centre is a brand-new family and walk-in clinic in northwest Calgary. A very exciting opportunity for family doctors looking to build a new practice as well as physicians with an existing panel. We offer a very competitive fee split, flexible hours, part- and full-time positions available. Ideal location with accessible diagnostic imaging clinics, pharmacy and Calgary Laboratory Services clinic nearby. Contact: Alma Grace Adriano, BSN, RN Clinic Administrator T 403.930.6090 T 403.612.1851 or Dr. Alvin Adriano, CCFP Medical Director T 403.612.3482 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 EDMONTON AB Tipaskan Medical Centre, 3236 82 Street NW, Edmonton AB T6K 3Y3, is looking for part- and full-time family physicians in a busy setting. A community-based clinic that offers flexible hours and is fully computerized using Healthquest electronic medical records. A pharmacy is located within the clinic.

An excellent opportunity for all types of practice. Contact: Dr. M. Wael Eldagni T 780.709.4349 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 Lessard Medical Clinic and West Oliver Medical Clinic are in need of family physicians. MD Group Inc. is looking for walk-in/ family practice physicians to join the team. We have positions available in each of our Lessard Medical Clinic and West Oliver Medical Clinic, each with eight examination rooms. Excellent location and facility; courteous and energetic support staff. Benefits and incentives include the convenience of multiple locations around Edmonton to support your living arrangements, staff familiarized with primary care programs and promotion, support staff including nurses for 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; onsite respiratory clinic as well as rotation of various specialists for your convenience and priority use. Seminars and dinner workshops are well documented and monitored for CME credits. Flexible hours, vast patient population at both

locations, continuing care and learning opportunities for accredited physicians. Full-time chronic disease management nurse for co-morbidity patients, billing support and attached pharmacy. Work with friendly and dedicated staff, nurses available for doctorâ&#x20AC;&#x2122;s assistance and referrals as well as on-site mental health and psychology services. There are two to four positions available now. This is a permanent, full-time, fee-for-service position. The physician will provide primary care to patients of the clinic, including diagnosing and treating medical disorders, interpreting medical tests, prescribing medications and making referrals to specialist physicians as appropriate. Ability to work effectively, independently and in a multi-disciplinary team, and effective written and verbal communication skills. The Lessard Medical Clinic is located at 6633 177 Street NW, Edmonton AB T5T 4K3. The West Oliver Medical Clinic is located at 101-10538 124 Street NW, Edmonton AB T5N 1R9. The physician must be licensed with the College of Physicians & Surgeons of Alberta (CPSA). Qualifications must comply with the CPSA license requirements and guidelines. Certification with the College of Family Physicians of Canada (CCFP) (required). Preference will be given to candidates who have or are eligible for a certificate with the Royal College of Physicians and Surgeons of Canada. Retention Benefit Program supports and promotes the retention of physicians in Alberta by rewarding their continuous years of service to Albertans. Physicians receive between $5,141 and $12,852 depending on their years of service to Albertans. This money will not be paid in 2017 but may be paid in 2018. Medical Liability Reimbursement reimburses physicians for their medical liability protection costs less a $1,000 deductible. Continuing Medical Education reimburses physicians for eligible continuing medical education costs. Each eligible physician receives $2,656 annual allotment, which can be carried forward for up to three years. Parental Leave Program provides $1,063 per week for up to 17 weeks to physician parents of a newborn or newly adopted child. >

SEPTEMBER â&#x20AC;&#x201C; OCTOBER 2017

Business Cost Program addresses escalating practice costs in community based practices. This fee modifier of $2.92 is added automatically to the first 50 select office visits and consultations. This program applies across the province and all physicians who provide visit services in an office-based setting will receive the modifier. We use Healthquest electronic medical records and maintain memberships with local primary care networks. 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

AMA - ALBERTA DOCTORS’ DIGEST

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 EDMONTON AB Medicus Family Health Clinic, 1536 91 Street SW, Edmonton AB T6X 1M5 is looking for part- and full-time family physicians in a busy setting with a lot of new patients. A community-based clinic that offers flexible hours, fully computerized and uses Healthquest electronic medical records. There is also a pharmacy located next to the clinic. Competitive compensation model and benefits plan offered. Join Medicus Family Health Clinic for excellent opportunity for all types of practice. Contact: Kris Salumbides T 780.729.1215 kris@qualitysleepcare.com EDMONTON AB Urban Medical Clinic, a full-spectrum family clinic is seeking a part- or full-time family physician. We are a friendly, rapidly growing, established family practice. We operate with booked appointments and accept walk-ins. The clinic is a modern state-of-the-art facility that is fully computerized using TELUS PS Suite electronic medical records. We are active members with the Edmonton Southside Primary Care Network (PCN) with services from an in-clinic nurse, dietician, behavior health consultant and other PCN support services. In addition, we have experienced and supportive staff. We are seeking a physician to join part- or full-time with long term offers. We can offer an attractive 80/20 split starting package for the first six months with subsequent overhead to be negotiated. Contact: Dr. Oshean Naidoo T 780.757.9545 onaidoo@telus.net >

INNISFAIL AB Well-established busy clinic in Innisfail with Canadian, British and South African trained family physicians has openings for two family physicians to replace two retiring physicians. We have a full functioning electronic medical records system, fully trained support staff and are part of the Wolf Creek Primary Care Network. Physicians participate in on-call rotation at Innisfail Health Centre and Penhold Medical Walk-In Clinic. Interested applicants must be licensed or eligible to apply for licensure with the College of Physicians & Surgeons of Alberta. Compensation is fee-for-service. Inquiries are kept strictly confidential. Contact: Dr. E. Barker ebarker3@telus.net

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 industryleading 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. 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 DRAYTON VALLEY AB Two physicians/locums required immediately to fill positions at the Malone Medical Clinic in Drayton Valley. Drayton Valley is one and one-half hour drive to the Edmonton International Airport and a three-hour drive to the Rocky Mountains. The 6,000 sq. ft. modern, very busy rural clinic is fully computerized and the hospital is half a block away. We have onsite laboratory and do pulmonary function testing, hearing testing and minor surgery. We are very flexible as to hours and days of the week to work. On-call is on a rotational basis at the local hospital. Contact: Dr. Mike Peyton or Heather Barrett, Office Manager T 780.542.3366 malone@telus.net or mpeyton@incentre.net to submit your CV www.malonemedicalclinic.com to view pictures of the clinic >

SEPTEMBER â&#x20AC;&#x201C; OCTOBER 2017

> 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 EDMONTON AB Exciting opportunity for family medicine physicians; become a member of our team of professionals. Newly renovated state-of-the-art facility, clinic member of the community for over 30 years and one of the largest members of the Edmonton West Primary Care Network (PCN). We offer permanent full-time, locum opportunities, daytime, evening and weekends. You choose your work hours. We are one of the busiest clinics in Edmonton and a highly motivated full-time physician can earn $500,000 to $700,000 or more annually. Plus we provide other great perks such as flexibility with your schedule, how you wish to organize your work days, no need to arrange locum coverage for your vacations as you are part of a large physician team. In addition to a busy booked schedule, we have a large walk-in patient population so you can see as many or as few walk-in AMA - ALBERTA DOCTORSâ&#x20AC;&#x2122; DIGEST

patients as you want. Full-time physicians have their own dedicated medical office assistant, on-site PCN resources such as chronic disease management nurse, two licensed practical nurses, panel coordinator and offsite PCN resources such as a nurse/pharmacist that updates our patient medication profiles upon their discharge from hospital. Required completion of appropriate university and degrees, licenses and certificates include College of Physicians & Surgeons of Alberta certification, licensure by provincial or territorial authorities. Two years of experience would be preferred, fluent in English, professional liability insurance and active license with Med Access electronic medical records (we can help with this if needed). Skills and duties include examining patients, taking histories, ordering appropriate testing and diagnostic procedures. Prescribing and administering medications and treatments. Advising patients on health care and communicating health promotion, disease prevention and performing patient advocacy role. Consult with other medical practitioners. To become part of our team, please contact. Contact: Nanci Stocks nanci_anne@hotmail.com or Amy Markovitz amy.ccmc@hotmail.com F 780.444.0476 to attention of Nanci or Amy 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 >

SERVICES

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

AMA Physician Locum Services

Locums needed. Short-term & weekends. Family physicians & specialists. Experience: •

Flexibility – Practice to fit your lifestyle.

•

Variety – Experience different Alberta practice styles.

•

Provide relief – Support rural colleagues and rural Albertans.

•

Travel costs, honoraria, accommodation and income guarantee provided.

CONTACT: Barry Brayshaw, Director, AMA Physician Locum Services ®

barry.brayshaw@albertadoctors.org T 780.732.3366

TF 1.800.272.9680, ext. 3366

www.albertadoctors.org/pls

PHYSICIAN(S) REQUIRED FT/PT Also locums required

DISPLAY OR CLASSIFIED ADS TO PLACE OR RENEW, CONTACT:

Daphne C. Andrychuk Communications Assistant, Public Affairs

ALL-WELL PRIMARY CARE CENTRES

Alberta Medical Association

MILLWOODS EDMONTON

T 780.482.2626, ext. 3116 TF 1.800.272.9680, ext. 3116 F 780.482.5445 daphne.andrychuk@ albertadoctors.org

Phone: Clinic Manager (780) 953-6733 Dr. Paul Arnold (780) 970-2070

SEPTEMBER – OCTOBER 2017

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For more information, visit md.cma.ca/match150. * Applicable to new clients and accounts. 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.