THE ALBERTA DOCTORS’
Surveying the future
Physicians share their New Year's resolutions for the health care system
What physicians Already Know Patients care about privacy
future: Achieve your financial goals
medical students! You've got electives, we've got funding
What do I do now? Responding to adverse events, complaints and litigation
Volume 37, Number 2
From The Editor
Going forward – can we? Dennis W. Jirsch, MD, PhD Editor
I’ve put together an amalgam – fictional, but I wager familiar, perhaps distressingly familiar – of the endless bunkum I read about our health care woes. “We’re in trouble in health care. Spending is going through the roof. It’s simply not sustainable. We need more accountability in the system. We need to target our waiting lists, and we’re going to have to embrace health care reform. Patient-focused care is going to be our mandate going forward.” Earnest Ernie – Administrator, Politico, Economist, Bureaucrat, etc. Well, Ernie has strung together most of the tired canards. I’m thankful there’s no mention of silos or collaborative teams or the promised salvation of the electronic medical record. First, let’s look at the cost thing. I’m indebted to Mr. Kevin Taft here, and the Parkland Institute. Let me interject, though, that I have no political affiliation and no ambitions, but I’d like to think I’ll take the truth where I find it. As Taft asserts in his new book, Follow the Money1, it’s surprising to hear that, in a province that is debt free, has the second largest oil reserves in
Alberta Doctors’ Digest
the world, and a GDP that is nearly twice that of other provinces, the cost of health care is an overwhelming issue. To be sure, health care costs a lot: some $11 billion in 2011, having risen from $4 billion in 1989. Adjust for inflation, though, as Taft and co-workers have done and put things in constant 2009 dollars – the tab has gone from $6 billion in 1989 to $13 billion some 20 years later. Things look better already.
It may be that the straightforward concept of accountability isn’t so much a problem as the system calling for it.
But wait. The province’s population has grown over the same interval by 50%; we’ve added 1.3 million new citizens to the 2.4 million that were here in 1989. Factor in our burgeoning population and we’ll find that health care spending has risen from $2,400 per person in 1989 to $3,500 per person in 20 years – figures again in 2009 dollars, a growth rate that works out to less than 2% per year. So much for out-of-control spending. What about the other elements of
Ernie’s cautionary message? Well, accountability is mentioned endlessly in health care and the call for more of it has become so ubiquitous that it sounds as if no one is minding the shop. I’m reminded of the farmer who once told me, regarding his hired hand, “I wouldn’t have taken him on unless I knew what I wanted him to do, and I sure wouldn’t have kept him on unless he did it.” It may be that the straight-forward concept of accountability isn’t so much a problem as the system calling for it. Our health care system – if I can call it that – has undergone turbulent rolling change over the past two decades, with the precipitous devolution of care into 17, then nine, regions followed by about-face centralization of a single behemoth. Our organization charts should be written in pencil, not ink. Murky accountability in the face of such impermanence is more expected than surprising. The task, as I’ve argued before, must be to develop an organizational structure that has not only pertinence, but persistence, and one that pushes decisions down as close to the patient as possible. We moved small steps toward this 20 years ago when we first named regional program leaders, but the dyads of a doc plus a nurse or other practitioner were never really handed the ball except when it came to delivering cuts in service decided by higher-ups. Program management got a bum rap in those early days, when docs and their nurse counterparts were meant to advise mandarins
regarding service delivery but neither docs nor their administrative confreres had enough training or commitment to begin to do much. I continue to think that some managerial combo of docs/nurses/others charged with managing resources at a local level has the most promise for effecting effective clinical care. What about the notion of targeting procedures and waiting lists? Won’t that help? Well maybe – it all depends on what we’re counting. In a budgetary sense, if extra dollars are spent on eyeballs or hips or hearts or whatever, what happens to the non-eyeball/non-hip/non-heart population? To the extent that easily described procedures are easy to draw attention to, the motley jungle of chronic illnesses that are less easily characterized falls behind. Einstein said, famously, that not everything that counts can be counted, and pace Albert E., I’d modify this in health to acknowledge that not everything that is not easily counted gets the attention it deserves.
... not everything that is not easily counted gets the attention it deserves.
Health care reform is one of those weasel phrases that can mean most anything. It has been used to refer to attempts to expand both the population and array of offered services, the number and capabilities of providers, quality improvements, as well as the provision of less-expensive care. The term is usually used sans definition, but I reckon it’s most typically shorthand for attempts to provide cheaper care. I recognize
two major initiatives in the search for cheap. One looks to develop organizational efficiencies, as in following best practices, implementing the electronic medical record, using generic products and pushing more care out of hospitals. The other effort looks to provide more care via cheaper health care workers, a practice that has come to be known as “de-skilling.” Patient-focused care is another term that has been bandied about for several decades – I first wrote about it in 19932 – and has become another catch-all phrase. It has been used to justify moving clinical services closer to patients in hospitals and to revamp care in patient-friendly ways, but it has once again been used to justify models of care using less-skilled, less-expensive workers. We are perhaps only a short distance along this road, but the path is far from clear. Conflict looms with infringement on historic professional areas of practice. The fragmentation of work into less meaningful tasks can’t be good, and an ever-larger body of less-skilled workers invites more, rather than less, external control. The time has come to consider what a health care system should look like, and “the vision thing” is long overdue. As the huge population of baby boomers become grizzled boomers, the demands for health care will be unprecedented. We enjoy low tax rates in the province but, to the extent that we emulate our southern neighbor, we may be unwilling to increase tax-based support. Technology may not help much either as it has become increasingly part of the expense problem, often promoting investigations and therapies that increase the lexicon of disease. Old age is now an illness, as is obesity, sexual dysfunction, baldness, anxiety disorders and so on.
The buck, as Mr. Harry S. Truman said, will have to stop somewhere. When I worked for a time for the Core Services Committee in New Zealand, I was used to hearing from citizens that “you can’t have everything.” Though the Kiwi public soon became tired of rationing, the issue of defining what it is we are and aren’t doing via publicly funded health care is a problem that won’t go away. I’d argue, accordingly, that we must become serious about patient-focused care, that our definitions of quality must be defined by the public we serve, and as we become increasingly realistic, that we look to panels or juries of citizens empowered to decide what care will and will not be provided. This is a million miles away from the muted input that citizens presently have – and the job won’t be easy. Citizen panels would have to be knowledgeable folk. They would need advice and information from bureaucrats and clinicians alike. They’d be, of necessity, on-going, charged with making the tough decisions that we sometimes refer to as rationing, and to the extent that such panels would say aye or nay, we’d have to live with it. I’d like to think of this as more democratic. Trot out the tired wordage once again – best practices, the electronic medical record, collaborative teams and getting by with less are all in our future – but I think we have to be more realistic. I’d let the public decide and I’d let the workers at the coal-face work out the details. Everyone else should try and help. “Going forward”: is there any other way? References 1. Follow the Money: Where is Alberta’s Wealth Going? Kevin Taft with Mel McMillan and Junaid Jahangir; Detselig Enterprises Ltd., Calgary 2012. 2. “Patient-focused care: the systemic implications of change,” Jirsch, D.W., Healthcare Management Forum 6(4): 27-32, 1993.
Alberta Doctors’ Digest
TABLE OF Patients First ®
Patients First ® is a registered trademark of the Alberta Medical Association.
The 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: Linda M. Slocombe, MDCM, CCFP President-Elect: R. Michael Giuffre, MD, MBA, FRCP, FRCPC, FACC, FAAC Immediate Past President: Patrick J. (P.J.) White, MB, BCh, MRCPsych Alberta Medical Association 12230 106 Ave NW Edmonton AB T5N 3Z1 T 780.482.2626 TF 1.800.272.9680 F 780.482.5445 email@example.com www.albertadoctors.org May/June issue deadline: April 16
The opinions expressed in the 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.
2 9 10 12 14
From the Editor Letters Insurance Insights Health Law Update
20 26 29 34
PFSP Perspectives Web-footed MD In a Different Vein Classified Advertisements
Mind Your Own Business
FEATURES 6 Surveying the future
Physicians share their New Year's resolutions for the health care system.
9 What physicians already know
Patients really care about privacy.
17 Attention medical students
You've got electives, we've got funding!
18 "PAC" for your future
Achieve your financial goals with pre-authorized contributions.
24 "What do I do now?"
Responding to adverse events, complaints and litigation.
32 Paying pharmacists to prescribe: Thoughts from the profession
The presidents of the Alberta Medical Association and the Section of General Practice weigh in on the payment of pharmacist prescribers.
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 the Alberta Doctors’ Digest. Advertisements included in the Alberta Doctors’ Digest are not necessarily endorsed by the Alberta Medical Association. © 2012 by the Alberta Medical Association Design by Sarah Tiemstra at Backstreet Communications
Cert no. XXX-XXX-000
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. Alberta Doctors’ Digest
C o v e r F e at u r e
Surveying the future Physicians share their New Year’s resolutions for the health care system The Alberta Medical Association (AMA) asked, and its members responded with gusto. In fact, it turns out Alberta physicians have a lot on their minds when it comes to the future of our health care system. In the December 2011 tracker survey, AMA members were asked to provide their New Year’s resolutions for Alberta’s health care system. The types of responses – from the optimistic “Let’s make a difference!” to the gloomy “All you can do is pray.” – were as diverse as the challenges and issues raised. AMA members’ resolutions reflect the following: • The health and safety of patients are at the heart of physicians’ concerns. • Physicians have front-line experience and want to share their knowledge in further enhancing our health care system. • There is no single major issue affecting our health care system – there are many. • Physicians want recognition for the work they do and the financial realities they face. Most importantly, physicians continue to put Patients First® and strive to provide Value for Patients®. • “Try to give the best of myself to patients under my care.”
Alberta Doctors’ Digest
• “My New Year’s resolution is to see each patient as an individual and try to champion their needs.” • “Patients first!” Physicians offer a unique perspective on the various aspects of health care delivery in our province. They witness and are affected by the challenges affecting the health care system, and they need support so that they in turn can deliver the best care to their patients. • “Help the doctor help the patient.” • “Continue to work to improve the health of physicians, residents and students, and thereby have a positive effect on the health and care of patients.” While the comments touched on a variety of different issues, there are several overarching themes that reflect physicians’ views on the state of Alberta’s health care system.
Improving access Physicians believe that timely access to quality health care is a critical component of putting Patients First®. Lack of accessibility and long wait times not only have an impact on patients’ health, but they also create challenges for overwhelmed physicians. Many respondents agree that an increase in capacity will address this issue. • “Shorten all operating room waiting lists, not just selective
high-profile procedures ... Having access to timely medical care is not happening and [it] won’t, short of increased funding.” Respondents also suggested ways to improve access. • “Hire more new graduates.” • “Recruit more specialists.” • “I suggest developing a billing code to allow a limited number of physician-patient telephone consultations.” • “Need to get serious about recruiting and facilitating the return of Canadians studying medicine overseas.” Several comments also touched upon the issue of improving access to long-term care. • “Become more involved in a long-term care strategy. Identify gaps in service/care/management of our patients in long-term care and avoid unnecessary acute care hospital transfers.” • “Significantly increase [the number of] long-term care beds.” • “I would like there to be more continuing care beds and supports for the elderly.”
Support for primary care Physicians acknowledge the importance of supporting and further enhancing the delivery of primary care.
• “Continue and expand support for the growth of primary care in the health system so that primary care can perform its critical role.” In particular, respondents are supportive of primary care networks (PCNs) and view them as one of the ways to improve access. However, many physicians have expressed concerns about the stability and funding for PCNs. • “PCNs are well-ensconced and facilitating improved access to frontline medicine – don’t let the new government attempt to ‘re-align’ them.” • “Stable and reasonable funding for PCNs [is needed]. At the current rate, they will be useless in three to five years.”
Utilizing electronic medical records Respondents understand that electronic medical records (EMRs) have the potential to positively change various elements of health care delivery such as clinic operations and accessing critical health information. However, physicians are frustrated with the usability and compatibility of EMRs. • “I will try to make EMR work. Sadly, systems are not designed to improve patient care or work flow … I have become an expensive data entry technician.” • “The downside of EMRs … is the extra unpaid time spent using it.” • “Decide on a single EMR for the whole province.”
Health care administration The administration of the province’s health care system is a primary concern to many respondents.
Respondents addressed the issue of intimidation. They view this as an obstacle for physicians who wish to advocate for their patients. • “[I want] to be more proactive in advocating for patients, as scared as I am of retribution by Alberta Health Services.” • “I wish for … an end to intimidation of physicians and other health care workers who speak up on behalf of patients in Alberta.” From a systemic perspective, physicians are frustrated with the lack of stakeholder engagement and consultation in the administration of health care. • “Good policy, not politics – family care clinics are a good example of putting politics first; a possible good idea but where is the stakeholder involvement without which it is just politics before policy?” • “Listen to health care providers regarding increasing demands with limited resources … the changing landscape has resulted in an inability to provide timely and safe care.” Many comment that this has shifted the focus away from the patient. • “Alberta Health and Wellness and the Alberta government should start to put patients first.” • “Try to align administrative policies with patient needs rather than bureaucratic goals.” Some wish to see a return to more localized forms of administration. • “Continue to advocate against AHS, in favor of a return to regionalization of health care.”
• “AHS is extremely inefficient and far removed from actual local issues in patient care.” Several physicians would like to see more stability and predictability. • “Stop reorganizing things.” • “Do five to 10 year planning based on needs, rather than have some … politician come and change the plan post-election.” Others strongly believe that privatization of the system is the only way to address the issues. • “Advocate for parallel private care in addition to a robust public system. People can pay for anything they want except better care, and it is unjust.” • “Accept the fact that we need more private health care to supplement the public service.”
Compensation and financial considerations Many physicians commented on the issue of compensation. • “Recognize the value of work of family physicians by compensating them for it.” • “Even up the discrepancy in remuneration between family doctors and specialists.” Furthermore, rising overhead costs are affecting certain physicians and they are looking for solutions to this issue. • “Fees should keep up with the increased pressure on overhead costs.” • “Overhead is getting ridiculous.”
Alberta Doctors’ Digest
The AMA conducts quarterly surveys as one method to identify issues that are important to its membership. Administered by Vancouver-based twisurveys, anonymity of survey responses is assured. In addition to the 13 benchmark questions asked on each survey, members are often given an open-ended question to collect their views on a variety of topics such as current health issues (e.g., H1N1) and AMA initiatives (e.g., the Physician and Family Support Program). Via email invitation, 9,000 members were asked to complete the December 2011 survey; 877 members responded.
Alberta Doctors’ Digest
Negotiations Physicians are looking for progress in negotiating a new master agreement. More importantly, they would like to see more physician involvement in health care decision making. They know that an agreement will allow them to focus on their primary task of providing quality health care in their communities. • “Negotiate fairly and include physicians in health care decision making.”
• “Obtain adequate funding and a master agreement that sustains the physician involvement at the governance tables.”
Engagement is essential With ongoing negotiations and an upcoming provincial election, physician input and engagement is essential to creating a system that puts Patients First®. The comments and suggestions provided in this survey show that physicians are passionate about advocating for their patients and delivering quality health care.
Letters It is with much interest that I read Dr. Paterson's article in the January/February Alberta Doctors' Digest about seasickness and sailing. I am a recent grad just starting a practice in Red Deer and just returned from a bareboat charter in the South Pacific. Being my first time out on the open seas, I certainly could have used a few scopolamine patches or IV metoclopramide. I'll definitely pack that in the kit for next time! Thanks for the article!
The Alberta Medical Association (AMA) welcomes comments about Digest articles and suggestions for future topics. Please contact Communications Assistant, Daphne C. Andrychuk, firstname.lastname@example.org, or write her c/o Public Affairs, Alberta Medical Association, 12230 106 Ave NW, Edmonton AB T5N 3Z1. The association reserves the right to edit all letters.
Regards, Edward Lee, MD Red Deer AB
F e at u r e
What physicians already know: Patients really care about privacy A recent survey shows that privacy concerns are affecting the health care decisions made by Canadian patients, thereby affecting the outcomes of patient care. Highlights from Canada: How Privacy Considerations Drive Patient Decisions and Impact Patient Care Outcomes, commissioned by US-based FairWarning, Inc., include: • 43.2% of Canadian patients stated they have withheld or would withhold information from their provider based on privacy concerns. • 31.3% stated they have or would postpone seeking care for a sensitive medical condition due to privacy concerns. • 98% believe that executives and managers of health care providers have a legal and ethical responsibility to protect patients’ medical records and private information from being breached. • 20.8% do not believe that their health care provider has proper privacy safeguards.
On the other hand, the majority of Canadians (73.6%) agree that their health care providers are committed to protecting privacy, and 83.6% have not worried about the security of their personal information. In addition, 96% of patients acknowledged that there are significant benefits to electronic health records, but they are concerned with the possible consequences of breached records such as criminal use (45.1%) and identity theft (59.6%). Most respondents would like their health care providers to ensure safety of their records through monitoring (76.8%), encryption of information (75%), staff training on data protection laws (70.6%) and swift action upon unauthorized access of information (67.7%). Another survey will be conducted in 12 months to provide benchmarks. For a full copy of the survey results and methodology, visit: www.fairwarning.com/documents/ Canada/2011-CanadaSurvey.pdf
• 59.2% believe that new and stronger laws are needed to guarantee the privacy of patient information.
Alberta Doctors’ Digest
AMA partners up
to provide even lower life insurance rates Glenn McAthey, CFP, CLU, CHS Director/Senior Insurance Advisor, ADIUM Insurance Services Inc.
On January 1, 2012, the Alberta Medical Association (AMA) introduced to its current insured members a new and improved term life insurance plan. What makes this change unique is that the AMA has collaborated with the British Columbia Medical Association (BCMA) and Saskatchewan Medical Association (SMA) to establish a common plan design by leveraging the combined volumes of the three associations to improve coverage and reduce premium rates.
Leveraging the combined volumes of the three associations to improve coverage and reduce premium rates.
The process began in the fall of 2010 with the three associations interviewing and then selecting an actuarial consultant. After collecting and analyzing the data from the three plans, the consultant presented 10
Alberta Doctors’ Digest
a strategy document to association management in the spring of 2011. The incumbent insurer for AMA and BCMA (Sun Life Financial) was asked to present a proposal. Due to the complexity of combining the plans it was not tendered to the wider insurance marketplace, but that opportunity is always available to us in the future. After receiving Sun Life Financial's proposal last June and negotiating final premiums and plan design, agreement was reached last September to launch the new plan effective January 1. Highlights of the new plan: • Lower rates – an average reduction of 26% for non-smokers. This reduction is for all current insureds, regardless of their current health status. These new rates were reflected in the January 1 renewal invoicing sent to all insured members. • The Waiver of Premium provision (i.e., the waiving of premium payments to age 75 if the insured is totally disabled from his/her regular occupation) which was previously included in the base plan is now offered as an optional rider. Insureds who wish to reduce premiums may cancel this rider in order to save a further 16% on premiums. • Up to $3,000,000 coverage is available, in units of $50,000. • Improved conversion privilege
– insureds who wish to convert any, or all, of their AMA Term Life Insurance Plan into a permanent life insurance plan (i.e., whole life, universal life) may do so without proof of good health at any time up to their 70th birthday. Previously, conversion was only available upon loss of coverage (e.g., cancelled membership) with limited product choice. • Improved Future Insurance Option Rider – insureds with this optional rider may now increase coverage by up to $500,000 over their original insurance amount (previously the maximum increase was $300,000) and the rider now extends to age 55 (previously age 50). • Living Benefit – insureds may now access 50% of their life insurance benefit up to $200,000 (previously $50,000) if they are terminally ill and not expected to survive 12 months. • Association (not-for-profit) group model is improved: – Lower rates and improved insurer expenses and reserves mean less premium going to the insurance company and more premiums staying in the AMA/BCMA/SMA pool. Premiums that otherwise would have gone to Sun Life Financial will now remain in our pool and any resulting premium surpluses will be returned to insureds through
the AMA Premium Discount Program. A premium refund is provided in British Columbia and Saskatchewan. – Continued non-commission, salary compensation for AMA (ADIUM) insurance employees/advisors ensures objective advice in a low-pressure environment. – Each association will continue to administer their insurance programs within respective jurisdictions.
Sample monthly premium for preferred1 non-smoker $1,000,000 coverage2 AMA (five-year age banding) Age
Retail plan (leading insurer, Term 10, entry age 20) Age
If you are considering term life insurance coverage at this stage of your career, or if you carry term life insurance with another company (e.g., retail plan, mortgage insurance through your bank, line of credit coverage) you really should consider the AMA Term Life Insurance Plan. Give us a call at 780.482.0682, toll-free 1.800.272.9680, ext. 682, or email email@example.com. More information, including a life insurance needs analysis and rate calculator, and an easy to complete application form may be accessed online at www.albertadoctors.org/ AdiumInsurance/Termlife.
ADIUM Insurance Services Inc. is a wholly owned subsidiary of the Alberta Medical Association. ADIUM administers the group Disability, Office Overhead Expense, Term Life, Critical Illness, Accidental Death & Dismemberment, AMA Health Benefits Trust Fund, Student Disability Insurance and PARA Disability and Life Insurance plans. ADIUM also has access to individual insurance products to help meet special risk or other unique insurance requirements that members may have. References 1. Preferred and lower elite non-smoker rates may be offered when applying for coverage. The insurer will examine key factors (e.g., cholesterol level, blood pressure, physical build, personal and family health history, recreational activities) to determine the appropriate rate category. 2. Before AMA Premium Discount of 15% in 2012.
Alberta Doctors’ Digest
Health Law Update
Is it OK for patients to pay for prevention plans? Jonathan P. Rossall, QC, LLM Partner, McLennan Ross LLP, Barristers and Solicitors
A private medical group adds to its outlets in Calgary and Vancouver by opening a new clinic in Edmonton this May. The clinics charge an annual fee for certain health services, raising questions about possible breaches of the Canada Health Act and re-opening the long-term debate about two-tiered medicine in Canada.
Opponents of clinics such as the Copeman Healthcare Centre have argued that charging patients for services such as these violates the principles in the Canada Health Act.
For an initial fee of $3,900 and $3,000 annually thereafter, the Copeman Healthcare Centre will provide patients with a “LifePlus executive checkup” from a select health care team which will include a doctor, a nurse, an exercise specialist (likely a kinesiologist), and
Alberta Doctors’ Digest
a registered dietitian. The executive checkup (which takes approximately four hours) includes blood and stress tests, eye, ear and lung exams. There are also assessments intended to determine a person's risk for mental illness, cancer and other health concerns. Following the tests and assessments, an individualized “prevention plan” is prepared for the patient. Families will have access to parenting courses as well as cognitive and psychological assessments and concussion management for children. Registered patients can also make regular appointments for medical concerns, for which the doctors bill the Alberta Health Care Insurance Plan. Opponents of clinics such as the Copeman Healthcare Centre argue that charging patients for services such as these violates the principles in the Canada Health Act, most notably the principle of “… facilitat(ing) reasonable access to health services without financial or other barriers.”1 In the preamble to the Canada Health Act it states that: … Canadians can achieve further improvements in their well-being through combining individual lifestyles that emphasize fitness, prevention of disease and health promotion … and they desire a system of health services that will promote physical and mental health and protection against disease. In addition, section 9 of the Alberta Health Care Insurance Act states that
9(1) No physician or dentist who is opted into the Plan who provides insured services to a person shall charge or collect from any person an amount in addition to the benefits payable by the Minister for those insured services. The question, of course, is this: are the services provided in clinics like this “insured health services” as referenced in either the federal or provincial legislation? Unfortunately, the Canada Health Act does not provide a very satisfactory definition of “insured health services,” simply referring to them as “hospital services, physician services and surgical-dental services provided for insured persons.” The Alberta Health Care Insurance Act provides a bit more guidance, referring to insured services as “… all services provided by physicians that are medically required.” What is, and what is not, “medically required” has been the topic of much debate in Alberta.
The question, of course, is this: are the services provided in clinics like this ‘insured health services’ as referenced in either the federal or provincial legislation?
One way of determining whether something is “medically required” is to determine whether there is a fee code associated with that service in the Schedule of Medical Benefits. Presumably the basket of services which comprise the “LifePlus executive checkup” are not associated with any particular fee code and therefore would not be “insured services” as defined in either piece of legislation. However, the fact remains that in order for patients of the Copeman Healthcare Centre to receive what are admittedly insured services from their physicians (for which the plan is billed), they must be registered with the health centre and pay the annual fee. Again, critics of this innovative type of arrangement suggest that this may amount to “extra billing” as prohibited by section 9 of
the Alberta Health Care Insurance Act. In fact, a few years ago the British Columbia Medical Services Commission did an audit of Vancouver’s Copeman Healthcare Centre and found no contravention of the Canada Health Act or the provincial legislation providing for public funding for insured services. The group has been operating a clinic in Calgary since 2008 without issue. So what’s the problem? According to the founder of the Copeman Healthcare Centre chain, Don Copeman, health delivery models such as Alberta’s primary care networks don't have the resources for the time-intensive appointments needed to make personalized prevention. In his opinion, the kinds of services
his clinics provide are never going to be funded by the public health care system, and so this gives rise to an opportunity. The reality is that the delivery of health care services in Alberta is already complicated. There is no single model and many patients demand choice and are prepared to pay for it. And if, as advertised, the preventative services provided by groups such as the Copeman Healthcare Centre are successful, the benefits will be seen down the line in the form of reduced utilization of the public health system. And that goal certainly aligns with the principles of the Canada Health Act. Reference 1. Canada Health Act, section 3.
Alberta Doctors’ Digest
Mind Your Own Business
Clear expectations, better relationships: An employee handbook sets guidelines PMP Staff
In order to help ensure your employees are aware of their entitlements, responsibilities and obligations, an employee handbook is an excellent solution. In fact, it is a business must-have for the efficient operation of your clinic. The handbook can be created in any number of ways and the topics that can be described within are endless. However, the basic employee handbook should include at least the following sections, which completely identify both the employer and employee obligations for each scenario or situation.
Work absences There are different types of absences from work that will occur, and the employer must be prepared with a clear policy to address each of them. The following are instances where a clear policy is helpful and must define the employer’s position on whether or not the employee will be paid full, partial or no pay for the absence: • Vacation: Under the Alberta Employment Standards, employees are entitled to paid vacation leave based on the time employed with the employer. The current statutory entitlement states that employees are entitled to: - Two weeks after each of the first four years of employment, and - Three weeks after five consecutive years of employment, and each year of employment after that. However, while there is a defined statutory entitlement, most employers have a customized approach to vacation entitlement which reflects their strategy to reward and retain employees. A vacation entitlement which exceeds that of the statutory requirement could resemble the following:
After completion of
One year of employment
Two to five years of employment
Six years of employment
15 years of employment
Regardless of the vacation policy you choose to implement, it must meet or exceed the minimum described within the Alberta Employment Standards. Things to consider when defining your vacation policy: - Your employees are entitled to receive vacation entitlement, and as their employer you need to define if they are to receive this either by 1) taking time off with pay, or 2) receiving their vacation pay on every paycheque. They are not entitled to receive both. - How are employees allowed to take their vacation? Can they take single days? Is there a maximum (e.g., two weeks) they can take at one time? - How are the vacation days requested, and who approves them? Is there a form? - How many employees are allowed vacations at the same time, and who provides the coverage in their absences? - If the clinic/practice closes for certain times annually, is this automatically considered vacation time for the employee? The establishment of a clear and concise vacation policy should provide clear direction for both management and employees, so there is no room for discussion on what is allowed and how it can be taken. • Illness: Employee absence due to illness will happen, and your defined policy must address if the employer will compensate the employee for absence due to illness. If the employer chooses to compensate, things to consider are: - How many sick days are available? - Is it open to both part- and full-time employees (pro-rated amount)?
Alberta Doctors’ Digest
- How is the illness reported, and to whom? Is a medical note required for absences? - Can an employee bank sick days and be paid out unused days annually? • Compassionate, bereavement and leave of absence: In the instances where an employee requires time off for compassionate or extended leave, the employer must define if it will be allowed and then if they will have a provision for partial compensation or no compensation at all. Additionally, consideration should be given to defining if there are varying days available depending on the relationship of the deceased to the employee. • Jury duty: Jury duty is not a voluntary absence for the employee, and the employer must decide whether to compensate the individual for time away and how many days are allowed. Additionally, the employer must determine if the employee will be paid any sort of reimbursement from the courts, and adjust the policy accordingly to accommodate for this payment. • Maternity and parental leave: Employees are entitled to maternity and parental leave as defined by the Alberta Employment Standards. However, how the employer manages the leave needs to be defined to consider:
many days are available, if they are paid or not, how the absences will be applied for, who approves and records them and what happens once the days are exhausted.
Annual statutory/other holidays Alberta has designated nine specific days as statutory holidays and an additional three as optional. All are listed in the chart below. When creating your vacation policies, it is extremely important to identify to your employees which, if any, of the optional holidays your clinic will be observing.
Statutory or optional
New Year’s Day
3rd Monday in February
Friday before Easter
Monday before May 25
First Monday in September
- At what point prior to commencing the leave is the employee required to notify the employer?
Thanksgiving Day Second Monday in October
- At the cessation of the leave, how far in advance does the employee have to notify the employer of his or her desire to return to work?
Monday following Easter
First Monday in August Optional
Establishing the dates that the employee plans to commence and cease the leave is crucial to the employer being able to manage the staffing complements of the clinic. • Medical/dental: Employees will request time off for such things as medical and dental appointments, therapy sessions (e.g., physical, occupational) or diagnostic testing. In these situations, the employer needs to define how the absence will be recorded (e.g., paid sick time, unpaid leave) and how the employee notifies the employer. • Personal: This can be considered the catch-all category. In the event where the employer chooses to not develop specific policies on situations listed above (aside from maternity/parental leave), they may simply want to define a number of personal days available to the employee to cover all the potential absences. In this case, the employer must define how
Confidential information The Health Information Act (HIA) provides the legislative authority surrounding the collection and retention of all health information. Your clinic is advised to develop a policy and procedure manual surrounding HIA that would include: • A confidentiality agreement between employer and employee. • Training of all staff regarding the HIA, as well as refresher courses for senior employees. • Identification of the clinic’s chief privacy officer.
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• Storage of information on employees’ desks after work hours – clean desk policy. • Policy/procedure on how to address a patient’s or a third party’s request for information and procedure on reviewing the information prior to release. • Policy/procedure to identify a privacy breach as well as follow-up to the breach.
Discipline process There may come a time in a clinic’s existence when an employee discipline process must be undertaken. When this occurs, it is very helpful if the staff handbook identified the process that the clinic administrators or supervisors will employ. Considerations here would include: • Definition of the process – verbal, written, suspension, termination. • Are there situations that would necessitate immediate termination?
review. Additionally, to ensure that the employee verifies reviewing and understanding the handbook, it is suggested that the employees sign a validation form. This form would then be placed on the employee’s personnel file for reference in the future, should there be a question regarding compliance to any of the topics listed within the handbook. In addition to the sections suggested, other areas to consider documenting are: employee benefits, work hours, pay deductions, staff hiring, pay periods, use of employer provided equipment, Internet usage and use of personal devices. While the creation and maintenance of the employee handbook can be a large task, the benefit it provides to both employer and employee are definitely worth it. The Practice Management Program is available to assist in the development of your employee handbook, or in a number of other areas related to the effective management of your practice. For assistance, please contact Linda Ertman at firstname.lastname@example.org or phone 780.733.3632.
• Who is involved in the process in addition to the employee? The direct supervisor? The department manager? The clinic owners’ group? • Who within management has the final say regarding the identified consequence? A clear and concise defined discipline process makes things much easier for both employee and employer.
Performance appraisal process Most employees want to know how they are doing on the job as well as how they will be evaluated. Within your clinic handbook, it will be important to clearly outline the appraisal process, touching on such items as: • What is the performance appraisal cycle (i.e., time periods within the year)? • Who is responsible for initiating the review? • What is included in the evaluation? Coupled with a clear discipline process, clarification of the appraisal process should alleviate stress for both employer and employee. After creating your handbook, present it to employees for discussion and questions. As a good business practice, the handbook should be reviewed upon an employee’s initial hire and then annually – typically coupled with their performance
Alberta Doctors’ Digest
For newly graduated or experienced physician(s) in Leduc, Alberta (10 minutes south of Edmonton).
A new professional building (expected to be open in summer 2013) already has a commitment from other professionals and is now looking for physician(s) to join us. Equity and other Special Incentives are available! Please reply in confidence to: email@example.com
F e at u r e
Attention medical students: You’ve got electives, we’ve got funding! Did you know the Alberta Medical Association’s (AMA’s) ADIUM Insurance Services Inc. has helped 240 medical students with travel costs for credited electives? The ADIUM Student Elective Travel Grant is available for AMA medical student members who are/were required to travel in order to complete credited electives as part of their curriculum. Ten medical students from each Alberta medical school will receive $500 to help defray the cost of their electives. To date, ADIUM has contributed $120,000 in travel grants to medical students in Alberta. A student may apply once he/she has determined and received written approval from his/her school for the
elective(s). Students may apply for each elective, but no student will receive more than one grant. Applications for the 2012 grant will be accepted for electives that commence between June 1, 2011 and May 31, 2012. The application deadline is May 31. ADIUM is also holding a draw where one lucky medical student will win an Apple iPad. Don’t forget to enter the draw for your chance to win! Application information and forms, plus draw information, are available on the AMA’s website at www.albertadoctors.org.
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F e at u r e
“PAC” for your future:
Achieve your financial goals with pre-authorized contributions MD Physician Services
Canadian Medical Association
Regular, pre-authorized contributions (PACs) make it easy to organize your finances, have your money work harder and reduce your investment risk. Many investors agree this pay-yourself-first approach provides peace of mind and makes it far easier to ensure your savings goals stay on track.
Making pre-authorized contributions will bring your goals closer because your money starts working for you more quickly and you maximize the benefits of compound interest.
Organize your finances Quarterly tax instalments, tuition fees, retirement, vacations and home improvements are just some of the many savings goals you might have. For shorter-term goals, start by deciding what your goals are, how much it will cost and the timeline. You will then need to determine the monthly savings required to meet those goals. For longer-term goals such as retirement or funding your child’s education, it can be more complex since the required savings goal is generally not as clear. A financial advisor can play a key role in helping to determine the appropriate savings amounts as well as the right type of investments. The timing of your PACs can also be set up for different accounts at different times of the month in order to spread out the impact on your cash flow. When your cash flow changes or your goals evolve, simply adjust the amount of your PACs accordingly.
Alberta Doctors’ Digest
Benefit from the power of compounding Making pre-authorized contributions will also bring your goals closer because your money starts working for you more quickly and you maximize the benefits of compound interest. By automatically reinvesting investment gains, earnings are generated on previous earnings. And the longer your money is invested, the more chance it has to grow exponentially.
Reduce your risk A PAC plan can also help you reduce overall investment risk with dollar-cost averaging. Dollar-cost averaging is a time-tested strategy that involves investing a fixed dollar amount on a regular basis, regardless of the direction the market is moving. Over time, this approach can lower the average cost of your investment. For example, if an investor puts $1,000 in an equity mutual fund at $36 per share, that investor will have 27.8 shares. If the price falls to $27 a share, $1,000 would then buy 37 shares. Having a regular disciplined approach avoids trying to time the market and potentially buying high and selling low.
Making pre-authorized contributions can help you reduce overall investment risk with dollar-cost averaging. The power of PACs Pre-authorized contributions are a simple and powerful tool to help you monitor your progress and realize your goals. Talk to an experienced financial advisor about integrating PACs into your financial plan.
Offsite Medical Services
Want Better Business Organization? Want Increased Revenue? Want Improved Patient Care? Transcription • Alberta Health & Wellness Initiatives New & Existing Business Models • Patient Coordination Insurance Coordination • Recruitment • Recall Lists
We provide streamlined patient care solutions by providing Offsite administrative services to physicians, medical clinics, specialists and dentists.
Pam Osatiuk, RNBScN
www.nexstepgroup.ca firstname.lastname@example.org • phone: 780.571.1505 • cell: 780.819.4301
Alberta Doctors’ Digest
Measuring up Dianne B. Maier, MD, FRCPC Former Program/Clinical Director, PFSP
When I reflect upon my involvement with the Physician and Family Support Program (PFSP), it has been an experience of opportunity and growth, privilege and service. It has been perpetually exciting to participate on the cutting edge of the physician health and well-being movement, impacting the work and personal lives of the entire profession and a newly noted quality indicator of health care systems.1 Measurement is the name of the game in health. How does PFSP measure up? In my opinion, by quantitative and qualitative measures, PFSP is a physician health program which deserves the trust and integrity of Alberta physicians and their families, thus, contributing very positively to the health care system in Alberta. The entire PFSP team is energetic, passionate and skilled and have worked diligently to develop PFSP as a physician for physician program. The clinical network of service providers and physicians for physicians is equally so. PFSP has been uniquely supported and resourced by the profession. This
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program belongs to the profession in Alberta, of that there is no doubt. The program measures well in Canada. PFSP is proud of its contributions to the national landscape of physician health. We hope we have been a positive influence regarding issues that inspire us: • The importance of physicians’ confidentiality with regard to our own health care and health information. • Addressing the stigma of mental illness and addiction within the profession. • Physician health programs utilizing occupational health principles: from health promotion and early intervention through to tertiary intervention. • Working collaboratively nationally for the health of all Canadian physicians. PFSP has also been able to share many of our health promotion and education initiatives internationally. PFSP develops physician health promotion and education following distinct principles, including: • Fatigue management – Do it for your patients. Do it for yourself. • Dealing with adverse events, complaints and medical legal litigation.
• Addressing addiction with colleagues – Daring to Care. • Career transitions – Small changes, big impact. • Healthier workplaces – Everybody plays a part. PFSP recognizes that health promotion needs to be specific to the health and lives of physicians and their families, to have positive impact on physician practices and communities and, hopefully, to translate to improved patient care. PFSP assists in knowledge translation, moving from tacit to explicit knowledge regarding physician health, while reaching individuals at all career stages as well as the larger communities and culture of medicine. Through relationship-building with the multiple stakeholders in physician health, thousands of physicians, residents and medical students attend PFSP presentations annually. Attendees always seem to be engaged at PFSP education events. The importance of increasing awareness and discussion of issues from perspectives that perhaps had not been previously entertained in other professional education, as well as the opportunity to engage in conversations with colleagues are reflected well in evaluations. Moreover, the PFSP educational space strives to be supportive and experiential whenever possible.
Education sessions promote personal skill and resilience-building, as well as encouraging attendees to consider how they will support each other as colleagues and continue to create supportive work life environments in their own communities of medicine. As long and as well as PFSP has delivered health promotion and education, we recognize this is a long-term venture. We continue to work at the grassroots and to take the important small steps. PFSP intends to explore further measurement and evaluation of its health promotion and education services. The program wants to be on the effective cutting edge. Health promotion and education, by definition, enable individuals and communities to engage with their own health and to seek early intervention and treatment. In essence, PFSP encompasses many recommended aspects of health promotion, inclusive of mental health promotion.2 We measure well. The indicator that is most important for the PFSP team is a call to PFSP for support and assistance from a physician at any career stage and/ or their immediate family. The community of Alberta physicians call PFSP for the gamut of issues: relationship and family, mental health, psychiatric disorders, addictive disorders, issues related to our occupation and workplace, other personal matters and assistance in finding their own family physician. How would the support, referral and case coordination services of PFSP measure up if we borrowed and applied the following nine key features of mental health practices/
interventions proposed by Bond and colleagues at the Dartmouth Psychiatric Research Center?3
and to encourage early intervention and treatment prior to impairment whenever possible.
1. Be well defined
Physician resource resilience and retention, and a positive culture of medicine, are also reflected in a clear goal of PFSP: Healthier physicians, healthier patients.
PFSP has defined, specific, living program guidelines which include program goals, services and processes. Roles and responsibilities of the PFSP team are well defined. The provincial clinical networks of the service provider and our physicians for physicians inclusive of family physicians, psychiatrists and addiction medicine physicians are expert and collegial. The confidentiality policy is clear. The program has worked to be as transparent as possible.
2. Reflect client goals Physicians want voluntary and confidential access to PFSP. Callers to PFSP appreciate the 24/7 assistance line, providing one-call access to all support services. The first call provides the opportunity for a caller to speak with another physician and then work together to determine the right supports, referrals and resources for the caller at that time. The PFSP case coordination team walks the paths related to complex and multifaceted issues – face-to-face with physicians and their families. We have agreements to work together, encouraging accountability and responsibility of the participants for their health.
3. Be consistent with societal goals PFSP is consistent with societal goals as well as the goals of the profession. Patient safety will always be a driver of physician health and thus, it is important to distinguish between illness and impairment,
4. Demonstrate effectiveness Year after year, PFSP has experienced increases in utilization through the number of new callers and those callers who re-access PFSP. PFSP callers represent the career spectrum of physicians and their immediate families. Yes, practicing physicians call PFSP! Alberta physicians and their families voluntarily call PFSP for support and referral regarding addiction, and many times, prior to any issue being apparent in the workplace. This is a measure of effectiveness. Alberta physicians and PFSP demonstrate program effectiveness in that nearly 60% of callers access and attend therapy, 3 - 7% of callers annually seek psychiatric care, and increasing numbers of physicians seek addiction treatment, focused on best practices and cognizant of the fiduciary responsibilities of physicians. Program effectiveness has been measured by external evaluation, ongoing client satisfaction surveys, the AMA tracker surveys and more focused biannual evaluations with case coordination participants and multiple stakeholders that have vested interests in participants’ health, for example.
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5. Produce minimal side effects Adverse side effects arising from participation in the program are relatively rare in PFSP experience. Sometimes, the therapeutic match between a caller and a therapist needs to be addressed and PFSP endeavors to have this happen.
7. Incur reasonable costs
Within the case coordination service, not all participants at all times are happy when the PFSP case coordination service plan is not in alignment with their plans. However, the case coordination team continues to walk and work with them through challenges as they happen.
The costs of PFSP support the gamut of primary, secondary and tertiary support services. Supporting our profession, each other and our families is worth every penny we have invested in it as a profession.
Positive side effects include the improved health of individual physicians and their family members, renewed commitment within relationships and families – and at the best of times – a saved or transformed life. Positively, if a physician requires a medical leave of absence, with PFSP support throughout their process and in conjunction with their workplace, a return to work is almost always assured.
PFSP began with excellent principles, intent and the support of the profession. Funding through the benefit stream of the Physician Services Budget has supported what has become an inclusive assistance program. While the PFSP journey since 1998 could not be called easy, it has been one that has responded and adapted to the needs of Alberta’s physicians.
Perhaps one of the most important positive collegial and system side effects is that colleagues, clinics, clinical and academic divisions and departments have always been supportive of the health of their colleagues and welcome them back to work – whether or not medical accommodations or a graduated return to work are required.
6. Have positive long-term outcomes PFSP has positive outcomes every week. Some are understandably challenging to measure given the confidentiality and privacy of treatment.
In the last few years, PFSP has employed a framework to measure outcomes, particularly with case coordination participants. Thus, in future years PFSP hopes positive long-term outcomes and trends can be shared.
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8. Be relatively easy to implement
9. Be adaptable to diverse communities and client sub groups PFSP works well whether the caller and/or case coordination participant is a medical student, resident, or a physician engaged in any type of practice – as well as our families. It works for our “population.” You may be wondering: “Where are the aggregate statistics? Where are the numbers?” The colorful statistical stories are presented annually to the PFSP Advisory Committee. Through the PFSP annual report, the quantitative and qualitative stories are then shared with relevant stakeholders
and with the membership via membership login on the AMA website and the PFSP webpage. The 2010 report can be found there now and I am confident the 2011 report will tell an even richer story. I know you are as grateful for PFSP today as I have been to participate in the program history from 2000-12. At times, people questioned my career path, but to quote Robert Frost: “Two roads diverged in a wood, and I – I took the one less traveled by, And that has made all the difference.”4 For me, the people I have met and worked with along the way – and you know who you are – have made that road incomparable. In the end, it is all about the human relationships and the human stories. References 1. Wallace, J., Lemaire, J. and Ghali, W.A. Physician wellness: a missing quality indicator, Lancet 2009 vol. 374: 1714-21. 2. Center for Addiction and Mental Health, Della Lana School of Public Health, and Toronto Public Health Best practice guidelines for mental health promotion programs for older adults: 55+ 2010. 3. Bond, G.R., Drake, R.E., and Becker, D.R. Beyond evidence base practice: Nine ideal features of a mental health intervention Research in Social Work Practice, 20(5) September 2010. 4. Frost, R., The Road Not Taken.
Physician and Family Support Program
Please call PFSP toll-free at 1.877.SOS.4MDS (1.877.767.4637), 24 hours a day, 7 days a week, 365 days a year.
Alberta Doctors’ Digest
F e at u r e
“What do I do now?”
Responding to adverse events, complaints and litigation The information in this article is intended to provide immediate and useful information for physicians and their families when facing adverse events, complaints, challenges to privileges and medical-legal litigation. This information has been compiled by the Physician and Family Support Program (PFSP) of the Alberta Medical Association (AMA). It is also available in brochure format at http://www.albertadoctors.org/PFSP/Index.
The first steps • When your patient experiences an adverse event or you receive a notice of claim, complaint or challenge to privileges, call the: Canadian Medical Protective Association (CMPA) Toll-free 1.800.267.6522 - The CMPA is the organization through which physicians in Canada carry medical liability protection. They provide legal counsel across Canada. The CMPA is a great support and excellent source of information. - Communicating and disclosing to your patient about an adverse event can be difficult. The CMPA has published a step-by-step brochure to guide you through disclosure. It can be accessed at www.cmpa-acpm.ca. - Calling CMPA is a critical first step when facing an adverse event and prior to responding to a notice of complaint or a challenge to privileges. - The CMPA medical officer will be able to give you valuable advice. If necessary, you will be referred to appropriate legal counsel for further guidance. Physician and Family Support Program (PFSP) Toll-free 1.877.767.4637 - The Physician and Family Support Program is an AMA program available to all physicians, residents and medical students and their families in Alberta, Yukon and Northwest Territories. - PFSP provides valuable, confidential, emotional support and counseling for you and your family. 24
Alberta Doctors’ Digest
- This is a confidential program. Information is not shared with the College of Physicians & Surgeons of Alberta or any administrative body. • Uncertainty about the process of complaint or litigation is normal. The CMPA will guide and support you through the specific steps and processes to be taken. Charts illustrating various medical-legal situations are available on the PFSP page of the AMA website at www.albertadoctors.org. • RECORD everything you can remember about the incident for your own future reference. Protect and secure the medical file. Do not change or write anything on the file. Make a photocopy of the file. • It is best not to discuss the content of a suit, complaint or challenge with others. It is, however, acceptable and beneficial to share your feelings in general around this challenging experience with an appropriate trusted individual.
Communicating and disclosing to your patient about an adverse event can be difficult. The CMPA has published a step-by-step brochure to guide you through disclosure.
What you may experience • In adverse situations, it’s perfectly normal to experience intense emotion and confusion. You may feel disbelief, hurt, anger, sadness, guilt, shame, fear, anxiety and self-doubt. • You may feel the urge to do something impulsive such as changing the way you practice, but this is not the best time to make significant decisions. Trust that these intense emotions will subside, especially once
you’ve begun receiving the support you need such as legal counsel and counseling. • Being excessively hard on yourself is unproductive – it can damage your morale and your ability to take action to make things better. Self-evaluation, on the other hand, can be a positive motivator for change. Analyzing the incident as to how it happened, why it resulted in a complaint or legal suit, and what can be learned from the experience may even mean you benefit in the long run. • Errors and adverse medical outcomes are usually the result of a number of factors. It’s reasonable for you to acknowledge your role in the incident. Recognize, though, that others – staff, the hospital, the system and sometimes even the patient – may have played a role. • You may feel that a complaint or legal suit is a betrayal or an affront in response to the long hours and the personal sacrifices of your career. • Complaint and legal processes can be time consuming and take longer than you might wish. Focus on one step at a time, with the guidance of your lawyer as well as your counsellor (PFSP). This can help prevent putting your life on hold, or dwelling on the “what ifs.” • Make a point of caring for yourself and your family. Eating well, adequate sleep, exercise and allowing yourself some pleasurable activities will help you cope with this stressful experience.
Helpful self-talk • I can expect to be very upset. This is an emotionally painful experience.
uncomfortable. This intensity lessens over time. I will make it through this; I will seek out help and support, and take one step at a time.
It is appropriate to evaluate the situation, attend to my role in the incident and learn from this process. First aid for family members • Family members can also expect to experience a wide range of emotions similar to the physician. You may also feel betrayed by the patient/health authority. You may feel anger and shame as to how this situation might reflect on you. • Be supportive. Your physician-family member needs the help of someone who believes in him/her. • Initiate discussion about feelings and emotions with your physician-family member. Encourage communication. In the Province of Alberta, communication between spouses is confidential. A physician-family member cannot be forced to disclose. • Seek counseling support through the PFSP for yourself and other family members if you need information, advice or counseling.
• Being sued is not an attack on me personally.
• Seek help from PFSP if you, your spouse or other family members are suffering from depression or anxiety.
• Virtually all physicians experience situations of miscommunication, adverse events and errors.
• Plan some family activities. Discuss and acknowledge each other’s feelings.
• Litigation and complaints can happen regardless of whether negligence actually occurred.
• It is reasonable that a patient should be compensated if he or she is injured by error.
PFSP would like to thank the Canadian Medical Protective Association (CMPA) and Valarie Prather, Bennett Jones, Calgary AB, for contributing material to the compilation of this information.
• I owe it to myself to keep balanced thoughts by acknowledging all the positive contributions and relationships I’ve made in medicine. This unpleasant event does not need to diminish the overall satisfaction of the practice of medicine. • It is appropriate to evaluate the situation, attend to my role in the incident and learn from this process. • Right now the feelings are very intense and
Information and resources More information and resources, including a list of books and articles, can be found on the Alberta Medical Association’s website and the PFSP webpage at www.albertadoctors.org. Alberta Doctors’ Digest
CMA website – clinical resources J. Barrie McCombs, MD, FCFP
The Canadian Medical Association (CMA) provides a wide range of clinical resources to help its members stay informed with the latest clinical information. This article offers a brief overview of the available resources.
CMA website The main website cma.ca gives access to a wealth of information and resources for CMA members. If you have never used the website before, you can register online using your CMA membership number. To view the clinical resources, click on the Clinical Resources/K4P tab near the top of the page. If you spend a long time browsing a resource, the time limit on the website may expire, requiring you to re-enter your user name and password.
If you have never used the website before, you can register online using your CMA membership number.
Clinical Resources/K4P Page This page provides an introductory video for new users. The most useful
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links are available from a handy menu on the left side of the page. More information about selected links is available in the main body of the page. When you finish using any resource, click on the Log Out or Log Off button so that the resource becomes available to other CMA members.
Ask a CMA librarian New users should take advantage of the assistance available from a CMA librarian. A librarian can help you with individual searches as well as how to use the online resources, as each has its own unique internal search and navigation system.
CMAJ The full text of the Canadian Medical Association Journal (CMAJ) is available here. Other CMA publications, such as the Canadian Journal of Rural Medicine, can be found under the CMA Publications link.
MD Consult MD Consult is a very popular resource as it offers a wide selection of textbooks, full-text journals, clinical practice guidelines and other resources. The default is to search all selections, but searches can be limited to individual sections, such as textbooks.
Users can search for a specific textbook or browse by title or specialty. The index lists both the name of the text and the vendor database where it is located. At the top of the alphabetical list is the popular Minute Clinical Consult quick-reference text.
DynaMed is updated daily with evidence-based information in point form. According to the CMA librarian, it is a very popular resource. Click on the Help link to learn how to improve your searches.
Readers can search for journals by title or browse by specialty. Due to their high cost, the site does not provide access to major journals like the New England Journal of Medicine and the Journal of the American Medical Association.
Stat!Ref provides several medical textbooks. A search tutorial is provided. To return to the CMA website, you must use the Logout link, rather than using your browser’s Back button.
Access Medicine provides more than 20 textbooks, including Harrison’s Principles of Internal Medicine and Tintinalli’s textbook on emergency medicine. Diagnosaurus is a free differential diagnosis tool that is available online and for download to handheld devices.
Drug information is provided by Lexi-Comp which recognizes most Canadian drug names, indications and dosages. All of these may differ from those listed in the drug information sections of other resources.
Virtual library for rural physicians
This resource allows the user to conduct MEDLINE literature searches. The search results include access to EBSCO’s full-text journals. For simple searches, users may find PubMed (pubmed.gov) easier to use.
The CMA librarian rates this MEDLINE searching tool as more precise than the one in the EBSCO section. If desired, users can limit their search to a specific range of dates.
By the time this article is published, the Alberta Rural Physician Action Plan will have discontinued the virtual library program. Fortunately, many of the same resources are available on the CMA website.
Clinical Practice Guidelines Links to Canadian guidelines are available here. MD Consult and other resources provide access to additional guidelines. Search tips are provided and the user can also browse by medical condition or specialty.
An@tomy.tv This human anatomy tool permits the viewer to see any part of the human body. An introductory tutorial is provided to help you learn how to “dissect” the pictures to see different layers.
Your comments and suggestions are welcome. Please contact me: email@example.com T 403.289.4227
Alberta Doctors’ Digest
Alberta Doctors’ Digest
In A Different Vein
Not so long in the Bluetooth Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP Co-editor
It wasn’t really like “Pass the Message” – you know, the children’s game where a message gets garbled when being passed along. The famous Pass the Message occurred during World War 1. The original message from the trenches to British headquarters, “Send reinforcements, we're going to advance” became after multiple transits, “Send three and fourpence, we're going to a dance.” My communication problem started, and continued, because I didn’t use a magic word. So I checked this morning with my administrative assistant, Karla, to see if she thought I might be simple-minded. She assured me that I might not be. With 1,486 fines of $180 being handed out in Calgary in the first four months of the new distracted driving law (i.e., for talking on the cellphone while driving), I knew I needed one of those thingies that allows you (when you are paged while in the car) to shout out, “Call my office.” I think I said something as follows to the lady behind the desk at the Ford dealership: “Do you have one of those things you can fit in the car so I can start answering a call in the car?”
Although I may not have used those precise words. I also waved my hands up and down in the air several times to clearly indicate someone with their “hands-free.” My car keys may have been in my right hand though they may not have been. She may not have clearly heard the words, “answering a call in,” though she should have. “We don’t have one of those,” she said. “You must have,” I said. “A lot of people have them, particularly now.” She looked in her catalogue. “We can get you a DB40 computerized XLT. But we have to bring it in from the States,” she said. “It’ll take a week. It’s $560 plus tax.” “Does it have one of those display panels?” I said. She looked at the catalogue: “No. You don’t need one.”
handed my keys with an additional dangly thing hanging from them, was told the instructions were in the car, and off I drove to an evening Journal Club. Nothing much seemed to have been done in the car, but there was a shiny box in the passenger seat. I also had that dangly thing hanging from my car key ring. In the orangey light outside the Redwater Rustic Grille before the Journal Club meeting, I read on the box: “DB40 XLT Remote Starter.” George the mechanic chuckled the next morning. “It was a Bluetooth you needed. Do you want that remote starter?”
When I was a boy scout, I learned with difficulty the Morse Code for the 26 letters of the alphabet, which seemed useful at the time, but the 38 different sequences on my remote I am going to leave.
“Ah,” I said. She phoned me the following week.
“No,” I said.
“The DB40 computerized XLT is in. Bring the car in Thursday and we’ll fit it.”
I heard him drawing in his breath between his teeth.
I was really looking forward to this. George the mechanic said, “We’re fitting the DB40, right? Just sign the work order here and here.” I signed – despite my father telling me several times never ever to sign anything without reading it first – and returned in the evening, paid, was
“Hmm, you signed the work order. But I’ve talked to my parts manager and we’ll give you a credit for half the cost of the remote.” “Well, I still need that Bluetooth thing,” I said. “We’ll do it no problem. Bring the car in Thursday.”
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The DB40 XLT instruction booklet gives me 38 different choices in the order of pressing the buttons on the dangly thing that hangs from my car key ring. If I press the top-right button briefly then hold it for three seconds and then the bottom left button briefly then press again for three seconds, I can remotely open the rear door, turn on the car lights, radio and rear defroster without starting the car “in valet mode” – whatever “valet mode” is. When I was a boy scout, I learned with difficulty the Morse Code for the 26 letters of the alphabet, which seemed useful at the time, but the 38 different sequences on my remote I am going to leave. Next Thursday, George chuckled again, “Fitting your Bluetooth this time eh?” “Yes,” I said, “Communication problem. Don’t know how it happened.”
I know people — quite intelligent people — who have had to phone for help in order to find out how to switch on their new iPads.
I got the phone call in an hour: “Alexander, you already have a Bluetooth installed. It just needs to be activated.” George and I spent half an hour shouting at the centre column of the dashboard: “Four zero three two five nine six six zero nine ...” “The number you have given me is four four three ...” 30
Alberta Doctors’ Digest
What I mean is this: Is the world a better, more efficient place with all this extra stuff? I used to do fine travelling in India and calling home by placing a request with the telephonist for what was termed a “lightning call.” You went and had breakfast, read the paper and within an hour you’d hear your name called out, you’d go to the phone and – bingo – there was your call. Now with my Apple iPhone (which accidentally slid off the sideboard into the dog’s water bowl) I struggle to find a network overseas that will function without bankrupting me. My friend, Francisco, who is a young physician as well as a jolly Spaniard, told me at dinner the other night about his new washing machine. “I buy new washing machine. And what I get? I get two CDs of instructions in plastic case. I just want to plug in, press button and maybe twirl a dial. I do not wish to spend an hour looking at screen. Two CDs! And then I have forgotten what to do at the beginning.” I know people – quite intelligent people – who have had to phone for help in order to find out how to switch on their new iPads. This world is divided into lumpers and splitters, and right now the tedious splitters have the conch. Us broad-stroke, big-picture lumpers are in full retreat: send three and fourpence, we’re going to a dance. A few months ago I bought a new sound system. The old disc player required frequent reloading of CDs during a dinner party. I expected to take it out of the box, plug in (after perhaps sticking the square thing into some hole) and relax to the perfect sounds of Django Reinhardt and the Hot Club de Paris. Most of the bits were sealed in rigid, clear plastic suitable for use as time capsules. To open them I suggest a
stabbing action with carpet cutters available from The Home Depot, followed by cuts using garden shears. Otherwise there will be blood on the floor. Now open the instruction booklet and read: Congratulations on your purchase of the A34d 7H Sound System and welcome to your easy-to-follow set-up instructions. If you really want to waste a lot of time, simply boot up and insert instruction disc B2 into your computer or go to www.wastealotoftime.com/ setup/difficulttofindinstructions and click the HELP button. Here you will find something to read and receive some useless information, but certainly no help. But first: READ ALL SAFETY INSTRUCTIONS. If you are French, turn the Quickstart sheet over three times, angle it to 90 degrees and read from the back. WARNING: To reduce the risk of fire, electrical shock, flooding and/or explosions, do not handle the XD 24 Digital Capacitor with wet hands or let the dog lick it. There is a danger of smoke inhalation if the battery is inserted incorrectly. Use only DL32.007 Dingsplat batteries (supplied with the A34 e7H Sound System (but not supplied with yours, loser). ADDED WARNING: This product is intended for use with only the power supply provided. Where the main plug is used as the disconnect device (dd) it should be fully operable. If not fully operable, check all dd connections to the power supply. Re-wire house if necessary and check the nearest overhead pylon. Congratulations on your choice! You are now ready to start the assembly. Unpack the carton, checking that all items are present. Save the carton (that you have stupidly cut up into little pieces) for sending everything
back when you discover you don’t have the co-axial jigger cable B52.
Place all items on a flat table. Congratulations! You are now really ready to start assembling. But first, read carefully all the instructions, memorizing and reciting them word perfectly. This is important. Select the correct insert A, B or C using the chart on page 8. (For readers in the Middle East this will be on the left-hand side of the page and read backwards. For definitions of Middle East countries go to www.wastealotoftime.com and click on the Help button, but only if your language of choice is Aramaic.) Place the correct insert A, B or C on the receiving dock and press down. When it does not click into place, use a soft hammer. Now take a rest. (To remove an incorrect insert, see page 10.) Now take the bliggered hookpile end of the Haldane connector jack and insert into the decommissioning 10 GB software archive.
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TROUBLESHOOTING: Go to www.reallyuselessinformation.com and click on the HELP button. Find out how the HELP button never, ever, ever gives you any help. MORE USELESS TECHNICAL INFORMATION: Power rating 100-240 V, 50-60 Hz, Inverter 64-67 V.A. “Brig af den rigtige indsats” – return to page 5. You are now reading the Danish instructions. The combination of Pass the Message with technoglob instructions is giving me a new neuropsychiatric illness: “gizmofatigue syndrome.”
ALL-WELL PRIMARY CARE CENTRES MILLWOODS EDMONTON Phone: Clinic Manager (780) 953-6733 Dr. Paul Arnold (780) 970-2070
I’ve had enough and I’m not taking it any more! Enough of communication quantity. I want quality!
Alberta Doctors’ Digest
F e at u r e
Paying pharmacists to prescribe: Thoughts from the profession Pharmacists have had the ability to prescribe Schedule 1 drugs and blood products since 2007. On February 13, Minister of Health and Wellness Fred Horne announced details of plans to facilitate an expanded role in renewing prescriptions for pharmacists by compensating them for doing so. The following letter from Alberta Medical Association (AMA) President Dr. Linda M. Slocombe and Section of General Practice President Dr. Ann R. Vaidya was sent to, and carried by, numerous provincial newspapers. To Whom It May Concern: Comparing a $20 prescription fee to a $35 physician office visit is simplistic to the point of being misleading. It also misses the mark in terms of the real issues: (i) the need to support greater inter-professional collaboration in the best interest of patients and (ii) avoid the further fragmentation of care. The $35 visit cited is the most common code that family physicians bill. This visit code covers hundreds of situations and will also vary in length, expertise required, etc. Even when a visit pertains primarily to a prescription renewal, there is an assessment that often includes a physical examination and an evaluation of any intervening conditions or events since the last visit. It’s important to note that many times, patients are brought back for prescription renewals so that the physician may also monitor the patient’s overall condition – particularly in the case of chronic-care patients with multiple conditions. The system receives excellent Value for Patients® from that $35. Pharmacists themselves have noted that they will not handle complex cases or renew certain types of drugs that have to be more carefully monitored. This is sound practice, but it is also clear that the average renewal by a physician will not be the same as that by a pharmacist. The main concern from the physician community is continuity of care and the impact this could have on patients if the patient’s overall treatment is fragmented by multiple prescribing points, without appropriate interprofessional consultation.
Alberta Doctors’ Digest
Regarding cost to the system, it is premature to say whether this step will result in savings, be neutral or even increase costs. The eventual outcome depends on a number of things: whether fewer physician and pharmacy visits will result; whether more costs will be generated if patient care issues are missed because the patient sees the pharmacist instead of the physician; whether this will actually free time for physicians as we keep track of multiple prescribers, engage in phone tag over renewals or amendments of prescriptions by pharmacists, etc. Please do not interpret these comments as a condemnation of pharmacist-physician collaboration. Pharmacists and physicians will continue to work closely together and in the interests of patients. There are new initiatives taking place, supported by both disciplines, to support collaboration and provide best care. In fact there should be more support for this collaboration – support for pharmacists in primary care networks, fees for pharmacists preparing complex drug reviews in collaboration with physicians and a pharmacist-physician e-communication fee. We suggest that this would have been better use of taxpayer money than to simply pay pharmacists for every renewal. We are also aware that some steps taken by the Alberta government have reduced revenues to pharmacists and could threaten their practices, especially in rural areas. It is extremely important to all Albertans that the viability of pharmacy practices be maintained. We believe they should be supported, but were other alternatives even considered by government? Dr. Linda M. Slocombe President, AMA Dr. Ann R. Vaidya President, AMA Section of General Practice Value for Patients® is a registered trademark of the Alberta Medical Association.
EDMONTON DOCTOR WANTED Doctor looking for Full-time Physician to join his busy family practice. Part time physicians could also be helpful. Dr. M. Lal 3504A – 137 Avenue NW Edmonton, AB Clareview Medical Clinic is located in a residential area with a high patient volume. The clinic was recently completely renovated and is situated next to a Pharmacy. There are six examination rooms, three offices and a treatment room. This is a fee for service opportunity offering a 70/30 split. Additional starting incentives are available such as guaranteed monthly income. Hospital Privileges Preferred Open Monday to Friday 9:00 a.m - 6:00 p.m, Saturday 9:00 a.m - 4:00 p.m. Extended hours are a possibility Walk-ins Welcome For additional information please contact: Dave Galon – (306) 536-4642 or Aileen Jang – (780) 232-9297
For InterdIscIplInary rehabIlItatIon servIces! LifeMark Health Institute (LMHI) is seeking physicians to join our interdisciplinary chronic pain team. We have immediate availability for various FTEs. The chronic pain services at LMHI are fully publicly funded and all participating physicians are remunerated via an ARP agreement. The result is a very collegial, supportive environment with a broad range of physician skill sets including: • Family practitioners • Neurosurgery • Occupational Medicine
• Physiatry • Psychiatry • Internal medicine
Most of the physicians have been with the clinic for many years – a reflection of the level of satisfaction with the professional culture/ environment. We have been providing chronic pain services to the community for over 15 years with our success lending to the strong team approach - physiotherapy, occupational therapy, psychology, nursing, dietary, kinesiology and administrators. We work very closely with PCNs and other community based physicians and continue to evolve our services to meet the needs of the population. Care of Dr. Ian Forster, please contact Jason Sheehy at 780-486-6890 for more information or via e-mail at firstname.lastname@example.org.
Alberta Doctors’ Digest
Classified Advertisements Locum wanted CROWSNEST PASS AB Maternity locum needed from August to December; possibility of a longer association. Full-service rural practice in the beautiful Rocky Mountains. Five general practitioners, anesthesia, general surgery and orthopedics working together in a primary care network. Contact: Dr. P. McKernan T 403.562.8804
coordinating care with other clinical specialties. Qualifications preferred are CCFP or Royal College certified in internal medicine, eligible license to practice in Alberta, experience leading multidisciplinary teams and willingness to work with the management team. Interested candidates can email their resume and cover letter to the hiring committee. Contact: email@example.com CALGARY AB
EDMONTON AB Justik Medical Clinic requires a locum for July and August. We are a multidisciplinary clinic in vibrant Old Strathcona. Our health care team includes family physicians, psychiatrist, internist, gynecologist, nurses, dietician, mental health worker and occupational therapist. Ancillary services offered in the building are diagnostic imaging, pharmacy, physiotherapy and massage therapy. The clinic offers a competitive fee split, flexible hours, a high staff-tophysician ratio and electronic medical records with remote access.
Westbrook Medical Clinic is recruiting part- and full-time physicians for our busy clinic in southwest Calgary to join three family physicians. The clinic is computerized but willing to accommodate doctors who are computer shy, 70/30 split. International medical graduates who are eligible to practice in Alberta: I am willing to sponsor you. Contact: Dr. Lota or Roseli (office manager) T 403.246.0877 firstname.lastname@example.org CALGARY AB
Contact: Paula McEachnie T 780.432.0211, ext. 212 email@example.com
Physician wanted CALGARY AB New clinic seeks a highly motivated general practitioner with a special interest in wound care. This position will be responsible for assessing patients and managing their care plan, supervising the care team and
Alberta Doctors’ Digest
Celebrating more than 30 years of excellence in serving physicians, MCI The Doctor’s Office™ has openings available to fit your lifestyle in both family practice and walk-in shifts. Flexible hours and schedules, no investment, no financial risk, no leases to sign, and no administrative or human resource burdens. MCI Medical Clinics (Alberta) Inc. provides quality practice support in nine locations throughout the city. Contact: Margaret Gillies TF 1.866.624.8222, ext. 433
firstname.lastname@example.org www.mcithedoctorsoffice.com CALGARY AB Med+Stop Medical Clinics Ltd. has immediate openings for part-time physicians in our four Calgary locations. Our family practice medical centers offer pleasant working conditions in well-equipped modern facilities, high income, low overhead, no investment, no administrative burdens and a quality of lifestyle 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 email@example.com CALGARY AB Established medical esthetic company in Calgary is looking for a motivated general practitioner with an interest in medical esthetics to join our team. Earn $75,000 to $100,000 for seven medical cosmetic days a month. Growth potential is unlimited. Contact: Stewart T 403.809.1136 firstname.lastname@example.org EDMONTON AB The University of Alberta, Faculty of Medicine & Dentistry, Department of Medicine, Division of Geriatric Medicine, in partnership with Alberta Health Services, is inviting applications from family physicians with expertise in care of the elderly to join the Glenrose Rehabilitation Hospital Geriatric Inpatient Rehabilitation Program in the Edmonton Zone.
The Glenrose Rehabilitation Hospital is the largest free-standing tertiary rehabilitation center in Canada serving patients of all ages who require complex rehabilitation to enable them to participate in life to the fullest. As a leading-edge academic teaching hospital, the Glenrose participates in educational training programs for health sciences professionals and offers an array of research and technology development opportunities. The successful candidates will join an integrated group of health care professionals. Geriatric patients are the focus of our service; treatment includes an integration of medicine, nursing, rehabilitation, social work and pharmacotherapies. These patients have had acute physical, cognitive and social decline in the past two to three months and have reduced independence. The responsibilities for successful individuals would include clinical rehabilitative care for six in-patients, working collaboratively with the interdisciplinary team, participating in an on-call roster (average one-in-eight second call), completing all administrative data related to cared-for patients, and participating in regular meetings related to patient care and quality improvement. Candidates must have an MD or equivalent and be eligible for licensure with the College of Physicians & Surgeons of Alberta. Training in care of the elderly and/or experience in the care of seniors would be an asset. We offer core geriatrics training to anyone interested. A proven track record of mentoring trainees and collaborating widely is preferred. The successful applicants will be expected to apply for an Academic Colleague Appointment in the Department of Medicine, University of Alberta, which will be considered under a separate process through the Faculty of Medicine & Dentistry. Remuneration is competitive and based on a sessional clinical alternate
relationship plan. After hour in-hospital coverage is provided. Details about the University of Alberta, Faculty of Medicine & Dentistry and the Division of Geriatric Medicine can be found on the faculty’s website at www.med.ualberta.ca; Alberta Health Services at www.albertahealthservices. ca, and the City of Edmonton at www.edmonton.ca. For further information, please contact: Dr. Hubert Kammerer, telephone 780.920.4773 or email at email@example.com or Dr. Elisa Mori-Torres, telephone 780.910.2509 or email at elisa.mori-torres@ albertahealthservices.ca. All qualified candidates are encouraged to apply; however, Canadians and permanent residents will be given priority. The University of Alberta and Alberta Health Services hire on the basis of merit. We are committed to the principle of equity in employment. We welcome diversity and encourage applications from all qualified women and men, including persons with disabilities, members of visible minorities and Aboriginal persons. Interested candidates should submit a curriculum vitae outlining their current clinical and leadership experience, and three reference letters. The competition will remain open until the position is filled. Contact: Dr. Hubert Kammerer or Dr. Elisa Mori-Torres Co-Site Chief, Geriatrics Glenrose Rehabilitation Hospital 10230 111 Ave NW Edmonton AB T5G 0B7 T 780.735.8845 F 780.735.8846
in business since 1955. We are currently seeking a full-time family physician who wishes to work in an appointment-based practice. The Links Clinic offers excellent patient volume, work hours and has been on electronic medical records for 20 years. The Links Clinic is part of the Edmonton Oliver Primary Care Network which provides a large range of allied health services. All these services are offered in the Mira Health Centre, 11910 111 Avenue, where the clinic is centrally located. DynaLIFE Dx Diagnostic Laboratory Services and CML HealthCare Imaging Inc. are also on site, along with other health-related services. There are no clinic management responsibilities or capital investment required. You can devote your time to medicine. Please give me a call if you may be interested and I would be happy to answer any questions. Contact me if you would like a tour. Contact: Dianne Walker, CA Business Administrator T 780.453.9467 firstname.lastname@example.org EDMONTON AB Two positions available at the West End Medical Clinic for part- or full-time general practitioners. Walk-in and family practice clinic. Physicians will enjoy no hospital on-call, paperless clinic and friendly staff. Clinic is in a busy area of west Edmonton and has four physician offices and eight examination rooms. Contact: Dr. Gaas T 780.893.5181 email@example.com EDMONTON AB
EDMONTON AB The Links Clinic, a 19-physician group with family practice, pediatrics and internal medicine, has been
Dr. Lal is looking for a full-time physician to join his busy family practice at 3504A 137 Avenue. Clareview Medical Clinic is in a
Alberta Doctors’ Digest
residential area with high patient volume. The clinic was recently renovated and is next to a pharmacy. This is a fee-for-service opportunity offering a 70/30 split. Additional starting incentives are available such as guaranteed monthly income. Hospital privileges preferred. Office hours are 9 a.m. to 6 p.m., Monday to Friday and 9 a.m. to 4 p.m. on Saturday. Extended hours are a possibility; walk-ins welcome. Contact: Dave Galon T 306.536.4642 or Aileen Jang T 780.232.9297 LETHBRIDGE AB Newly renovated primary care clinic in Lethbridge is actively seeking a physician to join our team of four doctors. Very easy-going group of physicians and staff, offering generous split in a well-equipped and bright atmosphere with pharmacy, pain specialist, mental health specialist, physiotherapist and chiropractor on site. Lethbridge is a beautiful city of 75,000, close to the mountains, great university and college, excellent recreational and art facilities, and nice climate. Contact: Shari Lethbridge Medical Clinic 300 3rd St S Lethbridge AB T1J 5Y9 T 403.394.2002 lethbridgemedicalclinic.com RED DEER AB Associate Medical Group (AMG) is looking to recruit part- and/or full-time physicians to join a well-established, busy family practice with a long-term presence in Red Deer. Red Deer, population 90,000, offers many recreational and educational opportunities. Laboratory and X-ray services and hospital are in close
Alberta Doctors’ Digest
proximity. AMG offers excellent staff, supportive colleagues and full electronic medical records. An interest in obstetrics is welcome. Good earning potential and the blend of practice can be tailored to your interests. Contact: Diane Klassen, Manager T 403.346.2057 F 403.347.2989 firstname.lastname@example.org RED DEER AB Associate Medical Group walk-in requires part- and/or full-time physician(s). The clinic is near a pharmacy and has good access to laboratory and X-ray services, and the hospital. Fully integrated electronic health records, excellent support team, supportive colleagues and working closely with the Red Deer Primary Care Network. Good potential for excellent remuneration. Contact: Diane Klassen, Manager T 403.346.2057 F 403.347.2989 email@example.com or Dr. Maureen McCall, Medical Director T 403.346.2057 F 403.347.2989 maureenmccall@ associatemedicalgroup.com
from Calgary. Invest in yourself and your family. Join four established physicians in a true family practice and have a life as well. Strathmore is a town of 12,000 people situated on the prairies, but is close to all the amenities of the Rockies and a big city. Our hospital has a 23-bed acute-care ward, long-term care and a busy ER (more than 30,000 visits per year). Emergency and acute-care skills are preferred, but not essential. Earning potential is limitless. Expenses are 30% of office billing. We are part of the Calgary Rural South Primary Care Network and have a robust chronic disease program. The group stresses team work and collegiality. Contact: Dr. Ward Fanning T 403.934.5205 (office) T 403.934.3934 (home)
Physician and/or locum wanted EDMONTON AB Summerside Medical Clinic requires part- and/or full-time physician(s). Locums are welcome. The clinic is in the vibrant, rapidly growing community of Summerside. Examination rooms are fully equipped with electronic medical records, printers in all examination rooms and separate procedure room.
SLAVE LAKE AB Congenial, extremely busy practice urgently requires a full-time family physician with interest in obstetrics. Good on-call schedule. Contact: Merylin Hodge T 780.805.0746 or Dr. John Keaveny T 780.849.4155 F 780.849.4574 firstname.lastname@example.org STRATHMORE AB Excellent practice opportunity in a rural setting only 50 kilometers
Contact: Dr. Nirmala Brar T 780.249.2727 email@example.com SHERWOOD PARK AB Synergy Medical Clinic, Women’s Wellness Centre and Medical Plus are looking to recruit part-time, full-time and locum general practitioners and specialists to join our state-ofthe-art facility. We are excited to be part of the brand-new Synergy Wellness Centre in Sherwood Park, home to 18 health-related clinics with on-site services including radiology, laboratory, physiotherapy,
dermatology, psychology, dentistry, sleep laboratory and cardio-pulmonary clinic. We offer a competitive fee split, fantastic staff, full electronic medical records and flexible hours. Contact: Mel firstname.lastname@example.org www.synergymedical.ca SLAVE LAKE AB Slave Lake Family Medical Clinic is urgently looking for a full-time family physician to work clinic and on-call hospital schedule. Paperless clinic, Netcare available. Urgently need locums to work Monday to Friday, 8:30 a.m. to 4:30 p.m. Contact: Daniel Payne T 780.849.2860 (office) T 780.849.4009 (home) email@example.com ALBERTA, BRITISH COLUMBIA AND ONTARIO Our company has several clinics in Alberta, British Columbia and Ontario in need of family physicians interested in working part-time, full-time and locum basis. Clinic locations with availability include Vancouver and lower mainland, Vancouver Island, Sherwood Park and Toronto. Contact: Trish Odowichuk T 604.816.7119 firstname.lastname@example.org
Contact: Catherine Zip T 403.299.5840 email@example.com CALGARY AB Evergreen Professional Medical Building, 4015 17 Avenue SE, has space for lease. Building has existing long-term tenants, family practice/walk-in medical center, pharmacy, dental clinic, denture clinic, physiotherapy/rehabilitation, Bank of Montreal/ATM center. Building is well-maintained/newly renovated, minutes from Peter Lougheed Hospital, Alberta laboratory services center and imaging center. Minutes from downtown, easy airport access, excellent parking ratio and high-traffic 17 Avenue SE with terrific street signage. Contact: T 403.606.1411 firstname.lastname@example.org HIGH RIVER AB Approximately 2,000 sq. ft. available in an updated facility in High River, three-minute drive to the High River Hospital and 25-minute drive to Calgary. Clinic currently has a full-time obstetrician/gynecologist and is suitable for up to three family doctors or alternately a specialist. Reasonable rent or will provide complete practice support with staff. Contact: David Baker T 403.660.8551 email@example.com
Space available VICTORIA BC CALGARY AB The Dermatology Centre at 124 42 Avenue SW has furnished or unfurnished space available for lease. This space would be suitable for a general practitioner or specialist. The building has a pharmacy and ample parking.
Over 1,000 sq. ft. of medical space designed for two to three physicians in a convenient location. Ideal for a family practice and walk-in clinic in the only prime neighborhood left in Victoria with no walk-in and limited family practice service. Space includes two reception stations, four or five treatment rooms, an office,
built-in high-speed networking and free parking for patients. Highly attractive and flexible lease terms with substantial rent-free period and below-market rent. Clinic set up and management services also available. Contact: Har T 250.818.1468 firstname.lastname@example.org
For sale Edmonton AB Successful medi-spa for sale in vibrant, busy, south-central location with a high volume of walk-by clients. Highly sought after non-invasive services including botox, voluma, laser hair removal, photo-rejuvenation and micro-dermabrasion. Knowledgeable, well-trained staff and loyal, repeat client base. Results-oriented marketing has produced numerous new clients. State-of-the-art laser and skin analysis technology. Truly a great, well-established turn-key operation with a solid reputation in the industry. Well-designed website created in 2010. Asking $350,000. Contact: Walter T 780.444.7782
Symposium 46TH ANNUAL MACKID SYMPOSIUM DEPARTMENT OF FAMILY MEDICINE MOUNT ROYAL UNIVERSITY CALGARY AB MAY 4 Alberta College of Family Physicians CPD road show, Department of Family Medicine, Calgary, presents keynote presentation: “Baffled, befuzzled and bemused: How not to get fooled again … and again … and again” by G. Michael Allan, MD, CCFP. All family physicians, residents
Alberta Doctors’ Digest
and interdisciplinary health providers are invited to attend. For more information regarding the symposium, visit: www.talksfordocs.com
Ship: Regent Seven Seas Voyager CARIBBEAN CME CRUISE November 17-December 1 Focus: Rheumatology and palliative care Ship: Celebrity Equinox SOUTHEAST ASIA CME CRUISE January 20-February 3, 2013 Focus: Clinical pearls in medicine Ship: Celebrity Millennium
Courses SEA COURSES CME CRUISES Companion cruises FREE. MEDITERRANEAN CME CRUISE May 18-30 Focus: Diabetes management update Ship: Celebrity Silhouette July 22-August 3 Focus: Esthetic medicine Ship: Celebrity Solstice August 11-18 Focus: Hospitalist medicine Ship: Mariner of the Seas ALASKA CME CRUISE July 15-22 Focus: Women’s health and endocrinology Ship: Celebrity Century August 19-26 Focus: Motivating healthy behavior Ship: Celebrity Century RUSSIA RIVER CME CRUISE August 10-22 Focus: Internal medicine update Ship: Uniworld Victoria BRITISH ISLES CME CRUISE September 6-16 Focus: Endocrinology Ship: Regent Seven Seas Voyager CANADA AND NEW ENGLAND CME CRUISE September 29-October 6 Focus: Psychiatry and the law Ship: Veendam ISTANBUL TO LUXOR CME CRUISE October 31-November 14 Focus: Cardiology and lipidology
Alberta Doctors’ Digest
Contact: Sea Courses Cruises TF 1.888.647.7327 email@example.com www.seacourses.com
Services ACCOUNTING AND CONSULTING SERVICES EDMONTON AB Independent consultant, specializing in managing medical and dental professional accounts, to incorporating PCs, full accounting, including payroll and taxes, using own computer and software. Pick up and drop off for Edmonton and areas, other convenient options for rest of Alberta. Contact: N. Ali Amiri, MBA Financial and Management Consultant Seek Value Inc. T 780.909.0900 F 780.439.0909 firstname.lastname@example.org www.seekvalue.ca DOCUDAVIT MEDICAL SOLUTIONS Retiring, moving or closing your family or general practice, physician’s estate? DOCUdavit Medical Solutions provides free storage for your paper or electronic patient records with no hidden costs. We also provide great rates for closing specialists. Contact: Sid Soil DOCUdavit Solutions TF 1.888.781.9083, ext. 105 email@example.com
RECORD STORAGE & RETRIEVAL SERVICES INC. RSRS is Canada’s leader in medical records storage and scanning services since 1997. Free services for closing primary care practices. Physicianmanaged and compliant. TF 1.888.563.3732, ext. 221 www.recordsolutions.ca
Display or Classified Ads To Place or renew, contact:
Daphne C. Andrychuk Communications Assistant, Public Affairs Alberta Medical Association T 780.482.2626, ext. 275 TF 1.800.272.9680, ext. 275 F 780.482.5445 firstname.lastname@example.org
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your better health pharmacy Associate Physicians: Part-time or Full-time MedSleep’s network of clinics are committed to providing the highest quality sleep services across Canada. We strive to be pioneers in Sleep Medicine utilizing the latest in technology, promoting education, and participating in clinical research and the advancement of new treatments. MedSleep is seeking part-time or full-time associate family physicians, respirologists, internists, ENTs or psychiatrists to join our growing medical team as we expand our services specifically in Calgary and Edmonton, Alberta. While previous sleep medicine experience is preferred, on-site training in Sleep Medicine can be provided. Our clinics provide clinical assessment and diagnostic sleep studies (portable and in-house polysomnography) for the full spectrum of sleep disorders. Low overhead with opportunity for both fee-for-service and additional third-party income.
For more information, or to submit your CV, please contact email@example.com and visit our website at www.medsleep.com to learn more about us.
Working Together We can Improve the Health of Diabetics. Living with diabetes can be a challenge for diabetics of all ages. Our team of certified diabetes educators will educate and teach your patients to self-manage their diabetes. We offer one-on-one private consultations, additional follow up appointments as required and A1C results sent directly to your office. calgarycoop.com/pharmacy
Are you looking to lease or purchase a
new or pre-owned vehicle?
– No hassles. – Factory incentive programs. – No shopping dealership to dealership. – Top price paid for your trade. – Delivery available to your hometown. – All makes offered.
“Let my 40 years of Auto Experience and Fleet Connections work for you. I will save you time and provide a no pressure quote on any vehicle.” David Baker spouse of Dr. Karen Bailey knows first hand that a physician’s time is valuable. He has helped many physicians in Alberta obtain their vehicle of choice without any hassle.
Call: 1.888.311.3832 or 403.262.2222 Email: firstname.lastname@example.org Visit: www.southdeerfootsuzuki.com MANY References available
Canada Post Publications Mail Agreement No. 40070054 Return Undeliverable Canadian Addresses to Alberta Medical Association, 12230 106 Ave NW, Edmonton AB T5N 3Z1
Alberta Doctors’ Digest