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PU SE INSIDE THIS ISSUE

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May Wellness Month Recap

TO THE START OF A NEW YEAR july 2019 | issue 40 13-14

Interview with Dr. James Wang, VP of RDBC

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Top 3 Financial Planning Questions from Residents


The purpose of Resident Doctors of BC is to support residents in fulfilling their education to become well-informed, prepared and professional physicians to enhance patient care. MISSION STATEMENT • • • • •

To To To To To

advocate for contractual matters support members’ education and encourage excellence in the teaching environment promote its members’ professional, personal and financial well-being foster collegiality among its members throughout British Columbia facilitate collaboration with the community and other professional groups

CONTACT US Phone 604-876-7636 | 1-888-877-2722 Email info@residentdoctorsbc.ca Facebook Resident Doctors of BC Twitter @ResidentDocsBC Instagram @ResidentDocsBC 350 - 1665 West Broadway Vancouver, BC V6J 1X1 CONTENTS 2 4 5 7 9 13 15 17 21

A Word From Our President Upcoming Events May Wellness Month Recap Resident Spotlight: Dr. Martina Scholtens “M” - Resident Submission An Interview With Dr. James Wang, Vice-President of Resident Doctors of BC The Story of Locomunity: The Ultimate Locum Resource Top 3 Financial Planning Questions from Residents in 2019 Preparing for Practice: Negotiated Benefits for BC

23 Locuming 25 Distributed Site: Fort St. John


A WORD FROM OUR A WORD PRESIDENT FROM OUR PRESIDENT

SEEKING BALANCE Colleagues, With the renegotiation of our collective agreement, this was an incredibly important year for our organization. Going into this year’s negotiations process, BC residents had a collective agreement that left much to be desired, especially compared to our colleagues in other provinces. As such, many RDBC staff and residents worked tirelessly over the past several years to prepare for this year’s negotiations. Fortunately, our new Collective Agreement reflects these efforts and has resulted in us making significant gains in a number of areas, including compensation, costs of residency (including the Ministry of Health’s announcement on CMPA), and resident wellness. While there is still work to do in advancing our collective agreement, I am very proud of what our team accomplished and hope the future RDBC team will be able to capitalize on our gains and continue to improve the lives of residents in our province. After spending the past year meeting with residents, program directors, government representatives, and health authorities discussing resident work conditions, a common theme that I reflected on was finding balance in residency. What does “finding balance” mean? Many sources espouse the benefits of “finding balance” by taking up hobbies, exercising more, traveling, and so on. Very reasonable suggestions for sure, but I feel those suggestions don’t completely address the whole issue of balance. Most of these solutions to finding balance are directed at finding something to balance WITH work. For instance, to balance my work with painting…or running… or knitting. However, what about finding balance AT work? At the end of the day, we spend a majority of our time at work, whether in the clinic, in the OR, on the ward, or in the ED. If we never seek balance at work, the entity we spend a majority of our waking moments in, how can we expect to ever find sufficient work-life balance? No amount of hobbies will emotionally balance a challenging patient encounter, a medical error, or a difficult resuscitation. And likely no one would expect that anything will achieve an emotional balance with the challenging aspects of residency. However, could our profession, and healthcare system in general, do a better job of balancing the work of residents?

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Do you ever feel guilty asking for vacation, or requesting a lieu day? Do you ever work an entire day without eating? When was the last time you took an actual break during the work day, or even a washroom break? Do you ever feel overwhelmed with the tasks assigned to you? Being a PGY-3 resident, I can definitely answer a resounding yes to all of those questions. Now I get it, the daily routine of being a physician does not easily afford the ability to take set breaks; you may be in the OR, or actively resuscitating a patient, or in a busy clinic. We are all dedicated professionals caring for patients, but that doesn’t mean we should ignore balance at work. What I found is that an imbalance at work can lead to an imbalance in life. Forgetting to eat lunch makes you susceptible to overeating when you get home, not taking a break during your day to destress makes you too exhausted to enjoy your precious time away from work. It’s no surprise that your time and experience at work can have a significant impact on your experience at home. As such, what you do at home is as important as the actions you take at work to find balance. That being said, I would be lying if I said I had an easy solution to finding balance at work. I have definitely not taken all my flex and lieu days and worked countless call shifts without eating. But I hope we can all take a moment to reflect on finding balance at work, both for ourselves and for the future learners we may be training. Think about taking a break after rounds or having a quick lunch before your next clinic. If a learner requests a break, don’t view it as a showing of weakness, but rather embrace their attempt to find balance at work. Indeed, some wellness experts are suggesting that we shift our focus away from evaluating an individual’s Work-Life Balance, but rather focus on how we can achieve a positive Work-Life Integration - recognizing that work inevitably will and is intricately tied to your life. From a systems perspective, RDBC and our partner organizations will continue to advocate for policies initiatives that will improve the work experience for residents and ensure that barriers to taking time away from work are minimized. It was an honour to serve as President during this year and during the negotiations process. I am forever grateful for the opportunity to serve and advocate on behalf of residents and will continue to work towards making residency a better experience for all. Sincerely, Dr. Nicholas Monfries President of Resident Doctors of BC

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UPCOMING EVENTS July 19

Prince George Social

July 24

Kelowna Social

July 27

Fireworks Social

August 17

Baseball Social

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MAY WELLNESS MONTH

MAY WELLNESS MONTH RECAP This year, our Health & Wellness Committee worked hard to bring to you a series of events that were fun for the whole family. The month started off with a retro 80s themed pop-up roller rink, where residents were able to grab a pair of skates (old school style!) and get out onto the rink floor (costumes optional!) to enjoy a classic throwback. After that was a busy day at the Vancouver Art Gallery, as their exhibition drew to a close and residents were invited to attend a tour while kids were led off for their own fun activities. A hands-on workshop on movement and lines followed for those with an interest in the arts! Finishing off the month was the Whitecaps vs. Toronto FC game. Residents were led out onto the field before the game to help hoist the flag before sitting back in their section and enjoying the game! It was a fun night all around and drew quite the crowd of residents. Lastly, running all month long, was our annual Happy Place contest. This year drew the largest amount of entrees yet! Two prizes were up for grabs: two tickets to the sold-out Whitecaps game, and a giftcard to MEC. Thank you to everyone who took the time to submit to us their happy place and what makes it happy—if you’d like to see all the entries—from beautiful BC scenery to adorable pet companions—be sure to visit our Instagram. A big thank you to everyone who participated in this year’s Wellness Month. We are already busy making plans for next year’s!

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WHITECAPS VS. TORONTO FC GAME MAY 31, 2019

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RESIDENT SPOTLIGHT

MAY, 2019 Dr. Martina Scholtens, PGY-5, Psychiatry

YOUR WRITING HAS been published in journals and media outlets since 2002, and your book, Your Heart Is the Size of Your First: A Doctor Reflects on Ten Years at a Refugee Clinic was published in 2017. As a physician, what is it that drives you to writing? A day’s work at the refugee clinic didn’t feel complete to me unless I captured something of what was memorable that day in writing. There was so much that was moving, or funny, or interesting, that I knew would be lost if I didn’t document it. And so I wrote first of all to remember. Then I began to write to sort out the things I found difficult, such as the disparity in wealth between patients and staff at the clinic, or whether I should accept an invitation to a patient’s birthday party. The word essay comes from the French, to try, and writing was a way to try to make sense of things. I wrote because I wanted to, not because I thought I should. But then I attended a narrative medicine conference where American physician writer Louise Aronson said that physicians ought to write — that they have a triple obligation to patients, to themselves and to society. She said physicians ought to write to memorialize their patients, to reflect on the work of doctoring, and to advocate for what their patients need. And that’s what I tried to do with my book, Your Heart Is the Size of Your Fist, about working at the refugee clinic. I also write to entertain. A reader once wrote that her kids were crying for dinner but she couldn’t put my book down, and that made

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me happier than it should have. Finally, writing lets me make something. The one thing missing for me in medicine is the opportunity to make things. MEAGAN From 2005 to 2015, youDR. worked at theMCKEEN Bridge Refugee Clinic, which was the only refugee clinic in BC and has now been shut down. You now own and manage the website “Refugee Health Vancouver”, where you strive to provide resources to other physicians working with refugees. What do you hope for physicians interested in this area of work or, are only starting, to take with them into their practice? Caring for refugees is fascinating and rewarding work, but challenging for linguistic, cultural, logistical, and financial reasons. I made the website to develop and collate resources to support clinicians at the point of care. In a broad sense, I hope new physicians bring curiosity and cultural humility to their encounters with refugees. Specifically, if they use one resource it ought to be this one: the Canadian Collaboration for Immigrant and Refugee Health checklist. You switched into Psychiatry from Public Health & Preventive Medicine in the Fall of 2018, after receiving a Master of Public Health degree. What made you decide to head into Psychiatry? What has the experience been like thus far, compared to Family Medicine and Public Health? After ten years as a family physician at the refugee clinic, I wanted to practice medicine through a different lens. Initially I decided to pull back for a wider view, looking at populations rather than individuals, and I


started training in public health. I soon realized two things. The first was that I sorely missed patient care. The second was that I would rather go narrow and deep than broad and general. Family medicine is vast, with its breadth of responsibility and the daily volume of patients. Public health is similarly broad, covering everything from water quality to health policy to pandemics. I’d enjoyed mental health at the refugee clinic, and so I was doing all of my public health electives in mental health, such as McGill’s Summer Program in Social and Cultural Psychiatry. Increasingly, I realized that psychiatry, with its direct patient care and specific focus, was a better fit with my skills and interests than public health. Then I was asked in an interview related to my book about my alter ego, and I flippantly replied, “My alter ego is a psychiatrist who lives on ten acres on Vancouver Island and drives a red Jeep with a border collie riding in the passenger seat.” And then I thought — well, why not? So I made the leap and now I’m a psychiatry resident living on a half acre in Victoria with a cat. Getting there. Public health and psychiatry are more closely related than you might think. Both dovetail with refugee medicine, which remains one of my main interests. Both are contextual, concerned with the bigger picture rather than an isolated complaint or data point. Both acknowledge the key role of social determinants of health. Both involve collaboration across sectors. And the skills I learned in my MPH — critical thinking, data analysis, program development, policy making — are applicable to psychiatry. I’m happy with the change. Psychiatry suits me. I love the orderliness of the DSM-5, mental status exam, and psychopharmacology. I also love all the room for nuance and uncertainty. Spending a half hour or more with a patient feels luxurious. So does directing the patient back to their family physician for their back pain. I do miss my stethoscope. In my first week of

of residency, the patient I was seeing with my preceptor started vomiting. We handed him a garbage can and watched. The family physician in me was itching to get him on an exam table, do a physical exam, and find some Gravol in the sample cupboard. What are your plans for the future, in terms of practice and your interest in narrative medicine? I plan to practice general psychiatry with a cross-cultural focus. I want a mix of patient care, teaching, writing, and speaking. My ideal is a dual academic appointment in medicine and the humanities. I intend to carry on with medicine and writing throughout my career. Anton Chekhov said, “Medicine is my lawful wife, and literature is my mistress. When I get tired of one I spend the night with the other. Though it is irregular, it is less boring this way, and besides, neither of them loses anything through my infidelity.” Psychiatry residency has been rich with writing material, and I have a few literary projects on the go. I plan to continue to participate in narrative medicine events. This summer I will be co-facilitating the Taos Writing and Wellness Retreat for Health Professionals in New Mexico– residents welcome! You can connect with Dr. Scholtens on her Twitter, @ MScholtensMD, her website, and view her book on Amazon.

Photo credit: Brooke McAllister

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RESIDENT SUBMISSIONS

“M” INTERVIEW Dr. Kiran Rikhraj, WITH PGY-1, Emergency Medicine IMMEDIATE PAST 30. THE NUMBER FLASHES overhead – a PRESIDENT big, bold, yellow; announcing itself with alarms raging in its wake. No one pays it attention. It is already imprinted in their minds; O2 saturation – 30%. Everyone is frozen; simply starting, staring at her. She is but a skeleton – a 5-year-old with thighs skinnier than my wrists. Her face is hidden by a mask, her breathing shallow and ragged. IVs, monitor lines, dressings cover her, leaving nothing of the child she might have been, could have been. In the middle of her bed lies a plastic pump that feeds directly into her heart. Her name is M. She is the girl with the Berlin Heart. I met M on the first day of my Pediatric Cardiac Surgery rotation at BC Children’s Hospital. Actually, to say I met her is misleading. Not once did I have a chance to look at her fully or speak a word to her as she was constantly surrounded. I caught glimpses; both of her appearance and her story – jet black hair, a soft whimpering cry for “Mommy,” a heart with 1 ventricle, a prayer for a transplant. The Berlin Heart was an interim device. Cannulas drew blood from her vena cavae into an external oxygen saturator, after which it traveled to an external pump that then propelled blood into her aorta. Her mum’s face shone with victory after the device was surgically implanted successfully. It was a look that said, “We will win. She will live while her heart slowly dies.” But here we were; back in the ICU. After a week of the Berlin working perfectly, M’s body turned against her. Collateral vessels that had developed during her slow decline now manifested themselves with a vengeance. They shunted blood away from her Berlin and to the rest of the body, thus preventing it from oxygenating her. She

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was rushed to the catheter lab to close the shunts and her peripheral oxygen saturation immediately jumped back to the 70s. But 2 hours later, she was dying in front of our eyes. “Dying.” How do you say that out aloud? How do you look squarely into her parents’ eyes and tell them that we don’t know what to do to keep her alive? Tell them that there are no backup plans left to save her? Because that is the reality clearly written on my attending’s face. This is a surgeon who has fixed countless of tiny, misshapen hearts, whose statistics are unparalleled in the province, who is God-like in the hospital. But now, he is lost. Because there is nothing

“Dying.” How do you say that out aloud? How do you look squarely into her parents’ eyes and tell them that we don’t know what to do to keep her alive? TO fix. To M’s parents he says, “Right now, we can only wait and watch what happens.” To the team, he moves us on to other patients. In that moment, how can you have the strength to walk away and care for other children? How will you leave behind the heartbreak, the helplessness, the fear, the frustration, the injustice and care for someone else’s baby the way you cared for her? But how do you convey that to the Mum and Dad who are clinging on to a dying light? Because they were clinging but in different ways. Mum was Captain Steel; “We will do whatever it takes. We will try everything you can offer. We will keep fighting. We will get a new heart.” I never spoke a word to her but


she was the most determined person I had ever met. She was clinging on to hope. Dad was a sailor without a voice – he listened, looked and followed. But mostly, he held M’s hand. He was clinging to the last threads of life. You keep clinging because how do you do the opposite? How do you look into your baby’s eyes and decide to let go? How do you hug her broken body and accept that it must be laid to rest? How do you live with yourself if you knew you didn’t try everything you possibly could to keep her living just a little bit longer? Beep, beep, beep. The beats of an artificial heart. It’s like a scene from a movie but it’s worse – it’s real life. I watch Mum and Dad. I want to ask them so badly: “Why? Why do you keep subjecting her to more treatments, treatments that are causing her to suffer even more than she is now? Why isn’t she fully palliative?” I want to convince them to stop and let her pass in peace because I cannot bear to see her struggling to breathe. Me. Someone who barely knows their story, who understands nothing of why they are making their choices, who naively assumes that she can even begin to comprehend their pain. The selfishness of my recommendation strikes me and I remain mum. I remain a silent spectator to their nightmare. And in a few minutes, I will walk away, leave the cliff-hanger and dive into someone else’s story. M survived that day. When my rotation ended a few days later, I left without looking back. I wish I could say that that day changed my life,

that I started to appreciate every day I was still breathing, that I was more caring toward my family and friends, that I began to live life to the fullest and treasured every moment. But I’d be lying. Because sometimes, when the whole world shifts around you, you stay the same. Because change doesn’t happen by itself – you have to draw lessons from you experiences to MAKE yourself change and remind yourself to be better. Whether M is alive today, I don’t know. Because I don’t want to know. She is a memory – unassuming, irreplaceable, unerasable. A memory I revisit from time to time to remind me of the unspoken lessons I learned. She is a story. A story that I hope you repeat to yourselves one day. She is M, the girl with the Berlin Heart.

Are you interested in writing for the PULSE? We are always looking for resident submissions. Email us at info@residentdoctorsbc.ca with your piece.

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Are you interested in sitting on the Board of Directors? We

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PLAN YOUR OWN SOCIAL Have a party... on us! Resident Doctors of BC wants to help you and your residency program plan a social event. We will sponsor up to $750 (up to $1,700 if two programs collaborate) towards your program social event. Interested? Visit our website and look under 'Contact'!

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FEATURE

AN INTERVIEW WITH DR. JAMES WANG, VICE PRESIDENT OF RDBC DR. JAMES WANG is the current Vice President of Resident Doctors of BC and chair of the Health & Wellness Committee. This is his second year of being involved in the RDBC leadership. In this issue, we chatted with him about his role as chair of Health & Wellness and multitude of events the Commitee held for this year’s Wellness Month. So, to start off the interview, as the chair of the Health & Wellness Committee, I have to ask: what does resident wellness mean to you, and what do you personally do to ensure your own wellness? In my view, resident wellness is probably the most important part of our journey through residency, even more so than clinical education. Residency is a special period of our career and it is rewarding at times, demanding at other times, but invariably exhausting throughout. If we do not take care of our own wellness, we diminish our capacity to learn, to take care of our patients, and to fully appreciate the ups and downs of these few years. This requires all of us, myself included, to be honest with ourselves about how burned out we are -- and then to act on it. Personally, I try my best to hang my stethoscope at the door of the hospital, so that once I am home, I can focus more on the people and activities I love outside of medicine. I always ensure that I make time for a fun activity every month, whether it’s going on a hike or watching a theatre production, which often also doubles as a social activity with my friends or family. It is too easy to get buried in one’s work, so I find that by prioritizing the non-urgent things, I am able to stay on top of my wellness and reduce burnout.

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The Health & Wellness Committee has had a busy year so far. From the Blood Drive, to implementing Plan Your Own Sports, to all the different Wellness Month activities that took place in May, the committee has had a lot on their plate. What would you say was the driving force behind making this year so event-focused? The feedback from residents! This is the honest truth. We received such a tremendously positive response from years past about our events that we have just kept going and expanding on them. We have kept the popular events from previous years that everyone loves, such as Fright Night and the Christmas Market, and we are always excited to pilot new events that may become regulars in the future. We have an incredibly dynamic and passionate team this year, so even though we have organized many events, we have also been implementing other day-to-day initiatives to improve resident wellness at individual hospitals. In addition, as this year was a negotiations year, we put extra resources into raising awareness about residents to the general public, which was the inspiration for this year’s Resident Awareness Week partnership with the Canadian Blood Services. This month of May, especially, was busy with events Residents were invited to attend: the pop-up roller rink, the day at the Vancouver Art Gallery, and the Whitecaps game. This was probably the most busy Wellness Month we have had in a long time, and with events happening


Residents at the Whitecaps vs. Toronto FC Game event on May 31, 2019, as part of May Wellness Month. one right after the other. What inspired the committee to switch things up a bit, and open up the month to three whole events? Like I mentioned earlier, we have a very enthusiastic team this year, so we had the energy and the drive to really make Resident Wellness Month a month-long experience, rather than a single-day event. In addition, the members of our committee have a wide range of interests, so we recognize that wellness might not look the same for every resident. We are hoping that by offering a diverse roster of activities, we can engage as many residents as possible. I am hoping that this will be well received by the resident body (I think it already has!) and then we can think about doing it again next year!

involved with RDBC and especially the Health & Wellness Committee in the future. The more people we have helping out, the more we can do for the wellness of the entire resident body! What was your personal favorite event or initiative done by the Committee this year? The Christmas Market! There is something so special about that festive time of the year.

Do you have any plans for future events and/or activities hosted by the Health & Wellness Committee, or any hopes for what you would like to see the Committee accomplish in the future? Our next big event is Orientation Week for the incoming new residents. In addition, the RDBC Blood Drive is still ongoing and everyone can still donate blood to compete for a prize for your program to fund a social event. I cannot believe how quickly this year has flown by. Looking back, it was a lot of fun and I encourage my fellow residents to get in get involved with RDBC and especially the

To get involved with the Health and Wellness Committee, or other RDBC initiatives, please contact us at info@residentdoctorsbc.ca. More information on committees can be found on residentdoctorsbc.ca.

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PARTNER FEATURE

THE STORY OF LOCUMUNITY: THE ULTIMATE LOCUM RESOURCE HOW A GRADUATE OF UBC MEDICAL SCHOOL BRIDGED THE GAP BETWEEN CLINICS AND LOCUM PHYSICIANS

onboardMD Team YOU PROBABLY KNOW, by now, that there’s a contradiction inherent in contemporary medicine: patients can’t get access to the health care they need, yet physicians across the country are burning out, and aspiring physicians can’t find work. In short: there aren’t enough doctors, and there are too many doctors. It just doesn’t make sense. While she was in practice as a locum in Family Medicine and Maternity care, this contradiction became apparent to Dr. Haneen AbuRemaileh—and she decided to do something about it. “Let’s just say the bystander effect doesn’t apply to me,” she says. “When I see something that needs to be done, I do it.” Dr. Abu-Remaileh, a first-generation immigrant from Jordan and graduate of UBC medical school, saw that there was a fundamental flaw in the way physicians were recruited and distributed across the country. She did some research and discovered some disturbing statistics. For example, specialist physicians in B.C. were reporting an average wait time of more than 21 weeks, while 16-percent of new specialist physicians were unable to find jobs. In addition to that, the Canadian Medical Association had just released a nationwide study on physician health and wellbeing that highlighted alarming rates of physician burnout: over a quarter of physicians reported

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Dr. Haneen Abu-Remaileh high emotional exhaustion, 19-percent scored low for social well-being, and 15-percent suffered from depersonalization, i.e. losing their sense of identity. “I kept coming across literature that outlined the problem,” Dr. Abu-Remaileh remembers. “The increasing rates of physician burnout, smaller cities and rural areas struggling to recruit and retain physicians, underemployed graduates, increasing wait times.” It occurred to Dr. Abu-Remaileh, who had already practiced as a locum physician, that much of this stress and overwork was partially rooted in the difficulty of finding a replacement to cover a practice. The existing process was time-consuming, complicated, and unclear—which means many doctors aren’t able to take the time off they need, when they need it. As a locum, Dr. Abu-Remaileh was in high demand, but the only way that physicians who might need her help could connect with her was via word of mouth. This all led her to create Locumunity, an online marketplace where job-seeking physicians and medical facilities can connect directly with each other. Think of it like a matchmaking site—but for locum physicians looking for temporary placements. Since its launch in 2017, Locumunity has quickly gained traction in the medical


community, with over 1700 physicians and 300 clinics now registered. “Prior to Locumunity, there was no centralized search tool to connect job-seeking physicians with medical facilities. Job postings were still in the classifieds section of printed medical journals, and fragmented online posting boards.”

to ask for help. Dr. Abu-Remaileh wants to change this. “Sometimes the best way to improve the health care experience for both doctors and patients is to make it easier for those physicians who want time off to take it.”

Locumunity helps clinics to fill the gap when one of their doctors falls ill or needs to take extended time off, as well as individual physicians who need a break—whatever the reason might be. “Some are new mothers who want to extend their maternity leave, some want to take a sabbatical to continue their education, and others might just need a bit of space to recover their mental health.”

Dr. Haneen Abu-Remaileh is a physician turned tech entrepreneur who has defied many odds. She is a first generation immigrant from Jordan, who gained entry into the highly competitive medical school at UBC and completed residency in Family Practice/Maternity care in Calgary.

Although Locumunity’s current focus is the locum space, employers have begun posting permanent, Telehealth, and urgent care jobs as well, which means that the data Locumunity is collecting at every step of the job-search process is becoming more and more robust—and more and more valuable. “Being a data-rich platform where, we can start teasing out the essential ingredients for a good fit between physician and clinic,” Dr. Abu-Remaileh says. “This will allow us to create predictive models and expand on the artificial intelligence in our matching algorithm, which will better enable physicians to find jobs on their own terms, while improving retentions for employers.” Dr. Abu-Remaileh’s long-term vision is to grow Locumunity into something bigger than a job-posting board—and she has built the momentum to pull it off. Last year, she was accepted into Techstars Seattle, one of the most prestigious high-tech accelerators in the U.S. For the first few months of 2018, Dr. Abu-Remaileh’s brought her team – and her family – to Seattle to attend the intensive program. In a culture that sends a message to doctors that they should always show confidence and hide their vulnerability, it can be hard

This article was originally published in onboardMD. Republished with permission. onboardMD’s mission is simple: to help Canada’s next generation of doctors navigate the beginning of their medical careers. Check out onboardMD’s suite of tools and resources, including articles that bring you tips, tricks and life hacks along with real-life stories from students, residents and doctors.

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FINANCES

TOP 3 FINANCIAL INTERVIEW WITH PLANNING QUESTIONS IMMEDIATE PAST FROM RESIDENTS IN PRESIDENT 2019 Bobby Ning CFP, Managing Director of The Financial Literacy Counsel Alphil Guilaran, Co-Founder of The Financial Literacy Counsel Did you know that medical residents have access to two financial coaching sessions every year to address their top financial concerns? The good news for BC medical residents who have questions about money, is that both Vancouver Coastal Health (VCH) and RDBC are at the forefront in Canada, when it comes to helping physicians increase their financial preparedness. As part of your employee wellness benefits at VCH, you have access to a host of coaching services, including financial coaching from the Financial Literacy Counsel. These benefits are available throughout residency training and expire upon completion of your residency. This service can be accessed by contacting VCH Employee Wellness at 604.872.4929 or 1.800.505.4929 or by contacting the Financial Literacy Counsel at consultation@flci.ca

TOP 3 FINANCIAL PLANNING QUESTIONS With the introduction of a new collective bargaining agreement affecting resident pay, benefits and after-tax income, new questions about financial planning have been surfacing. In this article, we will address the top 3 financial planning questions that residents have, in-light of the new agreement, so that you can increase your financial preparedness as you start a new year of residency on July 1, 2019.

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1. Should I cancel or reduce the disability insurance plan that I purchased in medical school or during residency? With the inclusion of a disability insurance program in the new collective bargaining agreement, residents have been asking what to do with the association or private plan they purchased in the past or during medical school. We recommend reviewing the merits of keeping the policy because it may lead residents to consider adjusting the coverage to meet the new realities of having coverage throughout residency training. It is important for residents to remember that having a disability insurance plan that will grow with you throughout your career, is vital in order to protect what you are working so hard to build and achieve. We encourage you to meet with the person or organization that set up your disability insurance program to let them know that your needs may have changed due to coverage now being a part of your compensation package. Your advisor is in the best position to advise you on what your next steps may be. Also, remember to ask whether canceling or reducing your coverage will preclude you from qualifying for future insurance programs when you are in practice. If your advisor is unavailable, don’t hesitate to reach out for a financial coaching session. Our team of advisors are available to guide you in making the best choices possible.


2. Should I pay down debt or invest, now that I am making money? The new collective agreement set out a revised pay-scale for all residents, so with a little extra after-tax income, it is natural to ask if you should prioritize paying down debt or work on saving money. The answer can be found using the following questions: 1. Can you sleep soundly at night with your current debt load? 2. How much do you owe? 3. How much do you earn and spend? 4. Does the line of credit turn into a loan? If so, when? It is important to develop the discipline of paying down debt early in your medical career to develop good habits. Debt can be a heavy burden to carry. If you need to speak to someone about how debt is contributing to burnout, anxiety or chronic stress, don’t hesitate to reach out to Employee Wellness to speak to someone about your situation. 3. Should I incorporate once I complete residency? This is a great transition-to-practice question that requires weighing the pros and cons of incorporating right after residency because each physician has their unique set of circumstances and priorities. Here are 2 scenarios to consider: 1. Resident completing residency with no debt is committed to saving money and living on a modest income.

Verdict: This resident should consider incorporation as they will be able to save at least $40,000 within the corporation since they don’t need the money for a long time. 2. Resident completing residency with a high debt load or is prioritizing saving for a down payment for a home purchase. Verdict: This resident should defer incorporation until they are able to save more than $40,000. As a rule of thumb, if you can save a minimum of $40,000 within a corporation, you should consider incorporating because of the tax savings. The best advice here is to get an expert opinion from a financial planner or accountant because incorporating is not to be taken lightly. Setting up a professional corporation requires careful consideration because of the initial and ongoing costs and complexities that are involved.

If you can relate to any of the questions above or if you have your own questions that you need answers to, do not hesitate to access your employee wellness benefits at VCH. You can access professional counselling, as well as financial coaching, throughout your residency training. Employee Wellness services can be accessed by contacting VCH Employee Wellness at 604.872.4929 or 1.800.505.4929 or by contacting the Financial Literacy Counsel at consultation@flci.ca

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ANNUAL FIREWORKS SOCIAL

Meet up for food and drinks on RDBC before heading out to the fireworks! JULY 27, 2019 THE BIMINI PUBLIC HOUSE 2010 W 4TH AVE, VANCOUVER 7 PM - 9 PM

RSVP ON WEBSITE

PLUS ONES WELCOME!

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AUGUST 17, 2019

VANCOUVER CANADIANS VS. BOISE HAWKS SCOTIABANK FIELD AT NAT BAILEY STADIUM, VANCOUVER

7:05 PM POST-GAME FIREWORKS 20


TRANSITION TO PRACTICE

PREPARING INTERVIEW WITH FOR PRACTICE: IMMEDIATE PAST NEGOTIATED PRESIDENT BENEFITS FOR BC IN BC, PRACTICING PHYSICIANS can take advantage of many benefits that are provided by the province and administered through Doctors of BC. While some of the benefits are automatic, some require action on your part to claim the benefits. The negotiated benefits are income-based and are calculated from “eligible income” in BC (fee-for-service billing, rural locum, sessional and service contract payments). AUTOMATIC BENEFITS Canadian Medical Protective Association Dues Rebate: The amount of refund depends on your CMPA work code but it occurs automatically as long as Doctors of BC has your banking information on file. The typical refund to a family physician received is about $2000/year (assuming no obstetrics or emergency work).

requirements of having Doctors of BC Resident Disability in place. Contributory Professional Retirement Savings Plan: The government provides contributions to your Registered Retirement Savings Plan (RRSP). The maximum basic benefit is $4,020 and length of service benefit (for service of 20 years or more) is $3430 for a total benefit of $7450. Parental Leave Program: Physicians who become parents, either by birth or adoption, receive a weekly income. The benefit is payable for up to 17 weeks during parental leave, and can be taken consecutively or nonconsecutively in the 52 weeks following birth. The benefit is a maximum of $1000/week. Ideally, apply 2-3 months prior to birth or adoption. Rural Education Action Plan: This program provides enhanced funding for rural physicians to access skills training. To be eligible, you must practice in an eligible Rural Practice Subsidiary Agreement community and apply through UBC for participation.

ACTION REQUIRED! BENEFITS WHICH REQUIRE APPLICATIONS

It’s important to know what benefits are available to you so you can take full advantage! Call 604-736-5551 or email benefits@doctorsofbc.ca to reach our dedicated benefits administrators. Email insurance@doctorsofbc.ca to book an appointment with a non-commissioned Insurance Advisor at Doctors of BC to learn more about the Physicians’ Disability Insurance and review your personal insurance coverage.

Physician Disability Insurance: Provides physicians with a government-funded disability insurance where benefits begin to pay after just 14 days. This insurance can provide up to $6,100 of monthly tax-free benefits that may pay in addition to your personal disability insurance policy. You typically must apply and provide proof of good health in order to qualify for the insurance unless you meet certain

Author: Erin Connors is a non-commissioned Insurance Advisor at Doctors of BC. She provides comprehensive insurance reviews and recommendations to Doctors of BC members and their families. To contact Erin or another advisor at Doctors of BC, please email insurance@doctorsobc.ca or call 1-800-6652262 ext. 7914.

Continuing Medical Education Funds: To qualify for the maximum benefit (in 2015 it was $1800) you need a gross income of $30,000 from the previous calendar year.

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Transition to Practice To-Do List

Book a free phone or in-person appointment with your Doctors of BC Insurance Advisor to: o o o

review your Disability Insurance options access government paid Physicians’ Disability Insurance (PDI) get 50% off first year premiums for Extended Health and Dental

Learn about other government paid Negotiated Benefits for physicians like Contributory Retirement Savings Plan (CPRSP), CMPA Rebate, and Parental Leave Program (PLP)

Access ClubMD discounts on incorporation, accounting and legal services.

Talk to your Doctors of BC Regional Advisor & Advocate to discuss: o o o

committees and societies you can join where to find practice support in your local area what resources within Doctors of BC are available and applicable to you

Contact us today at insurance@doctorsofbc.ca

YOUR RESIDENT INSURANCE TEAM insurance@doctorsofbc.ca

Channelle Erin Sawyer Connors

Hali Stus

Jeffrey Gopal

Julie Kwan

Paula Rooney

Renee Brickner

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TRANSITION TO PRACTICE

LOCUMING Vancouver Division of Family Practice AS YOU TRANSITION into practice from residency, you may have a roadmap in mind of what you would like your first few years to look like. Typically, physicians in their first few years of practice like to try out different clinic opportunities for short periods of time, which is referred to as locuming. Locuming allows new physicians to try out multiple clinics and get to see how they function and differ in policies, clinic culture, and patient population. As a locum, you might be covering for a physician’s patient panel while they’re away on vacation, servicing the walk-in clinic, or helping out a clinic by seeing their overflow patients. When you are browsing different clinics, it is useful to have a list of questions to ask the clinic managers. This will help ensure that you have all the information you need to make an informed decision about if the clinic might be a good fit for you. It can also help you explore what types of clinics you might eventually like when you start considering a more permanent position in the future. The following are items to consider when evaluating a clinic opportunity: Overhead Split – What portion of your billings goes to the clinic? • What is the overhead split? • Does this apply to private billings? • What about ICBC, medical legal files, etc.? • How are fees for letters/notes handled? • When can you expect payment? • Will the office provide you with daily minimums if you are not busy? Does this come with seeing a certain number of patients per hour? How is this assessed and distributed?

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Billing Support – How are billings dealt with in the clinic? • Does the office have a designated billing person or do they utilize a service? • How are rejections dealt with? • What billing are you responsible for? • What support in the clinic is available if you have billing questions? Office Support – What is in place to help you do your job? • Does the office have a manager or a clinic lead? • How many MOA’s are there? What is the ratio of MOA hours to GP hours? • Is there any EMR training available? • How are IT needs dealt with? • Are there staff meetings you need to attend? • Are there any additional supports in place? (allied health, billing service, nurse?) Practice Style – Consider getting information from a GP who works at the clinic about the way in which they practice in order to gauge patient and clinic expectations. • Volume – How many patients do they see per hour/day? • Are you expected to see a certain number of patients per hour/day? • Do they have any specialty areas of patients (obstetrics, sexual health, elderly patients, etc.)? Additional Services – What else are you responsible for? • Are you expected to cover house calls? • Are there any residential care patients for you to cover?


• How does the clinic deal with on-call time? • Does the clinic provide you with a contract, or can you bring in your own? Once you’ve decided on which clinic(s) to work at, there are several things you can do to be an effective locum. Make sure your Canadian Medical Protective Association (CMPA) coverage is appropriate for the type of work you’re doing. Moreover, it is important to make realistic commitments with your schedule; avoid cancelling with short notice and leaving a physician and/or community without coverage. It is also useful to get to know the staff and/ or community recruiter in your area. If you are considering the community or hospital where you are providing locum coverage as a permanent practice location, get to know the other physicians and staff at the clinic or organization, and the community itself. Some communities/organizations have designated staff to help new physicians settle into the community or answer any questions they have about the practice.

work in Vancouver, BC, the Vancouver Division of Family Practice is a non-profit organization that has an individualized locum matching program to help you find a clinic that suits your practice preferences. Whether you’re looking for something short-term or long-term, their team can connect with you and provide some new to practice resources and a catered list of job opportunities. To connect with them, feel free to e-mail recruitmentvan@divisionsbc.ca or call 604-569-2010 to set up a free meeting and get started! Resources: http://www.divisionsbc.ca/vancouver/ recruitmentretention http://practiceinbc.ca/ https://www.healthmatchbc.org/ https://www.tourismvancouver.com/

Towards the end of your locum coverage, there are a few important tips to ensure a smooth transition. First, it is helpful to alert the returning physician of any challenging interactions with patients, especially in a case where a patient dies or receives a serious diagnosis. Second, making notes of any outstanding test results or patient follow up for the returning physician is another useful tip. If you are a family doctor looking for locum

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DISTRIBUTED SITE: FORT ST. JOHN

Fort St. John www.tourismfortstjohn.ca

FORT ST. JOHN IS situated in Northeastern BC along the world-famous Alaska Highway. The city is a member municipality of the Peace River Regional District. The city has a growing population of 21,000, up from 18,600 in the 2011 census. The first census to include Fort St. John was in 1951 and recorded a population of just 884 people. It is now the largest city in the Northeast Region of BC. The city’s slogan is ‘the Energetic City’, mainly because its large resource base of oil, natural gas, forestry & agriculture. Fort St. John is the oldest non-native settlement in BC and is also one of the oldest native settlements. The city was originally established as a trading post in 1794 and over the years the community itself has moved a number of times for various economic reasons. Its present location is believed to be its sixth. Fort St. John was established a year after Sir Alexander Mackenzie explored the area in 1793. The area had a number of different names as various companies built forts on the river. It was named Fort St. John in 1821 when the previous fort was bought by the Hudson’s Bay Company. The fort was shut down in 1823 and reopened almost forty years later in 1860. THINGS TO DO Outdoor Adventures • Pioneer Pathway Walking tour- this is a walking tour of downtown Fort St. John on which you learn about the pioneers who founded and

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and built the city of Fort St. John and made it what it is today. • Peace Viewpoint- located at the south end of 100th street is the Peace River Viewpoint. At the viewpoint are two signs which explore the history of the Peace River and examine five other historic landmarks which can be seen from the lookout. • Site C Viewpoint- Site C is a BC Hydro project underway to build a large-scale dam and hydroelectric generating station near Fort St. John. A viewpoint is now open on the north bank of the Peace River above the dam site. • Kistkatinaw River Bridge- you can take a short detour from the main highway onto the old section of the Alaska Highway. Here you will find the last remaining curved wooden bridge on the highway. It is in a picturesque location and picnic areas can be found near in the Provincial Park. • There are many boating & fishing locations around Fort St. John. More information can be found online. Events • North Peace Arena- Home of the Fort St. John Huskies who play in the Northwest Junior Hockey League and the Senior Flyers who play in the North Peace Hockey league. These teams play all winter long at the arena. • ‘Be a home tourist’- launched in June 2019,


www.energeticcity.ca the be a home tourist program runs over the summer until September. It encourages people to do activities listed on a Fort St. John tourist passport and get them stamped as they visit. Participants are then eligible to enter a draw for prizes in the first week of September. • High on Ice Winter Festival- this annual winter festival sees a number of various events taking place over the 3-day festival. Events include professional ice carving, ice fishing & horse drawn sleigh rides to name but a few. • Taste of the Town is an annual food festival that runs in September. It encourages the people of Fort St. John to eat locally. Participating restaurants have special prices and special dishes over the duration of the festival. Be sure to check out Fort St. John’s event calendar for a day to day listing of events & activities happening in and around Fort St. John.

www.ouralaskahighway.ca

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PU SE The Pulse newsletter is always looking for submissions from residents like you! If you have article ideas, announcements, or other interesting insights about life as a resident doctor, please contact us at: info@residentdoctorsbc.ca

IMPORTANT PHONE NUMBERS

HSSBC Benefits & Payroll 1-866-875-5306

Physician Health Program 1-800-663-6729

Employee Wellness 1-800-505-4929

Profile for Resident Doctors of BC

July 2019 Pulse: To The Start of a New Year  

July 2019 Pulse: To The Start of a New Year  

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