The year that felt like a decade

By Girard Hengen

Reflecting on her 2020-21 term as “virtual” president of the Saskatchewan Medical Association (SMA), Dr. Barb Konstantynowicz recalls the words of a fellow physician.

“During a virtual meeting, a colleague in B.C. said it well: ‘The year that felt like a decade,’ ” Dr. Konstantynowicz said. “Despite this, I marvel at the strength, scientific knowledge, and abilities of so many physicians. I am incredibly proud of my colleagues who have stepped up in these difficult circumstances.”

Dr. Konstantynowicz became SMA president at the 2020 Spring Representative Assembly (RA). The spring RA, usually held in person in early May, was delayed to June due to the COVID-19 pandemic and conducted virtually. It was just one instance of many in which the SMA adapted to the demands and constraints brought on by the pandemic.

Dr. Barb Konstantynowicz

When Dr. Konstantynowicz became president, the pandemic was three months old. Masking was not widely accepted and obtaining personal protective equipment (PPE) was difficult for most community-based physicians’ offices, which were a mix of open, partially open, or virtual only. “There had been 11 deaths, and COVID-19 was still fairly new to all of us,” she said. “We had 626 recovered cases, 21 active cases.”

The beginning of the pandemic coincided with the final months of Dr. Allan Woo’s 2019-20 term as SMA president. Early on, physicians were looking for guidance on how to stay open or maintain their practices while safeguarding themselves, their staff, and their patients.

Throughout the pandemic, the SMA released several social media campaigns aimed at raising public awareness and compliance with public health measures, as well as encouraging patients to reach out to their family doctor for care when needed. The panel on the left was released after Saskatchewan was initially successful in flattening the curve, and urged residents not to become complacent.

By mid-March, temporary fee codes had been negotiated by the SMA, with the Ministry of Health covering virtual telephone and video-conferencing consultations. “The SMA is pleased with this development because it provides patients with remote access to physicians,” Dr. Woo said in a March 13, 2020, news release. “This kind of access also provides a safer work environment for doctors and their staff during this pandemic. We need a healthy physician workforce to tackle the challenges presented by the outbreak of COVID-19.”

The SMA also negotiated free, 12-month licensing for clinical video conferencing for health-care providers. This agreement has been extended to January 2022, with subscriptions now available to physicians.

By April the SMA had also negotiated another important agreement with the Ministry of Health and the SHA, the Pandemic Physician Services Agreements for fee-for-service physicians. These agreements, which expired June 30, 2020, stabilized physicians’ income and facilitated redeployment as needed.

Agreements developed during the initial stages of the pandemic were carried out amid the backdrop of ongoing negotiations with the Ministry of Health on a new physicians’ contract. The previous agreement expired on March 31, 2017. A tentative five-year retroactive agreement was struck in the summer, which physicians ratified in August 2020. Virtual care fee codes were incorporated in the new contract as a pilot project. On behalf of the SMA Board of Directors, Dr. Konstantynowicz thanked the SMA’s Negotiating Committee.

“This will continue to benefit the practice of medicine and the province’s health system for years to come,” she said in an Aug. 12, 2020, news release. “I would like to thank the Negotiating Committee of the SMA, and Ministry of Health representatives, who put in countless hours of work on behalf of Saskatchewan’s physicians to reach this deal. With the agreement now in place, physicians can work with a degree of certainty during these uncertain times created by the COVID-19 pandemic.”

THERE WAS A SIGNIFICANT STRAIN IN THE HEALTH-CARE SYSTEM AND THE NEED TO ADVOCATE AND COMMUNICATE WITH OUR MEMBERS WAS VITAL.

Meanwhile, SMA staff continued to negotiate benefits for physicians. In January 2021, new virtual care pilot fees were implemented to reflect changes negotiated in the new contract. A COVID-19 PPE Benefit Program was developed with the Ministry of Health that assists eligible physicians with PPE costs. The COVID-19 Illness and Mandatory Self- Isolation Benefit was also made available to physicians in late 2020.

In the area of physician wellness, a Physician and Health Worker Wellness group, established in collaboration with the SHA, offered access to mental health support and psychiatry. To promote mental health for physicians, members of the SMA’s Physician Health Program presented “wellness boosts” at virtual town halls hosted weekly by the SHA.

Brenda Senger, Director of Physician Support Programs, was featured in a wellness video for physicians

The SMA also worked with the CMA on several pandemic-related initiatives. The CMA launched a Wellness Support Line, which provides 24/7 mental health support and counselling to physicians, residents, medical students, and their immediate families. It augments services offered by the SMA’s Physician Health Program. The CMA also took a lead role in advocating for virtual care, developing recommendations on the national standards, legislation, and policy needed to pave the way for virtual care in Canada.

In an ever-changing information and technological environment caused by the pandemic, the SMA embraced new methods of conducting meetings and communicating with physicians. Like the 2020 Spring RA, the 2020 Fall RA and the 2021 Spring RA were held virtually.

Dr. Eben Strydom, who was elected to succeed Dr. Konstantynowicz as SMA president at the 2021 Spring RA, noted the third wave of the pandemic threatened to strain a health system already operating at its limits. “The continuing challenges of COVID-19 pandemic are top of mind for myself and for physicians,” he said in a May 7, 2021, news release. “One of my main priorities will be to continue the advocacy work of the SMA for physicians during these unprecedented times.”

In addition to the RAs, Board of Directors meetings were conducted via video conferencing, as was the annual President and Vice-President’s Tour. Committee and section meetings were also held virtually. The SMA kept physicians informed through frequent emailed Practice Alerts and President’s Letters, and the public informed through ad campaigns in print, radio, and television and on social media.

Public campaigns urged mask wearing when physical distancing was not possible. During the summer of 2020, the SMA unfurled banners across Saskatoon streets advocating for the need to wear masks. The SMA let the public know physicians remained open and ready to serve their patients, either in person or virtually.

In one social media campaign, the SMA called for people to share #WhyIMask with a photo of them in their mask.

Dr. Dalibor Slavik was one of many to share #WhyIMask

USask medical student, Sehjal Bhargava, also shared #WhyIMask

In later 2020, the SMA and representatives from several health-care organizations in Saskatchewan united in their call for additional measures to be taken to curb the spread of COVID-19. The following month more than two dozen health-care organizations joined forces in an online ad campaign that targeted young adults and asked them to “hang in there” by following public health guidelines.

“Saskatchewan’s physicians have heard sobering predictions for the health-care system if we do not get COVID-19 under control,” Dr. Konstantynowicz said in a Dec. 10, 2020, news release. “We are seeing more cases among all age groups, and this campaign encourages young adults to recognize that public health guidelines include them as well. The only way we will return to normal is by reducing the spread of this virus.”

Dr. Konstantynowicz became a frequent commentator in the media on behalf of physicians, urging the government to issue clearer directions on mask wearing, exercise caution with school reopenings, revisit changes to the Immunization Delivery Plan, and during the provincial election campaign to tackle challenges in rural health care that were exposed during the pandemic. Despite these efforts, a second wave hit late in 2020 and early 2021.

“There was a significant strain in the health-care system and the need to advocate and communicate with our members was vital,” said Dr. Konstantynowicz. “In December we saw the terrible toll COVID took in Saskatchewan – 117 people died in December and 121 died in January... There was still confusion knowing who to speak to about concerns, and many calls were made to understand the issues and advocate for what our colleagues needed to provide quality care.”

December also saw the arrival of vaccines and a delivery plan unveiled in January that incorporated vaccinations of physicians in early phases. This plan was subsequently changed by the Ministry of Health to an age-based system. The SMA pressed the government to prioritize the vaccination of all essential workers – including physicians not included in the first phase of the vaccine rollout - as identified cases of variants of concern mounted in spring 2021.

This Twitter panel was featured as part of a social media and online campaign to promote COVID-19 vaccination

“COVID-19 is mutating into variants of concern that threaten to overwhelm Saskatchewan’s health system. The virus is adapting. We ask the government to show flexibility and adapt to the rapidly changing circumstances of the pandemic,” Dr. Konstantynowicz said in an April 7, 2021, news release.

The advocacy efforts were successful, with government relenting the following week. “While I am pleased with this development, I am disappointed that it took this long,” Dr. Konstantynowicz wrote in a President’s Letter to physicians. “We have a long way to the end of the pandemic. Vaccinating all physicians is a crucial step needed to secure our health-care system. These vaccinations will keep you safe as you go about your work.”

When the time comes, the post-pandemic road to recovery will be a long one, with twists and turns that will continue to challenge the SMA as it guides physicians on a journey without a clear end. While the level of resiliency among physicians is nothing less than inspiring, there will be a toll. It is anticipated that the numbers of physicians needing physician health support will significantly increase once the pandemic is over and people have time to reflect on their experiences and the vicarious trauma.

“We will learn to live in a new normal,” Dr. Konstantynowicz said. “It is taking a long time and many of us long to get away, see family and dear friends. We have missed weddings, births, graduations, and funerals. We have all lost something in this turbulent time... This virus has touched us all in some way.” ◆