Alberta Doctors'
DIGEST
July-August 2015 | Volume 40 | Number 4
Aging, seniors
and caregivers
A special issue about one of the most
important themes in health care today
What are our seniors worth?
Dr. Jasneet K. Parmar explores the
value of seniors in our society
A coalition, a conference
and a conversation
Groundbreaking Alberta Medical
Association research on seniors' issues at the
Alberta Seniors Care Coalition Conference
Want to know the real
reason for caregiver burnout?
A blogger and author talks candidly
about the toll of caregiving
Patients First®
CONTENTS
DEPARTMENTS
Patients First® is a registered trademark
of the Alberta Medical Association.
Alberta Doctors’ Digest is published
six times annually by the Alberta
Medical Association for its members.
Editor:
Dennis W. Jirsch, MD, PhD
Co-Editor:
Alexander H.G. Paterson, MB ChB,
MD, FRCP, FACP
President-Elect:
Carl W. Nohr, MDCM, PhD, FRCSC, FACS
Immediate Past President:
Allan S. Garbutt, PhD, MD, CCFP
Alberta Medical Association
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September-October issue deadline: August 14
The opinions expressed in Alberta Doctors’ Digest
are those of the authors and do not necessarily reflect
the opinions or positions of the Alberta Medical
Association or its Board of Directors. The association
reserves the right to edit all letters to the editor.
The Alberta Medical Association assumes no
responsibility or liability for damages arising
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© 2015 by the Alberta Medical Association
Design by Backstreet Communications
From the Editor
Health Law Update
Mind Your Own Business
Insurance Insights
Dr. Gadget
28 35 38 39 PFSP Perspectives
In a Different Vein
Letters
Classified Advertisements
FEATURES
Editor-in-Chief:
Marvin Polis
President:
Richard G.R. Johnston, MD, MBA, FRCPC
5
10 12 16 26
7 What are our seniors worth?
A “care of the elderly” physician reflects on the value that society draws from this remarkable patient population
9 Want to know the real reason for caregiver burnout?
Blogger and author Bobbi Junior talks candidly about the extreme toll
of caregiving on families and loved ones
19 Our health care system must support the
triumph of aging
Canadian Medical Association president calls for a National
Seniors’ Strategy
20 High drama!
Alberta physician dodges the enemy, goes on to a remarkable career
22 A coalition, a conference and a conversation
Seniors’ care is the common denominator for important Alberta Medical
Association activities
32 The Physician Learning Program is celebrating
a big birthday
What can this five-year-old do for you?
34 What’s new on the web?
Times, they are a-changing …
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The AMA stands as an advocate for its physician
members, providing leadership and support for
their role in the provision of quality health care.
COVER PHOTO: Dr. Jasneet K. Parmar reflects on care of the elderly in our special issue on aging.
( provided by Curtis Comeau Photography)
JULY - AUGUST 2015
3
4
A SPECIAL ISSUE ON AGING
Dear reader
Marvin Polis | EDITOR-IN-CHIEF
W
atching others become older. Getting older ourselves. Working for the elderly
in our health care system. Fighting negative stigma. Asking hard questions –
about your patients or your own practice. Remembering to laugh. These are
just a few of the themes we explore in this special issue of Alberta Doctors' Digest.
There is no simple answer to the deceptively simple question: What does aging mean
in Alberta today? I hope you will enjoy the thoughts of our guest writers and our
columnists who kindly turned their contributions toward this theme.
I would be glad to hear from you about the issue. Email me care of [email protected].
And be sure to view my intriguing video interview with blogger/author Bobbi Junior on this important topic of aging and
being a caregiver in Alberta. Visit https://youtu.be/jo5FWWN7TCk.
Marvin Polis
Editor-in-Chief
AMA - ALBERTA DOCTORS’ DIGEST
FROM THE EDITOR
5
Changing things
Dennis W. Jirsch, MD, PhD | EDITOR
“The mistakes are all there,
waiting to be made.”
- S.A. Tartakower, Russian
chess master, speaking
of the chess board at the
beginning of a game.
W
e’re off and running with a new political
regime at the helm of the province. Many
of us are hopeful of developments that will
benefit patients and staff alike. In the past two decades
we’ve seen non-stop change with dramatic devolution
of the system into 17 regions in 1995, rejigging into nine
regions in 2003 and then an about-face reversal with
total centralization and the formation of Alberta Health
Services (AHS) in 2008.
Some think, against this background
of organizational tumult, that further change
(to Alberta’s health care system) could be as
radical as anything we’ve seen so far.
It’s been a rocky road throughout, requiring revamping
of organizational charts, letterheads and signage
every couple of years, but rolling personnel changes
have provided a dark game of “musical chairs” as jobs
disappear and reappear. It’s difficult to find much in the
way of recent improvement. Since the advent of AHS,
a number of chief and senior executives have come and
gone, and in a bizarre political move, the AHS board
and board chair were fired two years ago over issues
of executive pay.
As if this turbulence weren’t enough, there have been a
series of management fads throughout the constituent
organizations and AHS over the years, with intermittent
focus on: accountability; patient-focused care; care maps;
quality improvement; business process engineering
and so on. Each of them held sway for a time, but were
eventually superseded.
Some think, against this background of organizational
tumult, that further change could be as radical as
anything we’ve seen so far.
Dr. Thomas W. Noseworthy, well known for his numerous
roles in health care throughout the province over many
years, has urged in a recent editorial, “Let’s make the
system work, not change it.”1 Tom is arguing, I think,
that the system, such as it is, has had about as much
change as it can handle. There’s a kind of organizational
post-traumatic stress disorder at work. Many workers’
experiences have left them distrustful and disengaged;
they’re tired and hunkered down as they brace for
further change.
The system has held up to the extent it has because
health care is inherently local and decentralized, involving
a patient, his or her issues and the necessary resources.
Much that is external to this may be well meaning but
amounts to interference and greater complexity. I’m
reminded of former US President Ronald Reagan’s nine
most terrifying words in the English language, “I’m from
the government and I’m here to help.” It might still
apply if “AHS” replaced the word “government” in the
president’s phrase.
I concur that some degree of constancy, of permanence,
to health care structure and function is desirable. One
can’t include all change, however, since it is axiomatic
that if nothing is changed then nothing will change.
Perhaps it is attitudinal change I’m looking for, with
more involvement of patients and their families and
with professionals, however AHS is configured. Then too,
I’d like to see any board structures that are reinvented
populated with typical citizens, rather than party faithful
or business bigwigs.
In the early months of the new regime, I expect there
will be all sorts of “dog and pony shows” as ministerial
types, bureaucrats and the professions mingle. Each will
argue for special status or more resources. There may
be special circumstances, but I don’t think a big slug >
JULY - AUGUST 2015
6
> of money is in the offing, even given a left-of-center
government. Many remember a year in the mid-90s
when former Alberta Premier Ralph Klein pulled out
about a fifth of health care dollars. General dismay
followed, with public uproar, and in subsequent years
health budgets generally prospered in a relative sense.
Arguably though, much of the new and restored funding
was spent higgledy piggledy and without an overall
plan. The amount the province spends on health care
is approaching 40% of its total budget and is perceived
as a monster that must be reined in.
Going forward, as they say, it will still likely be all about
money. Dr. Noseworthy has been key in the development
of Strategic Clinical Networks in AHS that look to
optimize clinical activity. Perhaps Tom is referring to
these in his editorial when he suggests, “There are early
signs and a reasonable possibility that Alberta could
become the best health system in Canada.”
There may be special
circumstances, but I don’t think a big
slug of money is in the offing, even given a
left-of-center government.
I’d like to hear a lot more about possible successes,
however preliminary. We all would.
Benchmarking will evidently be a major tool in the
efficiency drive. The term comes from the chiseled
horizontal marks that surveyors make as reference
points, but has come to refer to the process of comparing
one’s business (health care) processes to others that
are more efficient and effective. The effort aims to
reduce variation from what is considered optimal and is
conceptually related to earlier initiatives involving care
algorithms or care maps. Care maps were an interesting
exercise and may have changed some care, but they
were all too often amalgams of common practice rather
than best practice, and seldom revisited from a quality
improvement perspective.
If the main impetus for benchmarking is saving money,
precisely what is being measured, and on what basis,
becomes extraordinarily important. Benchmark activities
that are not germane to the common patient experiences
of poor access, or inordinate delay, won’t help the
organization move forward.
AHS should focus on communication activities. We
readily hear about large events, as when a building
opens, or when an organizational nabob departs or
when ERs or ORs are clogged. In contrast, glossy
AMA - ALBERTA DOCTORS’ DIGEST
magazines and newsletters depict a world that is only
sunny. There’s a gap here, and an appetite for news
that is more relevant, more candid. Some years ago,
New Zealand, serious about its health budget woes,
invited a popular radio announcer to discuss health care
issues on radio, not once, but on a continuing basis. I
was on a mini-sabbatical with the kiwi health ministry
for several weeks and was surprised to overhear at bus
stops informed, sophisticated discussion from people.
“Well, we can’t have everything,” was a common refrain.
However we do it, we need a much more informed
citizenry if, collectively, we are going to make better
choices in health care.
I’m glad that some of the new
MLAs and ministers we have are young and
inexperienced. They are perhaps more likely
to question what our system needs and where
it should be going.
I’m glad that some of the new MLAs and ministers we
have are young and inexperienced. They are perhaps
more likely to question what our system needs and
where it should be going. I’m not at all uncomfortable
with their “lack of experience,” since expertise should
reside with the bureaucrats in the system.
Perhaps they’ll see that there are areas demanding
urgent attention, and will for the foreseeable future.
I’m thinking of the dilemma of chronic illness, with
the grim circumstances of mental health care and
eldercare as prime examples. While emptying out
mental hospitals and accruing to notions that the elderly
can “age in place” may be good things budgetarily,
they do not address the reality of numbers of folk who
need institutional care and don’t receive it. The elderly
represent the “pig in the python” of a swelling population.
Much has been achieved with home care, I admit, but
it is an insufficient modality to deal with life’s inevitable
conclusion. Blinkered inattention has led to the awful
reality and the true crisis of “bed blockers” in acute care
facilities and can only be dealt with if it is seen for the
stain that it is.
So there are some big changes I’d like to see. I’d agree
with Dr. Noseworthy, though, that we need to work
within the structures at hand.
We need to move on.
Reference
1. http://www.edmontonjournal.com/opinion/Opinion+Quit+
tinkering+with+structure/11094009/story.html.
COVER FEATURE
7
What are our seniors worth?
A “care of the elderly” physician reflects on the value that
society draws from this remarkable patient population
Jasneet K. Parmar, MBBS, DiP COE
I
have served as a
“care of the elderly”
physician for 23 years,
looking after the frail
elderly with devotion
and advocating for them
at every opportunity.
Yet contemplating that
group today, I can see that I didn’t really understand the
essence of who they were and are. I didn’t see the full
extent of their value and contributions until I actively
looked for it. I would like to share some of what I have
learned. I can say with confidence that seniors will never
look the same after you read this!
I can say with confidence that seniors will
never look the same after you read this!
A force to reckon with
Having a skewed view from a slim segment of seniors
that I have cared for, imagine my surprise when I learned
that 93% of seniors are living in the community.3 Most
Canadian seniors are able to look after themselves and
spend as much time on household chores as those aged
15 to 64.1 Over 6 million Canadians are 65 and older,
representing 15.6% of Canada’s population, and by
2030 they will number 9.5 million or 23% of the
population. A large majority of seniors remain active
later in life: 80% in social activities; 36% in volunteer
work and 13% in the work force.7
The shadow workforce
The myth that seniors are solely recipients of care was
shattered when I learned that the majority are involved
in providing some sort of assistance to someone they
know and that they perform more of this work than
younger individuals. This applies to seniors over the age
of 75 as well. Seniors aged 65 and older are most likely
to spend the longest hours providing care, with 23% of
senior caregivers providing 20 or more hours a week.4
For some, it is a large part of their lives, amounting to
the equivalent of a full-time job in time.1 This is crystal
clear to me as my 78-year-old mother is a full-time
caregiver of my 87-year-old father; and my father-in-law
at 89 years provides full-time care to my 87-year-old
mother-in–law.
Our society is full of examples of seniors as caregivers –
they are the shadow workforce of the health care system.
In 2007, of 2.7 million Canadian family caregivers over
45 who were helping seniors, 75% were between 45
and 65, and 24% were over 65.3 In 2012, there were
over 8 million caregivers of all ages in Canada with 56%
over 45 years of age.4 The work of the middle aged and
older caregivers in Canada was estimated at $25-26
billion annually in 2009, while these citizens incurred
$80 million annually in out-of-pocket costs.2 There is
insurmountable evidence that our health and continuing
care sectors would collapse without this unpaid labor.
The heart of volunteerism
Our society places tremendous value on the
contributions of volunteers. Seniors play an impressive
role in this domain, making up to 45% of the unpaid
assistance provided to both formal and informal sectors.
Seniors spend twice the amount of time volunteering
as younger cohorts.1 The value of this volunteer work
corresponded to 549,000 full-time-equivalent jobs
and over $5 billion annually in 2001.1 In 2012, baby
boomers and senior adults contributed more than
1 billion volunteer hours.7 Seniors are actively sought
after by non-profit and community organizations as
volunteers, and it is predicted that the future cohorts
of seniors – attaining more education, better health
and socio-economic status – hold tremendous
potential being engaged in productive activities. >
JULY - AUGUST 2015
8
> Anchoring families in turbulent times
Seniors are also a significant source of financial
assistance and parental supports for struggling families.
The aggregate net worth of Canadians over 55 stood
over $1.3 trillion in 1999.1 Most private intergenerational
transfers go from old to young and this wealth will be
inherited by children and grandchildren of these seniors.
In Canada, up to 35% of grandparents who share
homes with children and grandchildren are the financial
providers and over one-in-10 grandparents are the
primary caregivers to the grandchildren.1 The numbers
of grandparents assuming the role of parenting is on
the rise due to alcohol abuse, divorce, incarceration
and teen pregnancies.
The World Economic Forum
Report points out that society has an
opportunity to reap a “longevity dividend”
in which older people continue to make
substantial contributions for unprecedented
long periods of time.
Political capital and clout
The face of Canadian society
has already changed and the 21st century
will be characterized by active aging.
A sought-after labor sector
Retirement is not an automatic event these days.
More often it is a process that occurs over several
years. More than one-fifth of recently retired seniors
return to work; the rate of seniors returning to work is
exceeding the growth rate of the seniors’ population
itself.1 Substantial numbers of seniors are engaged in
the equivalent of at least half-time employment. The
participation rates of seniors in the Canadian labor
force have more than doubled from 6% in 2000 to
13% in 2013.7 Seeing seniors as a solution to
labor-market shortages, employers are supporting
seniors and their caregivers in part-time and flexible
arrangements. Older people are believed to have
accumulated social, process and organizational skills
that are particularly useful to service economies.5
A growing target market
The business world – retail, travel and financial sectors
particularly – certainly can spot value when they see it.
Seniors have become an important target market with
the recognition of the relationship between age and
wealth accumulation. As the proportion of seniors in
the total population grows, and their financial situation
continues to improve, their role as consumers becomes
important. The population aged 50 and above has
accumulated most of the discretionary funds and the
upcoming cohort of baby boomers is a prime example
of having captured the attention of market researchers
and advertisers.
As taxpayers, Canadian seniors pay less tax on average;
however, the proportion of income paid in taxes does not
differ much across age groups and seniors with higher
incomes pay as much income tax as the younger working
population.1 “Generational altruism” is described as the
older taxpayers paying for infrastructure and services for
which they may never gain personal benefit.5
Canadians take a greater interest in politics as they
grow older. Seniors’ social capital in the form of votes,
political activism and advocacy brings wisdom and
experience to all walks of life. They provide time, skills
and money to civic activities. It is projected that, as
the population ages, more seniors will hold office as
the larger portion of the electorate will be their peers.
The impact of seniors as voters is going to become
increasingly important when those over 65 will comprise
25% of the voters in 2030.1 The social capital of older
adults is yet to be fully realized and ensuring conditions
that lead to healthy aging means more engaged, healthy
and productive members of our society.
The longevity dividend
The World Health Organization states that “an aging
population is a triumph of modern society.” The face
of Canadian society has already changed and the
21st century will be characterized by active aging.6 The
World Economic Forum Report points out that society
has an opportunity to reap a “longevity dividend”
in which older people continue to make substantial
contributions for unprecedented long periods of time.5
Acknowledging the participation, roles and valuable
contributions of seniors in our society will help us reduce
the stereotyping of seniors and acknowledge the negative
bias in our health care system. The increasingly valuable
and diverse contributions to society obligate our respect
and understanding. We should nurture the meaningful
involvement of our seniors – and celebrate their inherent
and immeasurable value.
References available upon request.
AMA - ALBERTA DOCTORS’ DIGEST
FEATURE
9
Want to know the real reason
for caregiver burnout?
Bobbi Junior
Blogger and author of
The Reluctant Caregiver,
Edmonton’s Bobbi Junior
talks candidly about the
extreme toll of caregiving
on families and loved ones.
I
t wasn’t that Martha
didn’t want to care for
Carl anymore (not their
( provided by Lorna Lillo Photography)
real names). The fact was,
she no longer could. Overwhelmed as Carl’s health issues
increased, Martha, 72, recognized she was no longer
an effective caregiver for her 78-year-old husband. Carl
deserved better.
If I kill myself, Martha decided, they’ll have to appoint
someone to take care of him. It’s the only option left.
Diane Akerman, in her work with a suicide hotline, points
out that choice is a signature of our species. We choose
to live, sometimes we choose to die. But most of the time
we make choices just to prove choice is possible.
What happens to choice in a caregiver/care recipient
relationship? The caregiver has greater capacity than does
the recipient, so both act on the belief that the caregiver
should share that capacity with the recipient, allowing the
recipient the ability to continue to make choices.
While manageable in the short term, this is not
sustainable over time. Ongoing giving must be done
out of our abundance.
As with Martha and Carl, a point may come where
all choice has been given to the recipient. The family
caregiver no longer has the ability to assess whether
no is an appropriate response. The caregiver is now as
vulnerable as the one she cares for, perhaps even more so.
After Carl’s next check-up, the doctor left Carl to dress
and asked Martha to join him in his office, where they
could speak privately.
“You look like tired,” the physician remarked. “Have
you thought of getting some respite?”
“Carl would never go for it. He gets more confused
if I’m not there.”
“What about home care?”
“Someone does his bath. I don’t want more people
coming into the house.”
“Did you follow up with the O.T. appointment
I suggested?”
“There isn’t time to call.”
Martha raised a barrier for every option suggested.
The doctor recognized that while it appeared Martha
was being difficult, in truth, she had lost the ability
to choose and initiate anything other than what was
already in place. For Carl’s part, his health concerns were
constant and increasing, putting him into survival mode.
Neither he nor Martha had the emotional resources to
consider Martha’s needs.
“What would you like to do, then?” the doctor asked
Martha. Tears now flowed and she admitted her plan.
“The only way he’ll allow someone else to take care
of him is if I’m gone,” she said. “I think I need to die.”
“Do you mean suicide?”
“Unless you can think of a better answer.”
A better answer was found. Through his primary care
network, the physician contacted a social worker who met
with Martha alone so she could speak freely. Together
they identified that Martha was coordinating 11 service
providers to meet Carl’s needs. In addition to caring for
her husband, Martha was running a small business!
The solution was surprisingly simple. Monthly case
conferences with the area’s licensed practical nurse,
home care and a geriatric counsellor were organized by
the social worker. Appropriate services were identified
and put in place. With supports provided, rather than
needing to be sought by Martha, the couple’s situation
stabilized. After three months, meetings were moved to
an as-needed basis.
Carl’s health continued to decline, but Martha was no
longer at risk. Carl was able to remain at home another
three years, moving to a nursing home shortly before his
passing. In the end, Martha told the doctor she felt she
had provided well for her husband’s last years, a report
that felt like success to the entire team.
Editor's note: Be sure to view our intriguing video interview
with Bobbi Junior on caregiver burnout. Visit
https://youtu.be/jo5FWWN7TCk.
JULY - AUGUST 2015
10
HEALTH LAW UPDATE
Organ transplants:
Owners, ethics and an aging population
Jonathan P. Rossall, QC, LLM, and Mustafa Farooq | MCLENNAN
I
n Shakespeare’s
immortal play King Lear,
the aging king remarks,
“(N)othing will come of
nothing,” in response to his
daughter’s refusal to praise
him. It is a remarkably
ominous line that lets us,
the audience, know that our refusal to acknowledge a
problem is to some extent the problem itself.
The failure of our medical community to understand
the problem with our organ donation model faced with
an aging population can be seen in the recent incident
involving the National Hockey League Ottawa Senators’
owner Eugene Melnyk. He went public with the fact that
he had been battling Stage 4 colon cancer and needed
a live liver organ transplant because of his particular
blood type. In response, more than 2,000 people called
in, more than 400 people applied to donate and 12
candidates actually underwent screening. Eventually,
after only six days, Melnyk’s life was saved because one
of those people participated in a liver transplant.
The situation, while having a happy ending (that
speaks well to the generosity of everyday Canadians),
also demonstrates the problem that faces us. As our
population ages, and as organ transplant technology
progresses, demand for organs will continue to rise.
On the other side, however, the supply of organs is not
proportionally increasing. This requires us to examine
how Canada’s health care system currently deals with
organ transplant procedures, and what, if anything,
needs to change.
It is quite clear that aging will have a direct effect on the
need for an effective organ donor and transplant system.
As a study from the Urban Futures Institute suggests,
“… declining birth and death rates and an aging
population … combined with the rapidly growing need
for transplants and projected organ donation rates will
lead to an ever-widening shortfall between the need for,
and supply of, organs for transplantation”.1 Indeed,
in 2012, 230 Canadians with end-stage organ failure
died while on a transplant wait list.2
AMA - ALBERTA DOCTORS’ DIGEST
ROSS LLP
After a significant public push, in 2014 Alberta Health
Services (AHS) finally made available to Albertans the
Organ and Tissue Donation Registry. According to AHS
sources, this “… will allow Albertans to sign up online and
specify their wishes when it comes to organ and tissue
donation. For instance, donors can consent to donating
all their organs and tissues for transplantation, or only
selected organs”.3 Note, however, that this registry only
conveys the donor’s intent, and is not legally binding in
the sense that it does not overrule documents like an
advanced directive.
While things like the Organ and Tissue Donation
Registry are admirable in efforts to do better outreach
to Albertans about organ donation, there is still
significant work to be done to meet the challenges of
an aging population.
It is clear that as our population ages,
an important conversation needs to happen
among health care providers about organ
transplantation.
An example of a specific and major policy decision is
found in the Expanded Criteria Donor (ECD) designation.
For kidney donations, for instance, it has been
demonstrated in numerous studies that older donors,
especially 65 years and older, have a higher rate of graft
failure than younger donors.4 With the ECD criteria, older
donors who consent to the process are paired with the
older patients, or can choose to wait on the donor list.
Younger patients, especially children, are given priority
access to younger donor organs.
This ECD protocol is common in most Canadian organ
transplant practices, according to the Canadian Council
for Donation and Transplantation. Essentially, the
protocol confirms that we are making an ethical policy
decision that older recipients may be less deserving of a >
> better chance of recovery than younger patients
would be when receiving better organs. Thus, while
no official cap exists that cuts off older patients from
being on the transplant list, the protocol allows for older
patients to receive differential treatment than that of
younger patients.
Reverting to our recent example: if Eugene Melnyk
hadn’t been the owner of the Ottawa Senators, not
only might he have been waiting for a very long time
to receive an organ, but when he did have the
opportunity, it may have been to take a “less-than-ideal”
organ. Thus, when elderly patients are required to have
a transplant, they may face an extremely difficult
choice: remain on the waiting list, or have access to
a less-than-ideal older organ.
patients over a certain age. Other countries, like
Israel, are currently considering a cutoff age for certain
organ transplants.
While there are an increasing number of innovative
approaches to dealing with organ transplant issues,
like the Highly Sensitized Patient program and the
Organ and Tissue Donation Registry, it is clear that as
our population ages, an important conversation needs
to happen among health care providers about organ
transplantation. This conversation needs to include a
discussion of innovative methods to increase supply
(like presumed consent to donate and opt-out measures,
or providing state compensation to organ donors) and
a means of helping senior patients deal with the risks
associated with organ transplantation.
If we do not have these important conversations,
however, “nothing will come of nothing.”
While things like the Organ and
Tissue Donation Registry are admirable in
efforts to do better outreach to Albertans
about organ donation, there is still significant
work to be done on meeting the challenges
of an aging population.
The choices posed by the above protocol, among other
considerations, force us to ask whether we should have
a cap on the age of recipients. Studies show that after
graft loss, patients over 65 are seven times more likely
to die than younger to middle-age transplant recipients.5
Thus, we might ask ourselves if a protocol should be
established that rules out organ transplantation in elderly
References
1. Baxter D, Smerdon J. “Donation Matters: Demographics and
Organ Transplants in Canada, 2000 to 2040” (June 2000).
Available from: http://www.lhsc.on.ca/Patients_Families_
Visitors/MOTP/Organ_and_Tissue_Donation/Report46.pdf.
2. Canadian Institute for Health Information, “Canadian
Organ Replacement Register Annual Report: Treatment of
End-Stage Organ Failure in Canada, 2003 to 2012.” Available
from: https://secure.cihi.ca/free_products/2014_CORR_
Annual_Report_EN.pdf.
3. Ibrahim HN et al. “Predictors of graft failure and death
in elderly kidney transplant recipients” (2013) 96:12
Transplantation 1089.
4. Weiss-Salz et al. “Negative impact of 'old-to-old' donations
on success of cadaveric renal transplants” (2005) 19:3
Clinical Transplant 372.
5. Port et al. “Long-term survival in renal transplant recipients
with graft function” (2000) 57 Kidney International 307.
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JULY - AUGUST 2015
11
12
MIND YOUR OWN BUSINESS
Considering winding down or closing your practice?
A few simple planning steps and considerations will help keep you on track
Practice Management Program Staff
D
o you remember
how much time and
energy went into
starting your practice? If
you are at the point in your life when you are considering
winding down your practice or closing it altogether, give
yourself plenty of time to make arrangements that best
cater to the needs of you, your patients and your staff.
With good planning, communication and attention to
detail, you will be free to set your own schedule, pursue
another passion or start a new adventure! You’ve worked
hard to get to this point and regardless of the reason for
this pivotal decision, there are a few key considerations
and requirements that you must tackle:
1. Notifying and caring for your patients.
2.Managing your medical records.
3.Accommodating your staff.
If you’re unsure where to begin, we recommend picking
a closing date. Whether you are in a shared practice
or a solo practice, or if you lease premises, then plan
on closing at the end of the lease period to save on
penalty fees. If you are in a shared practice with a
practice agreement in place, make sure you refer to
the notification period agreed upon.
Don’t forget you are required to notify the College of
Physicians & Surgeons of Alberta (CPSA) in advance of
closing or leaving your practice in Alberta. The college
will want information describing:
• How the transfer of patient care will be managed.
• The location and disposition of patient records and
how they will be accessed.
• A forwarding mailing address and contact information
for you.
• All unused triplicate prescription forms.1
Notifying and caring for your patients
Your first and foremost concern when dissolving your
practice should be the welfare of your patients. There’s
nothing more aggravating than a last-minute adjustment,
so be prudent and give your patients plenty of time to
AMA - ALBERTA DOCTORS’ DIGEST
prepare for this big transition. You can post a notice on
your office door or add a personal touch with a letter
or phone call to individual patients. If another physician
is taking over your office or patient panel, a letter of
introduction seems appropriate.
Patients can feel the stress of having to find another
physician. Having built relationships with them, you will
feel obligated to do what you can to help the transition
of care. Providing your patients with a list of available
physicians in the clinic or area is a start, but also
consider connecting with local physicians to discuss
their openness to take on some of your patients and
consider referring more complex patients with ongoing
or immediate needs to other physicians early.
Of course, having an accurate and up-to-date patient
panel will make these tasks much easier and enable you
to diligently manage the transition of patient care!
Key points to remember
• 90 days documented notification for all the patients
you have seen in the last two years is the standard of
practice of the college.
• Recommend that no new patients are seen after
your announcement.
• Refer patients who require continual follow-up early
to ensure their medical needs are met.
• Notify your patients that their medical records
will be kept in secure storage until notified in writing
about transferring them to another provider if a copy
is requested.
• It is critical for you to maintain access to a complete
set of “original” patient medical records.
Managing your medical records
The storage of medical records is a big concern for a
number of physicians, and rightfully so – the retention
and management of these records is crucial. The college
guidelines state that if you are “unable to provide ongoing
management of patient medical records, either personally
or through a colleague, your medical records should be put
into commercial storage for custody, transfer as necessary
and destruction when that is appropriate.” >
> If you do not have an adequate electronic record-keeping
system, records should be printed and managed as hard
copies stamped with original and the electronic versions
destroyed appropriately. Things get more complicated
when you are practicing as part of a shared-care model.
We recommend that your practice agreement contain
a clause outlining a procedure for archiving medical
records. However, if your clinic does not assign patients
to any particular physician, the medical records belong
to the clinic, so don’t take them with you!
Retention period and storage requirements
• Retain records for 10 years following the last date of
service or two years past the patient’s 18th birthday,
whichever is longer.2
• Take reasonable steps to ensure against any
reasonably anticipated threat or hazard to the security
or integrity of health information during storage.
• Ensure you have the ability to find records in response
to requests (a retrieval system).
• Confirm individual electronic records are uniquely
identified with data preserved, authenticated with
version control and have access controls in place.
• Ensure you have control over disposition or destruction
of the medical records.
Following the retention period required under the
Health Information Act (HIA) and the CPSA, make
sure to securely dispose of documents.
Physically destroying hardware and medical records can be
difficult. To do so securely requires professional expertise.
As custodians of patient health information, physicians are
legally obligated to safeguard that information under the
HIA. Secure destruction techniques are an essential step
in the life cycle of patient records. You must plan records
management processes and activities to take place on
a scheduled basis. It is the custodian’s responsibility to
securely dispose of patient records after the necessary
retention period.
First steps to securely dispose of patient records
following retention period
1. List all hardware that contains personal
health information.
2.Review the list of options and organizations that
provide destruction services found at National
Association for Information Destruction.
www.naidonline.org/ncan/en/consumer/members.html
3.The custodian must enter into an Information
Management Agreement (IMA) with an information
manager (e.g., storage facility or destruction service)
and ask for a certificate of destruction.
4.Schedule the destruction and reconcile the destruction
certificates against your hardware list. Keep this
information on file.
5.Moving forward, develop a strategy for destroying
records on a regular schedule based upon the legal
retention requirements.
Accommodating your staff
13
Your departure is probably very stressful and emotional
for your employees as well, so give them plenty of notice.
Careful consideration needs to be given to the needs
of your staff. The sooner you can provide them with
information, the better. However, they will have many
questions and it is better if you are able to answer some
of them immediately to reduce the stress of the unknown.
Tips in accommodating your staff
• Ensure they are well informed before you start
notifying your patients.
• Help them develop responses to questions patients
may have.
• Patients will likely ask personal questions so prepare
your staff by letting them know what information you
are willing to share.
• Consider writing a letter of reference for your
hardworking and valued employees to help them find
alternative arrangements.
• Consider rewarding your employees with an incentive
or bonus if they remain with you until your practice
formally closes its door.
Don’t forget to negotiate retention incentives or bonuses
with your staff. They won’t be able to read your mind
and most certainly will be looking for a new job once you
make your announcement. In fact, you may need some
staff to stay on after the closure to complete the transfer
of medical records, reconcile billings, etc.
A few other considerations
• Maintain the phone number with a recorded message
notifying patients of the closure for up to three months
after you close.
• Issue a record of employment for all staff
within five days of their last day worked.
• Contact the Canadian Revenue Agency to cancel
employee payroll and your GST account, if applicable.
• Retain business records such as accounting and
employment records.
• Take care of other notifications, e.g., utilities, janitorial
services, other contractors.
• Consider maintaining your Alberta Medical
Association (AMA) membership so you can still vote,
serve on committees, receive publications, access
ADIUM home and auto insurance, and continue to
receive corporate rates from member companies –
all at reduced dues.
So far we’ve asked you to consider a number of
important stakeholders, but please consider yourself and
your family. Even if this transition goes smoothly, you and
your family are almost guaranteed to have higher stress
levels at some point. Effective communication between
you and your loved ones, getting plenty of sleep and
eating properly will help you come out on top. (If you >
JULY - AUGUST 2015
14
> need help, the Physician and Family Support Program is
there for you – 1.877.767.4637.) This goes without saying,
but the best is yet to come.
So enjoy your well-earned years of relaxation! If you’re
not ready for complete relaxation, consider keeping your
hand in the mix by becoming a locum with the freedom
to make your own schedule and temporarily fill in for
other physicians as needed or between golf games!
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• CPSA guidelines and policies can be found at:
www.cpsa.ab.ca.
• The Office of the Information and Privacy
Commissioner is the regulatory body for the
HIA and the Personal Information Protection Act:
www.oipc.ab.ca.
• The Government of Alberta HIA – guidelines and
practices manual: www.health.alberta.ca/documents/
HIA-Guidelines-Practices-Manual.pdf.
• The AMA has developed IMA templates at:
www.albertadoctors.org.
References available upon request.
The Practice Management Program is available to assist
in a number of areas related to the effective management
of your practice. For assistance, please contact Linda Ertman at
[email protected] or phone 780.733.3632.
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CUMMING SCHOOL OF MEDICINE
Office of Continuing Medical Education and Professional Development
Explore our professional
development courses and
conferences
SEP 14
Chronic Pain Management for the Family Physician – A Mainpro-C Course
SEP 17
Assessment of Decision-Making Capacity Workshop
(Geriatrics Update Pre-Course)
SEP 18
4th Annual Geriatrics Update: Clinical Pearls
SEP 18
Friday at the Medical School: Ophthalmology
OCT 2
Friday at the Medical School: Adult ADHD
OCT 19
Chronic Pain Management for the Family Physician – A Mainpro-C Course
OCT 23
Current Obstetrical Management Seminars
NOV 6
Friday at the Medical School: Allergy
NOV 16-19
40th Annual Family Practice Review and Update Course – Pearls for Practice
DEC 3-4
The Calgary Pain Conference
DEC 11
Friday at the Medical School: Choosing Wisely
To Register
All
inquiries
please contact
Elaine Chow-Baker
Acting Director
Continuing Medical Education
& Professional Development
Cumming School of Medicine
University of Calgary
[email protected]
403.220.4251
cumming.ucalgary.ca/cme
AMA - ALBERTA DOCTORS’ DIGEST
AA_
150
15
YEARS!
AMA congratulates Sun Life Financial on its 150th anniversary.
We’re proud to call this long-standing Canadian company
a partner for over 20 years.
We look forward to continuing our partnership with a company
that understands the unique insurance needs of physicians.
Congratulations Sun Life Financial!
JULY - AUGUST 2015
AA_AMA_150_Years_v4.indd 1
15-06-18 9:05 AM
16
INSURANCE INSIGHTS
What do physicians really think about
ADIUM Insurance Services?
Here’s what we found out on our 2015 satisfaction survey
J. Glenn McAthey, CFP, CLU, CHS | DIRECTOR,
T
he Alberta Medical
Association (AMA’s)
ADIUM Insurance
Services Inc. conducts a
survey every three years
to measure member
satisfaction with the
insurance programs, the
services provided, and to
help guide us on future
plans to improve the products and services we offer.
Thank you to all members who responded to our survey!
Who responded?
A statistically valid response rate of 11% was received from
members who are insured under at least one of the AMA’s
group insurance plans.
• Specialists (43%), family physicians (41%),
post-graduate residents (9%), medical students (4%)
and unidentified (3%).
• Male (60%), female (40%).
• 75% of respondents practice in an urban setting.
• 31% of respondents are in practice longer than
25 years.
I am satisfied with the service provided by ADIUM’s staff
when I purchase or renew my coverage:
2012
2015
Agree or strongly agree
67%
89%
Neutral
31%
10%
2%
1%
Disagree or strongly disagree
AMA insurance plans enhance the value of my
membership:
2012
2015
Yes
84%
87%
No
16%
13%
I am aware of the insurance planning tools on the AMA
website:
2012
2015
Yes
61%
75%
No
39%
25%
I have used the insurance planning tools on the AMA
website:
Comparative statements to 2012 survey
2012
2015
Yes
9%
21%
No
91%
79%
I find the premium rates and coverage competitive:
2012
2015
Agree or strongly agree
68%
74%
Neutral
29%
24%
3%
2%
Disagree or strongly disagree
AMA - ALBERTA DOCTORS’ DIGEST
ADIUM INSURANCE SERVICES INC.
>
> I was satisfied with the claims service received by Sun Life
(disability):
Verbatim comments
17
• The verbatim comments received were largely
very positive:
2012
2015
Agree or strongly agree
59%
79%
- “I trust ADIUM with what they have to offer.”
Neutral
34%
12%
- “First class support over many years. Thanks.”
7%
9%
Disagree or strongly disagree
- “Very enjoyable experience.”
- “Would recommend the service to others.”
I was satisfied with the claims service received by ADIUM
(disability):
2012
2015
Agree or strongly agree
69%
85%
Neutral
29%
12%
2%
3%
Disagree or strongly disagree
New statements for 2015 survey
The ADIUM insurance advisor I dealt with was:
Agree or
strongly agree
Neutral Disagree
Professional
94%
4%
2%
Knowledgeable
93%
6%
1%
Trustworthy
88%
10%
2%
AMA Health Benefits Trust Fund:
• I was satisfied with the performance of Alberta Blue
Cross in the processing of my Core Plan claims:
Agree or strongly agree
78%
Neutral
14%
Disagree or strongly disagree
8%
• I was satisfied with the performance of ADIUM in the
processing of my Cost-Plus Plan claims:
Agree or strongly agree
87%
Neutral
9%
Disagree or strongly disagree
4%
In an effort to save postage, time and trees, I would
prefer to receive/access insurance premium invoices and
insurance certificates electronically:
Agree or
strongly agree Neutral Disagree
Via email
78%
10%
12%
On my personal
AMA website portal
27%
20%
53%
Via an ADIUM
mobile app
12%
21%
67%
• There were isolated expressions of unhappiness
with the service received which we will reflect on
and learn from:
- “Didn’t like the four phone call transfers to find
someone who could finally help me.
• There were many comments about the limited coverage
provided under the AMA Health Benefits Trust Fund
“Core Plan” through Alberta Blue Cross. (There is
a rationale for the design of the Core Plan but this
feedback will be shared with our trustees. Watch for a
future article on this topic as well as communication to
participants in this plan.)
Summary of findings
• We are extremely pleased that members find our
premium rates and coverage to be competitive. Besides
priding ourselves on prompt and professional service
delivered objectively, our group plans have to add value
to what’s available in the marketplace. We will continue
to work with our insurers to make our plans even better
in the future.
• Members have a variety of preferences for how they
want to receive advice from their ADIUM insurance
advisor. For this reason, we will continue to make
our advisors available when it’s convenient for our
members, whether it’s by email, phone or a scheduled
face-to-face or telephone appointment.
• The high level of satisfaction with our insurance advice
and administrative services is something we intend to
maintain and even improve upon in the future.
• We will continue to use technology to improve access
to your insurance information and to improve our
operational efficiency. ADIUM will be transitioning
to a paperless office over the next year and will be
communicating to you on our progress.
Congratulations to Dr. Justin Wong, family medicine
resident from Calgary, on winning our Apple iPad mini
draw prize.
If you are not insured under any of our insurance
programs, I invite you to contact our office for an insurance
review and if warranted, how one or more of our products
may be of value to you.
Finally, thank you again to the members who took the time
to provide their feedback to us. It will help us better serve
you in the future.
JULY - AUGUST 2015
Because
so much
depends
on you.
AMA - ALBERTA DOCTORS’ DIGEST
AMA ADIUM INSURANCE DIGEST FULL PAGE AD.indd 1
2015-05-14 9:52 AM
9:52 AM
FEATURE
19
Our health care system must support the triumph of aging
CMA president calls for a National Seniors’ Strategy
Chris Simpson, MD, FRCPC, FACC, FHRS | PRESIDENT,
A
s a cardiologist
at Kingston
General Hospital
in Ontario, I work
primarily in an acute
care environment,
treating patients with
arrhythmias. I see
everyone from children with genetic arrhythmias that
predispose them to sudden death, all the way through
to elderly patients with end-stage heart disease.
My best days are when I’m with my patients. But,
being in this acute care environment every day,
I’m also witness to the many occasions our system
fails to provide Canadians with the support they need
and deserve.
Our goal is to have a strategy that
recognizes the triumph that is aging well.
CANADIAN MEDICAL ASSOCIATION
These patients fall. They develop hospital-acquired
infections. They are isolated and get depressed.
Their muscles waste away and they lose their ability
to get around.
But until we’re able to transfer them to a more
appropriate care environment, they simply have to lie
in a hospital bed, waiting, counting down the days,
weeks, months – sometimes years – until supports
are put in place to allow them to get care in the
community or at home. There are simply not enough
of these services to go around. There have been
positive changes thanks to the visionary leaders of the
senior or elder-friendly hospital movement, but we
simply must do more to get our elders out of hospitals.
The Canadian Medical Association (CMA) and our
83,000 members across the country believe that we
need a national strategy to ensure our seniors are
getting the care they need, when and where they
need it. We need to find ways to provide care as early
as possible to prevent avoidable loss of function and
independence; to avoid preventable deterioration
that results in expensive, avoidable hospitalizations –
expensive to seniors and expensive to the health
care system alike.
This strikes me particularly hard with our elders.
When they arrive at the emergency department,
they’re often alone, usually scared. Maybe it’s late
at night and they couldn’t reach their family doc, or
the next appointment with their specialist was a few
weeks away, or more. I know that they face a wait time
that’s unfortunately longer than it should be, and will
only serve to worsen their condition.
Our goal is to have a strategy that recognizes the
triumph that is aging well. We need a strategy that’s
built around the needs of individuals and their families.
One that puts the patient at the center and captures
all elements of care: from health promotion and illness
prevention, through hospital care, home and long-term
care and the availability of palliative care. Living well
should be the ultimate goal.
Once we’ve examined the patient, if anything gives us
room for concern, we’ll have them admitted. And this
is where things can go from bad to worse because our
acute care hospitals were not designed to care
for seniors.
To drive action on this critical issue in the public,
the CMA recently launched a new website
www.DemandAPlan.ca, where Canadians can add
their voices to the call for a national seniors’ strategy.
By joining our voices we can ensure that our political
leaders act to transform our health care system.
Thousands have signed on in support and we hope
you will too. With a federal election looming, now is
our chance to put the issue of developing a national
seniors’ strategy on the political agenda.
We know that in order to provide quality care to
seniors with complex, chronic conditions, they should
not be on a hospital ward if realistic, appropriate
and safe options exist in the community. Hospitals
are dangerous places for our senior patients.
JULY - AUGUST 2015
20
FEATURE
High drama!
Alberta physician dodges the enemy, goes on to a remarkable career
J. Robert Lampard, MD
the Oath of Allegiance and marching to the nearest
armory for roll calls and drills. But that isn’t what
happened to Dr. Hepburn. He was studying in Berlin at
the outbreak of WWI on August 4, 1914, and because
he held a British passport he was placed under house
arrest by August 14, 1914.
Dr. Hepburn’s medical life began when he met
Dr. William A. Wilson (Dr. Donald R. Wilson’s father)
on an Edmonton street in 1904. Wilson encouraged
the 19-year-old to make medicine his career choice.
After earning a teaching certificate and saving
money for two years in Assiniboine, he entered
McGill, graduating in 1910. Two and a half years of
postgraduate training followed, during which Hepburn
switched his interest from obstetrics and gynecology
to neurosurgery – influenced by the rising reputation
of Dr. Harvey Cushing.
To date, only eight end-of-life WWI
Dr. Howard H. Hepburn made a daring military enlistment during WWI.
( provided by the Hepburn family)
T
o date, only eight end-of-life World War I
(WWI) memoirs of Alberta physicians
have been uncovered. None rival the
remarkable 10-day enlistment story of neurosurgeon
Dr. Howard H. Hepburn (1885-1972). It was so daring
that documents relating to it were harbored in the
family safety deposit box for decades, for fear of
recrimination to those involved. Through the foresight
of his son, Dr. Allan Hepburn, also a neurosurgeon,
the events were shared in a brief biography of his
father written in 1997. It deserves a wider audience.
Normally, enlistment involved walking down to the
nearest recruiting station, proving one’s age and
identity, signing the accession statement, repeating
AMA - ALBERTA DOCTORS’ DIGEST
memoirs of Alberta physicians have been
uncovered. None rival the remarkable
10-day enlistment story of neurosurgeon
Dr. Howard H. Hepburn.
Seeking adventure, he followed contemporary
Dr. Allan C. Rankin to Siam by accepting the chief
surgeon position at the Bangkok Police Hospital.
There he treated many head injuries, often caused
from cutting down smelly durian fruit in the orchards.
In practice, he was a court physician to the King of
Siam. During his two years, he acquired numerous
Siam artifacts – vases, bowls, soapstone carvings,
ceremonial swords, knives, sabres and scabbards –
which he sent back to Canada.
With his contract over, he sailed for England
and then traveled to Berlin to meet classmate >
> Dr. Ambrose Lockwood. The two registered for studies
in neurology/neurosurgery and thoracic surgery. When
war was declared, the two students were interned as
enemy aliens. Concealing their passports and insisting
they were Americans who were non-belligerents, they
relaxed the attentiveness of their guard. With the help
of their Jewish-German professor of neurosurgery,
the two were able to exit into a boisterous recruiting
parade as it passed by. When it reached the railway
station, they slipped into the line-up to catch the last
train out of Berlin heading for Amsterdam.
But armed inspectors were checking the identity of
those in the queue. Fortunately, Hepburn happened
to lean on an adjacent shed door, which suddenly
opened. They found themselves in the station master’s
kitchen. In his poor German, Hepburn asked for
a glass of water. Then the two exited through the
opposite door onto the rail platform and boarded the
train. Without tickets, they had to elude the collectors
the whole way. Once, their train paused for a troop
train that came off an abandoned spur line and
headed for Belgium.
The good Lord sent the general
surgeon a bad case every once in a while to
keep him humble, and sent the neurosurgeon
a good case periodically to keep him sane.
In Amsterdam, they walked to the British embassy and
found it was being evacuated. Joining the departing
staff, they boarded a submarine for England. After
debriefing the British Intelligence Service about the
troop train, they enlisted in the Royal Army Medical
Corps – the first Canadians to do so. Assigned to the
#12 Stationary Hospital at Chaltham, they found it
was already embarking for Le Havre.
They arrived in France 10 days after escaping from
Berlin. Their first action was retreating from Mons,
Belgium, back to the French coast, where Dr. Hepburn
was transferred to the #3 Stationary Hospital. Over
the next year, Dr. Hepburn introduced many innovative
techniques: using boiled sea water secured each
morning for IVs, putting five pairs of gloves on and
removing one each time he saw a new patient, and
using paraffin-lined glass cylinders for vein-to-vein
transfusions of O-negative blood.
Promoted to captain, he was transferred to the
#10 General Hospital, followed by the #47 Field
Ambulance, the 9th Black Watch as its Regimental
Medical Officer and, in 1917, the #71 Artillery Unit.
When he was moved to the #24 General Hospital,
Hepburn was promoted to major and placed in charge
of surgery. Then he was made an acting lieutenant
colonel of the 1,800-bed hospital, before moving it
to Dunkirk, France. He transferred back to England
exactly five years after he had arrived. The king
awarded him a military cross and the government gave
him three participatory WWI medals.
His time on the continent had been eventful. Shrapnel
from an artillery shell injured his left bicep. He was
gassed with phosgene. A hepatic amoebic cyst he had
acquired in Siam began giving him trouble. Many years
later it would rupture into his colon, with relief that it
was not cancer.
In his spare time he published numerous articles
on warfare injuries. He also kept a frontal sinus
shell injury X-ray, which in 1917 produced a
pneumoencephalogram that outlined the brain. This
was a year before it was described in the literature.
Immediately after the war, Dr. Hepburn used his
leaves and free time to study surgery in Edinburgh,
earning his FRCS (Edin) (1919) and FACS (1920).
He would become a charter member and receive an
FRCSC (1930).
After demobilizing in Montreal, he spent a few weeks
with Dr. Adson at the Mayo Clinic, before visiting his
mother in Edmonton after her hip fracture. It became
a life-long trip. In Edmonton, he joined the militia as a
major (1920), while his friend and now dean, Dr. Allan
Rankin made him a lecturer in 1921. His instructorship
in surgery (1922) was elevated to an associate
surgeon position (1930), and the first director of the
division of neurosurgery (1934). In 1930 he created
the “Edmonton Tongs” that placed a cervical fracture
in traction.
During WWII he was appointed the chairman of
the difficult Medical Procurement and Assignment
Board for District 13 (Alberta). He was also made the
director of the Mewburn Pavilion when it opened. In
1949, he became the professor and head of surgery,
until 1950 when he reached 65 and was succeeded
by Dr. Walter C. Mackenzie. Retiring from surgical
practice in 1951, he was appointed the senior medical
officer of the Workers’ Compensation Board until
1963 (age 78). Well respected by his colleagues, he
was elected president of the Edmonton Academy of
Medicine, the Alberta Medical Association and the
Medical Council of Canada.
After his death in 1972, the Dr. H.H. Hepburn
Memorial Prize in Surgery was endowed to honor the
final year student. The Dr. H.H. Hepburn Memorial
Neurosurgical Conference Room at the Walter C.
Mackenzie Health Sciences Centre was dedicated by
Dr. Charles Drake in 1983 with the following words:
“The good Lord sent the general surgeon a bad case
every once in a while to keep him humble, and sent
the neurosurgeon a good case periodically to keep
him sane.”
JULY - AUGUST 2015
21
22
FEATURE
A coalition, a conference and a conversation
Seniors’ care is the common denominator for important AMA activities
The coalition and conference
O
n April 25 in Edmonton, the Alberta Seniors’
Care Coalition (ASCC) hosted a conference
to explore innovative approaches to seniors’
care. The Alberta Medical Association (AMA) is a
member of the coalition, which was initiated by
the Alberta College of Family Physicians and also
involves Alberta Health, Alberta Health Services
(AHS), the AHS Seniors’ Strategic Clinical Network
and Covenant Health.
The April conference, themed “Working Together for
Seniors’ Care,” was a multidisciplinary professional
development event. The goal was to provide relevant,
practice-based learning sessions with a focus on
seniors’ health, innovative models of service delivery,
dementia, palliative and end-of-life care.
As part of our contribution to the coalition and
conference, the AMA, partnering with Alberta-based
vendor ThinkHQ Public Affairs, conducted public
opinion research on Albertans’ attitudes toward aging,
being a senior and caregiving. This material was the
focus of a joint AMA/Canadian Medical Association
(CMA) session at the ASCC conference. While CMA
President Dr. Chris Simpson presented on national
findings gathered by the CMA, Alberta-specific
survey data was presented by ThinkHQ Public Affairs
President Marc Henry.
Here’s what the AMA found in the special survey
on health care and aging in Alberta:
• Albertans are not too worried that they’ll be treated
differently when they are seniors than younger
Albertans would be. We asked if seniors are treated
better, worse or about the same as everyone else.
How do we treat senior citizens?
By the government
7%
8% 8%
14%
29%
37%
42%
In the workplace
55%
In society overall
9% 7%
Highlights from the survey of 2,000 Albertans
appear over the next two pages.
42%
Better
AMA - ALBERTA DOCTORS’ DIGEST
As patients in the
health care system
42%
About the Same
6% 10%
36%
48%
Worse
Unsure >
> • They’re a little bit worried about getting older. The top
three things on peoples’ minds: Staying healthy/
health issues and concerns; having enough money/
affording things; finding access to proper care/
doctors/government support.
Albertans' concerns with getting older and aging
• For the survey, we defined “caregiving” as unpaid
care or support for an aging family member, relative
or friend who has a physical or mental disability,
is chronically ill or is becoming frail. Almost 20%
(one-in-five) are providing support like this today.
23
Caregiving for seniors in Alberta
2%
1%
2%
5%
5%
7%
19%
28%
8%
17%
79%
27%
Staying healthy/health issues and concerns
Having enough money/affording things
Finding access to proper care/
doctors/government support
Needing/availability of assisted living
Losing independence/having to move from home
Being treated poorly/loss of dignity
Being a burden/needing help from others
Other mentions
Don't know/nothing in particular
• They don’t feel informed about what is available to
support seniors in the health care system; more than
half of people over the age of 55 feel uninformed.
Albertans' knowledge of senior supports in the
health care system
13%
I receive care from a family member or friend
I participate in providing care for an
aging family member or friend
Neither
Only 16% believe they are unlikely to provide such
support at some point in their lives.
Caregiving for seniors in Alberta
19%
40%
16%
21%
41%
36%
8%
6%
Not at all informed
Not very informed
Somewhat well informed
Very well informed
Not at all likely
Not very likely
Somewhat likely
Very likely
Unsure
JULY - AUGUST 2015
>
24
> On average, caregivers provide 12 hours of support
in a typical week.
The conversation
There was another purpose for the public opinion
research that the AMA conducted. The results
were primarily intended to start a conversation
with Albertans about health care through the new
AMA-hosted website: albertapatients.ca.
Weekly caregiving time commitment
The albertapatients.ca site launched June 12. In a letter
to members, AMA President Dr. Richard G.R. Johnston
wrote: “As an organization, the AMA has not had the
ability to interact with large numbers of Albertans or
give them a way to help us understand their thoughts
and concerns regarding health care delivery. This
is a great opportunity for the AMA, because when
we know what matters to our patients, we can have
meaningful conversations, share the information
and play an active role in creating a patient- and
family-centered health care system.”
22%
34%
19%
25%
The website is an online forum for Albertans to come
together and participate in conversations about
health care. To join, visitors must register to create
an account, confirm their membership by email and
complete a member profile. All of this takes only
a few minutes.
1 hour or less
2-5 hours
6-12 hours
over 12 hours
What do caregivers do? Many things!
Once they have joined, people will have the
opportunity to:
Range of supports provided by caregivers
Note: more than one response was permitted.
• Participate in surveys about different aspects
of health care.
69%
60%
57%
44%
39%
35%
35%
14%
3%
5%
Errands/shopping
Companionship/supervision
Provide transportation
General day-to-day household
tasks (laundry, cleaning, etc.)
Medical management
(medications, doctor visits, etc.)
Financial management
Meal preparation
Personal assistance
(getting dressed, going to the
washroom, bathing, etc.)
Other
Prefer not to say
0
10
• Take quick polls and see instant results.
• Join discussion forums about topics that
interest them.
• Receive invitations for special surveys or
discussions that relate to the interests expressed
in their profiles.
20
30
40
50
60
These interesting findings suggest a need for further
discussion to seek ways to improve our care for aging
Albertans in healthy and supportive communities.
The AMA is committed to making this happen, as
discussed in the next section of this article.
AMA - ALBERTA DOCTORS’ DIGEST
70
The topics that will be discussed on albertapatients.ca
will flow directly from what Albertans tell us they want
to talk about. Since the launch period is still underway
at the time of this issue of Alberta Doctors’ Digest, the
focus has been issues of aging in Alberta, seniors’ care
and the experience of being a caregiver – based on the
80
research
findings addressed in this article.
In the months ahead we will be sharing the results
of the activity on albertapatients.ca through this
magazine and in other venues.
Stay tuned!
25
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26
DR. GADGET
I’m not 87 yet …
Wesley D. Jackson, MD, CCFP, FCFP
O
ne day last
weekend, shortly
after 7 a.m., I
received a notification
on my smartwatch that
my 86-year-old (“I’m
not 87 yet”) father left
his house. I picked up
my phone and was able to track him as he drove alone
to a nearby lake. After about 30 minutes, thinking it
would be safe to touch base, I called his cell phone
and ... no answer!
After we learned that my fiercely
independent father would frequently go
hunting and fishing alone, and after a close
call, we convinced him to get a phone
equipped with GPS technology.
A few minutes later my cell phone rang; he called
me back to tell me he couldn’t answer my call as he
was busy landing a 20-pound fish (a pike, for those
who may be interested). He then used the same
phone to take a picture of the fish, which uploaded
automatically to the cloud and was displayed on my
device a few minutes later. We were then able to swap
fish stories while I chided him gently again about
going to the lake alone.
My father was in his 40s when the first personal
computer was invented and in his 60s when the
Internet became a necessity of life for many of his
children and grandchildren. He, like many others in
AMA - ALBERTA DOCTORS’ DIGEST
his generation, had lived his entire life very happily
and successfully without the benefit of YouTube
or Google and could not see any reason to learn
and use these complicated tools. He was certainly
enticed by the devices that his descendants used,
but websites, passwords, modems, routers, Internet
service providers, email and many other complications
associated with progress provided significant
roadblocks to his adoption of modern technology.
A little more than 12 years ago, shortly after my
mother died, we convinced my father to carry a
small, simple-to-use cell phone programmed with
a quick dial so that he could contact us “in case of
emergency.” He quickly warmed to this technology
and carried the phone wherever he went. Two years
ago, after we learned that my fiercely independent
father would frequently go hunting and fishing alone,
and after a close call, we convinced him to get a
phone equipped with Global Positioning System (GPS)
technology, which would allow us to track him and
vice versa. As a bonus, this phone also allowed for
video calling, bringing him closer despite the almost
300 kilometer distance between us. The same device
provided reading material, Twitter and solitaire,
making it worthwhile to keep charged and with him at
all times.
My father’s experience is not uncommon among his
peers and demonstrates that good technology should
“fade into the background” for users as great devices
simplify and enrich our lives. New portable devices
are powerful computers containing many different
sensors available for use in multiple scenarios, while
continuing to appeal to the older generation.
As my father’s case has proven, mobile devices not
only improve emotional health through increased
quality of communication, but activity can also be
monitored and encouraged, promoting improved
physical health and well-being. Apps and sensors are >
> now available to monitor blood pressure, pulse, blood
glucose, weight and movement, with other options
such as blood oxygen levels on the horizon.
27
Already an app has been developed to study the
relationship between activity and the progression of
Parkinson's disease. This app was designed to give
the device user immediate feedback while sending
real-time data to researchers located anywhere in the
world. Several other research tools utilizing the power
of portable devices are either currently available or are
being developed.
As my father’s case has proven,
mobile devices not only improve emotional
health through increased quality of
communication, but activity can also be
monitored and encouraged, promoting
improved physical health and well-being.
Today's seniors are passively contributing to the
development of new diagnostic, research and
management tools that will contribute to improved
well-being for all. Progress in this area can only
accelerate as the younger generation becomes actively
involved in further development and use of relevant
portable and wearable technology.
Dr. Jackson's 86-year-old father lands a big one while safely keeping in touch with his
family using GPS. ( provided by Dr. Wesley D. Jackson)
LOOKING TO SET UP
YOUR PRACTICE?
WE’RE JUST WHAT THE
DOCTOR ORDERED.
For now, I think I’ll go fishing with my dad....
App spotlight
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of critical care, infectious disease and medical
microbiology clinicians and pharmacists in Calgary
which focuses on the treatment of bacterial infections
in hospitals, based on accepted guidelines where
available, and tailored to Calgary. https://itunes.apple.
com/ca/app/spectrum-calgary/id921339941?mt=8.
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28
PFSP PERSPECTIVES
Caution: Tsunami approaching
Approximately 45% of the national physician workforce is headed for the door
Vincent M. Hanlon, MD | ASSESSMENT
M
ost careers in
medicine have
a beginning,
middle and an end.
Even those superstar
colleagues we might
consider the Serena
Williams or Roger
Federer of our clinic or group will retire one day.
About 32,000 Canadian physicians are currently over
the age of 55.1 That’s approximately 45% of the national
physician workforce. More of our colleagues will be retiring
in the next few years. Many are now talking carefully about
ways to bring down the curtain on a life in medicine. These
conversations are all around us.
About 32,000 Canadian
physicians are currently over the age of 55.
That’s approximately 45% of the national
physician workforce.
One of my colleagues recently retired, full-stop,
after working for more than 20 years in the same
department. He said he’ll miss many of his patients
and co-workers, but not the night shifts.
Another colleague in the later stage of her career
was recently diagnosed with Parkinson’s disease.
Her end-of-career planning is now taking her in an
unexpected direction.
AMA - ALBERTA DOCTORS’ DIGEST
PHYSICIAN, PHYSICIAN AND FAMILY SUPPORT PROGRAM (PFSP)
A retired surgeon told me how he felt compelled
to retire in 2014 because his weekly OR block was
conditional upon him being part of his specialty call
rota. His surgical group and hospital were unable or
unwilling to accommodate his desire to get off the
call list (after more than three decades of taking call)
but continue doing some surgery.
I spoke with an academic physician whose retirement
from his large practice group was, in his words,
“badly handled.” He had developed a degree of
cognitive impairment. His “contact with officialdom
was excellent” regarding the investigation and
management of his health issue. He was referring
to his multiple conversations with the College of
Physicians & Surgeons of Alberta, Canadian Medical
Protective Association, and the psychiatrist and
psychologist he’d seen in consultations coordinated
by the Physician and Family Support Program
(PFSP). It was the abrupt end to his career as it was
orchestrated by his own department that left him
feeling bruised and somewhat bitter. It was not his
imagined endgame. He felt that even if he wasn’t able
to carry on in a clinical role, he could have continued
to contribute as an experienced teacher.
Health challenges and fitness to work
These conversations about the desire or need to
work differently later in our careers can also be
heard at some of our professional development
events. At the Alberta College of Family Physicians
60th Annual Scientific Assembly in Banff this past
February, University of Alberta occupational medicine
physician Dr. Jeremy Beach presented a case-based
interactive session on The Aging Physician – Health
Challenges and Fitness to Work. It was in a room full
of mostly middle-aged and older physicians. Levels
of engagement by participants were high and the
discussion was lively. >
> Issues of physician health, fitness to practice,
individual retirement preferences, desired workloads
and departmental resource planning are difficult to
reconcile to everyone’s satisfaction. The stakeholders
are diverse – older and mid-career physicians,
newly-minted colleagues with expectations for clinical
positions and academic appointments, nurses and
other members of the health care team including
residents and medical students, department heads,
zone medical directors, hospital administrators and,
last but not least, patients.
Arriving at the terminus of your occupational
journey can be a disappointment rather than a
celebration, especially if you have to get off the train
before your anticipated stop. Our relationship with
work is complex. Add the disruption of an unexpected
illness or injury in late career and such a transition can
be overwhelming.
29
Is there a new role ahead for you as a teacher or mentor?
( provided by Dr. Vincent M. Hanlon)
Arriving at the terminus of your
occupational journey can be a disappointment
rather than a celebration, especially if you have
to get off the train before your anticipated
stop. Our relationship with work is complex.
What does the literature have to say?
According to Betty Onyura et al, in a 2015 article
entitled "Reimagining the Self at Late-Career
Transitions: How Identity Threat Influences Academic
Physicians’ Retirement Considerations":
"An occupation often defines a person’s status,
establishes a social network, provides an area in which
competence can be demonstrated and praised, offers
specific goals to be attained, and provides structure
and meaning to a person’s day."2
The study participants were 21 Canadian academic
physicians (15 male and six female) whose
average age was 63. Through focus groups and
semi-structured interviews, the researchers identified
a number of perceived identity threats for individuals
facing late-career transitions. These included
apprehensions about self-esteem after retirement,
practice continuity and clinical competence, as well
as a loss of meaning and belonging.
Flexibility and adaptation are increasingly necessary at all stages of the career path.
( provided by Dr. Vincent M. Hanlon)
Members of the Department of Medicine at the University
of Calgary (U of C) have also been involved in a related
piece of late-career research. U of C internist and
physician health researcher Dr. Jane Lemaire spoke about
this project, entitled The Senior Physician Initiative (SPI),
at the International Conference on Physician Health in
September 2014 in London, UK.3 The main objective of the
SPI committee of the U of C’s Department of Medicine
was “to identify and advance career opportunities for
senior physicians that will benefit the members, the
department, patients and trainees.” >
JULY - AUGUST 2015
PFSP involvement
30
PFSP recognizes late-career transitions as an issue
of crucial importance for an increasing number of
our colleagues. We are hearing from them on PFSP’s
24-hour assistance line. We continue to coordinate
services based on an occupational health model
for those individuals with a complex mix of health,
workplace and personal issues requiring timely
assessment and treatment. Health promotion
activities remain a priority, while we consider some
new education initiatives to assist members in
making successful career transitions.
Does aging represent a full-stop or fork in the road for your career?
( provided by Dr. Vincent M. Hanlon)
> The research included focus group work with 15 senior
physicians and structured interviews with nine division
chiefs all within the Department of Medicine (at the
time 99 of 290 department members were aged
55 or older). Suggestions were elicited regarding clinical
content of inpatient and outpatient work done by senior
physicians, their work environments and schedules,
and models of remuneration. Potential benefits and
problems were identified.
The objective of this research work was not about
creating part-time, pre-retirement dream jobs for
aging doctors. According to Dr. Lemaire, the SPI
provided opportunities for reflection and dialogue,
which increased awareness and literacy about this
potentially divisive issue within the Department of
Medicine. Importantly, it drew attention to the need
for flexibility and adaptations in the career paths of
senior physicians.
The study generated some recommendations:
1. Reduced on-call service expectations for senior
physicians should be based on principles of mutual
agreement, collegiality and flexibility.
2.The Department of Medicine and the health region
should collaborate to produce innovative practice
opportunities for senior physicians.
Affirmative initiatives for senior physicians should
not compromise other physicians.
Flexibility and adaptation are increasingly necessary
at all stages of the career path. The medical
profession is grappling with specialist and generalist
over and under supply. These human resource
phenomena are leading to previously unimaginable
physician underemployment and unemployment.
The shifting landscapes of geography and population
demographics and rapid technological change further
complicate matters.
AMA - ALBERTA DOCTORS’ DIGEST
Researchers identified a number
of perceived identity threats for individuals
facing late-career transitions. These included
apprehensions about self-esteem after retirement,
practice continuity and clinical competence, as
well as a loss of meaning and belonging.
Forewarned is forearmed
I asked the aforementioned senior physician with
cognitive impairment what advice he would offer to
colleagues based on his experience of an unhappy
transition into retirement.
1. Root out agism – in our workplaces and in ourselves.
2.Look after the supportive relationships in your life,
i.e., your spouse. These are the people who walk
with you during the most difficult times in your life.
3.Make sure the fitness to work assessment,
e.g., neuropsychological testing, is relevant to the
work you actually do.
4.Establish clear goals with your care team
regarding treatment and return to work (if that
is a possibility).
5.Don’t be afraid to seek out the same kind of timely
and expert help for yourself as you want for your
own patients.
As an afterthought, he also recommended that
we be kind to the residents we are teaching because
they may turn up, years later, doing our late-career
fitness to work assessments – which is what happened
in his case.
It takes a decade or more of education and training to
become a physician. How much time should we spend >
> figuring out how to make a healthy transition from our
life in medicine to the next important stage of life?
“MCI takes care of
everything so I can take
care of my patients.”
References
1. Canadian Medical Association. Basic Physician Facts. 2014.
Accessed 2015-06-15.
2. Onyura B, Bohnen J, Wasylenki D, Jarvis A, Biblon B, Hyland
R, Silver I, Leslie K. Reimagining the Self at Late-Career
Transitions: How Identity Threat Influences Academic
Physicians’ Retirement Considerations. Academic Medicine.
2015;90:794-801.
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CMA BMA International Conference on Physician Health,
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JULY - AUGUST 2015
31
32
FEATURE
The Physician Learning Program is celebrating a big birthday
What can this five-year-old do for you?
T
o meet the benchmarks for its age group, a typical
five-year-old must be able to show concern and
sympathy for others, use the future tense and know
one’s address and phone number. As we celebrate our
five-year anniversary, the Physician Learning Program
(PLP) is proud to say that we have met those benchmarks
and many more. As we grow, our concern and future
planning extends to helping Alberta physicians better
understand their practices.
We make professional development easier
“The Physician Learning Program offers a simple, effective,
interesting way of providing self-audit and accumulating
continuing professional development points and
improving your patient care,” says recent Alberta Medical
Association (AMA) Medal for Distinguished Service
recipient, Dr. Donald E.N. Addington.
Dr. Addington reached out to PLP with an idea for a
project which examined the current prescribing practices
of typical and atypical antipsychotics in schizophrenia
compared to evidence-based guidelines. This project has
resulted in a more indepth look at best practices for many
psychiatrists in Calgary.
But this is just one example of a project facilitated by
PLP. Over the past five years, we have worked with many
physician groups in the province, including:
• Anesthesiology
• Diagnostic imaging
• Emergency
• Family medicine
• Hospitalists
• Neurology
• Oncology
• Orthopedics
• Pediatrics
• Psychiatry
• Surgery
• Urology
Through our work with these various groups, we have
been able to better understand the needs of Alberta
physicians and how data can enhance continuing
professional development.
AMA - ALBERTA DOCTORS’ DIGEST
Our bariatric surgery project saw Edmonton-based
surgeons working with PLP to demystify the treatment
options for obesity, with a special interest in removing the
stigma around bariatric surgery. This project culminated in
the creation of an educational video for physicians which
has been viewed more than 3,000 times on YouTube.
These are just a couple of examples of the ways in which
the Physician Learning Program has been able to help
some of your peers. Either by joining one of our currently
existing projects, or suggesting a new project with
answers yet to be resolved, we welcome your interest
and participation.
We make your life easier
“As family physicians, we spend a lot of our day deciding
which drugs to choose, how to manage our patients, how
to reach these many, many targets that are being put in
front of us. PLP is just one way of making life a little easier
for us,” explains Dr. Tina Nicholson, participant in the
Clinical Queries, Prescribing Practices project.
There are many factors that may influence how you make
choices in your practice. PLP is expertly positioned to
work with you to see how you measure up against these
changing targets. We work with a variety of groups,
including Choosing Wisely Canada, Health Quality Council
of Alberta, Toward Optimized Practice and the Canadian
Primary Care Sentinel Surveillance Network to bring you
the most up-to-date information affecting your practice.
We specialize in working with physicians to analyze your
data. Our partnerships with these groups allow us to be
ahead of the curve when tailoring projects to your needs.
PLP works closely with physicians to analyze and interpret
your data, and supports this work using feedback sessions
with your peers. By working with PLP, you can better
understand your practice while allowing us to do the
heavy lifting.
We aim to help you improve patient care
“This gave a real snapshot of what is actually occurring
in our hospital with our patients, not sort of reading a
study that was maybe published in Denmark or France or
Australia … it just adds and makes the patient experience >
> better,” said Dr. Jonathan McMann, participant in our
Pediatric Anesthesia project.
With our experience and expertise, the PLP team can
access and analyze data for physicians that they may find
difficult to both access and navigate. We work closely
with Alberta Health and Alberta Health Services (AHS) to
ensure our data is both accurate and complete. Thus far,
we have been able to use data from the following sources:
• Inpatient admission, discharge, transfer, service,
diagnosis and procedure interventions.
• Calgary acute care hospital electronic medical records
(Sunrise Clinical Manager).
• Diagnostic codes and health services completed
by fee for service.
• Laboratory tests: clinical chemistry, toxicology,
hematology, serology, urinalysis and immunology.
• Diagnostic imaging completed at AHS facilities.
• Dispensed pharmaceuticals at community pharmacies.
• Vital Statistics through Birth Registry, Death Registry,
Stillbirth Registry.
With access to most of the important administrative
health databases, PLP can truly help you understand your
practice using evidence-based analysis. With this new
understanding, you will be equipped with the tools to make
even better choices in your practice for your patients.
Need confidential advice
dealing with patient advocacy or
intimidation in the workplace? Call
the Zone Medical Staff Association
(ZMSA) operated
WHY PLP?
33
The PLP is a physician benefit program created
by a partnership between the Alberta Medical
Association (AMA), Alberta Health and Alberta
Health Services (AHS). We work with physicians,
by request, to identify clinical questions of interest
that can be answered using existing administrative
data. PLP data reports assist with self-reflection.
PLP-facilitated feedback sessions ensure that you
get maximum value from your PLP experience. All
data is confidential, accurate and personalized to
the needs of each individual physician within the
context of each project.
Our projects are all eligible for Continuing
Professional Development (CPD) credits from the
Royal College of Physicians and Surgeons of Canada
and the College of Family Physicians of Canada.
To learn more about the PLP experience, visit our
website at www.albertaplp.ca and view the video
on our homepage.
A novel approach to continuing
professional development
We all scan journals, talk to colleagues and attend
rounds to stay current in practice. If we come across
something we don’t know, we take steps to update
our knowledge (perceived gap). However, we don’t
know what we don’t know (unperceived gap), which
is problematic because we normally can’t seek
to remedy that.
The PAAL is a 24-hour confidential
service you can call to share the issue
and obtain advice from your ZMSA. All
calls are answered by Confidence Line,
an independent provider of confidential
reporting lines.
The unique, award-winning Physician Learning
Program launched five years ago attempts to
uncover unperceived gaps in knowledge in our
everyday practice. It does so by data analyzing
your practice (with your consent) using available
databases and confidentially providing you with
your practice profile in comparison to that of your
peer group, allowing you to reflect on differences
with your peers and whether some of these may
be significant enough to warrant modification
of your practice. We also help with analysis and
interpretation. Having completed successful pilot
projects with physician groups since its inception
(see main article), we are now preparing to offer
this program to more Alberta physicians.
The PAAL service has been transferred
out of Alberta Health Services and is
now operated at arm’s length by ZMSAs.
More information: http://www.royalcollege.ca/
portal/page/portal/rc/resources/publications/
dialogue/vol15_6/alberta_plp
Practitioner advocacy
assistance Line (PaaL)
1.866.225.7112
For more information visit
albertadoctors.org/paal

Tzu-Kuang (T.K.) Lee, MB, BS, FRCPC
Chair, Steering Committee,
Physician Learning Program
JULY - AUGUST 2015
34
FEATURE
What's new on the web?
Times, they are a-changing …
Leopold McGinnis | MANAGER,
WEBSITE, ALBERTA MEDICAL ASSOCIATION
A
nd so is the Alberta Medical Association (AMA)
website! In our tireless quest to make your
surfing experience fruitful and painless, we are
constantly making content and feature additions to the
albertadoctors.org website. In case you missed them,
here are a few of our latest enhancements:
• AMA Fee Navigator: Successfully navigating the fee
schedule is about as easy as winning a carnival ring
toss! Our new Fee Navigator takes the AMA mini-fee
schedule you’ve relied on for years to the next level.
It’s online, searchable, robust, easy to access and free.
There’s not enough room here to extol its many virtues,
so give it a try today: www.albertadoctors.org/feenav.
• Do it yourself! Submitting paper forms is not only
fashionably passé, but slow and tedious. Online claims
submission and processing makes forms exciting again!
Well, maybe not, but now you can submit and view your
claims on your time and have them processed much
more quickly. Both Continuing Medical Education and
insurance claims can now be made through the AMA
website. Responses have been VERY positive so far, so
try these features out, if you haven’t, and keep an eye
out for more self-serve options to come.
More self-serve options!
Due to popular demand (and use!), we will be creating
more self-serve features for members. New self-serve
options will make using and monitoring the AMA services
you rely on easier and more convenient. Look for more
news about these in MD Scope or your email inbox in the
not-too-distant future.
Have something you like/dislike about our website,
a feature request or something you’d like us to
focus on? You can always let us know at
[email protected] – we want to
hear from you!
Ann Dawrant
RE/MAXReal
EstateCentre
780-438-7000 - office
780-940-6485 - cell
• News for Docs: It’s hard to keep up with political and
medical affairs news. We can help! News for Docs
provides subscribers with a daily cross section of
provincial and national news on politics and medical
affairs. To sign up, visit: www.albertadoctors.org/
media-publications/publications/news-for-docs.
• Mega Menu: Getting lost on the AMA website is now
harder, thanks to the new Mega Menu. The Mega Menu
appears when you hover over one of the site’s main
tabs, giving you a quick snapshot of what you can find
in that section.
What’s next?
In the coming months we hope to make some of our web
content easier to find and more logically grouped. We’ll
be rearranging (and even deleting) some things, so if you
have any trouble be sure to consult the search box and
Mega Menu.
AMA - ALBERTA DOCTORS’ DIGEST
• Consistentlyintop5%
ofEdmontonrealtors
• PrestigiousRE/MAX
PlatinumClub
“Please call me to
experience the dedicated,
knowledgeable, and
caring service that I provide
to all my clients.”
Website
www.anndawrant.com
• 29yearsasa
successfulresidential
realtorinwestand
southwestEdmonton
• Bornandraisedin
BuenosAiresand
haslivedinEdmonton
since1967
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andSpanish
E-mail
[email protected]
IN A DIFFERENT VEIN
35
Aging – enjoy it!
Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP | CO-EDITOR
“I met a man whose name
was Time;
And he said ‘I must be going’;
But just how long ago
that was
I have no way of knowing...”
Jokes (my antidote to timor mortis) abound: aging jokes,
prostate jokes, dementia jokes, sexual fading jokes,
viagra jokes – don’t rage – laugh at the dying of the light.
Golf balls are harder to follow even though not hit as far –
like the older golfer who was having trouble with
his eyesight.
- October Song, The
Incredible String Band, 1965.
T
hat autocrat of the breakfast table, Oliver Wendell
Holmes, was still working as a judge in New
England at the age of 82. One morning he was
standing with a crony on the steps of the Courts of
Justice when a pretty young secretary skipped up
the steps.
“Oh, to be 10 years younger,” sighed Judge Holmes.
An optimist? Yes. An age-denier/sceptic ignoring the
dying of the light? Perhaps. But I like it. Sure, the muscles
and joints ache after sitting in a chair too long and a night
out till 3 a.m. is no longer so attractive, but I still like it.
One of the redeeming features of aging – and there
aren’t a lot – is that your brain becomes a more finely
tuned organ for detecting bullshit than in younger years
(if you can keep it agile). It’s more sensitive than an
airport drug-sniffer dog. It may work more slowly on
calculations, recalling names and language agility, but
for spotting dudes intent on throwing the brown stuff
around, it improves with age.
There are a few other redeeming features of aging:
kidnappers (except in the Southern Philippines) are
not that interested in you; in a hostage situation if you
play your cards right and shake your pill container, you
will be released first; you can discuss diseases and
operations at a party without getting bored; you have a
chance of boarding first at a crowded aircraft gate; you
can speak your mind and question the value of much
neo-technology; you can sing along to elevator music
or to the car radio and to hell with what anyone thinks;
and your joints are better than Environment Canada at
predicting the weather.
One of the redeeming features of
aging – and there aren’t a lot – is that your
brain becomes a more finely tuned organ for
detecting bullshit than in younger years (if you
can keep it agile).
The golf pro says to the old golfer: “Take Charlie with
you as your caddie. He’s 80 but has eyes like an eagle.”
The old golfer asks Charlie: “Are you sure you can follow
the ball?”
“Like an eagle,” Charlie, the caddie, says.
The old golfer (after taking his prophylactic ibuprofen)
hits a good one off the tee.
“See it Charlie?” the golfer asks.
“Sure.” They walk up the fairway – 100 yards, 200, then
250. The golfer begins to have doubts.
“Are you sure you saw it, Charlie?”
“Yup … I saw it … but, darn it, I’ve forgotten where
it landed.”
And then the declining sex life … like playing pool with a
piece of rope for a pool cue. But there’s Viagra – where
jokes abound among elderly males: >
JULY - AUGUST 2015
36
> The doc prescribes Viagra for the old man. “The dose is
important,” the doc says. “So make sure you follow all
my instructions. Monday take half a pill, then skip a day.
Wednesday, one pill, then skip a day. Friday try another
pill, then skip Saturday and Sunday.”
A week later the doc meets the wife in the street.
“How’s Willie doing?”
“He died,” she says. “It must have been all that skipping.”
As I leave Shakespeare’s stage five, full of wise saws
and modern instances and approach the sixth stage of
life, the stage of pantaloons, piping voice and spindle
shanks, dreading the seventh and final – sans teeth
(thank you modern implant dentistry – that should not
be a problem) sans eyes, sans taste, sans everything –
there is a slight laziness creeping in. There’s always a
good reason not to do something. The treatment for that
is exposing yourself to new experiences … and always,
laugh at the dying of the light.
Maintaining physical and mental health is a requirement,
a job – no longer an option. After 60, exercise becomes a
ritual, a need to fight off the decay invading you from all
sides: viruses, bacteria, yeasts, fungi, wasps, chemicals,
ticks, mosquitoes, cupcakes, Cadbury’s fruit and nut bars,
email fraudsters, psychos, kids, tax inspectors, Alberta
Health Services – all trying to hasten your decay.
The rationale for the white coat demise
is that bacteria flourish on the white coat
but not on the assorted grubby golf shirts
and jeans now worn by younger physicians.
This has apparently led to the banishing
of C. difficile and Methicillin-resistant
Staphylococcus aureus (MRSA).
The skin ages, with blotches and rough areas and
senile keratoses popping up. I never used sunblock as
a young man. Blazing sun? Bring it on – you got a tan
and looked healthy. Well look at them – those California
beach beauties. The Beach Boys don’t sing about them
now, those wrinkled crones, skin hanging on them like
a rumpled shirt. The shoulders stoop, steps become
shorter, the sparkle in the eyes fades, the sclerae become
sallow and hearing goes: “What was that you said?”
You think less about sex and more about death – there’s
a link there, a constant. The world (now “the planet” –
a Star Trek term implying that we’re in the Milky Way
looking down on the earth from Romulus) has changed.
I got to thinking about the huge societal and medical
AMA - ALBERTA DOCTORS’ DIGEST
changes of the last 50 years … and the challenges of
adapting to change:
“You must have seen many changes, Mr. McGregor,
in your lifetime?” says the young man.
“I have. And I’ve been against them all.”
Here’s a new world/planet scene: the line-up at a
Toronto Starbucks. Girl in jogging gear standing behind
me with her multi-racial friends: “I have to get an Apple.
My Blackberry won’t text back. I can’t go on like this.
It’s terrible.”
I can’t resist and turn round and say to her. “That must
be awful. How do you manage?”
She laughs. “OK, OK – first world problem.”
I get to the narrow ordering area between glass cages of
bakeries and order a breakfast sandwich and a banana
slice with icing.
“First name?”
I look blank. “Huh? Oh, Alexander. Hi, what’s yours?”
“Trevor.” He is amused. “We’ll call you when it’s ready.”
I get my banana slice – but without icing – and I am really
miffed.
Here’s an old world/planet scene: “Coffee? Only tea here,
son. There’s a non-smoking section over there and we’re
out of kippers today.”
Want more examples of social change?
When I was 13, a serial murderer called Peter Anthony
Thomas Manuel was hanged in Duke Street Prison,
Glasgow, Scotland. He lived over the hill from us and
had terrorized our neighborhood. Down the road, one
family, including the son who was my age, had been
found dead. The parents shot in the head sleeping in their
bed and the son was in the corridor as if running away.
I had difficulty sleeping in our big cold house with its
creaking stairs.
At his trial, dapperly dressed in a suit and red tie and
aping legal skills, he’d dismissed his defence lawyer. The
jury found him guilty of five murders and “not proven”
for three others. The Judge, Lord Cameron, ironically
congratulated Manuel on the conduct of his defence as
he placed the black cap on his wigged head pronouncing
Manuel to be hanged by the neck until dead.
“Aye, he’s a changed man,” said Baillie Johnson who
visited him to tell him his appeal had failed. “Gone is the
debonair cockiness we saw at the trial. He just stared at
me and said nothing.”
On the morning of his 8 a.m. hanging, at school we
counted the seconds down. “He’s goin’ up the gallow >
> steps. The hangman’s puttin’ the noose knot behind his
left ear. Now the black hood. Now...”
There was a light, almost merry feeling of relief that
morning to be rid of the little rat.
We don’t hang murderers any more. The risk of hanging
an innocent person outweighs the eye-for-an-eye
argument and the possible preventative benefit of capital
punishment.
And we don’t call people “traitors” any more. Going to
a foreign country to fight and kill your own country’s
troops used to be called treason, and you faced the death
penalty. It is now “radicalization” and you are a “foreign
fighter”; on return, you might go to jail and are a cause
for “concern” and “de-radicalization.”
Social change marches on. Getting pregnant outside
marriage is an inconvenience (or even a celebration)
rather than a disaster or a major embarrassment. Tattoos
of an iguana on your back and studs through your nose
or tongue are a fashion statement and a sexual stimulant
rather than a clinical clue that you were once in the
navy or jail.
And then there are the huge medical changes. Medical
textbooks have been superseded by “guidelines.” Patient
verbal consent for pretty much anything you suggested
used to be fine; now a fecal specimen for research
requires a legal document.
Appearing on the ward without a white coat meant it
was lost or being washed. Now no recognizable regalia
tagging you as a physician is a la mode. You can sneak
onto the ward disguised as a member of the public and
be undisturbed. Likewise, nursing staff (once in smart
crisp uniforms) can blend into the background to avoid
the annoyance of being called to the bedside by some
client/customer/significant other.
The rationale for the white coat demise is that bacteria
flourish on the white coat but not on the assorted grubby
golf shirts and jeans now worn by younger physicians.
This has apparently led to the banishing of C. difficile and
Methicillin-resistant Staphylococcus aureus (MRSA).
Stethoscopes slung around the neck like a sommelier
with his tasting cup (instead of properly in the coat
pocket) apparently do not collect neck microbes.
Dancer and Duerdon have challenged the whole
bacteriological house of cards that white coats and dirty
ties caused rising MRSA and C. difficle levels in hospitals.
In a must-read article in the Journal of the Royal College of
Physicians of Edinburgh they suggest that the evidence from
bacteriology is seriously flawed and that the demise of the
white coat has done more harm than good.1 For myself, I
had always assumed the white coat was actually to keep
the patients’ blood, sweat, pus and fleas off myself and not
the other way round.
It’s now hard for patients to determine who is doing
what on the wards. It’s one of their biggest complaints:
“Who’s my doctor?” The ward of the 21st century fills
me with anxiety with its emphasis on technology and
downgrading of clinical skills.
But there’s the enjoyment of reminiscence.
An old friend, Dr. Roy
Humble, a retired
anesthetist in Edmonton,
has published an excellent
book While You Sleep.2
This is an autobiography
of an active life with the
bonus for medical readers
of fascinating medical
situations managed the
best way possible under
difficult circumstances –
lessons (for those of us
used to easy specialist
access) that the best
doctors are often those
who have practiced in
challenging environments. He describes the vast changes
experienced during his career ranging through anesthesia,
surgery, obstetrics, pediatrics, general medicine and
even psychiatry. Some examples include operations
conducted with the light from a laryngoscope; managing
exsanguination from an unexpected placenta praevia;
unusual presentations of malaria, a death resulting from
misdiagnosis avoidable by simple history taking. A lively
chapter on the history of the art and science of anesthesia
completes the book.
Stethoscopes slung around the neck like
a sommelier with his tasting cup (instead of
properly in the coat pocket) apparently do not
collect neck microbes.
Roy writes: “If anyone of my vintage looks back at the
methods they used in the past, they would be amused
by what they did 10 years ago, alarmed by what they
did 20 years ago, and astonished by what they did
30 years ago.”
Roy tells of his training in Glasgow (where a student
was required to administer 10 anesthetics). I didn’t do
that, but at least I squeezed a bag while the anesthetist
went out for a smoke, and to qualify I had to fumble the
delivery of eight slippery babies. Now our poor students
make a lifetime choice early in their careers missing the >
JULY - AUGUST 2015
37
38
> benefits of a rounded medical education. Total trust in
the doctor has evolved into a partnership – and that’s
a nice thing. Smoking at rounds has become a nicotine
gum chew.
For myself, I had always assumed the
white coat was actually to keep the patients’
blood, sweat, pus and fleas off myself and not
the other way round.
When you think about aging, you think more about
where you came from, like the homing salmon, some
biological need to return to a spawning ground. I was four
years old when I jumped off the garden wall of our house
in Gullane and fell on the ground, my head lying in the
smell of fresh cut grass and I thought “I will remember
this moment forever,” and I have. The memory keeps
returning, for 65 years.
Life expectancy is another big change – healthier
lifestyles and better medical care so that threescore
years and 10 is no longer the expectation but is now
closer to fourscore years. Will this be an advance? Is a
pleasure worth giving up so you can spend three extra
years in a geriatric ward? Or worse, a psycho-geriatric
ward? The minutes are winging their way, not always
with pleasure, but with a sense of familiarity. You’re
a dog in a familiar kennel – and though this is one way
to cope – it may be a false creek. Take up new hobbies.
It’s my greatest fear – not cancer, certainly not a heart
attack – but losing my marbles – that loss of control,
becoming feeble.
What sustains you in the aging life? Love of family,
friends and a continuing fascination with life itself?
Dismiss the fear: “Timor mortis conturbat me.” Keep
interested and keep laughing – the best defence
mechanism. Do something new and different.
And remember Ulysses: “Old age hath yet his honour
and his toil. Some work of noble note may yet be done,
not unbecoming men that strove with gods.”
But I’m still with Judge Oliver Wendell Holmes:
“Oh, to be 10 years younger!”
References
1. Dancer SJ, Duerden BI. “Changes to clinician attire
have done more harm than good” (2015). JRCPE
Vol 44 Issue 4.
2. Humble RM. “While You Sleep; A personal journey
in anaesthesia.” Melrose Books, Cambridgeshire, UK,
2011. Also available from www.royhumble.com.
LETTERS
I wish to congratulate Dr. Kimberly
G. Williams on her article in the
May-June 2015 issue of Alberta
Doctors’ Digest (“Do leaders need to
change the world? Nice idea. Not
necessary.” Page 26).
Dr. Williams seems to have a vision
of leadership that encompasses the
values, beliefs, traits and skills that
underlie an effective definition. As a
member of the International Expert
AMA - ALBERTA DOCTORS’ DIGEST
Working Group for the 2015 Can
MEDs revision, I suggested that the
core role “manager” be changed to
“leadership” because I believed that
would be in closer alignment with a
vision that embraced those qualities
in every physician and, indeed, every
health care team member.
perspective to see people gravitate to
“leader” roles with little evidence of
leadership abilities. Leadership skills
are required by everyone on the health
care team and focusing on skill, rather
than role, will have a positive effect on
our culture and on the health
care team.
Regardless of the role a physician
has, leadership qualities will enhance
it. It is not uncommon from my
Dr. Scott Allan Lang
Calgary AB
CLASSIFIED ADVERTISEMENTS
PHYSICIAN WANTED
CALGARY AB
Med+Stop Medical Clinics Ltd. has
immediate openings for permanent
full-time physicians to provide primary
health care to patients at our four
Calgary locations. Requirements are
MD degree and must be eligible to be
licensed by the College of Physicians
& Surgeons of Alberta. Experience
is an asset but not required. Our
family practice medical centers
offer pleasant working conditions in
well-equipped modern facilities, high
income based on fee-for-service,
TELUS Health Solutions electronic
medical records, low overhead, no
investment, no administrative burdens
and a quality of lifestyle not available
in most medical practices. We also
have some part-time positions
available at two of our clinics.
Collaborate with our large network of
family physicians and their referrals to
maximize outcomes for your patients.
Opportunities for group therapy and
corporate health are available. There
are also opportunities to help develop
leading programs for mental health
at all levels of primary care within
our multiple sites located throughout
Calgary and Edmonton.
An attractive compensation
package will be offered to the
successful candidate.
All candidates must be immediately
eligible for licensure or already
licensed with the CPSA and provide
proof of malpractice insurance
from the Canadian Medical Protective
Association. Compensation is
fee-for-service.
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 protected]
CALGARY AND EDMONTON AB
Imagine Health Centres in Calgary
and Edmonton have an immediate
opening for a psychiatrist certified
with the College of Physicians &
Surgeons of Alberta (CPSA).
Imagine Health Centres are dynamic
multidisciplinary clinics with a large
array of services including family
physicians, specialists and many
other allied health professionals such
as pharmacists, physiotherapists,
psychologists and more. Imagine
Health Centres are dedicated to
promoting the health of patients
utilizing the most up-to-date
preventative and screening strategies.
The successful candidate will work
closely with our multidisciplinary
team to optimize management of our
patients with mental health issues.
39
All inquiries will be kept strictly
confidential and only qualified
candidates will be contacted.
Submit your CV to: Dr. Jon Chan
[email protected]
EDMONTON AB
The College of Physicians & Surgeons
of Alberta is looking for physicians
of all specialities to serve on its
Complaint Review Committee or
hearing tribunals. Candidates must
have a minimum of five years of
practice experience and be in good
standing with the college.
Deadline to apply is September 15.
Contact:
[email protected] >
AMA Physician
Locum Services
®
Locums needed. Short-term & weekends. Family physicians & specialists.
Experience:
•
Flexibility – Practice to fit your lifestyle.
•
Variety – Experience different Alberta practice styles.
•
Provide relief – Support rural colleagues and rural Albertans.
•
Travel costs, honoraria, accommodation and income
guarantee provided.
ContaCt: BarryBrayshaw,Director,AMAPhysicianLocumServices ®
[email protected]
T780.732.3366
TF1.800.272.9680,ext.366
www.albertadoctors.org/services/physicians/practice-help/pls
JULY - AUGUST 2015
40
>
EDMONTON AB
Two positions are immediately
available at the West End Medical
Clinic/M. Gaas Professional
Corporation at unit M7, 9509 156
Street, Edmonton AB T5P 4J5. We are
also looking for specialists; internist,
pediatrician, gynecologist and
orthopedic surgeon to join our busy
clinic. Full-time family physician/
general practitioner positions are
available. The physician who will join
us at this busy clinic will provide family
practice care to a large population of
patients in the west end and provide
care to patients of different age groups
including pediatric, geriatric, antenatal
and prenatal care.
Physician income will be based on
fee-for-service payment and the
overhead fees are negotiable. The
physician must be licensed and
eligible to apply for licensure with the
College of Physicians & Surgeons of
Alberta (CPSA), their qualifications
and experience must comply with the
CPSA licensure requirements and
guidelines. We offer flexible work
schedules, so the physician can adopt
his/her work schedule. We also will
pay up to $5,000 to the physician for
moving and relocation costs.
Contact: Dr. Gaas
T 780.756.3300
C 780.893.5181
F 780.756.3301
[email protected]
EDMONTON AB
Family medical clinic in west Edmonton
is seeking part- and/or full-time family
physicians. We offer flexible hours,
low overhead (negotiable), fully
computerized clinic using Mediplan
electronic medical records. The clinic
is associated with Edmonton West
Primary Care Network.
Contact: Dr. Patocka
T 780.487.7532
[email protected]
EDMONTON AB
Family physicians needed in
Edmonton. Beverly Medical Clinic Inc.
is a new state-of-the-art medical clinic
that is expanding rapidly. The clinic is
growing and needs more dedicated
family physicians as one of the
physicians is planning to slow down.
We are currently seeking two
family physicians.
AMA - ALBERTA DOCTORS’ DIGEST
Terms of employment and wages:
The family physician positions are
permanent, full-time, fee-for-service
with anticipated annual income of
$300,000. The physician and the
clinic will share fee-for-service billings,
70% (physician) and 30% (clinic)
for overhead expenses.
Flexible work hours: Clinic is open
9 a.m. to 9 p.m. weekdays and
weekends allowing physicians to
have flexible work hours and flexible
work arrangements.
Job duties: The physician will be
providing primary care to patients of
the Beverly Medical Clinic, including
diagnosing and treating medical
disorders, interpreting medical tests,
prescribing medications and making
referrals to specialist physicians
as appropriate.
Education and experience: Medical
degree with specialist training in
family medicine. Preference will
be given to candidates with family
practice experience and candidates
must be eligible for registration with
the College of Physicians & Surgeons
of Alberta. Preference will be given to
candidates that are College of Family
Physicians of Canada certified and
preference will be given to Canadian
citizens and permanent residents.
Skills required: Specialist training
in family medicine, ability to work
effectively, independently and in a
multidisciplinary team, effective written
and verbal communication skills.
Contact: Dr. A. Elfourtia or
Dr. Z. Ramadan
Beverly Medical Clinic
4243 118 Ave
Edmonton AB T5W 1A5
T 780.756.7700 or
C 780.224.7972
EDMONTON AB
Dx Medical Centres is a new,
spacious and modern clinic in Mill
Woods with high-visibility exposure
in a busy residential area. We are
looking for general practitioners for
the growing practice to join our team
working collaboratively with multiple
disciplines of the health care field.
Our clinic offers a pleasant working
environment in a contemporary
facility. The clinic is paperless with
excellent support staff. We would like
to offer you the opportunity to work
in an enhanced practice environment
that fits your lifestyle, needs and
availability without investment or
administrative time commitments.
We provide competitive split to
our valued physicians on a
fee-for-service schedule.
Candidates must be licensed or
eligible to apply for licensure with
the College of Physicians & Surgeons
of Alberta.
Contact: Christina
T 780.705.8400
[email protected]
EDMONTON AB
Family physicians needed in
Edmonton. The Beverly Towne
Medical Clinic is a new medical clinic
in Edmonton at 11730 34 Street.
(The clinic is operated by the Beverly
Medical Clinic Inc.)
We are currently seeking three family
physicians to join this new practice.
Terms of employment and wages:
These family physician positions are
permanent, full-time, fee-for-service
with anticipated annual income of
$300,000. The physician and the
clinic will share fee-for-service billings,
70% (physician) and 30% (clinic) for
overhead expenses.
Flexible work hours: The clinic is open
9 a.m. to 9 p.m. during the week, and
also on weekends, allowing physicians
to have flexible work hours and
flexible work arrangements.
Job duties: The physician will be
providing primary care to patients
of the Beverly Towne Medical Clinic,
including diagnosing and treating
medical disorders, interpreting
medical tests, prescribing
medications, and making referrals to
specialist physicians as appropriate.
Education and experience: Medical
degree with specialist training in
family medicine. Preference will
be given to candidates with family
practice experience and candidates
must be eligible for registration with
the College of Physicians & Surgeons
of Alberta. Preference will be given to
candidates that are College of Family
Physicians of Canada certified and
preference will be given to Canadian
citizens and permanent residents.
Skills required: Specialist training
in family medicine; ability to work
effectively, independently and in a
multidisciplinary team; effective written
and verbal communication skills. >
>
Contact: Dr. A. Elfourtia or
Dr. Z. Ramadan
T 780.756.7700 or
C 780.224.7972
Beverly Towne Medical Clinic
11730 34 St
Edmonton AB
EDMONTON AND FORT
MCMURRAY AB
MD Group, Lessard Medical Clinic,
West Oliver Medical Centre and
Manning Clinic each have 10
examination rooms and Alafia
Clinic with four examination rooms
are looking for six full-time family
physicians. A neurologist, psychiatrist,
internist and pediatrician are required
at all four clinics.
Two positions are available at the
West Oliver Medical Centre in a
great downtown area, 101-10538
124 Street and one position at the
Lessard Medical Clinic in the west
end, 6633 177 Street, Edmonton.
Two positions at Manning Clinic in
northwest Edmonton, 220 Manning
Crossing and one position at Alafia
Clinic, 613-8600 Franklin Avenue in
Fort McMurray.
The physician must be licensed or
eligible to apply for licensure by the
College of Physicians & Surgeons
of Alberta (CPSA). For the eligible
physicians, their qualifications and
experience must comply with the
CPSA licensure requirements
and guidelines.
The physician income will be based
on fee-for-service with an average
annual income of $300,000 to
$450,000 with competitive overhead
for long term commitments; 70/30%
split. Essential medical support and
specialists are employed within
the company and are managed by
an excellent team of professional
physicians and supportive staff. We
use Healthquest electronic medical
records (paper free) and member
of a primary care network.
Full-time chronic disease management
nurse to care for chronic disease
patients at Lessard, billing support and
attached pharmacy are available at
the Lessard and West Oliver locations.
PHYSICIAN(S) REQUIRED FT/PT
Also locums required
Work with a nice and dedicated
staff, nurse available for doctor’s
assistance and referrals. Also provide
on-site dietician and mental health/
psychology services. Clinic hours
are Monday to Friday 8:30 a.m. to
8:30 p.m., Saturday and Sunday
10:30 a.m. to 5 p.m.
Contact: Management Office
T 780.757.7999 or
T 780.756.3090
F 780.757.7991
[email protected]
[email protected]
WESTLOCK AB
The Associate Medical Clinic is
seeking permanent full-time general
family practitioners for our active
multidisciplinary clinic. We are in a
rural setting but easily accessible to
Edmonton (90 kilometers north) so
you can enjoy the best of both worlds.
The Aspen Primary Care Network
works very closely with our clinic to
enhance patient care delivery and
to optimize your practice. The clinic
currently has six general practitioners
and two orthopedic specialists. We
also enjoy the services of visiting
internal medicine and general surgeon.
The Westlock Healthcare Centre
in our community is a very busy,
well-equipped modern 45-bed facility
with 24-hour emergency department,
rehabilitation services, stroke program,
maternity services, operating theaters,
full diagnostic imagining services and
on-site laboratory.
Our support staff are easy to work
with and look forward to making your
work life as pleasant as possible.
Physicians in our community enjoy
rural recruitment incentives as well
as the standard fee-for-service.
ALL-WELL
PRIMARY CARE CENTRES
MILLWOODS EDMONTON
Contact: Karen Bouman
Clinic Manager
Associate Medical Clinic
203-10030 106 St
Westlock AB T7P 2K4
T 780.349.3341
F 780.349.6686
[email protected] >
Phone: Clinic Manager (780) 953-6733
Dr. Paul Arnold (780) 970-2070
JULY - AUGUST 2015
41
42
>
PHYSICIAN AND/OR
LOCUM WANTED
CALGARY AND EDMONTON AB
You require balance … you demand the
best. Join the fastest growing medical
group in Alberta to practice medicine
the way it was meant to be.
Imagine Health Centres (IHC) is
currently looking for family physicians
and specialists to join our dynamic team
in either Calgary or Edmonton. Physicians
will enjoy extremely efficient workflows
allowing for very attractive remuneration,
no hospital on-call, paperless electronic
medical records, friendly staff and
industry-leading fee splits.
Imagine Health Centres are
multidisciplinary family medicine
clinics with a focus on health
prevention and wellness. Come and
be a part of our team which includes
physicians, physiotherapists, massage
therapists, psychologists, nutritionists
and pharmacists.
Imagine Health Centres prides itself
in providing the very best support for
family physicians and their families in
and out of the clinic. Health benefit
plans and full financial/tax/accounting
advisory services are available to
all IHC physicians. There is also an
optional and limited time opportunity
to participate in ownership of our
innovative clinics.
Compensation is fee-for-service.
Current positions available are locum,
part- or full-time.
We currently have three Edmonton
clinics with a fourth opening this fall in
Windermere (southwest Edmonton).
The current clinics are near South
Edmonton Common, Old Strathcona
and west Edmonton.
We currently have one clinic in
southeast Calgary with a second clinic
that opened downtown in April.
All inquiries will be kept strictly
confidential and only qualified
candidates will be contacted.
Submit your CV to: Dr. Jon Chan
[email protected]
DEVON AB
Devon Medical Clinic requires
physicians or locums to help meet
the needs of our growing community.
We currently have one physician on
maternity leave and a few others are
looking to reduce their work load.
The clinic uses TELUS Wolf electronic
medical records, a diagnostic imaging
clinic and pharmacy are the same
building, and the hospital is across
the street. Emergency room shifts
are optional, we are part of the
Leduc Beaumont Devon Primary
Care Network and we are closed
on weekends.
We enjoy a pleasant working
environment with excellent
support staff.
Contact: Kim
T 780.987.3315, ext. 227
[email protected]
EDMONTON AB
Summerside Medical Clinic and Edge
Centre Walk-in Clinic require part- and
full-time family physicians, specialists
and locums are welcome. The clinics
are in the vibrant, rapidly growing
communities of Summerside and Mill
Woods. Examination rooms are fully
equipped with electronic medical
AMA - ALBERTA DOCTORS’ DIGEST
records, printers in all examination
rooms and affiliated with the Edmonton
Southside Primary Care Network.
The Edge Centre has 5,000 sq. ft.
and can accommodate other medical
professionals such as dentist,
massage therapist, physiotherapist,
chiropractor, etc.
Contact: Dr. Nirmala Brar
T 780.249.2727
[email protected]
SHERWOOD PARK AB
Dr. Patti Farrell & Associates is a new
busy modern family practice clinic with
electronic medical records and require
locum coverage periods throughout
2015. Fee split is negotiable. Current
clinic hours are Monday to Friday
8 a.m. to 4 p.m. are negotiable.
Dr. Farrell is a lone practitioner
(efficient clinic design built for two
doctors) looking for a permanent
clinic associate.
Contact:
C 780.499.8388
[email protected]
SHERWOOD PARK AB
The Sherwood Park Primary Care
Network is looking for several
physicians to cover a variety of locum
periods in a variety of Sherwood Park
offices. Practice hours vary widely.
Majority of practices run electronic
medical records. Fee splits are
negotiated with practice owners.
Some practices are looking for
permanent associates.
Contact: Dave Ludwick
T 780.410.8001
[email protected]
PRACTICE WANTED
CALGARY AB
I am a family doctor looking to take
over any medical clinic from which
the owner is relocating or retiring. I
would also consider buying a medical
building.
If you are a family physician or
specialist looking for part- or full-time
work please contact me.
Contact: Dr. D. Das
T 403.585.6840
[email protected] >
>
SPACE AVAILABLE
EDMONTON AB
Office space available would be
most suitable for an orthopedic
surgeon, rheumatologist or general
practitioner interested in patients
with musculoskeletal issues. Other
specialties are also welcome. Our
office currently has six orthopedic
surgeons and an endocrinologist.
We have been paperless for 15 years
and currently use Accuro electronic
medical records. We do not have
radiology facilities on sight, but
are electronically linked to several
radiology facilities. Excellent long
term support staff is also available.
Contact: Marilyn Nelson
Clinic Manager
T 780.433.7033
[email protected]
COURSES
CME CRUISES WITH
SEA COURSES CRUISES
• Accredited for family physicians
and specialists
• Unbiased and pharma-free
• Canada’s first choice in CMEatSEA®
since 1995
• Companion cruises FREE
ST. LAWRENCE AND MIQUELAN
September 19-27
Focus: Third annual McGill
CME cruise
Ship: Crystal Symphony
FIJI TO TAHITI
November 10-21
Focus: Endocrinology and diabetes
Ship: Paul Gauguin
PANAMA CANAL
November 20-30
Focus: Dermatology, psychology
and infectious diseases
Ship: Zuiderdam
SOUTH AFRICA
November 24-December 9
Focus: Adventures in medicine
Ship: Regent Seven Seas Mariner
CARIBBEAN NEW YEAR’S
December 27-January 3, 2016
Focus: Dermatology and
women’s health
Ship: Freedom of the Seas
AUSTRALIA AND NEW ZEALAND
January 5-19, 2016
Focus: Caring for an aging patient
Ship: Celebrity Solstice
SERVICES
TAHITI AND COOK ISLANDS
February 20-March 2, 2016
Focus: Geriatrics and women’s health
Ship: Paul Gauguin
Independent consultant, specializing
in accounting and tax preparation
services, including payroll and source
deductions, using own computer and
software. Pick up and drop off for
Edmonton and areas, mail or courier
options available for rest of Alberta.
SOUTH AMERICA
February 28-March 9, 2016
Focus: Hot topics in medicine
Ship: Celebrity Infinity
CARIBBEAN
March 13-20, 2016
Focus: Primary care review
Ship: Liberty of the Seas
TASTE OF THE EAST
April 12-May 2, 2016
Singapore, Asia, India and
United Arab Emirates
Focus: Adventures in Medicine
Ship: Regent Seven Seas Voyager
WEST COAST WAYFARER
June 13-19, 2016
Focus: Internal medicine and
infectious diseases
Ship: Crystal Serenity
BALTIC AND NORTHERN CAPITALS
June 19-July 1, 2016
Focus: Cardiology, neurology
and gastroenterology
Ship: Celebrity Silhouette
GREECE AND TURKEY
July 9-16, 2016
Focus: ER medicine: Novice to expert
Ship: Celebrity Equinox
ICELAND AND NORWAY
July 16-28, 2016
Focus: Primary care
Ship: Holland America Zuiderdam
JAPAN AND KOREA
September 18-29, 2016
Focus: Endocrinology and dermatology
Ship: Celebrity Millennium
MEDITERRANEAN
September 24-October 8, 2016
Focus: Cardiology and endocrinology
Ship: Celebrity Silhouette
For current promotions and pricing,
contact: Sea Courses Cruises
TF 1.888.647.7327
[email protected]
www.seacourses.com
43
ACCOUNTING AND
CONSULTING SERVICES
Contact: N. Ali Amiri
MBA Consultant
Seek Value Inc.
T 780.909.0900
[email protected]
[email protected]
DOCUDAVIT MEDICAL SOLUTIONS
Retiring, moving or closing your
practice? Physician’s estate?
DOCUdavit Medical Solutions
provides free, paper or electronic
patient record storage with no hidden
costs. We also provide great rates
for closing specialists.
DOCUdavit Solutions has achieved
ISO 9001:2008 and ISO 27001:2013
certification validating our
commitment to quality management,
customer service and information
security management.
Contact: Sid Soil
DOCUdavit Solutions
TF 1.888.781.9083, ext. 105
[email protected]
DISPLAY OR
CLASSIFIED ADS
TO PLACE OR RENEW, CONTACT:
Daphne C. Andrychuk
Communications Assistant,
Public Affairs
Alberta Medical Association
T 780.482.2626, ext. 3116
TF 1.800.272.9680, ext. 3116
F 780.482.5445
daphne.andrychuk@
albertadoctors.org
JULY - AUGUST 2015
“I DIDN’T KNOW
WHAT TO EXPECT
AS I TRANSITIONED
FROM MEDICAL
STUDENT TO
RESIDENT. MD
HELPED MAKE
IT EASIER.”
“When you’re entering residency, your goals seem
a long way away. MD listened to my goals—like
buying a house and car, and planning for my
wedding—then prepared me well to achieve them.
That’s when I fell in love with MD. They’ve done
amazing work for me. I feel very safe and secure
knowing they’re always there.”
– Dr. Noor Amily, Obstetrics and Gynecology Resident
EVERY PHYSICIAN HAS A STORY. HEAR MORE
FROM YOUR PEERS: MD.CMA.CA/MYSTORY
FOUR TIMES MORE PHYSICIANS TRUST MD.1
Fifty-three per cent of Canadian Medical Association members trusted MD Financial Management as their primary financial services
firm, four times more than the next closest individual competitor at twelve per cent. Survey respondents (MD clients and non-MD
clients) were also asked to identify their primary financial institution (MD or Other), and rate their level of trust associated with that
institution. MD received the highest trust rating compared with all other firms rated. Source: MD Financial Management Loyalty
Survey, June 2014.
1
MD Financial Management provides financial products and services, the MD Family of Funds and investment counselling services
through the MD Group of Companies. For a detailed list of these companies, visit md.cma.ca. Incorporation guidance limited to asset
allocation and integrating corporate entities into financial plans and wealth strategies. Professional legal, tax and accounting advice
regarding incorporation should be obtained in respect to an individual’s specific circumstances. Banking products and services are
offered by National Bank of Canada through a relationship with MD Management Limited.
15-00031_MD_AMA_Amily_8.5x11_E.indd 1
2015-06-08 4:14 PM