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CMA Members' Forum 2012 - questions and responses

Monday August 13, 2012
St. Pat's High School, Yellowknife, NWT
2:15-3:30 p.m.
Number of participants: 171

1. Question received in advance, Dr. R. Feroe (Alta.)

Are physicians leading by example? Do we help patients connect healthy air, water, and healthy built environments to healthy bodies? Do we use active transportation? Do we advocate for healthy walkable Communities? Do we buy and encourage local healthy food?

Response provided by Dr. A. Reid
CMA agrees with and advocates that all physicians lead by example. However, we are all human and have challenges reaching a completely healthy lifestyle ourselves. Local Yellowknife physicians helped organize a walk/run with the Canadian Medical Foundation (CMF) to promote active participation by physicians for an active lifestyle. We are very excited that over the next while, CMA will be partnering with CMF in the new Canadian Physician Institute (Canadian Institute for Physician Health?). If we want a vibrant medical profession, we need to work on physician well-being. Unless we are healthy and vibrant ourselves, it is difficult to lead by example. CMA is taking great steps in that direction.

2. Comment from the floor, Dr. J. O'Brien-Bell (B.C.)

Congratulations on the run, which was a financial success for the CMF. My suggestion is for CMA to investigate the feasibility of having this as an annual event with an outside running club. It could provide the CMF with regular and significant finances and physicians with an enjoyable experience.

3. Question from the floor, Dr. V. Dirnfeld (B.C.)

If we want to tackle the situation with the social determinants of health and the severe disparities that exist, as was discussed during General Council, where is the funding going to come from? Increased income tax? Blocking loopholes? Decreasing other funding, such as police? Does anyone have a solution? What are the possible solutions?

Response provided by Dr. J. Turnbull
You have identified a key issue and I think what most people engaged in this field agree with is that we cannot afford not to do it, if you consider the cost of putting someone in jail, the costs associated with a homeless person in just one year. We have to think of strategic ways of using existing investment and reinvest early on in extreme causes. What we heard today is that everyone is supportive of looking at some strategic direction of social determinants of health. The challenge for the Board is to create that strategic plan - who we will work with, what the deliverables will be. One of the key items will be funding. How do you support healthy lifestyles?

Response provided by Dr. J. Haggie
Looking at this year's General Council (GC) recommendations, the sessions provided a foundation and policy development for the next steps. We need to look at what the individual physician can do, what provincial and territorial medical associations (PTMAs) can do at the regional level and obtain guidance from CMA for a more strategic direction or advocacy campaign. The challenge will be fiscal, but it won't all be taken out of health care. The picture is not all gloom and doom. There is a way out. The direction from GC will provide guidance regarding which way the CMA Board goes.

Response provided by Dr. D. Bach
Part of the solution is found in Dr. Turnbull's presentation to GC and in the clinic he runs in Ottawa. It takes an investment, but there is a huge payoff. Many politicians may be supportive of the social aspect, but all will be supportive of an economic argument. The financial gurus will understand that an investment now will result in cost saving in the future.

4. Question from the floor, Dr. E. O'Shea (Ont.)

Regarding the site Rate your MD: A colleague has felt hurt by comments posted on this site. As an organization, do we have any ability to respond to this hurtful dialogue? Are there any legal aspects that can be pursued by CMA?

Response provided by Dr. M. Golbey
This issue has been raised before. It seems there is very little that CMA can do, although we will look at what could potentially be done. Some comments are libelous or slanderous. We will look at it.

5. Comment from the floor

Prevention information and techniques are available. Can some of this be made available to members? We need some information about what strategies are currently available.

Response provided by Dr. J. Turnbull
One of the next steps is to gather best practices and make them available to members - best practices in our individual practices as well as in our individual communities. The task will be to have some kind of vehicle to collect these best practices and make them available to all of us.

6. Question received in advance, Dr. G. Ducasse (Sask.)

Would the CMA consider creating scholarships for deserving medical students that would be repayable by the students when they graduate, by working in communities that find it hard to attract doctors? My understanding is that this strategy has been successful in other countries and might be useful in our context. The recipients of these scholarships would work in these communities for a specified minimum number of years. "

Response provided by Dr. J. Haggie
This is an interesting issue about recruitment. For the most part, there is no national plan for physician HR - hopefully this will be addressed in the near future. Yes, it has worked in some jurisdictions, but even if physicians can be recruited in this way, retention continues to be an issue. Some element of debt reduction as part of a national strategy would be an excellent first step. Not sure CMA has a role.

7. Comment from the floor, Dr. R. Collins-Nakai (Alta.)

Regarding Dr. Bach's reference about "pay now, pay later," there is huge evidence by the University of Chicago regarding investing in children under the age of 5 and ensuring those investments pay off. And they do. They pay off in terms of fewer mental health issues, greater employment, educability, fewer chronic disease and greater family cohesion. There are a number of good reasons to invest in early childhood. UBC has started to collect information to help other groups invest in early childhood. Academic centres across Canada have data that would create evidence.

Response provided by Dr. Anna Reid
In NWT, there is such an early childhood strategy, From Cradle to Education. It is a joint strategy of the Health and Education departments.

8. Comment from the floor, Dr. D. Wexler (Ont.)

While health care is universal, it isn't exactly. Some patients cannot get to your office. One thing that would change this is for us to go to them. CDA undertakes a skin screening program across the country and I would be willing to bet that we don't get to the very people we are talking about.

Response provided by Dr. J. Turnbull
Excellent suggestion. Several months ago, during head and neck cancer week, specialists specifically targeted homeless people for head and neck exams. It resulted in three patients being diagnosed with cancer.

9. Question from the floor, Dr. G. Campbell (Alta.)

People will be sick regardless. There has been a decline in the public's perception of the physician's role. Our role is being usurped by other health workers, i.e., chiropractors and pharmacists, among others. What is the CMA doing to strengthen, protect and advocate to the public that the physician is the best person to help improve their health?

Response provided by Dr. J. Haggie
The National Report Card that was released yesterday essentially points out that patients who have a family physician are more likely to rate their physician A or B. CMA has been on record as stating that all Canadians should have a family physician. It is part of our ongoing advocacy effort on the hill. The CMA-PTMA reputation campaign is another example. The physician reputation has declined according to statistics, so this issue is on the CMA radar to look at over the next year or so.

10. Question from the floor, Dr. (Georgetown, Ont.)

Regarding access to care. How do you access the care you need? An important part of the population doesn't have the resources to access appropriate services. Many are financially disadvantaged. I understand that one of the suggestions from CMA is a coordination of housing, family services and health. Can you comment on international medical graduates (IMGs) and the disparities that exist regarding standards for IMGs to start practising.

Response provided by Dr. J. Haggie
Regarding seamlessness of care, you highlight a real issue between primary, secondary and tertiary care. The health care transformation principles mention this on many levels with respect to person-patient centered care. EMRs, as a functioning tool, will assist in this endeavor.

Regarding standards of license, FMRAC is looking into this issue. IMGs face many cultural issues. There is a lot we can do at the provincial or regional level to acclimatize our IMG colleagues.

11. Comment from the floor, Dr. K. Moore (Ont.)

There is a unique initiative in Ontario - a collaboration between the Ministry of Health and the OMA - an 18-month well-baby care program, to assess parenting and baby care. It is intended to help improve outcomes for children with disabilities or developmental delays. All children should have the same opportunities. Public health partnership - with ministries and public health departments (i.e., LIHN) - assist in identifying those without a primary care physician.

Response provided by Dr. J. Haggie
One of CMA's strands of advocacy is the concept of some type of body such as Centre for Excellence in the UK where there would be a national repository of such information. Canada is a country of hot spots of excellence. One jurisdiction knows about an innovation, while others don't.

12. Question from the floor

One aspect of the SDH which was omitted is transportation. Lack of transportation is proportionate to lower economic patients. Maybe we can counter some of these effects by improving transportation, especially in rural areas. Many appointments are missed due to lack of transportation. This past week, we learned that Acadia bus lines in NB and NS, are going to stop in a few months. Therefore, when you get back to NS, the closing bus line will be an emergency medical issue.

Response provided by Dr. M. Golbey
There is an organization called Hope Air - a great charity that has been in existence for 25 years. It provides transportation for patients who would otherwise miss appointments. You need to be living under the poverty line to qualify, but the service is offered across the country. This includes all types of transportation, including air transportation.

Response provided by Dr. A. Reid
One of the problems we experienced as rural MDs in BC, is that although there was a bus going to the neighboring town, the bus only went a few times a week. The schedule didn't always coincide with the specialist's schedule. We all have a responsibility to help coordinate appointments.

13. Comment from the floor, Dr. D. Dellandrea (Ont.)

As medical director for a women and child care centre, we see many disadvantaged single mothers, many with addiction problems. One of the things we did that has paid off is to have a dedicated clinical nurse who has ready access to resources in the community. While we wait for future think tanks, we all need to do what we can at the present time to care for these people. One of the things we can do, is to make sure to ask medical students whether they want to accompany us at home appointments. These are some of the most important experiences they can have. It allows them to see health from a different perspective.

14. Question received in advance, Dr. R. Andrews (N.B.)

Would the CMA consider granting retired physicians aged 80 and over membership for a nominal $10 a year?

Response provided by Dr. D. Bach
The question of how CMA fees are structure something the Board is currently looking us. We recognize that there are problems with the current structure. Retired members are important to the CMA and we want to ensure they continue to feel valued. A CMA Board working Committee is collecting data. I imagine there will be changes in the future.

15. Question received in advance, Dr. M. Trusler (B.C.)

The Health Care Innovation Working Group is focusing on practical innovations that each province and territory can put to use to enhance patient care and improve value for taxpayers. However, as a physician with some practical front line ideas to contribute, I don't have a clear idea as to how to engage any of our governments in a meaningful dialogue. Is there a straightforward process for discussing our ideas with provincial and territorial governments? If so what is it and who should we contact?

Response provided by Dr. J. Haggie
The problem governments have is that they have no way to assess content. You really need to go through a physician group, i.e., specialist society, PTMA or through the CMA member panel. You need to have in mind that it needs to be put in a physician context. I would suggest to start with your PTMA; if you think it's a national issue, then contact the CMA.

Response provided by Dr. J. Turnbull
It is essential that physicians become more engaged at all levels. There are opportunities within your hospital, your community or regional health authority - but get engaged and change the system.

16. Comment from the floor, Dr. R. Reid (N.S.)

Members can be engaged by attending local political party riding events and meetings. Physicians who participate are soon asked to serve in some capacity, i.e., expert panel, and their opinions are sought. If most of us did this, there would be a significant impact.

17. Question received in advance, Dr. R. Hasel (Que.)

Why can't physicians be credited for helping to provide better health care at a lower cost, the famous bottom line? I have noticed that as a physician or as an administrator, anything that we do as a physician that is proven successful, is always attributed to "the administration," "board of directors" or "regional health authority," whereas anything that goes wrong is "the doctors' fault." Why is the contribution of physicians portrayed as being mostly negative, when the administrators have all the levers of "control"? Physicians rarely have the courage to congratulate other physicians on a job well done. Maybe we need to change, and start to recognize the selfless devotion of many great Canadian physicians to their patients, their colleagues, and the "the system".

Response provided by Dr. M. Golbey
CMA does try to recognize physicians who do great things. We do so provincially, CMA does nationally. Awards are given to amazing physicians. We acknowledge that we probably don't do enough…I suggest that it is human nature to reach out and find scapegoats.

18. Question from the floor, Dr. K. Hay (Alta.)

Many of us work with social determinants of health all the time. How do we avoid the maternalism or paternalism to tell people how to live their lives? How will CMA approach that?

Response provided by Dr. J. Haggie
It's about behaviour change. As a physician, all you can do is inform and educate. You can tell people what is best for their health, but ultimately the decisions are theirs. Most patients are quite happy with the idea of a partnership approach.

Response provided by Dr. J. Turnbull
Before we lecture our patients, we need to look at institutional barriers. We can advocate for a reduction of those barriers.

19. Question from the floor, Dr. R. Wexler (Ont.)

Can CMA play a role in developing specialty-specific EMRs?

Response provided by Dr. M. Golbey
EMR is a mine field. There are many different products out there - one is owned by CMAH, but it is not specialty-specific. It would be difficult for CMA to take on this endeavour. It is expensive and has been fraught with bad experiences. CMA could collate information about resources available, perhaps.

CMA Members' Forum 2012 - questions and responses