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PTMA Newsletter - Issue 1 2015

End of life: CMA positioned to take lead role in crafting new regulations

The Canadian Medical Association (CMA) is ready to play an integral role in the crafting of any new laws governing medical aid in dying, following the unanimous Supreme Court of Canada decision striking down the existing law prohibiting physician-assisted death.

In a news release following the ruling, CMA President Chris Simpson said any new legislation must “ensure patient needs are respected and the physician perspective is reflected.”

The court’s ruling is suspended for 12 months, meaning medical aid in dying remains illegal until that time. The Court deferred to Parliament and provincial legislatures to respond, should they so choose, with legislation that would respect the Charter rights of patients and providers.

The ruling dealt with the Carter case about whether the prohibition on assisted death in the Criminal Code of Canada was unconstitutional under the Canadian Charter of Rights and Freedoms. The Carter case began in 2011, when the BC Civil Liberties Association (BCCLA) joined Dr. William Shoichet, Gloria Taylor – who had an incurable, progressive disease – and the family of Kay Carter, who also had an incurable disease, to challenge the law against assisted dying.

In 2012, the B.C. Supreme Court ruled the Criminal Code of Canada provisions against assisted dying violated the rights of the gravely ill. The federal government appealed that decision, and the provincial Court of Appeal overturned the lower court ruling in October 2013 and upheld the ban, citing the 1993 precedent case of Sue Rodriguez. The Supreme Court granted the BCCLA, the Carter family and others permission to appeal the case.

In the wake of the CMA’s annual General Council meeting in August, the association’s long-standing policy against medical aid in dying was changed to support the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether or not to provide medical aid in dying.

A 2014 survey of 5,000 members showed 45 per cent favoured legalizing physician-assisted death, while 27 per cent said they would likely participate if the act is legalized.

In its news release, the CMA stated the association would conduct a detailed analysis of the ruling and its implications.

The Supreme Court set out some criteria that would define individuals who would be eligible for physician-assisted dying, noting that they must be competent adults who clearly consent and are suffering with a “grievous, irremediable medical condition” that is intolerable to the individual.

When the Supreme Court heard the case in October 2014, the CMA appeared as an intervener to provide insight into the diverse views of its membership and highlight practical considerations if the law was changed.

Simpson said the CMA has already been developing draft guidelines to deal with the practical considerations of medical aid in dying, and the association will now also examine ways to support doctors who choose to participate in assisted dying with education and training.

At the same time, Simpson stressed the CMA respects all members’ views on this sensitive topic and is equally supportive of those members whose choose not to offer medical aid in dying.

“A physician should not be compelled to participate in medical aid in dying should it become legalized,” the CMA policy states. “However, there should be no undue delay in the provision of end-of-life care, including medical aid in dying when it becomes legal.”

The Court noted a physician’s decision to participate in assisted dying is a matter of conscience and in some cases religious belief, and stated nothing its decision would compel physicians to provide assistance in dying. The Court stated what happens now is in “the hands of the physicians' colleges, Parliament and provincial legislatures.”

“The CMA is well positioned to continue to play a leadership role in the debate around end-of-life care in Canada,” said Simpson. He noted the extensive consultation process the CMA undertook in 2014 with a series of town hall meetings for both the public and its members to share their views on the issue.

Simpson also stressed that the CMA continues to advocate for quality care on other end-of-life issues, such as the need for access to proper palliative care services for all Canadians and the need for a national strategy in this area.



CMA alarmed by government measures

The CMA is concerned about recent actions by provincial governments in Quebec and Ontario to unilaterally impose measures restricting physicians’ ability to deliver optimal care.

“The new legislation proposed in Quebec and recent actions taken by the Ontario government represent an alarming trend of governments refusing to work together with medical associations to better manage the health care system,” said CMA President Chris Simpson.

In Quebec, legislation introduced last year – Bill 20 – proposes a sweeping series of restrictions on the province’s doctors, including requiring both family physicians and specialists to maintain a minimum caseload of patients and increasing the duties of attending specialists in hospitals. Another bill – Bill 10 – would give sweeping new powers to the health minister. Both bills are now before the provincial legislature.

Family doctors in Quebec would be required to meet specific targets in terms of number of patients seen or face cuts of up to 30% in the capitation fee they receive for each patient.

In Ontario, the provincial government has just imposed a series of measures to limit physician billings, after the Ontario Medical Association (OMA) rejected the most recent government offer in negotiations that have been ongoing since March 31, 2014.

The agreement offer rejected by the OMA included $580 million in fee cuts over two years. The OMA said the offer set an arbitrary baseline for the physician services budget that is more than $80 million below current levels, and funded growth of no more than 1.25% per year despite current growth of 2.7%. The OMA said the government planned to claw back payments to physicians if the budget ceiling was exceeded.

Following the OMA announcement, the provincial government announced that effective immediately it is cutting all fees to physicians by 2.65%.

In addition, the government said it is: eliminating funding for continuing medical education courses; reducing the fee for walk-in clinic visits; eliminating the premium for accepting new patients who are healthy; limiting the number of family doctors in well-serviced areas who can join family health teams.

“The actions in Quebec and Ontario represent a return to the bad old days when provincial governments used bludgeoning tactics against physicians to try to control their health care budgets,” said Simpson.

“The proposed Quebec legislation and measures in Ontario cannot help but have a negative impact on patient care, as well as alienating doctors who want to work to help deliver care more effectively.”

Simpson said the CMA would like to see the governments in Ontario and Quebec return to holding constructive talks with medical organizations about how they can partner to bring forward innovative and constructive solutions to meet the challenges facing health care delivery in all jurisdictions.



CMA names new CEO

Tim Smith – a longtime employee with the Canadian Medical Association and its subsidiaries – has been appointed the new CEO of the CMA.

Dr. Brian Brodie, chair of the CMA Board of Directors, made the announcement following a board meeting last Friday.

Smith has held the CEO position in an acting capacity since December 2013.

“Over the past year, Tim has demonstrated both the ability and capacity to lead the organization. Under his leadership the organization has seen a significant culture shift and a fresh and exciting approach towards delivering greater member value,” Brodie said in a release.

He noted that Smith has spent 25 years working with physicians across Canada, and for the past 17 years has led strategic and operational activities within the CMA and its subsidiaries.

While interim CEO, Smith oversaw an organizational restructuring that has included the creation of a new subsidiary comprising CMA Publications and other revenue-generating activities, a transformation of the CMA’s General Council meeting and the launch of a new corporate website. In the past year, the CMA has also adopted a new mission and vision statement and a three-year strategic plan.

Smith has said his priority is to strengthen the association by focusing on building more member value and attracting and retaining new members.

Smith has a Master of Business Administration and Bachelor of Arts (Economics) from the University of Ottawa, and a Certificate in Healthcare Administration from the University of Saskatchewan.



CEO of CMA’s newest subsidiary named

A veteran in running not-for-profit health organizations in Canada has been appointed as the Chief Executive Officer (CEO) of the CMA’s newest subsidiary.

The announcement of Lindee E. David as CEO of 872147 Canada Inc. (NewCo) was made by Dr. Brian Brodie, chair of the CMA Board of Directors.

“With extensive experience in the not-for-profit and corporate sectors and with a proven track record of achieving business results in an ever-evolving health care market, all of us at the CMA look forward to welcoming Ms. David,” said Dr. Brodie, in making the announcement.

David’s portfolio includes new product introduction, knowledge and clinical products formerly managed by the CMA including CMAJ and other CMA Publications and CMA’s Conjoint Accreditation Program.

David joins the CMA from Crohn’s and Colitis Canada where she served as CEO. Prior to joining Crohn’s and Colitis Canada, she held positions with, among others, the ALS Society of Canada, Janssen Ortho, a division of Johnson and Johnson, Canadian Blood Services and the Canadian Hemophilia Society. As executive director of the Canadian Hemophilia Society in the 1990s, David advocated on behalf of recipients of blood and blood products resulting in the largest-ever government settlement for those with infected with contaminated blood.

“These are exciting times and we are confident that under Ms. David’s leadership, our newest subsidiary will offer our members new benefits and greater value,” said Brodie.

Creation of the new subsidiary was approved unanimously by the CMA Board last summer to address a number of strategic opportunities and to accurately reflect the CMA’s value proposition of advocacy, knowledge and financial products and services.”

In her role as NewCo. CEO, David will work closely with Tim Smith, CEO of CMA and Brian Peters, CEO of MD Financial Management.



New clinical tool! ClinicalKey added to CMA Clinical resources portfolio

As a reminder, effective December 31st 2014, MD Consult was no longer available to members after it was discontinued by the publisher (Elsevier). MD Consult was one of CMA’s most valued online clinical tools providing access to leading medical textbooks and journals, guidelines, images, and a large collection of customizable patient handouts.

We are pleased to announce that we will add Elsevier’s ClinicalKey to our suite of clinical resources on cma.ca early in 2015. ClinicalKey includes electronic textbooks and journals, the Clinics of North America, First Consult and Procedures Consult. ClinicalKey offers more than 15,000 patient education handouts, customizable to each patient’s specific needs.

It is important to note that while there are some similarities, the two products include several very different features. More information, including a detailed Q&A, to follow when we launch.

If you or members have any questions regarding the sunset of MD Consult or the introduction of ClinicalKey, please contact a CMA Librarian.



RxTx Mobile App Update

The CMA is committed to meeting the evolving needs of our members and member-driven feedback helps us shape everything we do.

Effective 05 January 2015, the CMA has opened up access to the RxTx Mobile App, a valuable drug information tool, to all CMA members, including students, residents, practising and retired physicians. A series of segmented emails are planned for early in the new year to invite members to register. All members with a registered cma.ca account can also visit www.cma.ca/cpsapp to register for access to the app.

For additional information contact Renee de Gannes-Marshall.



New CMA Member Discount: Save on UpToDate®

CMA members save up to 50% on an UpToDate® subscriptions. While CMA continues to offer DynaMed point of care summaries as a benefit of membership, we now have another option for members’ point of care tool needs!

UpToDate® is the evidence-based, physician-authored resource physicians, residents, and medical students trust for reliable clinical answers. UpToDate® incorporates the latest medical findings, the best available evidence, and practical recommendations for patient care — so whatever your clinical question, you can be sure to find the answer in UpToDate®.

To access their CMA member discount, members only need to log in to the cma.ca UpToDate® access page and follow instructions.



Physician Leadership

Upcoming PMI physician leadership courses

Developing and Leading Systems Improvement – June 1-2, 2015, Halifax, NS

Leadership Strategies for Sustainable Physician Engagement – June 3-4, 2015, Halifax, NS

A full list of 2015 PMI open-enrolment courses is available here.

In-house PMI physician leadership courses

Bring customized physician leadership courses to a workplace, event, conference or annual meeting. Training can be offered to physicians alone or to interdisciplinary teams that include physicians, other providers, managers and administrators. Contact us at pmi@cma.ca or 800 663-7336 ext. 2932 for more information.

New! Online PMI physician leadership course Effective Communication Skills for Physician Leaders – Coming in April

Physicians will gain knowledge of concepts and key themes in effective communication to enrich their practice and will develop a greater understanding of their communication style and its impact on others. This six-week facilitated online course consists of online modules, videos, readings, discussion forums and self-assessment tools, and requires four to five hours of investment per week.

Contact onlineleadership@cma.ca to learn more.



Choosing Wisely Canada

CMAJ tests your knowledge

Interested in testing yourself on when specific tests, treatments or procedures may or may not be necessary? Wonder how your answer compares to your colleagues from across the country?

As part of their commitment to educate physicians about Choosing Wisely Canada, the Canadian Medical Association Journal (CMAJ) has formatted recommendations from the first wave of Choosing Wisely Canada into a true-false quiz series. Twelve quizzes will be featured on the CMAJ homepage over an 8-month period. Visit http://www.cmaj.ca/ to test your knowledge.

CWC goes mobile

We are pleased to announce the release of a Choosing Wisely Canada mobile app, available on Android and Apple platforms. The strength of this bilingual app is its searchability. All recommendations and patient pamphlets have been categorized by keywords for ease of use and efficiency. Visit the Google Play or Apple App Store to download the CWC app today.

Choosing Wisely in the literature

A number of important articles have been published on the topics of overuse in the health care system and the Choosing Wisely movement over the past few months. We are eager to share a number of citations that may be of interest to you.

  • Bhatia RS, Levinson W, Lee DS. Low value cardiac testing and Choosing Wisely. BMJ Qual Saf. 2014 Oct 10. [Epub ahead of print].
  • Colla CH, Morden NE, Sequist TD, Schpero WL, Rosenthal MB. Choosing Wisely: Prevalence and Correlates of Low-Value Health Care Services in the United States. J Gen Intern Med. 2014 Nov 6. [Epub ahead of print].
  • Fenton JJ, Franks P, Feldman MD, Jerant A, Henry SG, Paterniti DA, Kravitz RL. Impact of Patient Requests on Provider-Perceived Visit Difficulty in Primary Care. J Gen Intern Med. 2014 Nov 6. [Epub ahead of print].
  • Harvey EJ. Choosing wisely (and carefully) Canada. Can J Surg. 2014 Jun;57(3):149, 151.
  • Hudzik B, Hudzik M, Polonski L. Choosing wisely: Avoiding too much medicine. Can Fam Physician. 2014 Oct;60(10):873-6.
  • Levinson W, Kallewaard M, Bhatia RS, Wolfson D, Shortt S, Kerr EA; On behalf of the Choosing Wisely International Working Group. ‘Choosing Wisely’: a growing international campaign. BMJ Qual Saf. 2014 Dec 31. [Epub ahead of print].
  • Siemens DR, Finelli A. Choosing Wisely Canada: It’s our turn. Can Urol Assoc J. 2014 Jul;8 (7-8): E580-1.
  • Wolfson D, Santa J, Slass L. Engaging physicians and consumers in conversations about treatment overuse and waste: a short history of the choosing wisely campaign. Acad Med. 2014 Jul;89(7): 990-5.


Health Information Technology and eHealth at CMA

The CMA is developing guiding principles for physicians for the optimal use of “big data” analytics services. These will include considerations when responding to requests for access to the clinical data in one’s EMR.

For more information, contact Conrad Amenta, Senior Advisor, Health Information Policy and e-Health.



Upcoming events in your province or territory

Date Event City Province Details
20-FebAcademy of Medicine – Ottawa 8th Annual Clinical DayOttawaONMD/CMA Exhibiting
23-FebU of T Writes Barris Academy TalkTorontoONMD Seminar
26-FebU of T Specialist PMCTorontoONMD Seminar
27-FebWestern Opthomology TalkLondonONMD Seminar
27-FebWhitehorse Physician AppreciationWhitehorseYTMD Event
26-28- FebAlberta College of Family PhysiciansBanffABMD/CMA Exhibiting
28-FebThe Black Physicians Association of Ontario – Black Health Symposium 2015TorontoONMD/CMA Exhibiting
3-MarU of T PARO Tax TalkTorontoONMD Seminar
3-MarFiscalite des placements : particuliers et societeQuebecQCMD Event
4-MarU of A CaRMS Match DayEdmontonABSponsorship
4-MarU of C CaRMS Match DayCalgaryABSponsorship
4-MarUBC CaRMS Match DayVancouverBCSponsorship
4-MarUBC Spring PMCVancouverBCMD Seminar
4-MaruOttawa CaRMS Match DayOttawaONSponsorship
4-MarQueen’s CaRMS Match DayKingstonONSponsorship
4-MarU of T Family Medicine Core dayTorontoONMD Seminar and Exhibiting
10-MarSaskatoon Transition to ResidencySaskatoonSKMD Seminar
10-MarSeminar for Female Physicians Kitchener(1)KitchenerONMD Seminar
11-MarRetirement Readiness SeminarNiagara FallsONMD/OMA Seminar
11-MarSeminar Series for Female Physicians (2)WindsorONMD Seminar
12-MarRetirement Readiness SeminarTorontoONMD/OMA Seminar
14-MarU of A Internal Med Retreat 2015CanmoreABMD Seminar
15-MarU of T Neurology Financial TalkTorontoONMD Seminar
18-MarSeminar Series for Female Physicians (2)LondonONMD Seminar
19-MarUBC Chilliwack Resident SeminarChilliwackBCMD Seminar
19-22-MarAlberta Psychiatric Association: Scientific Conference and Annual General MeetingBanffABMD/CMA Exhibiting
22-MarMed Ed Seminar QCQuebecQCMD Seminar
22-MarOshawa GeneralsOshawaONMD Family Event
26-MarClient Appreciation Wine and CheesePrince GeorgeBCMD Networking Event
27-MarU of A Family Med Retreat – FreZer 2015JasperABMD Exhibiting
31-MarTransition to Residency - uOttawaOttawaONMD Seminar
31-MarTransition to Residency-uOttawa (FR)OttawaONMD Seminar
2-AprSeminar for Female Physicians Kitchener (2)KitchenerONMD Seminar
9-11-AprDocs on Ice London 2015LondonONMD/CMA Exhibiting
9-11-AprSociety of Rural Physicians of Canada-23rd Annual Rural and Remote Medicine CourseMontrealQCMD/CMA Exhibiting
12-AprSeminar Series for Female Physicians (3)LondonONMD Seminar
15-AprTransition to Residency – NOSM EastSudburyONMD Seminar
16-17-AprJournées Montfort 2015OttawaONMD/CMA Exhibiting
16-18-AprThe Manitoba College of Family Physicians: 57th Annual Scientific AssemblyWinnipegMBMD/CMA Exhibiting
21-AprTransition to Residency – NOSM WestThunder-BayONMD Seminar
23-AprCanadian Medical Hall of Fame – 2015 Induction CeremonyWinnipegMBMD/CMA Sponsorship
24-25-Apr2015 Canadian Conference on Physician LeadershipVancouverBCMD/CMA Exhibiting
25-28 AprCanadian Conference on Medical EducationVancouverBCMD/CMA Exhibiting
30-Apr-3-MayOntario Medical Association Annual General Meeting 2015TorontoONMD/CMA Exhibiting
2-MayAvengers: Age of UltronSt. CatharinesONMD Family Event
2-MayAvengers: Age of UltronHamiltonONMD Family Event
2-MayAvengers: Age of UltronMississaugaONMD Family Event
3-MayAvengers: Age of UltronTorontoONMD Family Event
7-MaySeminar for Female Physicians Kitchener (3)KitchenerONMD Event
6-9-MayPrimary Care TodayTorontoONMD/CMA Exhibiting
23-24-MayBritish Columbia College of Family PhysiciansVancouverBCMD/CMA Exhibiting
29-MayOntario Medical Student Bursary Fund – Golf TournamentMarkhamONMD Sponsorship
30-MayNew Brunswick Medical Society Foundation-Celebration of Medicine 2015St. Andrew’sNBMD/CMA Exhibiting

For additional information please contact Geneva Forestell.