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PTMA Newsletter - Issue 5 2015

CMA Board – May Meeting Summary

Major Discussion Topics

  • Medical aid in dying
  • Immunization
  • Election campaign strategy – seniors care
  • Governance
  • Member engagement

Medical aid in dying

Draft guiding principles and a legislative framework approved for circulation.

Input from members and other stakeholders on key questions will be sought in advance of an in-depth discussion of the topic at General Council in August.

Immunization

Motions will be prepared for GC strongly supporting initiatives to encourage vaccination.

The CMA will develop a multiyear plan to address improving immunization rates in Canada.

Truth and Reconciliation Commission

The CMA Board of Directors unanimously endorsed the following resolution:

The Canadian Medical Association acknowledges the completion of the important work of the Truth and Reconciliation Commission of Canada and the importance of recognizing and not forgetting the terrible impact that the residential school system has had and, as a consequence of ongoing intergenerational trauma, continues to have on the health of many First Nations, Inuit and Metis People of Canada.

Member Engagement

Insights from the CMA Member Baseline Survey and the CMA member engagement strategy were presented as the basis for a discussion on the topic.

Face to face, online, polling and social media have all been identified as channels for engaging members.

Federal Levers

A discussion took place on what approach the CMA should take to lobbying the federal government for increased federal funding to support the provinces/territories.

The Board adopted a motion calling for implementation of a demographic top-up cash transfer from the federal to the provincial/territorial governments.

Election Strategy

An overview of the CMA campaign for the 2015 federal election was provided. The objectives of the campaign are:

  • make seniors’ care a ballot issue
  • secure a commitment by all party leaders to implement a seniors’ strategy by 2019

Governance

  • Presentation by Dr. Francine Lemire, Executive Director and CEO, College of Family Physicians of Canada (CFPC) on proposed governance changes at CFPC
  • A wide-ranging discussion took place on future governance of the CMA Board of Directors
  • The Governance committee will review options for maintaining the size of the Board and principles for the Board member selection process

2016 Membership Dues

  • General Council will be asked to maintain the CMA full membership dues for 2016 at $495

Emerging Issues

World Medical Association

  • Dr. André Bernard, the CMA representative to the WMA provided an update on the most recent WMA council meeting
  • Various issues which raise questions about CMA’s ongoing participation in the WMA were spelled out
  • The CMA will engage in consultation about CMA involvement in international work with recommendations to the Board meeting in October

MCC Qualifying Exam

  • The Board was made aware of concerns of the Resident Doctors of Canada (RDoC) about a capacity limit for the MCC Qualifying Exam Part II in the fall of 2015
  • About 800 residents are impacted especially those in family medicine
  • The CMA unanimously endorsed the RDoC position on capacity for the fall exam

Government relations in Quebec and Ontario

  • The joint initiatives of the CMA and QMA in speaking out on Bill 20 were applauded
  • The OMA request for a binding dispute resolution mechanism was noted

Palliative Care: CMA National Call to Action report

  • CMA Past President Dr. Louis Hugo Francescutti detailed the positive response to release of his review of best practices in palliative care across Canada

Privileging

A discussion was held about regulations governing the appointment and re-appointment privileges for physicians in certain jurisdictions.

An updated CMA principles documents will be prepared to support PTMAs in the current environment.

Modern workplace

An in-depth discussion of future workplace needs of CMA and NewCo took place.

Recommendations on next steps will be brought to the October Board meeting.

Core Committees

Reports from Board liaison members were presented.

Focus was on decision to eliminate committees in favour of new means to engage CMA members.

The Board participated in a generative discussion around new means to engage members.

Commitment made that valuable work of the committees will not be lost as new processes are put in place.

Committee on Archives and Awards

The CMA Award for Young Leaders will be expanded to recognize two recipients in each of the categories of Student, Resident and Early Career Physician.

Policies

Several new policies or updates were approved including:

  • Physician Resourcing Planning
  • Advanced Care planning
  • Harms Associated with Psychoactive Prescription Drugs
  • Complementary and Alternative Medicine
  • Guiding Principles for Recommending Mobile Health Applications to Patients
  • Advanced Reproductive Technology White Paper


Seniors Care Update

Don’t Leave Seniors Out in the Cold

The Canadian Medical Association and an Alliance of partner organizations are asking Canadians to add their voice to the call for a National Seniors Strategy. Demand a Plan is a website dedicated to building and engaging a community of supporters and the hub for all election activities related to seniors care.

Our goal is to gather 10,000 supports to carry our message forward by Election Day. To date over 6000 Canadians have added their voice to our call for action.

We need physicians to carry the message forward and make seniors care a ballot box issue during the next federal election. Please help us spread the word. http://www.demandaplan.ca/spread-the-word.

PODCAST – A Need for Strategy

Dr. Simpson, CMA President discusses the need for federal government involvement in a multi stakeholder effort to improve senior health care in Canada. As the cost of health care rises, Dr. Simpson calls for an inclusive approach that encompasses economic policy, social policy, tax policy as well as the health care system. Listen to the Zoomer Radio interview.

Roundtables in federal ridings

CMA is calling on MPs to hold roundtable meetings with their constituents on seniors care. CMA has supported the organization of, and participated in over 20 of these roundtables with MPs from all parties across the country, in both rural and urban settings.

A similar event was held in Campbellton, NB with a group of physicians, hosted by Dr. Dharm Singh, President of the Restigouche Medical Society with invited guests, NBMS President Dr. Camille Haddad and MP Minister Bernard Valcourt. Please contact Renee Belanger should you be interested in hosting a similar event in your area.

Please visit the Demand a Plan website for future event listings.



Results of the National Palliative Medicine Survey, 2014

More than half of physicians providing palliative care services in Canada have no formal training in the discipline (56%) and for the vast majority who provide these services (84%), it is not their primary field of practice, according to a recent study.

The Canadian Society of Palliative Care Physicians and the CMA in partnership with the College of Family Physicians of Canada, the Royal College of Physicians and Surgeons of Canada, and Technology Evaluation in the Elderly Network, released the results of their National Palliative Medicine Survey in May. The survey that sought to examine the types of physicians who deliver palliative care, the ways it is practiced, and the educational processes employed for these physicians, also revealed that for the majority (57%) of respondents, non-cancer patients made up 20% or less of their palliative care practices.

With an aging population and the increasing prevalence of patients with chronic diseases (including congestive heart failure, COPD, and severe dementia), there is growing recognition that palliative care services are required for patients beyond cancer patients. Canada needs to work towards an adequate palliative medicine workforce, while ensuring that minimum palliative medicine standards are met. Further survey results can be found at:



Choosing Wisely Canada

On June 2, 49 NEW Choosing Wisely Canada recommendations of tests, treatments or procedures commonly used that are not supported by evidence and/or could expose patients to unnecessary harm were released by 10 specialties including:

Emergency MedicineCanadian Association of Emergency Physicians
Hospital MedicineCanadian Society of Hospital Medicine
Nuclear MedicineCanadian Association of Nuclear Medicine
Paediatric SurgeryCanadian Association of Paediatric Surgeons
PsychiatryCanadian Academy of Child and Adolescent Psychiatry
Canadian Academy of Geriatric Psychiatry
Canadian Psychiatric Association
SpineCanadian Spine Society
Transfusion Medicine
*releasing 5 additional recs
Canadian Society for Transfusion Medicine
Vascular SurgeryCanadian Society for Vascular Surgery

 

Learn more and join the conversation on Twitter @ChooseWiselyCA and Facebook.



CMA adopts policy on advance care planning

Physicians should assist all their patients in developing advance care plans — and honour such plans unless there are reasonable grounds not to do so.

This is the main message for members of the Canadian Medical Association (CMA) contained in the association’s new policy on advance care planning, adopted at the recent meeting of the association’s board of directors. The policy is a substantive reworking of an existing policy dealing with resuscitation and other life-saving measures.

The policy restates themes that senior CMA officials have stressed during recent consultations with the public and members on end-of-life care. These start with the principle that all Canadians – and all physician members – should have an advance care plan.

“This policy is a critical component of the CMA’s overall approach to end-of-life care issues,” said President Chris Simpson.

“Survey results (which are) showing … while 95% of Canadians think having a clear conversation with a loved one about the type of care they want at the end of life is important – but only 30% have done so – show the need to raise awareness about this subject.”

Town hall meetings held across Canada by the CMA last year reflected almost unanimous agreement about the importance of advance care plans.

Also known as living wills or advance directives, advance care plans are potentially an appropriate topic in any encounter between a patient and his or her physician, the CMA policy states, adding such planning should be routine practice.

The policy notes that while patients often believe an advance care plan will be honoured in any circumstances, “the reality of medical practice makes this impossible.”

The document states that making an advance care plan too specific to a medical situation where the patient becomes incapable could make it unenforceable, whereas a plan that is too general may be too vague to give useful information to the presiding physician.

Other key principles included:

  • Advance care plans should be revisited if a person’s health status changes.
  • All advance care plans should identify a proxy decision-maker.
  • A duly executed advance care plan should be honoured unless there are reasonable grounds to suppose it no longer represents the wishes of the patient, or if the patient was coerced or lacked capacity when the plan was prepared.

The document touches on the issue of dementia by urging that advanced care planning for patients with dementia be developed as early as possible, while the patient can still express personal preferences.

The policy also contains various resolutions adopted by the association during its annual meetings over the past two years, including the need to integrate advance care plans into electronic medical records.



Upcoming physician leadership courses

Enhance your leadership skills in historic Halifax (pre-CMA General Council)

Managing People Effectively – August 21-22, 2015, Halifax, Nova Scotia

Conflict Management and Negotiation – August 21-22 2015, Halifax, Nova Scotia



CMA to take on “alternate universe of facts” hindering vaccination

The Canadian Medical Association is preparing to take a high-profile stance in support of strategies to improve immunization rates.

At its May meeting, the CMA Board of Directors endorsed several resolutions that will go to the association’s annual General Council meeting in August, including calling for proof that all children attending child care or school have received age-appropriate immunizations except where medically contraindicated.

The board also endorsed development of a multi-year business plan to address challenges to immunization, including outlining the physician role. Specific objectives and deliverables will be brought to the October 2015 board meeting.

“Physicians have a critical role to play in vaccination,” said CMA President Chris Simpson. “It’s an important issue to me because it’s difficult … to understand why a demographic is ignoring medical advice,” he said, commenting on the anti-vaccination movement and its reliance on “an alternate universe of facts”.

The CMA has a long-standing record backing immunization initiatives, based on support for the recommendations of the National Advisory Committee on Immunization (NACI). Since 2005, the association has provided resources to physician offices to encourage vaccination and is on record as supporting the development of a national immunization strategy.

Simpson notes that immunization in Canada is a complex issue and that, with few exceptions, the provinces consistently fall below national targets for vaccine coverage for six preventable diseases: invasive meningococcal disease, invasive pneumococcal disease, varicella, pertussis, influenza and rubella. Simpson said this is even true of the two – Ontario and New Brunswick – where childhood vaccination is mandatory.

As well as calling for mandatory proof of vaccination for children, the resolutions to be discussed in August deal with strategies focusing on parents who are vaccine-hesitant, encouraging the development of vaccine registries and promoting the critical role physicians have in immunization.

“While immunization is an area that impacts the practice of a majority of CMA members, both family practitioners and specialists, the medical community has not been very vocal in the current conversations,” the CMA background paper on the subject notes. “This is a vacuum that CMA could fill by playing a major role in bringing together the expertise to support its members, work(ing) to improve immunization rates and ultimately improve population health.”

The CMA is also working with the Canadian Federation of Medical Students to develop a resolution for General Council on standardization of medical school vaccination protocols across the country.



CMA voices support for residential schools commission

The work of the commission investigating the residential schools system in Canada – where thousands of aboriginal children were taken from their homes and died or suffered abuse – has been recognized by the Canadian Medical Association (CMA).

The Truth and Reconciliation Commission of Canada is scheduled to present its recommendations this week after five years of research.

In an extraordinary motion brought forward by Northwest Territories physician Dr. Ewan Affleck and supported by CMA President Chris Simpson, the CMA Board of Directors acknowledged completion of the work by the commission “and the importance of recognizing and not forgetting the terrible impact that the residential school system has had and, as a consequence of ongoing intergenerational trauma, continues to have, on the health of many First Nations, Inuit and Métis people of Canada.”

“Some will ask if this is the role of the CMA, and indeed it is” said British Columbia board member Dr. Nasir Jetha. Affleck said the legacy of the residential school system continues to have a huge impact in the North, with many individuals facing “massive health care issues” as a clear consequence of being residential school survivors.

He said he was presenting the resolution “in the spirit of truth and reconciliation.”

Quebec physician Dr. Laurent Marcoux was one of many board members who spoke in favour of the resolution, which passed unanimously.

After working with the Cree people for four years, Marcoux said it was clear to him that the residential schools are not just a bad memory; many people he saw “are living the impact.”

Simpson feels it is very important for national organizations such as the CMA to take a symbolic stand and recognize the work of the commission. He said the impact of the aboriginal schools had already been recognized internationally through a presentation by CMA former president Dr. Anna Reid at a recent London, UK, conference on the social determinants of health.

The CMA needs to give public support to the commission findings to aid in the healing process for Canada’s native peoples, Simpson and other board members affirmed.



Upcoming events in your province or territory

Date Event City Province Details
19-22-JunCAS 2015-Canadian Anesthesiologists’ Society Annual MeetingOttawaONMD/CMA Exhibiting
23 - JuneCare At The End Of Life: A Rapidly Evolving Canadian LandscapeOwen SoundONCMA Event
23-JunUBC PG Residents OrientationPrince GeorgeBCMD Seminar
23-JunPanel Discussion BarrhavenBarrhavenONMD Seminar
24 JunCare At The End Of Life: A Rapidly Evolving Canadian LandscapeSarniaONCMA Event
24-JunHow To Make The Perfect RibsVancouverBCClient Appreciation
24-JunGolf AfternoonVirdenMBClient Appreciation
25-JunU of T Resident OrientationTorontoONTrade Show
25-JunUBC Resident OrientationVancouverBCTrade Show
26-JunResident Orientation – U of CCalgaryABTrade Show
29-JunResident Orientation – U of AEdmontonABTrade Show
29-JunResident Orientation – DalhousieHalifaxNSTrade Show
30-JunCalgary Stampede BreakfastCalgaryABClient Appreciation
30-JunResident Orientation – NOSMSudbury/Thunder BayONTrade Show
2-JulResident Orientation – uOttawaOttawaONTrade Show
2-JulMcMaster Resident OrientationHamiltonONTrade Show
2-JulWestern Resident OrientationLondonONTrade Show
2-JulResident Orientation Queen’sKingstonONTrade Show
2-JulUniversity of Saskatchewan Resident OrientationSaskatoonSKTrade Show
8-JulIs Incorporation The Right Choice For Your Practice?TorontoONMD Seminar
11-JulPrivate Screening of Minions Trois-RivièresQCFamily Event
12-JulPrivate Screening of Minions SaskatoonSKFamily Event
20-JulOntario IMG Financial TalkTorontoONMD Seminar
20-JulOntario IMG CMA TalkTorontoONMD/CMA Seminar
21-JulNewfoundland Wine Tasting at 48 HighGrand Falls – WindsorNFLClient Appreciation
24-JulStudent Orientation –U of CCalgaryABTrade Show
31-JulResident OrientationLavalQCTrade Show
7-AugResident Orientation – SherbrookeSherbrookeQCTrade Show
14-AugUniversity of Saskatchewan Student OrientationSaskatoonSKTrade Show
20-AugLaval Golf TournamentLavalQCNetworking
24-AugStudent Orientation U of AEdmontonABTrade Show
23-26-AugCMA Annual General CouncilHalifaxNSMD/CMA Sponsoring and exhibiting
25-AugFondation de l’Hôpital Montfort – Charity Golf TournamentOttawaONMD
25-26-SeptAlberta Medical Association Annual General Meeting 2015EdmontonABMD/CMA Sponsoring & Exhibiting
24-26-SeptSaskatchewan College of Family PhysiciansReginaSKMD/CMA
25-27-SeptFederation of Medical Women of CanadaTorontoONMD/CMA Sponsoring & Exhibiting
25-27-SeptIce BowlSaskatoonSKMD/CMA Sponsoring & Exhibiting

For additional information please contact Natalie Theriault.