Ontario Physicians Supporting Patient Self-Care

Transcription

March 2016
Volume 83 Number 3
www.oma.org
OMA BACKGROUND PAPER
Ontario Physicians Supporting
PM41144507
Patient Self-Care
OMA Annual General Meeting
Health Policy Report
Featured events, Section program listing,
registration and travel information
Updates on primary health care reform, Zika virus,
registered nurse prescribing
New OMA Billing Guide
Commentary
OHIP Payments for Case Conference Services
Optimism in health care leadership
Sport Med 2016
Exercise Is Medicine Canada
Sport-related concussion, safety in play,
back pain, CrossFit injuries
Engaging patients in physical activity dialogue,
practical tools for physicians
Dedicated to Doctors. Committed to Patients.
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W W W. K L I N I X . C O M
Executive, Board, Council,
Committee Chairs
Executive Committee
Board of Directors
President
District
Dr. M. Toth, Aylmer
1
Dr. A. Ng, Windsor
Dr. C. Jyu, Scarborough
President Elect
2
Dr. T. Jevremovic, London
Dr. C. Pinto, Toronto
Dr. V. Walley, Toronto
Dr. M. Toth, Aylmer
11 Dr. S. Chris, North York
Dr. L. Colman, Etobicoke
Dr. R. Forman, Toronto
Elected by Council
Past President
3
Dr. C. Cressey, Palmerston
Dr. K. Cherla, Georgetown
Dr. V. Tandan, Hamilton
4
Dr. V. Tandan, Hamilton
Dr. R. Mann, Peterborough
Dr. R. Tytus, Hamilton
Dr. J. Stewart, North Bay
Dr. L. Barron, Limehouse
Dr. V. Walley, Toronto
Dr. S. Whatley, Mount Albert
Dr. H. Yamashiro, Richmond Hill
Chair of the Board
Dr. S. Chris, North York
5
Honorary Treasurer
Dr. G. Beck, Ottawa
6
Dr. G. Athaide, Whitby
Secretary
7
Dr. A. Steacie, Brockville
Dr. J. Stewart, North Bay
8
Dr. G. Beck, Ottawa
Dr. A. Kapur, Ottawa
Academic Representative
Dr. J.R. Swenson, Ottawa
Council
Chair
9
Dr. P. Bonin, Sudbury
10 Dr. J. Johnsen, Thunder Bay
Dr. A. Hudak, Orillia
Vice-Chair
Dr. S. Acharya, Nepean
Committee Chairs
Agreement
(OMA-Ministry of Health and
Long-Term Care)
Agreement Board Co-ordinating
Committee
Dr. V. Tandan
Forms Committee
Dr. C. Pinto
Joint Committee on the Schedule
of Benefits
Dr. J. Harvey, Co-Chair
Medical Audit Oversight Committee
Dr. D. Hellyer
Physician Services Committee
Dr. V. Tandan, Pro Tempore
Uninsured Services Committee
Dr. J. Weisbloom
Workplace Safety & Insurance Board
Knowledge Transfer and Education
Subcommittee
Dr. C. Cressey, Interim Chair
Workplace Safety & Insurance Board
Steering Committee
Dr. J. Tracey, Interim Chair
Governance
Health Policy
Board Governance Committee
Dr. G. Beck
Health Policy Committee
Dr. S. Whatley
Audit Committee
Dr. A. Abdulla
eHealth Working Group
Dr. S. Chris
Awards Committee
Dr. S. Kennedy
Hospital Issues Committee
Dr. A. Steacie
Board Insurance Committee
Dr. C. Cressey
Member Services
Board Planning Committee
Dr. L. Colman
Member Services Board Committee
Dr. R. Tytus
Budget Committee
Dr. G. Beck
Physician Health Program Advisory Panel
Dr. M. Judson
Committee on Committees
Dr. S. Acharya
Public & Political Advocacy
Council Committee on Structure & Bylaws
Dr. D. Weir
Nominations Committee
Dr. V. Tandan
Staffing Committee
Dr. A. Ng
Communications Advisory Committee
Dr. M. Toth
Outreach to Women Physicians Committee
Dr. C. Cannon
You always get better
results on your own.
Except when being part of a group is actually, well, better.
Because OMA Insurance represents more than half of Ontario
doctors, we have the group buying power to offer our clients some of
the most competitive rates on the market. And because we’re strictly not
for profit, our non-commissioned advisors can advocate solely on your
behalf, making sure you get just the coverage you need, when you need it,
at every stage of your life and career. Let’s hear it for teamwork.
For insurance solutions designed to meet
doctors’ needs, call 1.800.758.1641 or visit
OMAinsurance.com /omr
Not for profit. All for doctors.
March 2016
Volume 83 Number 3
www.oma.org
FEATURES
March 2016
Volume 83 Number 3
www.oma.org
7 Editorial: Advocating for our patients
OMA BACKGROUND PAPER
Patient Self-Care
Health Policy Report
Featured events, Section program listing,
registration and travel information
Updates on primary health care reform, Zika virus,
registered nurse prescribing
New OMA Billing Guide
Commentary
OHIP Payments for Case Conference Services
Optimism in health care leadership
Sport Med 2016
Sport-related concussion, safety in play,
back pain, CrossFit injuries
Engaging patients in physical activity dialogue,
practical tools for physicians
PM41144507
OMA Annual General Meeting
A new OMA health policy paper highlights the advantages of supported
decision-making in which patients and physicians work together to identify
health issues, set goals, and develop solutions. “Ontario Physicians Supporting
Patient Self-Care” reinforces the physician-patient relationship as the foundation
of medical practice, and emphasizes the vital role that doctors play in educating
and facilitating our patients’ active participation in their own care. This paper
marks the second important policy document released as part of the OMA’s
ongoing Check-Up Ontario initiative.
9 OMA Annual Meeting: calendar of events, registration
and travel information, Section program listing
15 Physicians Supporting
Patient Self-Care: OMA
Background Paper
Physicians play an important
role in educating and facilitating
patients’ active participation in
their own care. Patients share
valuable information with physicians in terms of what motivates
them, and the treatments they
think may be most effective for
them. A new OMA background
paper discusses the meaning
of patient self-care, the benefits
attributed to self-care, communication strategies for discussing this topic with patients, and
factors that promote patient selfcare. While the concept of patient
self-care is not new, the ideas
put forth in the OMA paper are
intended to reinforce its importance as Ontario’s health care
system confronts the increasing
demands of a growing chronically
ill patient population.
The 136th OMA Annual General and Council Meeting will be held April 28
to May 1 in Niagara Falls. Featured events include the Annual Awards
Ceremony and Presidential Installation, Adam Linton Memorial Lecture,
17th Annual Women’s Health Care Seminar, Health Care Advocate
Workshop, and seminars on Retirement Planning/Life After Medicine, and
End of Life Planning and Care. Information on registration and travel arrangements, as well as a listing of OMA Section meetings, is provided.
24 Optimism in health care leadership: finding water
in the desert
Dr. Darren Larsen, Chief Medical Information Officer for OntarioMD, explores
the value of optimism in medicine and in health care leadership, drawing on
various sources to affirm that optimism is one of the most important traits of
a good leader. Dr. Larsen states: “An optimistic approach to leadership does
not neglect the real need for critical analysis. True optimists are not blind to
the risks and challenges they face every day. They tend to acknowledge pain
points and think through how they can be addressed quickly yet effectively.
This allows them to look forward to the next goal and the new trials that
come with it.”
26 Sport Med 2016 highlights; office poster on
sport-related concussions for physicians
The 2016 Sport Med Symposium featured lectures, workshops and plenary
sessions on the assessment, prevention and management of sport and exercise injuries. Topics covered included sport-related concussion, back pain
diagnosis, safety in play, CrossFit injury treatment, and injection techniques.
The OMA Section on Sport and Exercise Medicine has produced an office
poster on sport-related concussions, which appears on page 29.
Publications Mail
Agreement # 41144507
Undeliverables, please return to:
Ontario Medical Review
150 Bloor St. West, Suite 900
Toronto, Ontario M5S 3C1
ONTARIO MEDICAL REVIEW
3
March 2016
Taking the lead
on physician
assisted dying
CMA has created principles-based recommendations on
physician assisted dying to respect and protect patients
and physicians, while preserving dignity on all sides.
CMA. Action that matters.
Get involved and make an impact.
cma.ca/action | #CMAaction #eolCare
March 2016
Volume 83 Number 3
www.oma.org
Editor
Jeff Henry
Managing Editor
Elizabeth Petruccelli
FEATURES
30 Exercise is Medicine Canada: helping physicians
engage patients in physical activity dialogue
Exercise is Medicine Canada (EIMC) is a program that provides useful tools,
training, information and support to help physicians make routine physical
activity assessment and exercise prescription a standard part of disease
prevention and treatment for all patients. EIMC also hosts regular CME
workshops across the country to educate health providers on how to assess
current physical activity and talk to patients about increasing physical activity
to improve health.
Associate Editor
Mark Evans
Advertising/Circulation Co-ordinator
Kim Secord
Production Co-ordinator
Angelica Santacroce
34 OHIP Payments for Case Conference Services:
OMA Quick Reference Guide
A new reference guide provides a general overview on the payment rules
for billing OHIP case conference services. Recently updated by the OMA
Economics, Research and Analytics Department, the guide covers the
following four areas: case conference definition, payment requirements,
eligible participants and patients, and multidisciplinary cancer conferences.
Classifieds Co-ordinator
Vita Ferrante
Art Direction
Artful Dodger Communications Inc.
Publisher’s Notes
Published 11 times yearly by the
Ontario Medical Association
150 Bloor St. West
Suite 900
Toronto, Ontario
M5S 3C1
Tel. 416.599.2580 or
Toll-free: 1.800.268.7215
Fax: 416.340.2232
Email: [email protected]
OMA website: www.oma.org
ISSN 0030 302X
Any opinions expressed in articles and
claims made in advertisements are
the opinions of the authors/advertisers
and do not imply endorsement by the
Ontario Medical Association.
The Ontario Medical Review welcomes
readers’ views. Letters to the editor
should be addressed to Ontario Medical
Review, 150 Bloor St. West, Suite
900, Toronto, Ontario M5S 3C1; fax
416.340.2232; email: jeff.henry@oma.
org. Note: letters may be edited for
space and clarity. Please include name,
address and daytime phone number.
(Additional “Publisher’s Notes” appear
on page 55)
CAPSULE NEWS/EVENTS
8
Ontario Medical Student Bursary Fund 12th Annual Golf Tournament
to be held May 27 at Angus Glen Golf Club
13 OMA 17th Annual Women’s Health Care Seminar to be held April 28,
Sheraton on the Falls, Niagara Falls
22 Check-Up Ontario: update on OMA initiative to strengthen care for
patients with chronic disease
DEPARTMENTS
1
OMA Executive, Board, Council, Committee Chairs
6
OMA Constituency Groups: Sections, Forums, Medical Interest Groups
42 Health Policy Report
44 In Memoriam
46 Classifieds
56 Medectoon/Advertisers’ Index
5
March 2016
Constituency Groups
SECTIONS
Medical Students
Mr. A. Damji, Ms. M. Stroz
FORUMS
Addiction Medicine Dr. R. Cooper
Nephrology Dr. C. Rabbat
Academic Medicine Forum
Dr. R. Swenson, Chair
Allergy and Clinical Immunology
Dr. B. Wong
Neurology Vacant
Neuroradiology Dr. S. Symons
Rural Medicine Forum
Dr. S. Cooper, Chair
Cardiac Surgery Dr. C. Peniston
Neurosurgery Vacant
Cardiology Dr. J. Swan
Nuclear Medicine Dr. C. Marriott
Chronic Pain Dr. C. Giorshev
Critical Care Medicine Dr. M. Warner
Dermatology Dr. S. Gupta
Obstetrics and Gynecology
Dr. B. Mundle
Occupational and Environmental
Medicine Dr. P. Jugnundan
Diagnostic Imaging Dr. D. Jacobs
Emergency Medicine Dr. M. Haluk
Ontario’s Anesthesiologists
Dr. P. Tenenbein
Endocrinology and Metabolism
Dr. J. Shaban
Orthopedic Surgery Dr. S. Papp
Eye Physicians and Surgeons of Ontario
Dr. K. McReelis
Otolaryngology - Head and Neck Surgery
Dr. D. Hacker
Palliative Medicine Dr. D. Cargill
Clinic Endoscopists
Dr. A. Bellini
Clinical Hypnosis
Dr. M. Qaadri
College and University Student Health
Dr. D. Lowe
Community Health Centres (CHC) and
Aboriginal Health Access Centres (AHAC)
Dr. I. Tamari
Pediatrics Dr. S. Kao
Complementary and Integrative Medicine
Dr. S. Herr
Physical Medicine and Rehabilitation
Dr. D. Berbrayer
Hyperbaric Medicine
Dr. W. Evans
Plastic Surgery Dr. S. Krajden
Ontario Psychiatric Hospitals
Dr. S. Allain
Gastroenterology Dr. I. Murray
General and Family Practice
Dr. L. Donohue
MEDICAL INTEREST GROUPS
General Internal Medicine Dr. C. Shaver
General Surgery Dr. J. Kolbasnik
Primary Care Mental Health Dr. M. Paré
General Thoracic Surgery Dr. M. Blitz
Psychiatry Dr. A. Freeland
Genetics Dr. C. Li
Public Health Physicians Dr. H. Shapiro
Geriatric Medicine Dr. A. Baker
Radiation Oncology Dr. R. Dinniwell
Hematology and Medical Oncology
Dr. T. Asmis
Reproductive Biology Dr. Ari Baratz
Hospitalist Medicine Dr. W. Coke
Respiratory Disease Dr. H. Ramsdale
Infectious Diseases Dr. N. Rau
Rheumatology Dr. P. Baer
Interns and Residents Dr. N. Snelgrove
Sport and Exercise Medicine Dr. A. Moldes
Laboratory Medicine Dr. N. MacNeill
Urology Dr. J. Kell
Long Term Care & Care of the Elderly
Dr. A. Moser
Vascular Surgery Dr. A. Hill
6
Sleep Medicine
Dr. A. Soicher
Surgical Assistants
Dr. D. Esser
March 2016
EDITORIAL
Advocating for our patients
new OMA health policy paper highlights the advantages of supported decision-
A
making in which patients and physicians work together to identify health issues, set
goals, and develop solutions.
“Ontario Physicians Supporting Patient
Self-Care,” which appears on pages
15-23, reinforces the physician-patient
relationship as the foundation of medical practice, and emphasizes the vital
role that doctors play in educating and
facilitating our patients’ active participation in their own care.
The paper duly notes: “Without
patient self-care, Ontario’s current
health care system will likely be under
significant pressure to perform, and
may simply not be able to manage
patients’ multiple needs over a sustained period of time. Many researchers
argue that without self-care, health systems around the world will collapse due
to the rising number of elderly patients
and others who will experience incidents of chronic illness, often with comorbid or multiple morbidities.”
This paper marks the second important policy document released as part of
the OMA’s ongoing Check-Up Ontario
initiative. Last month, the OMR featured
Ontario physicians’ recommendations
to ensure that patients with dementia
and their informal caregivers receive
the care and support they need, including our call for a provincial dementia
strategy. The dementia paper was well
received among colleagues, and generated a lot of positive response from the
public, media and other health organizations.
Check-Up Ontario is a multifaceted
undertaking that aims to bring together
evidence, clinical expertise and the lived
experience of patients and caregivers.
We’ve initiated a public consultation
tour to identify key chronic care challenges affecting Ontario’s aging population, and to help devise and implement
innovative, patient-focused solutions to
tackle chronic health issues.
Since January, the OMA has visited
six communities across the province
and met with more than 75 local health
experts, several media outlets and government representatives. The knowledge we gain through these meetings
will be combined with the results of an
academic literature review, a citizen
panel and expert round-table in partnership with McMaster Health Forum,
as well as an OMA member survey.
The experience to date has been very
rewarding, and I look forward to the
findings and recommendations coming forward from our Check-Up Ontario
initiative.
The OMA is active on several fronts
addressing the future of primary health
care reform in Ontario. The Board
of Directors recently established an
advisory group to identify and provide
input on issues related to the Ontario’s
government’s proposed changes to
the primary health care system. Our
response to government’s discussion
paper is now posted on the OMA members’ home page, along with extensive
physician-specific resources regarding
primary health reform. Further details
are provided in the Health Policy Report
(see pp. 42-43).
The OMA’s commitment to patient
advocacy and advancing collaborative
solutions to protect and sustain our
health care system is evident in all fac7
ets of our ongoing “Put Ontario Patients
First” campaign. Members currently
receive weekly email updates that provide news and information about campaign developments and milestones.
The OMA recently extended our
advertising reach throughout the province, including television, radio, outdoor billboards, transit shelters around
Queen’s Park, and Facebook. Initial
research findings show that our ads are
resonating strongly with our target audience. The key messages hitting home
include:
• There are cutbacks to funding of
doctors and/or funding of the healthcare system;
• There is concern that cuts will affect
the quality of health care Ontarians
will receive;
• The cuts need to be stopped;
• Doctors will be less accessible; and,
• Doctors may leave Ontario or retire
early.
More than 27,000 Ontarians have
joined our online coalition, and more
than 54,000 patients have signed the
OMA petition. The OMA is being recognized in the legislature on a frequent
basis as the petitions are read into the
public record by opposition MPPs.
Thank you for making the petition a real
success!
We will continue to provide regular
updates to members. On behalf of my
colleagues on the OMA Board, I want to
thank all members for your continuing
support and participation.
Dr. Mike Toth
OMA President
March 2016
AMENT
N
R
U
O
T
FRIDAY
MAY
27
7:45AM SHOTGUN
ANGUS GLEN GOLF CLUB
MARKHAM, ONTARIO
$500 per ticket / $2,000 per foursome
Includes:
18 holes of golf with cart
Breakfast & lunch
Golf contests with great prizes
And more!
Register today at
www.omsbf.org/golf
2016 Key Sponsors*:
PRESENTING
GOLD
SILVER
Contact [email protected] for more information!
* Sponsors confirmed as of March 1, 2016
OMA AGM Calendar of Events
136th OMA Annual General and Council Meeting
Thursday, April 28 – Sunday, May 1, 2016
Sheraton on the Falls Hotel, Niagara Falls, Ontario
Pre-registration for all meetings is required. You may register online at www.oma.org/AGM
SUMMARY OF EVENTS
Thursday, April 28
Friday, April 29
Saturday, April 30
Sunday, May 1
0730 – 1700
Annual Meeting and
Council Registration
(see page 11 for details)
0730 – 1700
Annual Meeting and
0730 – 1700
0730 – 1200
0830 – 1630
17th Annual Women’s
Health Care Seminar
(see ad on page 13
for details)
Morning and Evening
Section Annual Meetings,
Seminars and Workshops
0900 – 1700
Annual Meeting of
Council
0900 – 1700
Annual Meeting of
Council
1230 – 1330
Council Luncheon
1230 – 1330
Council Luncheon
Throughout the Day
and Evening
Seminars, Workshops
and Forums to be held
April 28-29
(see pages 10-11 for
details)
1200 – 1400
Adam Linton Memorial
Feature Luncheon
(see pages 10-11 for
details)
1830 – 2400
Awards Ceremony,
Presidential Installation,
Gala Dinner/Dance
1400 – 1700
Council Policy Session
9
March 2016
FEATURED EVENTS
THURSDAY, APRIL 28
FRIDAY, APRIL 29
HEALTH CARE ADVOCATE WORKSHOP
(0930 – 1830)
END OF LIFE PLANNING AND CARE SEMINAR
(0800 – 1200)
0930-1600: Workshop
1600-1830: Health Care Advocate Reception
The OMA session on End of Life Planning and Care will present information to enhance your ability to offer optimal care
to your patients. The session will provide:
1. An overview of local resources and supports in End of
Life Planning and Care (EOLPC) in your area (Hamilton
Niagara Haldimand Brant LHIN)
2. Resources on Advance Care Planning (ACP)
• Terminology, tools, additional resources and billing
information
3. Resources on Palliative Care (PC)
• Terminology, tools, additional resources and billing
information
This program has been reviewed by the College of Family
Physicians of Canada and is awaiting final accreditation by the
College’s Ontario Chapter for up to 2.5 Mainpro-M1 credits.
Following the success of the Health Care Advocate
Workshop held during the fall 2015 Council Meeting, the
OMA will be hosting another training session at the upcoming Council Meeting. Those who attended the fall session, as
well as newcomers, are welcome. The workshop expands
on the key learnings from the fall session, and will include:
• How to network effectively at events
• Further develop your elevator speech
• How to deliver new key messages to the media
• Post-workshop reception with advocates and local stakeholders from the Niagara Region
For more information, please contact Amber Anderson, OMA
Public Affairs Department, at [email protected].
Breakfast will be available prior to the start of this seminar.
Lunch is available for those who also register for the Adam
Linton Memorial Feature Luncheon.
RETIREMENT PLANNING AND LIFE AFTER
MEDICINE SEMINAR
(1500 – 2015)
For more information or to register, please contact
1.800.268.7215, ext. 2850, or practicemanagement@oma.
org. You may also visit register online at www.oma.org/
Member/Resources/Documents/PMASReg.html.
Topics and speakers include:
• Winding Down Your Practice (Dr. Tom Faloon)
• Succession Planning for Physicians (HealthForceOntario)
• Insuring Your Retirement (OMA Insurance)
• Financial Planning (MD Financial Management)
• Lifestyle Planning for Retirement — How to Replace
Satisfactions Lost From Work (Alan Roadburg, PhD)
SPRING 2016 RURAL CAUCUS MEETING
(0900 – 1200)
(Note: date and time change)
The spring 2016 Rural Caucus Meeting is open to Council
Delegates who are already registered to attend OMA Council.
The meeting will provide an update on topics discussed at the
fall 2015 Rural Caucus meeting, and will focus on two timely
topics of importance to rural physicians.
A dinner break will be held from approximately 1745-1830.
For more information or to register, please contact
1.800.268.7215, ext. 2850, or practicemanagement@oma.
org. You may also register online at www.oma.org/Member/
Resources/Documents/PMASReg.html.
To register for the 2016 Rural Caucus Meeting, please
contact [email protected]. Pre-registration is
required for this meeting.
ACADEMIC MEDICINE FORUM (AMF)
MEMBERS MEETING (1800 – 2130)
1800-1900: Meet and Greet (light refreshments available)
1900-2130: AMF Members Meeting
ADAM LINTON MEMORIAL FEATURE LUNCHEON
(1200 – 1400)
AMF members are invited to attend a networking meeting
that will focus on Social Media and Managing your Digital
Reputation, featuring Lee Godfrey of internet : intelligence inc.
Expand your knowledge of the digital world and learn the latest trends in social media — and remember that even if you
aren’t active online, your reputation might be!
The 24th annual Adam Linton Memorial Feature Luncheon
and lecture will be presented on Friday, April 29, from 12001400, as part of the Annual General Meeting. The lecture
honours the memory and accomplishments of Dr. Adam
Linton, OMA President from June 1991 to January 1992. Dr.
Linton was a nationally renowned educator who spent much
of his time working to improve Ontario’s health care system.
10
March 2016
FEATURED EVENTS
This year’s speaker is Ken Hughes. Mr. Hughes is the founding Chair of Alberta Health Services, where he oversaw the
merger of 12 health delivery regions into a single entity. He
has spoken extensively about health system innovation. His
transformation experience is timely considering proposed
changes in Ontario.
To p re - re g i s t e r, p l e a s e c o n t a c t J e n n i f e r C s a m e r,
OMA Strategy and Governance, at 416.599.2580 or
1.800.268.7215, ext. 3461, or email jennifer.csamer@oma.
org, by April 18.
There is no charge for this event, thanks to a generous contribution from the Canadian Medical Association and its subsidiary, MD Financial Management. Pre-registration is required.
Please visit www.oma.org/AGM.
AWARDS CEREMONY, PRESIDENTIAL
INSTALLATION, GALA DINNER/DANCE
(1830 – 2400)
SATURDAY, APRIL 30
This event will take place at the Scotiabank Convention Centre
(6815 Stanley Ave., Niagara Falls). OMA members are invited
to join in celebrating the many contributions and accomplishments of our medical colleagues. The evening commences
at 1830 with the Annual Awards Ceremony and Presidential
Installation. A brief reception will follow at approximately 1930,
and dinner will be held at approximately 2000. A dance will
take place after dinner.
OMA COUNCIL POLICY SESSION AND ANNUAL
GENERAL MEETING OF COUNCIL (1400 – 1700)
The OMA is holding a Council Policy Session that will bring
Council members together to focus upon a single emerging
policy issue. This year’s topic will be Creating and Sustaining
a High-Performing Health System in Ontario.
ORIENTATION SESSION FOR NEW COUNCIL
DELEGATES (1730 – 1830)
The gala is presented, in part, by a generous contribution
from the Canadian Medical Association and its subsidiary, MD
Financial Management.
The Chair and Vice-Chair of Council will be holding an Orientation Session for new and returning Council Delegates. This
brief informational session will focus on your role as Council
Delegates and how to get your voice heard at Council. You are
encouraged to sign up for the session being held on Friday,
April 29, from 1730-1830, at the Sheraton on the Falls Hotel.
For tickets, please contact Jennifer Csamer, OMA Strategy
and Governance, at 416.599.2580 or 1.800.268.7215, ext.
3461, or email [email protected].
GENERAL INFORMATION
Manager, Corporate Traveller, at 905.901.0292, or email
[email protected].
• If you prefer to book your own travel, all information regarding
the discount codes for Porter Airlines, VIA Rail and Park’N
Fly, can be found online at www.oma.org/Advantages, call
1.800.268.7215, or email [email protected].
REGISTRATION
To register online for all meetings, including Council,
please visit www.oma.org/AGM. You may also register
for Council by contacting Jennifer Csamer, OMA Strategy
and Governance, at 416.599.2580 or 1.800.268.7215,
ext. 3461, or email [email protected]. If you have
any special dietary requirements, please contact Jennifer
Csamer at 416.599.2580, ext. 3461, no later than April 22.
For more information on the OMA Advantages Affinity and
Discount Program, visit www.oma.org/Advantages, call
1.800.268.7215, or email [email protected].
TRAVEL INFORMATION
For those travelling to Niagara Falls, please be reminded that
the OMA has the following services available:
NOVEMBER 2016 COUNCIL MEETING AND
ANNUAL MEETING 2017
• The fall 2016 OMA Council Meeting will be held in Toronto
on Saturday, November 26 and Sunday, November 27, at
the Hilton Toronto Hotel.
• The 137th OMA Annual and General Council Meeting will
be held in Toronto from Thursday, May 4 to Sunday, May 7,
2017, at the Hilton Toronto Hotel.
• NEW! Corporate Traveller: The OMA has an agreement with Corporate Traveller to assist OMA Delegates
with all OMA business travel bookings. They have been
given access to the special discounts made available by
Porter Airlines, VIA Rail and Park’N Fly for this event. For
assistance, please contact Brian White, OMA Account
11
March 2016
SECTION PROGRAM LISTING
(alphabetical)
Pre-registration is required for all meetings at www.oma.org/AGM. This schedule is preliminary and may be amended.
Your Section flyer outlining agenda items will be distributed in the coming weeks.
- 1000 – 1100
Negotiation Strategies for Hospital Medicine Programs
With Hospital Administration
Dr. Stephen Chin
ANNUAL OMA COLLABORATIVE SESSION
ON MENTAL HEALTH
(Hosted by the OMA Section on Primary Care
Mental Health)
Friday, April 29
0900 –1200
• Annual General Meeting
1100 – 1200
- 0900 – 0945
Mindfulness
Dr. Darryl Wolski
PHYSICAL MEDICINE AND REHABILITATION
(Meeting to be held at the OMA office in Toronto)
Friday, April 29
• Scientific Session
0730 – 1200
- 0945 – 1030
Form 1 — Application by Physician for Psychiatric
Assessment
Dr. Michael Paré
- 0730 – 0800
Introduction and Registration
Dr. David Berbrayer and Dr. H. Amani
- 1030 – 1145
Current and Upcoming Potential Changes to Regulation
Ada Maxwell-Alleyne
- 0800 – 0900
Resetting Brain Circuits with Neurosurgery
Dr. Andres M. Lozano
CLINICAL HYPNOSIS
(Meeting to be held at the OMA office in Toronto)
Thursday, April 28
Time: TBD
- 0900 – 1000
21st Century Approach to Chronic Non-Cancer Pain
(CNCP) and its Trappings
Dr. John Flannery
GENERAL AND FAMILY PRACTICE
- 1000 – 1100
Neuroradiology of Stroke: Update on Acute Stroke and
Brain Aneurysm Management
Dr. Vitor Mendes Pereira
Friday, April 29
1700 – 1830
• Reception and Dinner
1830 – 2200
- 1100 – 1200
The CMA’s Principles-Based Recommendations for a
Canadian Approach to Assisted Dying: Ten Essential
Principles Vital to Physicians, Patients and Society as a
Whole
Dr. Cindy Forbes
GENERAL INTERNAL MEDICINE
Friday, April 29
• Annual General Meeting and Dinner
1800 – 2100
Health Care Advocate Training
Dr. Albert Schumacher
• Annual General Meeting and Lunch
1200 – 1300
HOSPITALIST MEDICINE
Friday, April 29
• Scientific Session
0900 – 1100
- 0900 – 1000
CSHM Core Competencies in Hospital Medicine
Dr. Marcel Doré
12
March 2016
17th Annual OMA Women’s Health Care Seminar
Welcome to Canada:
Exploring International and Refugee Health
and the Unique Needs of New Canadians
Thursday, April 28, 2016: 8:30 a.m. - 4:30 p.m.
Niagara Falls, ON: Sheraton on the Falls
Featuring keynote speaker Janice Stein, PhD
Professor and Founding Director of the Munk School of Global Affairs, University of Toronto
Topics include:
• First Response – Women’s Health
• International Health
• Pediatric Health
• Trauma
The 17th Annual Women’s Health Care Seminar is complimentary to OMA
members, and has been accredited in previous years for CME credits.
To register, visit www.oma.org/AGM, or contact [email protected].
Physician Health Program
Good Health Matters
BETTER HEALTH FOR YOU AND YOUR FAMILY
PHP EDUCATIONAL WORKSHOPS
The OMA Physician Health Program (PHP) is a
confidential service for physicians, residents, medical students and their family members.
Crucial Conversations®
Course Benefits
• Resolving disagreements by talking respectfully
and skillfully with co-workers in a safe way
• Building acceptance rather than resistance
• Speaking persuasively
• Fostering teamwork
Our caring, health-care professionals offer assistance to those who may be experiencing problems
ranging from stress, burnout, emotional or family
issues, through to substance abuse and psychiatric
illness.
The community of professionals interested in
their own health and well-being is growing.
The Physician Health Program staff and an
expanding resource network of professionals
are available to provide and/or support
health promotion and prevention, educational
presentations, seminars, or retreats throughout
the province.
Crucial Accountability™ Companion
Course Benefits
• Mastering performance discussions/appraisals
and reviews
• Motivating others without using power
• Managing projects without taking over
• Turning solutions into actions
For more information about PHP visit php.oma.org
or call confidential toll-free line: 1.800.851.6606
OMA Background Paper
Patient Self-Care
by OMA Health Policy Department
What Is Patient Self-Care?
P
atient self-care refers to the “personal and medical care performed by the patient,
usually in collaboration with, and after instruction by, a health care professional.”1
It involves the physician and/or health care team performing an evaluation of the
patient’s need for assistance and the ability of the patient to undertake a higher level of
self-care. It may include patient identification and evaluation of symptoms, medications,
and treatments, and/or it may involve an array of preventive self-care activities designed
to avoid or slow disease or chronic conditions.
At times it may be helpful to include
other members of the patient’s circle
of care, such as their family members,
friends, or community resources, so
that the patient can more fully benefit
from self-care strategies.1
The physician-patient relationship
is the foundation of medical practice.
Many of Ontario’s physicians successfully collaborate with their patients,
viewing them as partners to meet
agreed-upon health goals. The physician plays a key role in educating and
facilitating patients’ active participation in their own care. Patients share
valuable information with physicians
in terms of what motivates them and
the treatments they think may be most
effective for them.
Self-care is often referred to in the
literature as self-management or collaborative care with a focus on the
“empowered” or “activated” patient.
The patient is an active participant in
health care and is involved in problemsolving and decision-making about
treatment options.
Why Patient Self-Care Makes
Sense
The concept or patient self-care is not
new. Most chronic care patients are
already involved in some sort of selfcare activity and benefit from the selfcare support that physicians provide.
However, the reality is that more people
in Ontario are living with chronic, longterm health conditions.2
Without patient self-care, Ontario’s
current health care system will likely be
under significant pressure to perform,
and may simply not be able to manage
patients’ multiple needs over a sustained period of time. Many researchers argue that without self-care, health
systems around the world will collapse
15
due to the rising number of elderly
patients and others who will experience
incidents of chronic illness, often with
comorbid or multiple morbidities. As
a result, researchers such as those at
the Deloitte Centre for Health Solutions
in the United States recommend that
more physicians “move from treating
episodic illness to working in partnership with patients and other providers
to create shared decision-making strategies to tackle chronic conditions.”2
A second reason Ontario physicians support patient self-care is that
they recognize that many patients are
already involved with some form of
self-care, due to the ongoing nature
of chronic illness. Supporting self-care
ensures that physicians can continue to
monitor and oversee the health needs
of their patients while supporting them
in their day-to-day health care activities.
The American Association of Family
March 2016
Physicians Supporting Patient Self-Care
Physicians estimates “that between
95% and 99% of chronic illness care is
delivered by the person who has the illness. On a day-to-day basis, the patient
is in charge of his or her own health and
the daily decisions they make have a
significant impact on patient outcomes
and quality of life.”3
For example, it is estimated that the
average patient with diabetes has only
six hours of face-to-face contact with
their health provider per year.2 During
the remaining several hundreds of
hours the patient is responsible for their
own care. Supporting diabetic patients
to make self-care decisions that have a
positive impact on their health is of significant benefit to patients over the long
term, a concept already well-accepted
by Ontario physicians.
Thirdly, while physicians have the
necessary and valuable knowledge and
expertise to diagnose and prescribe
treatments, patients have important
information to share about their lives
in terms of what is most important
to them and what motivates them. 3
Physicians who encourage patients
to share that information with them
have hope for better overall treatment
outcomes. An article from The Journal
of the American Medical Association
notes that the fact that patients are the
primary providers of their own care is
“inescapable.” “Patients are in control.
…Each day, patients decide what
food to eat, whether they will exercise,
and to what extent they will consume
prescribed medications…(Therefore)...
the question is not whether patients
with chronic conditions manage their
illness, but how well they manage.”4
In the literature, empowered patients
are often described as:
• Having the ability to understand their
health condition and the impact it
will have on them both mentally and
physically.
• Being able to make informed choices
about treatments.
• Feeling comfortable to ask questions
about their condition and their care.
• Seeking out additional information
when necessary.
• Monitoring their condition and care
in between visits with their physician
or other health care providers.
• Recognizing and managing minor
ailments and knowing when to consult with their physician,
• Understanding the need to make
lifestyle changes that will benefit
them in the long term, and adhering
with treatment choices, and
• Participating in joint decision-making
with their physician or other health
care providers.5
How Ontario Physicians
Enhance Their Care By
Supporting Improved Self-Care
Researchers indicate that outdated
approaches to patient care may overlook the patient’s personal preferences
and create dependency on the physician, while self-care takes into account
the solutions a patient is more likely to
adhere to and benefit from because
they are a better fit for the patient’s lifestyle.
For example, a patient with arthritis
may need a hip replacement. While one
patient may want to have the surgery
right away, another patient may worry
that the surgery may not completely
relieve pain or restore mobility, and
may instead choose to manage pain
with medication and/or weight loss.6
“In such cases, there are multiple,
reasonable treatment options, each
with their own risks and benefits, and
the ‘correct’ path forward…(can be)…
guided by a patient’s unique needs
and circumstances.”6
Ontario physicians go beyond the
functions of treatment and diagnosis to
include steps such as:
• Acknowledging the patient’s feelings
and ideas.
• Providing information to the patient
about their condition(s) and possible
treatments.
• Helping the patient to set achievable
treatment goals.
• Assisting the patient to integrate
treatments into their everyday life
and functioning.
• Designing a collaborative course of
action where both the patient and
the physician are responsible for the
health outcome.
• Directing patients toward additional
resources for information and/or
support between physician visits.7
16
The literature about self-care
acknowledges the work that physicians do in illness prevention. As a regular part of practice, many physicians
encourage people to take responsibility for keeping themselves and their
families fit, both mentally and physically,
by eating well, getting enough sleep,
reducing stress, exercising regularly,
and avoiding foreseeable health hazards such as excess alcohol consumption, drug use, and smoking. Self-care
models help to articulate the behaviours that physicians can adopt to motivate and sustain patient engagement
toward improved self-care.
In an article relating to patient selfmanagement of chronic disease,
The Journal of the American Medical
Association describes the move along
the care continuum from outdated
care models to a collaborative self-care
model (see table on p. 17).4
Advantages Or Benefits
Attributed To Patient Self-Care
In addition to the empowered patient,
some of the literature notes that
self-care can also translate into the
empowered physician as well. Most
physicians join the health profession
to help patients and their families
achieve better health and improved
quality of life. Improved capacity for
self-care helps to achieve these aims,
thus, “By improving their skills to support patient and family engagement,
health care professionals improve their
work satisfaction and their own quality
of life as well.”8
As well, many studies show that
improved patient self-care can increase
the rates of patient commitment to prescribed medications and treatments,
improved maintenance of good physical health, and encourage more effective interactions between patients and
physicians.9 When physicians support
patients to improve their self-care,
health outcomes are no longer their
sole responsibility. Instead, it is a joint
process where physicians and patients
partner together to improve patient
health.3
In terms of patient benefits, many
researchers assert that patients who
are active in their own self-care expeMarch 2016
rience a better overall quality of life.
Helping people to care for the health of
their families and themselves results in
more engaged individuals who:
• Are happier.
• Are more confident about when and
what to do to monitor their own and
their family’s health and illnesses.
• Know when to consult a physician or
other health care professional.
• Understand more about illness
prevention and self-treatment of
minor ailments.
• Are more compliant with recommendations for self-care and selfmedication.
• Are likely to be less dependent on
physicians when faced with longterm conditions.
• Are better prepared to discuss
their health care goals with
physicians and other health care
professionals.10
In terms of benefits to the health
care system as a whole, researchers
have found that patient and family
empowerment have had positive
outcomes such as improved quality
and safety and a better patient
experience. For example, the Journal
of Ambulatory Care Management in
the United Kingdom reports that an
11-country survey conducted in 2011
found that patients engaging in their
own care report “higher-quality care,
fewer errors, and more positive views
of the health system.”8
Patient self-care also may free up
physician time to address more complex
Comparison Of Traditional And Collaborative Care In Chronic Illness
(Source: The Journal of the American Medical Association)
Issue
Traditional Care
Collaborative Care
What is the relationship between
the patient and the physician?
Physicians are the experts who tell
patients what to do. Patients are
passive.
Shared expertise with active
patients. Physicians are experts
about the disease and patients are
experts about their lives.
Who is the principle caregiver and
problem-solver? Who is responsible for outcomes?
The physician.
The patient and physician are the
principle caregivers; they share
responsibility for solving problems
and for outcomes.
What is the goal?
Compliance with instructions. Noncompliance is a personal deficit of
the patient.
The patient sets goals and the
physician helps the patient make
informed choices. Lack of goal
achievement is a problem to be
solved by modifying strategies.
How is behaviour changed?
External motivation.
Internal motivation. Patients gain
understanding and confidence to
accomplish new behaviours.
How are problems identified?
By the physician, e.g., changing
unhealthy behaviours.
By the patient, e.g., pain or inability
to function; and by the physician.
How are problems solved?
Physicians solve problems for
patients.
Physicians teach problem-solving
skills and help patients in solving
problems.
17
March 2016
issues. This may help to increase the
capacity of the health care system as a
whole to address the growing number
of chronic diseases that are now the
biggest cause of death and disability
worldwide, including cardiovascular
diseases, cancer, diabetes, obesity,
arthritis, musculoskeletal disorders and
chronic respiratory diseases.5
Many studies have shown that
improved patient self-care reduces
the cost of health care. For example,
Judith Hibbard of the University of
Oregon developed a “patient activation
measure” that scores the degree to
which a patient considers himself a
manager of his health and care. She
conducted a study of the “relationship
between patients’ activation scores
and their health care costs at Fairview
Health Services, a large health care
delivery system in Minnesota. In an
analysis of more than 30,000 patients,
they found that those with the lowest
activation scores, that is, people with
the least skills and confidence to
actively engage in their own health
care, incurred costs that averaged 8%
to 21% higher than patients with the
highest activation levels, even after
adjusting for health status and other
factors...As well… patient activation
scores were shown to be significant
predictors of health care costs.”6
The Physician-Patient
Conversation About Self-Care
Not every patient will be capable of,
or interested in, improving their level
of self-care. A report produced by the
Accenture Consulting Group refers to
patients who are in the “zone of dependence,”11 and patients who are in the
“zone of empowerment.”
In the zone of dependence, patients
often completely rely on physicians
and other health care workers for their
health care and advice. They place a
high degree of trust in their physicians
and do not look for alternative sources
of information on their own. They tend
to listen to their physicians about their
health issues, rather than try to engage
in any sort of problem solving, trusting
the physician’s opinion even if it is contrary to their own. To this patient, health
outcomes are the responsibility of the
physician and the patient does not get
involved.11
In the zone of empowerment are
patients who are most likely to succeed
in self-care. In addition to relying
upon the physician and trusting their
advice and expertise, patients in this
zone are informed about their medical
condition(s) having sought information
from a variety of sources, such as the
Internet, other health care providers,
other patients with similar conditions,
etc. They believe this information
is helpful to have in addition to the
information they receive from their
physicians. They rely on the physician
as the medical expert and trust the
advice given, but they believe that they
share the responsibility for positive
health outcomes together with the
physician. It is a partnership. 11 “It is
in this zone that the best healthcare
outcomes can be achieved.”11
Given the different views and capabilities of various patients, how can
physicians encourage patients to move
along the care continuum to where
they are empowered patients with joint
responsibility for their care?
Research recommends that physicians open a dialogue with their
patients that allows the patient to participate in the conversation and provide information as someone who is
an expert in their own lives.8 This is an
approach that many Ontario physicians
are familiar with. Physicians can think
about how they communicate with their
patients based on some basic communications principles:10
1. Everyone wants to be heard and
understood — Does the physician
tell the patient what to do and expect
the patient to follow directions? Or
does the physician ask the patient’s
point of view and acknowledge it as
valid input into the goal-setting process?
2. People want to feel cared about —
Does the physician stop whatever
else he or she is doing during the
conversation, or does the physician
allow interruptions, take phone calls,
text or send emails?
3. It is not what you say, but how you
say it — Does the physician choose
words and inflection carefully, or is he
18
or she dismissive and/or directive?
4. Utilize non-verbal communication —
Does the physician seem distracted
or sit with arms crossed, or does
the physician make eye contact,
nod affirmatively when the patient is
speaking, sit with an open posture
(arms not crossed)?
In terms of what is actually said, an
article from the American Academy
of Family Physicians, entitled Helping
Patients Take Charge of Their Chronic
Illnesses, provides a few examples of
how a physician can modify the physician-patient conversation to involve
their patients3 (see table, p. 19).
Advising Patients On Self-Care:
The Five A’s
The Physician Resource Guide to
Patient Self-Management Support,
from the American Medical Association
(AMA), recommends constructing the
patient self-care conversation around
five A’s: Assess, Advise, Agree, Assist,
and Arrange.
The AMA indicates that it may not be
possible to address all five A’s in one
patient consultation, and that the discussion can pick up where left off at the
next appointment.12
1. Assess
The physician asks the patient about
their health behaviours, for example:
• “Most of the patients I work with
have trouble (taking medications
regularly, living with pain, adhering
to an exercise program, etc.). What
trouble are you having?”
• “Of all that I have asked you to do,
what is the hardest?”
• “Are there additional challenges that
are making it difficult for you to stick
to your health care plan (for example,
vision or hearing impairment, mobility issues, etc.)?”
• “Is there anything you have been
thinking about doing to improve your
health? Have you tried anything?”
• “How important on a scale of 1 to 10
is it for you to quit smoking, control
your blood sugar, lose weight, exercise more, etc.?”
• “Why is it a 4 and not a 1?” (Try to get
the patient to tell you why change
would be a positive thing for them.)
March 2016
Physician-Patient Conversations: Old Model Versus New Model
(Source: American Academy of Family Physicians)
Patient Says
Physician’s Response
(old model)
Physician’s Response
(new model)
“I hate this exercise plan.”
“Then try walking after dinner every
night with your husband for 10
minutes.”
“What do you hate about it? What
would help you do better at it?”
“I don’t think I can quit smoking.”
“Smoking is the leading cause of
preventable death...”
“Why do you think that? What has
happened in the past when you
tried to quit? What concerns you
most when you think about trying
to quit?”
“I haven’t been able to test my
blood sugar four times a day.”
“It’s hard at first, but just keep
trying. You really need to keep track
of it.”
“What is preventing you from
doing that? Do you know what the
numbers mean?”
2. Advise
The physician advises the patient about
their condition, using plain speech as
much as possible rather than talking in
acronyms and medical jargon.
• Physicians could first ask the patient
what they know about their condition so that the physician gains a
sense of how familiar the patient
is with their disease(s) and to see
where clarification may be needed.
• Have a brief key message or takeaway for each diagnosis or symptom.
• Ask the patient to repeat back what
you have said so that you know they
have understood. This “closing the
loop” or “teach back” method is a
proven technique to improve health
literacy.
3. Agree
The physician and the patient collaborate to develop a specific action plan,
taking into account the attitudes and
preferences of the patient. The plan
should state:
• What — What are the tasks the
patient is responsible for before your
next consultation?
• When — When during the day will
the patient perform these tasks?
• How often — Specify a reasonable
number of times the tasks should be
completed.
• Where — Designate a location where
the patient can perform these tasks.
• Why — Why is the patient doing
these tasks? Why is it important to
them?
• Problem-Solving — Help the patient
to work through some of the challenges that could prevent them from
completing their tasks.
• Confidence Level — Check the
patient’s level of confidence in actually following through with the plan,
on a scale of 1 to 10. If the confidence level is below a 7, perhaps the
plan needs to be adjusted so that
the patient can achieve their goals
and feel a sense of accomplishment.
4. Assist
Teach the patient basic problem-solving skills so that they can work through
their issues on their own, for example:
• Identify the problem.
• Brainstorm some solutions.
• Choose the best solution that will
19
work for them.
• Try it.
• Find resources to support your
choice, for example a self-help book,
a support group, a website, etc.
• If it doesn’t work, identify why not.
• Decide if another solution would
work better.
• Consult physician, other health
care provider, community resource,
peers, etc., for solutions.
5. Arrange
Arrange for followup purposes with the
patient.
• Use phone, email, or staff the patient
is familiar with to followup with the
patient to see if the plan is working.
If not, schedule a followup appointment.
• Also, provide the patient with a list of
additional resources, self-help organizations, support groups, community programs, etc., that may help
them to improve their self-care.
Other Factors That Promote
Patient Self-Care
In addition to having a co-operative
and supportive conversation with the
March 2016
patient, there are other factors that can
contribute to improved patient self-care.
Education
Ontario physicians know that in order
for patients to actively participate in their
care and to make decisions regarding
their health, they need to have a good
understanding of their disease(s). The
World Health Organization notes that,
“Skills in education…are indispensable
for effective promotion of self-care.
Access to information, the quality of the
information and the ability to interpret
and apply information are important
elements of the self-care promotion
process.”13
There are many opportunities for
empowered patients to take the technical skills they learn from their medical
team and apply them in their everyday
lives. For example:
• Providing a diabetic patient with
information about diet, exercise, and
medications, along with the technical skills to monitor their blood glucose and inject insulin can help the
patient to maintain or improve their
level of health in between physician
visits.
• Patients with hypertension who
self-monitor their blood pressure
and self-administer antihypertensive
medication are often successful in
lowering their blood pressure levels
and improving their health as well.14
• Self-dialysis is a procedure that is
currently being done by patients in
their homes. Performing the procedure at home gives the patient both
the comfort of a familiar, safe place
and the convenience of care while
knowing that their physician is available for advice and/or assistance if
necessary.
• The same can be said for patients
with some cancers who self-administer chemotherapy medications.
The patients also benefit from avoiding contact with other sick people at
a time when their immune system
may already be compromised and
from having to travel to a medical
facility when they are not feeling their
best.
Much has been written about how
to deliver patient education in a manONTARIO MEDICAL REVIEW
ner that has the greatest impact on the
patient. In addition to the traditional
forms of education that offer information and technical skills, patient-centred
education attempts to teach patients
more general skills that will help them to
reinforce changes in their lives. Patients
are taught problem-solving and goalsetting skills and learn to answer questions like:
• “How is this disease going to affect
me?”
• “What will be the most effective
treatments for me?”
• “How can I fit those treatments into
my everyday life?”4
The sources of this education can be
the physician, other health care professionals, support groups, other patients
with similar conditions, etc.
These self-management skills complement traditional education by supporting patient efforts to live the best
possible quality of life with their chronic
condition.4 “Evidence from controlled
clinical trials suggests that…programs
teaching self-management skills are
more effective than information-only
patient education in improving clinical
outcomes…”4
As well, patient confidence is
increased when patients succeed in
solving a self-identified problem and
carrying out a treatment behaviour that
helps them to achieve a self-directed
goal.4
The table on p. 21, published in an
article in The Journal of the American
Medical Association, compares the
differences between traditional patient
education and patient-centred or selfmanagement education.4
Start Small
Research shows that taking small
steps or beginning with the less serious
aspects of an illness can help patients
develop the skills that they need to
address larger issues over time.3
Research done in the United
Kingdom indicates that promoting
individual responsibility for minor ailments leads to increased confidence
by patients who try self-care measures.
Furthermore, “Data reveal 84% of
those who have experience with selfcare feel confident in managing new
20
episodes.”…“In short, it (self-care of
minor ailments) puts the patient back
in control.”2
Interprofessional Teams To
Support The Patient
Patients suffering from chronic conditions can often benefit from the
experience and self-care approaches
recommended by other allied health
care practitioners, including nurses,
physiotherapists, dietitians, diabetic educators, psychologists, etc.
Physicians who practise in a multidisciplinary team or who collaborate externally with other health care providers
can help to co-ordinate their patients’
care with other professionals to
empower their patients to practise selfcare in other areas of their treatment.
Co-ordinated care plans can be
an important tool for physicians and
patients to manage numerous medical therapies from various health professionals within the patient’s circle of
care. Without a strong communication
link between care providers, negative
consequences such as poor health outcomes, errors in treatment, increased
readmissions to hospitals, and dissatisfied patients may result.15
Additional Resources For
Patient Use
In order to more fully support patients
in their self-care regimes, additional
research or tools may help patients
make and maintain positive changes in
their lives.
For example, the Institute for Health
care Improvement has developed
a toolkit with specific activities for
patients with chronic illnesses. “This
includes providing a visit summary
with goals and action plans to guide
patients and families when they leave
the clinic, and refers patients to relevant health community programs.”11
Tools or supports highlighted by the
Institute may include:
• Individual coaching with the physician or other health care provider,
• Telephone support and online programs, and
• “Communication platforms to
exchange information (e.g., health
information exchanges), enable selfMarch 2016
Comparison Of Traditional Patient Education And Self-Management Education
(Source: The Journal of the American Medical Association)
Question
Traditional Patient Education
Self-Management Education
What is taught?
Information and technical skills
about the disease.
Skills on how to act on problems.
How are problems formulated?
Problems reflect inadequate control
of the disease.
The patient identifies problems he
or she experiences that may or may
not be related to the disease.
What is the relation of the education
to the disease?
Education is disease-specific and
teaches information and technical
skills related to the disease.
Education provides problem-solving skills that are relevant to the
consequences of chronic conditions in general.
What is the theory underlying the
education?
Disease-specific knowledge;
creates behaviour change which
in turn produces better clinical
outcomes.
Greater patient confidence in his or
her capacity to make life-improving
changes (self-efficacy); yields better
clinical outcomes.
What is the goal?
Compliance with the behaviour;
changes are taught to the patient to
improve clinical outcomes.
Increased self-efficacy to improve
clinical outcomes.
Who is the educator?
A health professional.
A health professional, peer leader,
or other patients, often in group
settings.
monitoring (e.g., patient portals) and
provide research support (e.g., medical libraries for patients).”11
Other resources may include:
• A list of courses for patients when
they have been newly diagnosed
with diseases such as diabetes, heart
disease, etc., and/or more generic
courses such as pain management,
stress management, meditation,
exercise classes, and so on.5
• Pamphlets or booklets about
specific medical conditions.
• Information about home care and/or
hospice care in the area.
• Names of health websites or
magazines so the patient can do
their own research.
• Support groups for the patient and
for their family members and/or
caregivers.
• A copy of their file or diagnosis so
that the patient can share it with
other health care providers in their
circle of care.
• Information about advanced
care planning and designating a
substitute decision maker.
• A list of symptoms and corresponding direction about who to contact,
21
for example:
- If you have a flu that prevents you
from taking your medication, contact your family physician.
- If you experience a fever, contact
the transplant nurse.
- If the voices in your head get
worse, contact your doctor.
- If your weight increases by more
than three pounds in three days,
double your diuretic. If no weight
loss is experienced, contact the
congestive heart failure nurse on
your family health team, or your
family physician.5
March 2016
Family And/Or Caregiver
Participation
The reality of chronic disease(s), multiple morbidities, long-term illness,
and health issues related to aging and
frailty is that at some point patients
with these conditions may not be able
to adequately perform self-care activities on their own. In preparation for
this possibility, physicians engage with
patients’ families or other formal/informal caregivers to involve these individuals in self-management activities when
patients are no longer able to care for
themselves.
Families and/or caregivers can
become involved by being invited by
health care providers to participate in
meetings between the patient and the
health care provider to be educated
about the patient’s health, to provide input into goal setting, or to suggest ways in which they can help the
patient. As well, families can participate in “family networks in local communities where family members have
the opportunity to share knowledge,
experiences and worries with other
family members.”5
As family members and/or caregiv-
ers often know the patient best, they
can serve as an effective early-warning
system to physicians about a patient’s
physical and mental well-being. For
example, up to 50% of persons with
chronic health conditions suffer from
concurrent depressive symptoms.
Depression may affect self-care abilities through reduced patient activity
levels, limited self-efficacy, inadequate
communication with physicians and/or
other health care providers, and noncompliance with medication regimes.16
Family members and/or caregivers
who are involved with patients suffering from chronic conditions can be
educated about the signs of oncoming
depression and alert the physician if
concerns develop.
Conclusion
In his article, Shared Decision Making
— The Pinnacle of Patient-Centered
Care, Dr. Michael Barry suggests that
physicians view the health care experience through the patient’s eyes so that
they may become more responsive to
patients’ needs and, thereby, become
better clinicians.17 Dr. Barry’s recommendation to ask patients, “What mat-
ters to you?” as well as “What is the
matter?” has been repeated in many
different articles and lectures about
patient self-care.17
Ontario physicians favour supported
decision-making where the patient and
the physician work together to identify
health issues, set goals, and develop
solutions. This relationship can lead
to better patient health and greater
satisfaction for both the patient and
the physician. Having a conversation
with patients in a supportive and collaborative manner, along with providing patient education, resources and
tools, and inviting families and/or caregivers to engage as well may help to
empower patients so that they can
truly benefit from self-care. While some
patients may never make the leap from
dependent patient to self-care partner, involving those who are willing
to participate in supported decisionmaking can add significant value to the
patient-physician relationship and to
the overall patient experience.
For more information, contact Katherin
Platt, OMA Health Policy Department, at
[email protected].
Update On OMA Initiative To Strengthen Care For Patients With Chronic Disease
The OMA is committed to improving the health of people with chronic diseases. An important part of this work is
through papers like “Ontario Physicians Supporting Patient Self-Care.” But we know that chronic illness is complex
and we need to take an integrated approach in order to make meaningful change. Check-Up Ontario is a multi-faceted
initiative that is bringing together evidence, clinical expertise, and the lived experience of patients and their caregivers.
The OMA has been to six communities across the province, seeking input at community meetings. The knowledge
gained through this process will be combined with the results of an academic literature review, a citizen panel and an
expert round-table undertaken by McMaster Health Forum, as well as an OMA member survey to guide patient-first
recommendations to strengthen care for people with chronic diseases.
22
March 2016
References
1.
4.
Evaluative Sciences. Quality monitor: 2012
report on Ontario’s health system. Toronto,
Self-care [definition]. [about 1 screen].
self-care in general practice. Br J Gen
ON: Queen’s Printer for Ontario; 2012.
Available at: http://medical-dictionary.the
Pract. 2007 Oct;57(543):814-21. Available
Available at: http://www.hqontario.ca/
freedictionary.com/self-care. Accessed:
at: http://www.ncbi.nlm.nih.gov/pmc/
portals/0/Documents/pr/qmonitor-full-
2016 Feb 22.
articles/PMC2151815/. Accessed: 2016
report-2012-en.pdf. Accessed: 2016 Feb
8.
22.
Self Care Forum – helping people take care
16.
Bayliss EA, Bosworth HB, Noel PH, Wolff
of themselves [Internet]. London, England:
JL, Damush TM, Mciver L. Supporting
of their chronic illnesses. Fam Pract Manag.
Self Care Forum; c2016. Interviews with the
self-management for patients with com-
2000 Mar;7(3):47-51. Available at: http://
Self Care Forum board; [about 11 screens].
plex medical needs: recommendations
www.aafp.org/fpm/2000/0300/p47.html.
Available at: Available at: http://www.
of a working group. Chronic Illn. 2007
Accessed: 2016 Feb 22.
selfcareforum.org/about-us/interviews/.
Bodenheimer T, Lorig K, Holman H,
11.
Jun;3(2):167-75.
17.
Barry MJ, Edgman-Levitan S. Shared
Accenture Management Consulting
decision making--pinnacle of patient-
of chronic disease in primary care. JAMA.
Innovation Centre. The empowered
centered care. N Engl J Med. 2012 Mar
2002 Nov 20;288(19):2469-75.
patient: the changing doctor-patient rela-
1;366(9):780-1.
The European Network on Patient
tionship in the era of ‘self-service’ health-
Empowerment. Patient empowerment –
care. Singapore: Accenture Management
living with chronic disease: a series of short
Consulting Innovation Centre; 2011.
discussion topics on different aspects of
Available at: http://www.cas-uk.com/
self management and patient empower-
SiteCollectionDocuments/PDF/Accenture-
ment for the 1st European Conference
Change-Traditional-Doctor-Patient-
on Patient Empowerment. Copenhagen,
Relationship.pdf . Accessed: 2016 Feb 22.
12.
Bradley K, Gadon M, Irmiter C, Meyer
Patient Empowerment; 2012 Apr 11-12.
M, Schwartzberg J. Physician resource
Available at: http://www.enope.eu/
guide to patient self-management sup-
media/39886/a_series_of_short_discussion
port. Chicago, IL: American Medical
_topics_on_different.pdf. Accessed: 2016
Association; 2012. Available at: http://
Feb 22.
selfmanagementalliance.org/wp-content/
James J. Health policy brief: patient
uploads/2013/09/phys-resource-guide.
engagement. Bethesda, MD: Health Affairs;
pdf. Accessed: 2016 Feb 22.
2013 Feb 14. Available at: http://health
7.
Feb 22.
10.
Funnell MM. Helping patients take charge
Denmark: The European Network on
6.
9.
Richards S. Self-care – a nursing essential.
Grumbach K. Patient self-management
5.
Health Quality Ontario; Institute for Clinical
Greaves CJ, Campbell JL. Supporting
Practice Nurse. 2012 Jul 20;42:26-30.
3.
15.
media/387. Accessed: 2016 Feb 22.
Mosby’s medical dictionary [Internet]. 8th
ed. St. Louis, MO: Mosby/Elsevier; c2009.
2.
at: http://www.wish-qatar.org/app/
13.
World Health Organization, Regional Office
affairs.org/healthpolicybriefs/brief_pdfs/
for South-East Asia. Self-care in the con-
healthpolicybrief_86.pdf. Accessed: 2016
text of primary health care - report of the
Feb 22.
regional consultation in Bangkok, Thailand,
McWilliam CL. Patients, persons or part-
7-9 January 2009. New Delhi, India: World
ners? Involving those with chronic dis-
Health Organization; 2009. Available at:
ease in their care. Chronic Illn. 2009
http://www.searo.who.int/entity/primary_
Dec;5(4):277-92.
health_care/documents/sea_hsd_320.pdf.
Edgman-Levitan S, Brady C, Howitt P.
Patient and family engagement: partnering
14.
McManus RJ, Mant J, Haque MS, Bray
with patients, families, and communities
EP, Bryan S, Greenfield SM, et al. Effect of
for health: a global imperative: report of the
self-monitoring and medication self-titration
Patient and Family Engagement Working
on systolic blood pressure in hypertensive
Group. World Innovation Summit for Health
patients at high risk of cardiovascular dis-
(WISH); 2013 Dec 10-11; Doha, Qatar:
ease: the TASMIN-SR randomized clinical
The Qatar Foundation; 2013. Available
trial. JAMA. 2014 Aug 27;312(8):799-808.
23
March 2016
FEATURE
Commentary
Optimism in health care leadership:
finding water in the desert
by Darren Larsen, MD
ecently, after my last blog post, a physician colleague shared that, in his opinion,
R
“as usual (I was) overly cheerful and optimistic.” His comment got me thinking:
could this be true? When conveying a complex message or guiding people toward
an often difficult goal, can one be too optimistic? Does optimism alienate people? Is it
authentic? What effect does it have on leadership?
Those who interpret a person as being
overly optimistic likely think they see
the world only through rose-coloured
glasses. They may believe that optimism is misguided and ignores reality.
To be sure, there are daily challenges we face in health care which can
be overwhelming. There are often times
when everything around us seems
aligned to ensure our failure. Given that,
I wonder if it is best to bow to negative
forces in our work and life, or counter
them? Is being pessimistic the same as
being realistic, and therefore, is more
authentic, or does it deny authenticity
by closing the door on new ideas? Is
being optimistic a delusional belief system or is it really an expression of hope?
In 2001, I made my first foray away
from clinical care in my medical career.
At that time, I took on part-time work
as medical consultant in a new Ministry
of Health and Long-Term Care agency
called OFHN — the Ontario Family
Health Network (now Primary Care
Branch). Primary care renewal and the
creation of the first FHNs was a bold,
disruptive idea, and five physicians
were hired as consultants to flesh out
and promote the program.
Essentially, we were tasked with selling the idea of change to our peers at
a time when there was discord, and
reform was not particularly welcome.
There was no formal change management process. We were left to figure
things out by trial and error. Back then,
in public physician forums, I was told
I was too young to understand, I was
naive, and that I hadn’t experienced
enough of the cold stark realities of the
health system yet to be credible. Some
peers clearly stated that I had “sold
out” and “moved to the dark side.” Yet,
despite that, something encouraged
me to press on and kept the spark alive.
What was that?
Upon reflection, I think I value certain
traits in leadership that allow me to stay
focused, even in the face of adversity or
uncertainty. These include:
• An endless curiosity about the
unknown.
• Trust in the process I am involved
24
in, even if the outcome is not yet
known.
• A belief that the only certain thing in
life is change.
• A general sense that things get better and that the future is exciting.
Likely, these traits encompass an
optimistic world view.
Where do these traits come from?
Perhaps they are inherited. Or they are
learned as a child. I look to my parents to think about the origins of my
optimism, and think especially of my
mother. She was definitely a person
whose glass was always half full. She
believed strongly that virtually all people
were good at heart and that if given the
choice between right and wrong they
would almost always choose “right.”
Her favourite word was “fabulous.”
Even as her future was slipping away
from her due to an aggressive form of
cancer, she joked, laughed, sang and
remained positive about every aspect
of life. Maybe I am a reflection of that.
But the statement of my colleague
that I was overly optimistic challenged
March 2016
Optimism In Health Care Leadership
my approach. When I am leading with
optimism, is it possible that I am overlooking something? Am I avoiding the
painful realities of the current state of
health care, where budgets are tight,
people are worked past capacity, supply and demand never seem to balance, and pessimism easily prevails?
Is being optimistic simply missing the
mark? Hopefully not.
An optimistic approach to leadership
does not neglect the real need for critical analysis. True optimists are not blind
to the risks and challenges they face
every day. They tend to acknowledge
pain points and think through how they
can be addressed quickly yet effectively.
This allows them to look forward to the
next goal and the new trials that come
with it. Optimists address challenges.
They tend not to be threatened by them.
Interestingly, pessimism is rampant
in doctors. A survey conducted by The
Physicians Foundation in 2012 found
that pessimism was firmly implanted
in American physicians’ minds. There,
“over three-quarters of physicians —
77.4 percent — were somewhat
pessimistic or very pessimistic about
the future of the medical profession.”
Yet, surprisingly, in a survey of 800
Americans in 2013 via Statista, half of
them self-report as being optimists,
while only 4% describe themselves
as pessimists, and 43% say they are
somewhere in between. And if my profession is much more pessimistic than
the general population, is there room
for optimism in its leadership? I would
suggest absolutely yes!
In business literature, optimism
is seen as one of the most important
traits of good leadership. In a recent
Forbes magazine article on leadership,
Carmine Gallow proposes five reasons
why optimists make better leaders.
1. Optimists see opportunity where
others see uncertainty and despair.
This is critical in a time when radical
health care transformation initiatives
are the norm as we are experiencing
in Ontario right now.
2. Optimists are inspiring and effective communicators. They can get a
message across effectively as they
stand out among the white noise of
negativity.
3. Optimists rally people to a better future. They show others hope,
which is key to surviving periods of
hardship.
4. Optimists see the big picture. They
do not get caught up in the cycle
of circular negative discussions or
thinking. They can see above and
beyond today.
5. Optimists elicit superhuman effort.
They cause others to use their
energy in ways that surprise them.
They attract many followers who are
happy to work on their cause.
And in thinking how I most want to
lead change, I am constantly comparing myself to others and asking who is it
that I would climb a mountain to follow?
What do they look like? What do they do
or have that motivates me? Whatever it
is, I want to emulate them. Great physician leaders are everywhere around us.
They are busy working away showing
positivity in the face of adversity. They
seem fearless when others are withdrawing. From them I derive strength. I
count these people among my closest
friends, and that gives me inspiration.
Realistically, our time on this earth
is short. We have only a small window
25
to create and enact positive change.
To do this well we must use the same
energy that some put into pessimistic
and negative thinking, and channel it to
productivity and new ideas.
Being optimistic is the single biggest
advantage I have in the work I do, both
in medicine and in health care leadership. Every day, I draw upon the energy
of others who do the same, and the
partnerships that are created in this
combined effort have the most amazing potential. And the best thing is, with
this optimism I am able to look forward
to virtually every day and the challenges
and opportunities that lie ahead in it. To
to be branded excessively cheerful and
optimistic is, I suppose, a compliment.
It is a sign that I have succeeded.
Your thoughts are welcome! And
of course, I just have to say it — keep
smiling!
Dr. Larsen is Chief Medical Information
Officer for OntarioMD (Darren.Larsen@
ontariomd.com), and has been practising as a family physician for 25 years. He
currently teaches family medicine at the
University of Toronto and is on staff at
Women’s College Hospital.
March 2016
FEATURE
Sport Med 2016:
key topics — back pain, safety in play, CrossFit injuries,
sport-related concussion, injection techniques
by Barbara Klich
T
he 2016 Sport Med Symposium featured a variety of lectures, workshops and
plenary sessions on topics related to the assessment, prevention and manage-
ment of sport and exercise injuries.
Presented by the OMA Section on Sport
and Exercise Medicine, the conference
attracted more than 200 family physicians, sport medicine specialists and
allied health professionals to Toronto on
February 5-6. Topics covered included
back pain diagnosis, safety in play,
CrossFit injury treatment, sport-related
concussion, and injection techniques.
Back Pain: Obtaining A Precise
Diagnosis To Reduce Pain And
Enhance Performance
Dr. Stuart McGill, Professor, University
of Waterloo, presented the 2016 John
Sutton Memorial Lec ture ship, entitled “Back Pain: Obtaining a Precise
Diagnosis to Reduce Pain and Enhance
Performance.”
Dr. McGill told delegates that he is
“befuddled” by clinicians who provide
a non-helpful diagnosis, such as “nonspecific back pain” or “mechanical
back pain,” for patients suffering from
back ailments.
“Some patients have been scarred
with the highly iatrogenic radiological
diagnosis of ‘degenerative disc disease,’ and it is no wonder they may
have psychosocial issues. We do not
say to older patients they have ‘degenerative face disease,’ ” he said.
Dr. McGill noted that asking the
patient a few questions will often indicate that the patient does not understand the cause of the pain, nor has
the patient been provided with a solid
direction on what to do. He advised that
a process is required to interpret patient
history, followed by pain provocation to
isolate the mechanism that causes pain
and robs performance.
He recommended that delegates
“ask the patient if there is pain when
rolling over in bed, when standing in
one position, after rising from bed, or
whether pain ramps up throughout
the day — these are all important in a
diagnosis.”
Once patients understand the pain
triggers, they can be coached to eliminate the pain-causing mechanism.
This is an essential step in winding
down pain sensitivity, and must be
completed prior to an exercise prescription. The next stage commences
with a progressive exercise program
to build the foundation for a pain-free
body using the precisely defined pain
trigger as a guide.
Dr. McGill noted that a precise diagnosis is related to intolerance or sensitivity to specific motion, postures,
and loads. These are identified via provocative testing of the patient. Once
the sensitivities have been provoked,
the understanding of the mechanism is
refined by repeating the pain-triggering
tests with variance of neural tension,
anatomical stress, and stiffening, stabilizing motor strategies and probing for combinations that reduce or
increase pain.
“If the pain has mechanical compo26
nents, removing them provides immediate symptom reduction, he said.
“This gives patients a sense of control
and confidence as they realize they
have the ability to bend, reach, lift, and
carry without fear of triggering more
pain. Then, the movement technique
to eliminate the pain is workshopped
with the patient, enhancing their confidence and control.”
Dr. McGill provided some examples,
noting that when the patient is ready
for progressive exercise, the technique
and dosage are specifically tuned to the
individual.
The next stage for restoring the athlete following back injury is a transition
into progressive training to rebuild the
required athleticisms.
“The athleticisms needed for the
specific sporting goals are formalized
in order to guide the program to ensure
the most efficient route is taken and that
the biological boundaries of capacity
are respected,” he said.
“The boundaries will have been
redefined by injury history, which may
not heal in a traditional sense, but may
be successfully managed.”
He stressed that the way a person
moves matters, and anatomy matters.
“It is interesting to look at other factors as well — the incidence of orthopedic disease is not only influenced by
anatomy, but so is function. For example, those with a shallow hip acetabulum linked with incidence of dysplasia
March 2016
Sport Med 2016
can squat deeply with no stress in either
the hip or imparted to the lumbar spine
and typically can generate high power
in the deep position.
“In contrast, the deep acetabulum is linked to FAI (femoroacetabular
impingement), more spine-bending
stress in a deep squat, and shifts the
power development to the top half of
the squat. It is important to consider
many factors when it comes to treatment of back pain,” he said.
Dr. McGill is the author of several
books. His latest, Back Mechanic, provides a step-by-step method to identify
pain triggers, and offers various patterns to eliminate the trigger from daily
movement. A progressive exercise program can then be designed based on
individual goals and triggers to build the
foundation for pain-free movement.
Lectureship: Safety In Play: Is the
Pendulum Swinging Too Far?
Dr. Eric Koelink, Assistant Clinical Professor, Pediatric Emergency Medicine,
McMaster Children’s Hospital, presented the 2016 Tom Pashby Sport
Safety Fund Lectureship, entitled
“Safety in Play: is the Pendulum Swinging Too Far?”
Dr. Koelink began his presentation
by polling the audience for their opinion
on the status of safety in play. Results
found that 88% of participants felt play
was too safe, while 12% felt it was not
safe enough.
He then reported that playgroundrelated injuries — based on the number
of emergency room visits due to fallsrelated incidents from 2004 to 2010 for
children aged 0 to 14 years — totalled
20,049 in 2004, and 21,952 in 2010.
Hospitalizations due to falls-related
incidents in the same years, and for
the same age group, totalled 1,582 in
2004 and 1,553 in 2010. From 1992
to 1995, there were two children who
died from strangulation or choking in
the playground.
Dr. Koelink told delegates that reducing the maximum fall height of equipment has resulted in innovative designs
for new, age-appropriate equipment
at lower heights. Protective guardrails
and barriers add some protection, and
vertical rather than horizontal bars that
discourage climbing, are important.
Improved protective surfacing under
playground equipment, such as loose
fill, pea gravel, wood chips, synthetic
surfaces to a depth of at least 15 cm
for preschool equipment and 30 cm for
full-size equipment, are also helpful.
He noted that research conducted
by the Hospital for Sick Children found
that school playgrounds in Toronto
which had been upgraded to the
Canadian Standards Association standards had a 40% decrease in injuries.
An estimated 520 injuries may have
been prevented during the four-year
study period as a result.
Dr. Koelink then proceeded to review
some of the safety recommendations
put forth by the Canadian Pediatric
Society:
• Trampolines: Should not be used for
recreational purposes at home by
children or adolescents.
• Skiing/Snowboarding: Make helmet
use mandatory. Ensure safe design
and prevention-oriented maintenance program for ski facilities.
• All-Terrain Vehicles (ATVs): Children
and youth under 16 years of age
should not operate ATVs.
• Snowmobiles: Children younger
than 16 years of age should not
operate snowmobiles. Children
younger than six years of age do not
have the strength or stamina to be
transported safely as passengers on
snowmobiles.
Dr. Koelink told delegates that the
level of challenge required and desired
by children varies enormously with age,
physical development, and emotional
development, therefore, it is almost
impossible to design a piece of playground equipment that meets the
needs of all children.
“In my opinion, 21,952 visits in a
year for playground-related injuries to
the ER are too many. One death is too
many. There is still much work that can
and should be done to prevent injuries,” he said.
A second poll on the status of safety
in play, conducted at the conclusion of
Dr. Koelink's presentation, found that
76% of audience members now felt
play was safe, while 24% felt it was not
safe enough.
27
CrossFit
CrossFit, a popular fitness regimen that
involves core strength and full-body
conditioning programs, was the focus
of multiple presentations at this year's
Sport Med.
In a session entitled “CrossFit
Injuries,” Dr. Erin Weersink, Assistant
Professor, Department of Family
Medicine, Western University, told delegates that based on the limited literature and clinical experience, CrossFit is
safe. However, Dr. Weersink advised
that overuse injuries predominate,
particularly in the back, shoulder, and
knee areas.
“If coaching is inadequate and not
focused on proper form, injury rates will
likely be higher,” she said. “Many athletes overestimate their ability, predisposing to poor form and injury.”
Dr. Weersink noted that the overall
CrossFit injury rate is less than in contact sports, and likely similar to other
gym/fitness activities.
CrossFit Rehab
In a presentation entitled “Going
Beyond the Symptoms,” physiotherapist Jesse Awenus of Toronto told delegates that the rehab of a CrossFit injury
has more to do with figuring out why it
happened, and then developing a specific rehab program consistent with the
individual athlete’s presentation.
“Simply treating the site of injury
without addressing other factors will
ultimately lead to poor healing and
re-injury,” he warned.
Mr. Awenus said that once an injury
has occurred, the initial rehab does not
change from that of the general population, but what does change is figuring
out why an injury has occurred, what
predisposed the athlete to being injured
in the first place.
“For example, hip weakness or a
stiff ankle can lead to a complaint of
knee pain, therefore, the hip and ankle
need to be treated to fix the knee pain,
he said. “The number one risk factor
for sustaining a future CrossFit injury
is having a previous injury to the same
area of the body. For example, a
sprained ankle and subsequent loss
of proprioception leading to future
sprains. Therefore, the number one
March 2016
Sport Med 2016
goal should be prevention of injuries.”
Other causes of injuries are lack
of adequate mobility and/or stabili ty
causing increased strain on characteristic areas of the body, such as
repeated overhead pressing causing
rotator cuff or labral injuries due to lack
of end range thoracic spine extension,
inadequate upward scapular rotation,
or poor humeral head centralization in
the glenoid.
In an ensuing discussion with the
audience, presenters stressed that
people who have been involved in
a sedentary life will often approach
CrossFit too vigorously, and they
should be advised to begin a program
with some caution at first. Presenters
also advised that there is a need for
qualified instructors who can assess
the readiness of all participants.
Sport-Related Concussions For
Physicians
The OMA Section on Sport and Exercise
Medicine has produced a one-page
colour poster entitled Sport Related
Concussions for Physicians. The handy
resource — ideal for posting in physician
offices — provides succinct information
regarding common symptoms, assessment, post-concussion syndrome, treatment, return to learn, and return to play.
For example, the treatment section
notes that “85% of adult patients recover
in 7-10 days,” while children often take
longer. With respect to return to play, the
poster lists the following:
• Step 1: Physical Rest and Mental
Activity — as tolerated; stop if symptoms worsen.
• Step 2: Light Aerobic Exercise —
for example, walking/stationary bike
for 10 to 15 minutes at <50% intensity, increasing duration and intensity
as symptoms allow.
• Step 3: Sport Specific Exercise —
for example, skating, running, throwing, individual skills.
• Step 4: Non-Contact Training/Drills
— wear a “red/yellow jersey” for
scrimmage, resistance training (for
example, weights, push-ups, core
exercises). Get clearance from MD
before proceeding to contact.
• Step 5: Contact Practice — if symptom-free with full-contact training/
practice, can proceed to competition/game.
• Step 6: Return to Game — there
should be a minimum of 24 hours
between each step. If symptoms
persist or worsen, rest, and do not
proceed to the next step.
All delegates in attendance at this
year's symposium received a copy
of Sport Related Concussions for
Physicians. The poster has also been
reproduced on page 29 of this issue
(see opposite), and is available for
download from the OMA Section on
Sport and Exercise Medicine website
at sportsandexercisemedicine.ca.
Injection Techniques
Dr. Karen Murtaugh, Assistant Clinical
Professor, McMaster University, led
a practical workshop on “Injection
Techniques.”
Dr. Murtaugh told delegates that
there is no convincing evidence that
any injectable substance cures or prevents the advancement of any condition. The main indication for injection is
pain relief.
“The advantages of injection are a
quick response, particularly with cortisone, avoidance of most systemic
complications, and it may be the most
cost-effective option for pain relief,” she
said.
Dr. Murtaugh reported that cortisone
is the only anti-inflammatory medication injected into a joint, and it is indicated for pain and inflammation such
as bursitis, tendonitis, tenosynovitis,
and arthritis. Major tendons should not
be injected.
While there is no lifetime limit on cortisone use, Dr. Murtaugh told delegates
that caution is warranted in weightbearing joints, or if effects do not last
beyond three months. She said that
patients must be aware of side-effects
with cortisone, and must recognize
signs and symptoms of infection.
With respect to injection after-care,
Dr. Murtaugh said that exercise will
depend on the substance injected,
activity level of the patient, and local
pathology.
“General advice is to avoid impact
activity for approximately one week in
weight-bearing joints, avoid contact
28
sport for one week, and avoid excessive activity for 24 to 72 hours following
most injections,” she said, adding that it
is important to make sure the patient is
aware of signs and symptoms of infection and knows who to contact if they
have concerns.
“Always document discussion of
risks and procedures accurately and
see the patient in your office if there is
any suspicion of infection.”
Dr. Murtaugh's general advice with
regard to reducing pain is to enter the
skin in a quick and controlled manner
and use the minimum volume necessary. In reducing complications, avoid
multiple-use vials when possible,
draw up injection solution with a different needle than that used to inject,
use a “no touch” technique, and avoid
depositing any solution (other than local
anesthetic) in subcutaneous tissue.
She concluded her workshop by
reminding delegates that injections are
a skill like any other procedure.
“Your colleagues are a great re source, so observe and ask questions.
Work with a proper diagnosis, based
on clinical examination, not only imaging. And practice, practice, practice.”
J.C. Kennedy Award For Excellence
In Sport Medicine
The J.C. Kennedy Award for Excellence
in Sport Medicine was presented to
Dr. Duong Nguyen, an orthopedic surgeon in Toronto, for his paper entitled
“Sex, Age and Graft Size as Predictors
of ACL Re-Tear: a Multivariate Logistic
Regression of Cohort of 503 Athletes.”
The paper's focus is identifying risk
factors for graft re-tears within two
years of ACL surgery using a multivariate logistic regression statistical
analysis with model fitting/sample size
calculation. Hypotheses are that female
sex, a smaller size graft, and younger
patients will increase the odds of failure. The conclusion was that physicians
should counsel female patients, those
younger than 25, and those with a graft
size <8mm, accordingly, and consider
modifying their surgical or rehabilitation
techniques to mitigate these risks.
Barbara Klich is a Toronto-based freelance
writer.
March 2016
Sport Med 2016
SPORT RELATED CONCUSSIONS FOR PHYSICIANS
ƌĞĂƚĞĚďǇƚŚĞKD^ĞĐƟŽŶŽĨ^ƉŽƌƚΘǆĞƌĐŝƐĞDĞĚŝĐŝŶĞ
COMMON SYMPTOMS
POST-CONCUSSION SYNDROME
RETURN TO PLAY
ŽŐŶŝƟǀĞ
ͻŽŶĐƵƐƐŝŽŶƐǇŵƉƚŽŵƐƉĞƌƐŝƐƚďĞǇŽŶĚ
ƚŚĞ͞ŶŽƌŵĂů͟ĞǆƉĞĐƚĞĚĚƵƌĂƟŽŶ͖ŽĐĐƵƌƐ
ŝŶϭϬͲϭϱйŽĨƉĂƟĞŶƚƐ͕ĐĂŶůĂƐƚĨƌŽŵ
ǁĞĞŬƐƚŽŵŽŶƚŚƐ͘
^ƚĞƉϭ͗WŚǇƐŝĐĂůƌĞƐƚĂŶĚŵĞŶƚĂů
ĂĐƟǀŝƚǇ ĂƐƚŽůĞƌĂƚĞĚ͖ƐƚŽƉŝĨƐǇŵƉƚŽŵƐ
ǁŽƌƐĞŶ
ͻŝĸ
ĐƵůƚǇƚŚŝŶŬŝŶŐͬƌĞŵĞŵďĞƌŝŶŐ
ͻ&ĞĞůŝŶŐƐůŽǁĞĚĚŽǁŶ
ͻŝĸ
ĐƵůƚǇĐŽŶĐĞŶƚƌĂƟŶŐ
WŚǇƐŝĐĂů
ͻ,ĞĂĚĂĐŚĞ͕ŶĂƵƐĞĂͬǀŽŵŝƟŶŐ
ͻŝǌǌŝŶĞƐƐ͕ďĂůĂŶĐĞƉƌŽďůĞŵƐ
ͻ&ƵǌǌǇͬďůƵƌƌĞĚǀŝƐŝŽŶ͕ƐĞŶƐŝƟǀŝƚǇƚŽ
ůŝŐŚƚͬŶŽŝƐĞ
ͻ,ĂǀŝŶŐŶŽĞŶĞƌŐǇ͕ƟƌĞĚ
ͻdƌĞĂƚŵĞŶƚŽƉƟŽŶƐŝŶĐůƵĚĞ͗ƐůĞĞƉ
ĂŝĚƐ͕ĂŶƟͲĚĞƉƌĞƐƐĂŶƚƐ͕ŚĞĂĚĂĐŚĞ
ƉƌŽƉŚǇůĂǆŝƐ͕ƉŚǇƐŝŽƚŚĞƌĂƉǇ͕ǀŝƐŝŽŶ
ƚŚĞƌĂƉǇ͕ǀĞƐƟďƵůĂƌƚŚĞƌĂƉǇ͕ŶĞƌǀĞ
ďůŽĐŬ͕KdĨŽƌĐŽŐŶŝƟǀĞƌĞƚƌĂŝŶŝŶŐĞƚĐ͘
ͻZĞĨĞƌƌĂůƚŽĂƉŚǇƐŝĐŝĂŶĞǆƉĞƌŝĞŶĐĞĚŝŶ
W^ŝƐŽŌĞŶŚĞůƉĨƵů
^ƚĞƉϯ͗^ƉŽƌƚƐƉĞĐŝĮĐĞǆĞƌĐŝƐĞƐ
;Ğ͘Ő͘ƐŬĂƟŶŐ͕ƌƵŶŶŝŶŐ͕ƚŚƌŽǁŝŶŐ͕
ŝŶĚŝǀŝĚƵĂůƐŬŝůůƐͿ
ŵŽƟŽŶĂůͬDŽŽĚ
ͻ/ƌƌŝƚĂďŝůŝƚǇ͕ƐĂĚŶĞƐƐ͕ŵŽƌĞĞŵŽƟŽŶĂů͕
ŶĞƌǀŽƵƐŶĞƐƐŽƌĂŶǆŝĞƚǇ
TREATMENT
ϴϱйŽĨĂĚƵůƚƉĂƟĞŶƚƐƌĞĐŽǀĞƌŝŶϳͲϭϬ
ĚĂǇƐ͖ŬŝĚƐŽŌĞŶƚĂŬĞůŽŶŐĞƌ͘
^ůĞĞƉ
ͻ^ůĞĞƉŝŶŐŵŽƌĞŽƌůĞƐƐ͕ƚƌŽƵďůĞĨĂůůŝŶŐ
asleep
ĞƐƚƚƌĞĂƚŵĞŶƚŝƐĐŽŐŶŝƟǀĞΘƉŚǇƐŝĐĂů
rest, good ƐůĞĞƉŚǇŐŝĞŶĞΘƉĂĐŝŶŐ͘
DĞŶƚĂůƌĞƐƚŝƐŶŽƚĂůůŽƌŶŽƚŚŝŶŐ͊
tŚĞŶƐǇŵƉƚŽŵƐƐƚĂƌƚƚŽŝŵƉƌŽǀĞ͕
ďĞŐŝŶůŝŐŚƚƉƌŽŐƌĞƐƐŝǀĞĐŽŐŶŝƟǀĞĂĐƟǀŝƚǇ
;ĐŽŵƉƵƚĞƌ͕ds͕ƌĞĂĚŝŶŐͿĂƐƚŽůĞƌĂƚĞĚ͘/Ĩ
ƐǇŵƉƚŽŵƐǁŽƌƐĞŶ͕ƐƚŽƉƵŶƟůƌĞƐŽůǀĞƐ͘
ASSESSMENT
^dϯdŚĞ^dϯŝƐĂƐĐƌĞĞŶŝŶŐ
ĞǀĂůƵĂƟŽŶƚŽŽůƚŽĂƐƐĞƐƐ
ŝŶũƵƌĞĚĂƚŚůĞƚĞƐхĂŐĞϭϯĨŽƌ
ĐŽŶĐƵƐƐŝŽŶ͘/ƚŝŶĐůƵĚĞƐĂ
ƐǇŵƉƚŽŵĞǀĂůƵĂƟŽŶ͕
^ƚĂŶĚĂƌĚŝǌĞĚƐƐĞƐƐŵĞŶƚŽĨ
ŽŶĐƵƐƐŝŽŶ͕ŶĞĐŬ͕ďĂůĂŶĐĞ
ΘĐŽŽƌĚŝŶĂƟŽŶĞǆĂŵ͘
dŚĞ^dϯĚŽĞƐŶŽƚ
ŝŶĚĞƉĞŶĚĞŶƚůǇĚĞƚĞƌŵŝŶĞƚŚĞ
ĚŝĂŐŶŽƐŝƐŽĨĐŽŶĐƵƐƐŝŽŶďƵƚ
ĐĂŶĂƐƐŝƐƚƚŽŵŽŶŝƚŽƌƌĞĐŽǀĞƌǇ
ΘƌĞƚƵƌŶƚŽƉůĂǇƐƚĂƚƵƐ͘
CHILD DŽĚŝĮĞĚ^ƉŽƌƚŽŶĐƵƐƐŝŽŶ
SCAT ƐƐĞƐƐŵĞŶƚdŽŽůĨŽƌĐŚŝůĚƌĞŶ
ĂŐĞƐϱͲϭϮǇĞĂƌƐǁŝƚŚƉĂƌĞŶƚĂů
ŝŶƉƵƚ͘
EXAMSEĞƵƌŽ͕ŶĞĐŬ͕Ed͕ďĂůĂŶĐĞ
tests
/D'/E'EŽƚŐĞŶĞƌĂůůǇŝŶĚŝĐĂƚĞĚ͖
ĐŽŶƐŝĚĞƌŝĨ'^фϭϱ͕ƉƌŽůŽŶŐĞĚ
>K͕ĨŽĐĂůŶĞƵƌŽůŽŐŝĐĂů
ƐǇŵƉƚŽŵƐ͕ǁŽƌƐĞŶŝŶŐ
headache, protracted
ǀŽŵŝƟŶŐŽƌĐŽŶĨƵƐŝŽŶ
^ƚĞƉϮ͗>ŝŐŚƚĂĞƌŽďŝĐĞǆĞƌĐŝƐĞ
;Ğ͘Ő͘ǁĂůŬŝŶŐͬƐƚĂƟŽŶĂƌǇďŝŬĞĨŽƌϭϬͲϭϱ
ŵŝŶĂƚфϱϬйŝŶƚĞŶƐŝƚǇ͕ŝŶĐƌĞĂƐŝŶŐ
ĚƵƌĂƟŽŶĂŶĚŝŶƚĞŶƐŝƚǇĂƐƐǇŵƉƚŽŵƐ
ĂůůŽǁͿ
WŚǇƐŝĐĂůƌĞƐƚƌĞƋƵŝƌĞĚƵŶƟůŵĞŶƚĂů
ĂĐƟǀŝƚǇƚŽůĞƌĂƚĞĚ͘dŚĞŶĂŐƌĂĚƵĂů
ƐƚĞƉǁŝƐĞĂƉƉƌŽĂĐŚĐĂŶďĞŝŵƉůĞŵĞŶƚĞĚ
ĨŽƌƌĞƚƵƌŶƚŽƉůĂǇ͘
^ƚĞƉϰ͗EŽŶͲĐŽŶƚĂĐƚƚƌĂŝŶŝŶŐͬĚƌŝůůƐ
tĞĂƌĂ͞ƌĞĚͬǇĞůůŽǁũĞƌƐĞǇ͟ĨŽƌ
ƐĐƌŝŵŵĂŐĞ͕ƌĞƐŝƐƚĂŶĐĞƚƌĂŝŶŝŶŐ
;ǁĞŝŐŚƚƐ͕ƉƵƐŚͲƵƉƐ͕ĐŽƌĞĞǆĞƌĐŝƐĞƐͿ
* get clearance from MD before
ƉƌŽĐĞĞĚŝŶŐƚŽĐŽŶƚĂĐƚ
^ƚĞƉϱ͗ŽŶƚĂĐƚƉƌĂĐƟĐĞ
/ĨƐǇŵƉƚŽŵĨƌĞĞǁŝƚŚĨƵůůĐŽŶƚĂĐƚ
ƚƌĂŝŶŝŶŐͬƉƌĂĐƟĐĞ͕ĐĂŶƉƌŽĐĞĞĚƚŽ
ĐŽŵƉĞƟƟŽŶͬŐĂŵĞ
^ƚĞƉϲ͗ZĞƚƵƌŶƚŽ'ĂŵĞ
dŚĞƌĞƐŚŽƵůĚďĞĂŵŝŶŝŵƵŵŽĨϮϰ
ŚŽƵƌƐďĞƚǁĞĞŶĞĂĐŚƐƚĞƉ͘/ĨƐǇŵƉƚŽŵƐ
ƉĞƌƐŝƐƚŽƌǁŽƌƐĞŶ͕ƌĞƐƚĂŶĚĚŽŶŽƚ
proceed to the next step.
RETURN TO LEARN
dŚŝƐƐƚĞƉďĞŐŝŶƐǁŚĞŶƚŚĞƉĂƟĞŶƚŝƐ
ƌĞĂĚǇƚŽŵŽǀĞŽŶĨƌŽŵĐŽŐŶŝƟǀĞƌĞƐƚ͕
ďƵƚŶŽƚƌĞĂĚǇĨŽƌƉŚǇƐŝĐĂůĂĐƟǀŝƚǇ͘
/ĨƚŚĞƉĂƟĞŶƚƐƟůůŚĂƐƐǇŵƉƚŽŵƐďƵƚŝƐ
ŝŵƉƌŽǀŝŶŐ͕ƚŚĞǇǁŝůůƐƚĂƌƚĂƚKW,ƐƚĞƉ
ϮĂ͘dŚŝƐƐƚĞƉŝŶĐůƵĚĞƐŝŶĚŝǀŝĚƵĂůŝǌĞĚ
ĐůĂƐƐƌŽŽŵƐƚƌĂƚĞŐŝĞƐƚŽŐƌĂĚƵĂůůǇ
ŝŶĐƌĞĂƐĞĐŽŐŶŝƟǀĞĂĐƟǀŝƚǇ͗
ͻĂůůŽǁĨƌĞƋƵĞŶƚďƌĞĂŬƐ
ͻƉƌŽǀŝĚĞĂĚĂŝůǇŽƌŐĂŶŝǌĞƌ
ͻƌĞĚƵĐĞͬƉƌŝŽƌŝƟǌĞŚŽŵĞǁŽƌŬĂŶĚ
ĂƐƐŝŐŶŵĞŶƚƐ
ͻĞǆƚƌĂƟŵĞΘƋƵŝĞƚƌŽŽŵĨŽƌĞǆĂŵƐ
ͻƉƌŽǀŝĚĞĂĐĐĞƐƐƚŽŶĂƚƵƌĂůůŝŐŚƟŶŐ
/ĨƚŚĞƐƚƵĚĞŶƚŝƐƐǇŵƉƚŽŵͲĨƌĞĞĂƚƌĞƐƚ
ĂŶĚĐŽŵƉůĞƚĞƐƐƚĞƉϮĂ͕ƚŚĞǇƉƌŽĐĞĞĚƚŽ
ƐƚĞƉϮď͘ƚƚŚŝƐƐƚĂŐĞ͕ƚŚĞǇƌĞƚƵƌŶƚŽƚŚĞ
ĐůĂƐƐƌŽŽŵǁŝƚŚŽƵƚĂŶǇŝŶĚŝǀŝĚƵĂůŝǌĞĚ
plans.
RESOURCES
parachutecanada.org
casem-acmse.org
ophea.net
onf.org
bjsm.bmj.com/content/47/5/250.full
;ZĞĐŽŵŵĞŶĚĂƟŽŶƐĂƌĞďĂƐĞĚŽŶƚŚĞϮϬϭϮ
/ŶƚĞƌŶĂƟŽŶĂůĐŽŶĐƵƐƐŝŽŶ
consensus statement)
ŽŶƐƵůƚǇŽƵƌůŽĐĂů^ƉŽƌƚĂŶĚǆĞƌĐŝƐĞDĞĚŝĐŝŶĞWŚǇƐŝĐŝĂŶĨŽƌĂƐƐŝƐƚĂŶĐĞ͘
ƐƉŽƌƚƐĂŶĚĞǆĞƌĐŝƐĞŵĞĚŝĐŝŶĞ͘ĐĂ
29
March 2016
FEATURE
Exercise is Medicine Canada:
engaging patients in physical activity dialogue — practical tools,
CME workshops to assist physicians
by Brian R. MacIntosh, PhD, FACSM; Susan Yungblut, BScPT, MBA; Renata Frankovich, BMath, MD, FCFP, DipSportMed;
Paul Oh, MD, MSc, FRCPC; Jonathon Fowles, PhD, CSEP-CEP
“What if there was one prescription that could prevent and treat dozens of diseases, such
as diabetes, hypertension and obesity? Would you prescribe it to your patients? Certainly.”
- Robert E. Sallis, MD, FACSM, Exercise is Medicine® Task Force Chairman
Why Exercise?
T
he health benefits of physical activity — and the deterioration of health and
susceptibility to chronic disease associated with a sedentary lifestyle — are well
known. If more people would meet the goal of 150 minutes of moderate to vigorous
physical activity per week, as outlined in the Canadian Physical Activity Guidelines,
Canada would have a healthier population.
Many of the chronic conditions that currently contribute to the high incidence of
chronic disease can be diminished by
regular physical activity. This includes
cardiovascular disease, obesity, diabetes, hypertension, several cancers and
Alzheimer’s disease. In fact, increasing physical activity is probably the
single most important lifestyle intervention a sedentary person can make to
improve his or her health.
Recent research indicates that for
the primary prevention of diabetes
and secondary prevention of coronary
heart disease, stroke, and heart failure,
physical activity is as effective as, or
more effective, than many drug interventions. This makes exercise a valuable and effective preventive medicine
(see Figure 1, opposite).
How Much Exercise?
The Canadian Physical Activity Guidelines published by the Canadian Society
for Exercise Physiology (http://www.
csep.ca/en/guidelines/get-the-guidelines) identify that 150 minutes per
week of moderate to vigorous physical activity (MVPA), like a brisk walk, is
the amount of exercise that every adult
should strive for to be healthy.
For a sedentary person, it will be
easier to increase physical activity if
they begin with short, 10-minute bouts
of mild to moderate physical activity
on a daily basis. It is not necessary to
reach the 150 minutes in the first week,
but they can build to that target over a
period of a few months.
When someone achieves the recommended guidelines of 150 minutes
per week of MVPA, there is approximately a 30% reduction in mortality risk, in addition to numerous other
health benefits, including reduced risk
of diabetes, cancer, depression, and
stroke. The side-effects of this treatment include improved quality of life.
30
In short, evidence shows that more
physical activity is better (see Figure
2, opposite), and increased vigorous
activity results in greater fitness and
greater overall health benefit.
Evidence also shows that, unfortunately, the great majority of Canadians
are not currently active enough to
meet the Canadian Physical Activity
Guidelines and therefore do not achieve
these numerous health benefits.
There are many barriers that impede
people from being physically active
(e.g., lack of time, motivation, confidence, facilities, etc.). In addition,
despite the proven positive physical
and mental health benefits of exercise,
long-term adherence to exercise programs can be challenging. Only about
half of all persons who initiate an exercise program continue the habit for
more than six months.
The issue of non-adherence is particularly important because exercise
March 2016
Figure 1
Relationship Between Cardiorespiratory Fitness and Health Risk For Men and Women,
Expressed as Attributable Fraction1 (Proportion of Deaths Attributed to Listed Causes)*
Attributable Fractions (%)
18
16
14
12
10
8
6
4
2
0
Men
Women
w
Lo
*
F*
R
C
er
ok
Sm
y
sit
e
Ob
ion
ns
e
rt
pe
y
H
l
ro
te
s
le
ho
c
gh
Hi
es
et
b
a
Di
* Reproduced with permission of BMJ Group. (Note: Figure 1 is adapted from Reference 1, which appears on page 33.)
** Low CRF refers to low cardiorespiratory fitness.
Figure 2
Health Benefits of Exercise2,3
All-Cause Mortality Risk Reduction
60
50
40
30
Proportion Vigorous
Moderate
20
10
0
0
50
100
150
200
250
300
Quantity of Physical Activity/Exercise Each Week (min)
By increasing moderate to vigorous physical activity, all-cause mortality (blue line) is reduced for even small increases, up to 150
minutes of physical activity per week (red dot). Beyond this duration, there are further benefits, but the slope of the relationship
decreases. A similar line could be drawn to represent risk for various chronic diseases (diabetes, heart disease, and some cancers).
When physical activity includes vigorous intensity (red line), additional risk reduction is obtained. Vigorous physical activity is most
beneficial for increasing cardiorespiratory fitness.
(Note: Figure 2 is based on data presented from References 2 and 3, which appear on page 33.)
31
March 2016
is most beneficial to achieve optimal
health benefits when maintained over
time. Strategies to encourage more
people to meet the Canadian Physical
Activity Guidelines, and to maintain their
exercise programs, are required.
Motivate Patients To Become
Physically Active
Despite the strength of the evidence
supporting the need for increased
physical activity, many physicians are
not routinely assessing and advising
their patients on the health benefits of
physical activity or prescribing exercise “as medicine.” Family physicians
have substantial time constraints, and
often lack physical activity counseling
skills, training or knowledge. Yet, with
appropriate training, it is possible to
engage physicians in the assessment
of physical activity and prescription of
exercise with only a small investment
of their time.
A first step that can be immediately
incorporated into practice — alongside
routine monitoring of patients' weight
and blood pressure — is one of the key
aspects of assessment by consistent
evaluation of the Exercise Vital Sign
(see Sidebar 1, below). This means
asking every patient, every time, how
much physical activity they are getting.
It is also important to counsel patients
about the risks of a sedentary lifestyle.
Exercise is Medicine Canada
Exercise is Medicine Canada (EIMC)
is a program that provides physicians
with training and support in prescribing
exercise to their patients. EIMC believes
that enabling health care professionals to make routine physical activity
assessment and exercise prescription a
standard part of the disease prevention
and treatment for all patients can be an
important part of an effective strategy to
improve the health of Canadians.
EIMC hosts regular workshops
across the country to educate physicians and other health care professionals on how to assess current physical
activity and talk to their patients about
increasing physical activity. The workshops, which are accredited by the
College of Family Physicians of Canada
and the Royal College of Physicians and
Surgeons of Canada, can help more
physicians engage their patients in the
discussion about a healthy lifestyle.
To view a schedule of workshops,
or to find out how to bring a workshop
Sidebar 1
The Exercise Vital Sign
• Ask your patients: "On average, how many minutes per week are you engaged
in moderate to vigorous physical activity, like a brisk walk?"
• Remind your patients that you recommend 150 minutes of moderate to vigorous physical activity per week (this is consistent with the Canadian Physical
Activity Guidelines published by the Canadian Society for Exercise Physiology).
Sidebar 2
Exercise is Medicine Canada: Advisory Council Member Organizations
•
•
•
•
•
•
•
•
•
•
Canadian Society for Exercise Physiology, Chair
College of Family Physicians of Canada
Canadian Academy for Sport and Exercise Medicine
Canadian Nurses Association
Canadian Physiotherapy Association
Dietitians of Canada
Canadian Kinesiology Alliance
Canadian Society for Psychomotor Learning in Sport and Exercise Psychology
Royal College of Chiropractic Sport Sciences (Canada)
Clinical Exercise Professional Representative
32
to your team, visit the EIMC website at
exerciseismedicine.ca.
The EIMC Advisory Council, whose
members represent several Canadian
health and exercise science organizations (see Sidebar 2, below), is helping members of the health professions
engage in exercise assessment and
prescription.
The EIMC website provides useful information and tools for engaging patients in the physical activity
dialogue. In addition to providing an
exercise prescription pad and a suggested flow-chart of questions and
answers (see Figure 3, opposite), the
website also contains links to important professional resources for health
care teams, including physicians, other
regulated health professionals (e.g.,
physiotherapists and registered kinesiologists), and highly qualified exercise professionals, which can facilitate
these strategies with co-operation
from community programs that provide opportunities for active living.
Effective motivational strategies are
required to achieve and sustain active
behaviours in Canadians. EIMC is asking physicians to promote, support
and facilitate change. EIMC advocates
a multidisciplinary support system to
safely accept referrals for intensive
counseling and barrier reduction in
community settings to help patients
reach their health goals through
increased physical activity. Success
of this initiative will also require political endorsement of health policies that
support community programs and the
involvement of qualified exercise professionals to assist in the process.
EIMC has a recognition program
to help physicians select appropriately qualified exercise professionals.
Health professionals are encouraged
to look for EIMC Recognized Exercise
Professionals in their community for
referral and support for patients who
require assistance to safely exercise,
but who no longer require clinical care,
thereby greatly increasing the patient’s
ability to control and improve their
health throughout their life.
Many patients, especially those who
have no cardiorespiratory risk factors,
can safely exercise, analogous to taking
March 2016
an over-the-counter medication. Some
patients who have been sedentary for a
long time or with chronic medical conditions may require the assistance and
monitoring of an appropriately qualified
exercise professional to help them with
their physical activity routine and an
exercise “prescription.”
exerciseismedicine.ca (materials are
available in English and French). You
can also follow EIMC on Facebook
(http://ow.ly/YWatO) and Twitter (twitter.
com/EIM_Canada).
We encourage physicians to participate in EIMC’s vision that “Physical
activity is an integral part of prevention
and treatment of chronic disease in the
Canadian health care system.”
Join Exercise Is Medicine Canada
EIMC is building a professional referral
network linking health and exercise professionals to assist the communication
and referral process. Health care professionals are encouraged to join this
professional network to keep informed
of the activities of EIMC and to help
support this important initiative.
To join EIMC, learn more about the
program, access the tools, or find out
about local workshops, please visit
Fowles is Director, Centre of Lifestyle
Studies, Acadia University.
References
1.
Blair SN. Physical inactivity: the biggest
public health problem of the 21st century.
Br J Sports Med. 2009 Jan;43(1):1-2.
Available at: http://bjsm.bmj.com/content/
43/1/1.long. Accessed: 2016 Feb 25.
2.
Gebel K, Ding D, Chey T, et al. Effect of
moderate to vigorous physical activity on
Brian MacIntosh is Chair, Exercise is
Medicine Canada, and Professor, Faculty
of Kinesiology, University of Calgary. Susan
Yungblut is Director, Exercise is Medicine
Canada. Dr. Renata Frankovich is a Sport
Medicine Physician and Assistant Professor,
University of Ottawa, Faculty of Medicine. Dr.
Paul Oh is Medical Director, Cardiovascular
Prevention and Rehabilitation Program,
Toronto Rehabilitation Institute. Jonathon
all-cause mortality in middle-aged and
older Australians. JAMA Intern Med. 2015
Jun;175(6):970-7. Erratum in: JAMA Intern
Med. 2015 Jul;175(7):1248.
3.
Arem H, Moore SC, Patel A, Hartge P,
Berrington de Gonzalez A, et al. Leisure
time physical activity and mortality: a
detailed pooled analysis of the doseresponse relationship. JAMA Intern Med.
2015 Jun;175(6):959-67.
Figure 3
Prescription And Referral Tool Created By Exercise Is Medicine Canada
(The tool can be downloaded from exerciseismedicine.ca; hard copies can be ordered from the EIMC office at [email protected])
WHAT DO WE KNOW ABOUT EXERCISE?
Exercise prescription & referral
• Exercise will make you feel good and can be fun!
Canada
www.exerciseismedicine.ca
• Exercise is effective. If exercise was a drug, it would be one of the most effective and
safe ways to prevent and treat many chronic diseases such as heart disease,
Name
hypertension, diabetes, osteoporosis, anxiety disorders and depression!
Date
Age
• Exercise is safe for your joints. Regular low impact exercise and gradual muscle
strengthening can stabilise and protect your joints from osteoarthritis and reduce the
Relevant diagnoses
risk of falls and injuries that is associated with poor physical fitness.
• Improving fitness is more important than losing weight. Low cardiovascular fitness
REDUCE SEDENTARY BEHAVIOUR
Move more
/
Sit less
is associated with a much higher risk of disease and death than being overweight.
/ Use stairs / Limit screen time
• Walking is free anywhere and any day of the year!
PHYSICAL ACTIVITY RECOMMENDATIONS
WHAT ABOUT AEROBIC INTENSITY AND MUSCLE STRENGTHENING?
AEROBIC / CARDIOVASCULAR ACTIVITY
Frequency
Intensity
Light
Moderate
How can I assess intensity?
days / week
• Light exercise will usually not cause adults to sweat and breathe harder. It is easy
Vigorous
to have a conversation at this intensity. Walking is the typical example of light exercise.
moreminutes / session
Time
• Moderate-intensity exercise will cause adults to sweat a little and breathe harder.
Type
It is possible to have a conversation in short sentences. Examples are brisk walking (as
if you are late for the bus!) and bike riding.
STRENGTH / RESISTANCE ACTIVITY
• Vigorous-intensity exercise will cause adults to sweat and be “out of breath”. It
days / week
is difficult to have a conversation. Examples are jogging, swimming laps, cross-country
Example
skiing and hiking on hills.
CANADIAN PHYSICAL ACTIVITY GUIDELINES FOR ADULTS 18 YEARS AND OLDER
What is strength and resistance exercise?
To achieve health benefits, adults aged 18 years and older should accumulate at least
150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in
bouts of 10 minutes or more. It is also beneficial to add muscle and bone strengthening
activities using major muscle groups, at least 2 days per week. More physical activity
provides greater health benefits.
• Strength and resistance exercises make your muscles work harder by adding weight
or resistance to the movement.
For more information
REFERRAL FOR ADDITIONAL EXERCISE ASSESSMENT AND COUNSELING
You can consult your health professional, an exercise professional or visit the
Resources page on exerciseismedicine.ca.
Name / Contact
Follow-up / Other
CASEM
ACMSE
YOUR HEALTH PROFESSIONAL
ROYAL COLLEGE OF CHIROPRACTIC
SPORTS SCIENCES (CANADA)
Name
Signature
COLLEGE ROYAL DES SCIENCES SPORTS
CHIROPRACTIQUE (CANADA)
Licence #
33
March 2016
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Quick Reference Guide
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ŚƌŽŶŝĐƉĂŝŶŽƵƚͲƉĂƚŝĞŶƚĐĂƐĞĐŽŶĨĞƌĞŶĐĞ
Ύ KƚŚĞƌƉŚǇƐŝĐŝĂŶƐĂƌĞĞůŝŐŝďůĞƚŽďŝůů<ϳϬϭ͕<ϳϬϯĂŶĚ<ϳϬϰĂƐůŽŶŐĂƐƚŚĞƉŚǇƐŝĐŝĂŶŽĨƚŚĞĂƉƉƌŽƉƌŝĂƚĞ
ƐƉĞĐŝĂůƚǇĂŶĚŵŽƐƚƌĞƐƉŽŶƐŝďůĞĨŽƌƚŚĞĐĂƌĞŽĨƚŚĞƉĂƚŝĞŶƚŝƐƉĂƌƚŝĐŝƉĂƚŝŶŐŝŶƚŚĞĐĂƐĞĐŽŶĨĞƌĞŶĐĞ͘
^ĞƌǀŝĐĞƐƌĞŶĚĞƌĞĚŝŶƐƵƉƉŽƌƚŽĨŵƵůƚŝĚŝƐĐŝƉůŝŶĂƌǇĐĂŶĐĞƌĐŽŶĨĞƌĞŶĐĞƐ;DƐͿĂƌĞĚŝƐĐƵƐƐĞĚƵŶĚĞƌ^ĞĐƚŝŽŶ
ďĞůŽǁ͘
͗WĂǇŵĞŶƚZĞƋƵŝƌĞŵĞŶƚƐ
WĂǇŵĞŶƚůŝŐŝďŝůŝƚǇ
ĂĐŚĐĂƐĞĐŽŶĨĞƌĞŶĐĞŝƐƐƵďũĞĐƚƚŽƐƉĞĐŝĨŝĐƉĂǇŵĞŶƚƐƌĞƋƵŝƌĞŵĞŶƚƐůŝƐƚĞĚƵŶĚĞƌƚŚĞƌĞƐƉĞĐƚŝǀĞĨĞĞĐŽĚĞ͖
ŚŽǁĞǀĞƌ͕ƚŚĞĨŽůůŽǁŝŶŐƐĞƌǀŝĐĞƌĞƋƵŝƌĞŵĞŶƚƐŵƵƐƚďĞƐĂƚŝƐĨŝĞĚďǇĂůůĐĂƐĞĐŽŶĨĞƌĞŶĐĞƐ͗
• ĐĂƐĞĐŽŶĨĞƌĞŶĐĞŵƵƐƚďĞĐŽŶĚƵĐƚĞĚďǇƉĞƌƐŽŶĂůĂƚƚĞŶĚĂŶĐĞ͕ǀŝĚĞŽĐŽŶĨĞƌĞŶĐĞŽƌďǇ
ƚĞůĞƉŚŽŶĞ;ŽƌĂŶǇĐŽŵďŝŶĂƚŝŽŶƚŚĞƌĞŽĨͿ
• /ƚŵƵƐƚŝŶǀŽůǀĞĂƚůĞĂƐƚϮŽƚŚĞƌĞůŝŐŝďůĞƉĂƌƚŝĐŝƉĂŶƚƐĂƐƐƉĞĐŝĨŝĞĚŝŶƚŚĞƐƉĞĐŝĨŝĐĐĂƐĞĐŽŶĨĞƌĞŶĐĞ
ƐĞƌǀŝĐĞ;ƐĞĞ^ĞĐƚŝŽŶďĞůŽǁĨŽƌĂĚĚŝƚŝŽŶĂůĚĞƚĂŝůƐͿ
• ƚůĞĂƐƚŽŶĞŽĨƚŚĞƉŚǇƐŝĐŝĂŶƉĂƌƚŝĐŝƉĂŶƚƐŝƐƚŚĞƉŚǇƐŝĐŝĂŶŵŽƐƚƌĞƐƉŽŶƐŝďůĞĨŽƌƚŚĞĐĂƌĞŽĨƚŚĞ
ƉĂƚŝĞŶƚ
• dŚĞƉŚǇƐŝĐŝĂŶŵƵƐƚĂĐƚŝǀĞůǇƉĂƌƚŝĐŝƉĂƚĞŝŶƚŚĞĐĂƐĞĐŽŶĨĞƌĞŶĐĞĂŶĚƐƵĐŚƉĂƌƚŝĐŝƉĂƚŝŽŶŝƐĞǀŝĚĞŶƚ
ŝŶƚŚĞŵĞĚŝĐĂůƌĞĐŽƌĚ
• dŚĞƌĞŵƵƐƚďĞĂŵŝŶŝŵƵŵŽĨϭϬŵŝŶƵƚĞƐŽĨƉĂƚŝĞŶƚƌĞůĂƚĞĚĚŝƐĐƵƐƐŝŽŶ
• ĂƐĞĐŽŶĨĞƌĞŶĐĞŵƵƐƚďĞƉƌĞͲƐĐŚĞĚƵůĞĚ
WĂǇŵĞŶƚǆĐůƵƐŝŽŶƐ
ĐĂƐĞĐŽŶĨĞƌĞŶĐĞŝƐŶŽƚĞůŝŐŝďůĞĨŽƌƉĂǇŵĞŶƚ͗
• /ŶĐŝƌĐƵŵƐƚĂŶĐĞƐǁŚĞƌĞĂƉŚǇƐŝĐŝĂŶĐůĂŝŵŝŶŐƚŚĞƐĞƌǀŝĐĞƌĞŵƵŶĞƌĂƚĞƐŽƚŚĞƌƉĂƌƚŝĐŝƉĂŶƚƐǁŚŽ
ĂƌĞŶĞĐĞƐƐĂƌǇƚŽŵĞĞƚƚŚĞŵŝŶŝŵƵŵƌĞƋƵŝƌĞŵĞŶƚ
2
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•
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dŽĂƉŚǇƐŝĐŝĂŶǁŚŽƌĞĐĞŝǀĞƐƉĂǇŵĞŶƚĨŽƌƚŚĞƉƌĞƉĂƌĂƚŝŽŶĂŶĚͬŽƌƉĂƌƚŝĐŝƉĂƚŝŽŶŝŶƚŚĞĐĂƐĞ
ĐŽŶĨĞƌĞŶĐĞŽƚŚĞƌƚŚĂŶďǇĨĞĞͲĨŽƌͲƐĞƌǀŝĐĞ;ŝŶĐůƵĚĞƐĐŽŵƉĞŶƐĂƚŝŽŶǁŚĞƌĞƚŚĞƉŚǇƐŝĐŝĂŶƌĞĐĞŝǀĞƐ
ƌĞŵƵŶĞƌĂƚŝŽŶƵŶĚĞƌĂƐĂůĂƌǇƉƌŝŵĂƌǇĐĂƌĞ͕ƐƚŝƉĞŶĚ͕WWŽƌ&WŵŽĚĞůͿ
tŚĞƌĞŝƚŝƐĂŶŝŶĐůƵĚĞĚĞůĞŵĞŶƚŽĨĂŶŽƚŚĞƌƐĞƌǀŝĐĞ;Ğ͘Ő͕͘ŚƌŽŶŝĐĚŝĂůǇƐŝƐƚĞĂŵĨĞĞƐͿ
tŚĞŶƚŚĞƐĞƌǀŝĐĞŝƐƌĞŶĚĞƌĞĚĨŽƌĞĚƵĐĂƚŝŽŶĂůƉƵƌƉŽƐĞƐƐƵĐŚĂƐƌŽƵŶĚƐ͕ŽƌĐŽŶƚŝŶƵŝŶŐ
ƉƌŽĨĞƐƐŝŽŶĂůĚĞǀĞůŽƉŵĞŶƚ͕ŽƌĂŶǇŵĞĞƚŝŶŐǁŚĞƌĞƚŚĞĐŽŶĨĞƌĞŶĐĞŝƐŶŽƚĨŽƌƚŚĞƉƵƌƉŽƐĞƐŽĨ
ĚŝƐĐƵƐƐŝŶŐĂŶĚĚŝƌĞĐƚŝŶŐƚŚĞŵĂŶĂŐĞŵĞŶƚŽĨĂŶŝŶĚŝǀŝĚƵĂůƉĂƚŝĞŶƚ
/ĨĂŶŽƚŚĞƌĐĂƐĞĐŽŶĨĞƌĞŶĐĞŽƌƚĞůĞƉŚŽŶĞĐŽŶƐƵůƚĂƚŝŽŶŚĂƐĂůƌĞĂĚǇďĞĞŶƉĂŝĚĨŽƌƚŚĞƉĂƚŝĞŶƚŽŶ
ƚŚĂƚĚĂǇ
DĞĚŝĐĂůZĞĐŽƌĚZĞƋƵŝƌĞŵĞŶƚƐ
/ŶŽƌĚĞƌƚŽĨƵůůǇƐĂƚŝƐĨǇƉĂǇŵĞŶƚƌĞƋƵŝƌĞŵĞŶƚƐ͕ƚŚĞŵĞĚŝĐĂůƌĞĐŽƌĚŵƵƐƚŝŶĐůƵĚĞĂůůŽĨƚŚĞĨŽůůŽǁŝŶŐ
ĞůĞŵĞŶƚƐ͗
• ŝĚĞŶƚŝĨŝĐĂƚŝŽŶŽĨƚŚĞƉĂƚŝĞŶƚ
• ƐƚĂƌƚĂŶĚƐƚŽƉƚŝŵĞŽĨƚŚĞĚŝƐĐƵƐƐŝŽŶƌĞŐĂƌĚŝŶŐƚŚĞƉĂƚŝĞŶƚ
• ŝĚĞŶƚŝĨŝĐĂƚŝŽŶŽĨƚŚĞĞůŝŐŝďůĞƉĂƌƚŝĐŝƉĂŶƚƐ͕ĂŶĚ
• ƚŚĞŽƵƚĐŽŵĞŽƌĚĞĐŝƐŝŽŶŽĨƚŚĞĐĂƐĞĐŽŶĨĞƌĞŶĐĞ
&ŽƌďŝůůŝŶŐƉƵƌƉŽƐĞƐ͕ŽŶĞĐŽŵŵŽŶŵĞĚŝĐĂůƌĞĐŽƌĚŝŶƚŚĞƉĂƚŝĞŶƚΖƐĐŚĂƌƚĨŽƌƚŚĞĐĂƐĞĐŽŶĨĞƌĞŶĐĞƐŝŐŶĞĚ
ŽƌŝŶŝƚŝĂůĞĚďǇĂůůƉŚǇƐŝĐŝĂŶƉĂƌƚŝĐŝƉĂŶƚƐ;ŝŶĐůƵĚŝŶŐůŝƐƚŝŶŐƚŚĞƚŝŵĞƚŚĞƐĞƌǀŝĐĞĐŽŵŵĞŶĐĞĚĂŶĚ
ƚĞƌŵŝŶĂƚĞĚĂŶĚŝŶĚŝǀŝĚƵĂůĂƚƚĞŶĚĂŶĐĞƚŝŵĞƐĨŽƌĞĂĐŚƉĂƌƚŝĐŝƉĂŶƚŝĨĚŝĨĨĞƌĞŶƚͿǁŽƵůĚƐĂƚŝƐĨǇƚŚĞŵĞĚŝĐĂů
ƌĞĐŽƌĚƌĞƋƵŝƌĞŵĞŶƚƐ͘
/ŶĐŝƌĐƵŵƐƚĂŶĐĞƐǁŚĞƌĞŵŽƌĞƚŚĂŶŽŶĞƉĂƚŝĞŶƚŝƐĚŝƐĐƵƐƐĞĚĂƚĂĐĂƐĞĐŽŶĨĞƌĞŶĐĞ͕ƐĞƉĂƌĂƚĞĐůĂŝŵƐĨŽƌ
ĞĂĐŚƉĂƚŝĞŶƚĂƌĞĞůŝŐŝďůĞĨŽƌƉĂǇŵĞŶƚƉƌŽǀŝĚĞĚĂůůƉĂǇŵĞŶƚƌĞƋƵŝƌĞŵĞŶƚƐĂƌĞĨƵůĨŝůůĞĚĨŽƌĞĂĐŚ
ŝŶĚŝǀŝĚƵĂůƉĂƚŝĞŶƚ͘
ŶǇŽƚŚĞƌŝŶƐƵƌĞĚƐĞƌǀŝĐĞƌĞŶĚĞƌĞĚĚƵƌŝŶŐĂĐĂƐĞĐŽŶĨĞƌĞŶĐĞŝƐŶŽƚĞůŝŐŝďůĞĨŽƌƉĂǇŵĞŶƚ͘
͗ůŝŐŝďůĞWĂƌƚŝĐŝƉĂŶƚƐĂŶĚWĂƚŝĞŶƚƐ
ůŝŐŝďůĞWĂƌƚŝĐŝƉĂŶƚƐ
&ŽƌĂůůĐĂƐĞĐŽŶĨĞƌĞŶĐĞƐ͕ƚŚĞƌĞŵƵƐƚďĞŽŶĞƉŚǇƐŝĐŝĂŶƉĂƌƚŝĐŝƉĂƚŝŶŐĂŶĚĂƚůĞĂƐƚƚǁŽŽƚŚĞƌĞůŝŐŝďůĞ
ƉĂƌƚŝĐŝƉĂŶƚƐ͘dŚĞƚǁŽŽƚŚĞƌĞůŝŐŝďůĞƉĂƌƚŝĐŝƉĂŶƚƐŵĂǇŝŶĐůƵĚĞƉŚǇƐŝĐŝĂŶƐ͕ƌĞŐƵůĂƚĞĚƐŽĐŝĂůǁŽƌŬĞƌƐ͕
ƌĞŐƵůĂƚĞĚŚĞĂůƚŚƉƌŽĨĞƐƐŝŽŶĂůƐŽƌƉĂƌƚŝĐŝƉĂŶƚƐƐƉĞĐŝĨŝĞĚŝŶƚŚĞƐĞƌǀŝĐĞďĞŝŶŐƌĞŶĚĞƌĞĚ͕ĂƐŶŽƚĞĚďĞůŽǁ͗
ĂƐĞŽŶĨĞƌĞŶĐĞ
<ϭϮϰ>ŽŶŐͲdĞƌŵĂƌĞͬŽŵŵƵŶŝƚǇ
ĂƌĞĐĐĞƐƐĞŶƚƌĞ;ͿƉĂƚŝĞŶƚƐ
<ϳϬϭDĞŶƚĂůŚĞĂůƚŚŽƵƚƉĂƚŝĞŶƚƐ
<ϳϬϮĂƌŝĂƚƌŝĐŽƵƚƉĂƚŝĞŶƚƐ
<ϳϬϰWĂĞĚŝĂƚƌŝĐŽƵƚƉĂƚŝĞŶƚƐ
ĚĚŝƚŝŽŶĂůůŝŐŝďůĞWĂƌƚŝĐŝƉĂŶƚƐ
ŵƉůŽǇĞĞƐŽĨĂ
WĞƌƐŽŶŶĞůĞŵƉůŽǇĞĚďǇĂŵĞŶƚĂůŚĞĂůƚŚĐŽŵŵƵŶŝƚǇ
ĂŐĞŶĐǇĨƵŶĚĞĚďǇƚŚĞDŝŶŝƐƚƌǇŽĨ,ĞĂůƚŚĂŶĚ>ŽŶŐͲdĞƌŵ
ĂƌĞ
DĞŵďĞƌƐŽĨƚŚĞĂƌŝĂƚƌŝĐZĞŐŝŽŶĂůƐƐĞƐƐŵĞŶƚdƌĞĂƚŵĞŶƚ
ĞŶƚƌĞ;ZdͿƚĞĂŵŝŶǀŽůǀĞĚǁŝƚŚƚŚĞƉĂƚŝĞŶƚ͛ƐĐĂƌĞ;Ğ͘Ő͘
ƐŽĐŝĂůǁŽƌŬĞƌ͕ƉƐǇĐŚŽůŽŐŝƐƚͿ
ĚƵĐĂƚŝŽŶĂůƉƌŽĨĞƐƐŝŽŶĂůƐĂŶĚͬŽƌƉĞƌƐŽŶŶĞůĞŵƉůŽǇĞĚďǇ
ĂŶĂĐĐƌĞĚŝƚĞĚĐĞŶƚƌĞŽĨŚŝůĚƌĞŶ͛ƐDĞŶƚĂů,ĞĂůƚŚKŶƚĂƌŝŽ
3
<ϳϬϱ>ŽŶŐͲƚĞƌŵĐĂƌĞ͕ŚŝŐŚƌŝƐŬ
ƉĂƚŝĞŶƚĐŽŶĨĞƌĞŶĐĞ
<ϳϬϲŽŶǀĂůĞƐĐĞŶƚĐĂƌĞƉƌŽŐƌĂŵ
ĐĂƐĞĐŽŶĨĞƌĞŶĐĞ
ŵƉůŽǇĞĞƐŽĨƚŚĞŽŶǀĂůĞƐĐĞŶƚĂƌĞWƌŽŐƌĂŵ
ůŝŐŝďůĞWĂƚŝĞŶƚƐ
ĂĐŚĐĂƐĞĐŽŶĨĞƌĞŶĐĞŝƐĂƉƉůŝĐĂďůĞƚŽĂƐƉĞĐŝĨŝĐƉĂƚŝĞŶƚĂƐĨŽůůŽǁƐ͗
• <ϭϮϭʹ,ŽƐƉŝƚĂůŝŶͲƉĂƚŝĞŶƚŝŶĂŶĂĐƵƚĞĐĂƌĞ͕ĐŚƌŽŶŝĐĐĂƌĞŽƌƌĞŚĂďŝůŝƚĂƚŝŽŶŚŽƐƉŝƚĂů
• <ϭϮϰʹ>ŽŶŐͲƚĞƌŵĐĂƌĞŝŶƐƚŝƚƵƚŝŽŶŝŶͲƉĂƚŝĞŶƚŽƌƉĂƚŝĞŶƚ
• <ϳϬϬʹWĂůůŝĂƚŝǀĞĐĂƌĞŽƵƚͲƉĂƚŝĞŶƚ
• <ϳϬϭʹDĞŶƚĂůŚĞĂůƚŚĂĚƵůƚŽƵƚͲƉĂƚŝĞŶƚ;ƐĞĞ<ϳϬϰĨŽƌŵĞŶƚĂůŚĞĂůƚŚŽƵƚͲƉĂƚŝĞŶƚĐĂƐĞĐŽŶĨĞƌĞŶĐĞƐ
ŝŶǀŽůǀŝŶŐĂƉĂƚŝĞŶƚůĞƐƐƚŚĂŶϭϴǇĞĂƌƐŽĨĂŐĞͿ
• <ϳϬϮʹKƵƚͲƉĂƚŝĞŶƚƌĞŐŝƐƚĞƌĞĚǁŝƚŚĂĂƌŝĂƚƌŝĐZdĨŽƌƚŚĞƉƵƌƉŽƐĞŽĨƉƌĞͲŽƉĞƌĂƚŝǀĞĞǀĂůƵĂƚŝŽŶ
ĂŶĚͬŽƌƉŽƐƚͲŽƉĞƌĂƚŝǀĞĨŽůůŽǁͲƵƉŵĞĚŝĐĂůĐĂƌĞ
• <ϳϬϯʹ'ĞƌŝĂƚƌŝĐŽƵƚͲƉĂƚŝĞŶƚĂƚůĞĂƐƚϲϱǇĞĂƌƐŽĨĂŐĞŽƌĂƉĂƚŝĞŶƚůĞƐƐƚŚĂŶϲϱǁŝƚŚĚĞŵĞŶƚŝĂ
• <ϳϬϰʹWĂĞĚŝĂƚƌŝĐŽƵƚͲƉĂƚŝĞŶƚůĞƐƐƚŚĂŶϭϴǇĞĂƌƐŽĨĂŐĞ
• <ϳϬϱͲ>ŽŶŐͲƚĞƌŵĐĂƌĞŝŶƐƚŝƚƵƚŝŽŶŚŝŐŚƌŝƐŬŝŶƉĂƚŝĞŶƚ;ĂƐŝĚĞŶƚŝĨŝĞĚďǇƐƚĂĨĨŝŶƚŚĞůŽŶŐƚĞƌŵ
ŝŶƐƚŝƚƵƚŝŽŶǁŝƚŚĐůŝŶŝĐĂůŝŶƐƚĂďŝůŝƚǇďĂƐĞĚŽŶĂĐŚĂŶŐĞŝŶƚŚĞZĞƐŝĚĞŶƚƐƐĞƐƐŵĞŶƚ/ŶƐƚƌƵŵĞŶƚʹ
DŝŶŝŵƵŵĂƚĂ^Ğƚ;Z/ͲD^ͿĨŽƌEƵƌƐŝŶŐ,ŽŵĞƐͿ
• <ϳϬϲͲWĂƚŝĞŶƚĞŶƌŽůůĞĚŝŶĂŽŶǀĂůĞƐĐĞŶƚĂƌĞWƌŽŐƌĂŵĨƵŶĚĞĚďǇƚŚĞDK,>d
• <ϳϬϳͲŚƌŽŶŝĐƉĂŝŶŽƵƚͲƉĂƚŝĞŶƚ;ĂƐĚĞĨŝŶĞĚĂƐĂƉĂŝŶĐŽŶĚŝƚŝŽŶǁŝƚŚĚƵƌĂƚŝŽŶŽĨƐǇŵƉƚŽŵĂƚŽůŽŐǇ
ŽĨĂƚůĞĂƐƚϲŵŽŶƚŚƐͿ
͗DƵůƚŝĚŝƐĐŝƉůŝŶĂƌǇĂŶĐĞƌŽŶĨĞƌĞŶĐĞƐ;DͿ
DĞĨŝŶŝƚŝŽŶ
K,/W^ĐŚĞĚƵůĞƐƚŝƉƵůĂƚĞƐƚŚĂƚ͞DŝƐĂƐĞƌǀŝĐĞĐŽŶĚƵĐƚĞĚĨŽƌƚŚĞƉƵƌƉŽƐĞŽĨĚŝƐĐƵƐƐŝŶŐĂŶĚĚŝƌĞĐƚŝŶŐƚŚĞ
ŵĂŶĂŐĞŵĞŶƚŽĨŽŶĞŽƌŵŽƌĞĐĂŶĐĞƌƉĂƚŝĞŶƚƐ͘͘͘͟ϲWĂƌƚŝĐŝƉĂƚŝŽŶŵĂǇĞŝƚŚĞƌďĞŝŶƉĞƌƐŽŶ͕ďǇƚĞůĞƉŚŽŶĞŽƌ
ďǇǀŝĚĞŽĐŽŶĨĞƌĞŶĐĞĂŶĚŵƵƐƚŵĞĞƚĂƚƚĞŶĚĂŶĐĞƌĞƋƵŝƌĞŵĞŶƚƐĞƐƚĂďůŝƐŚĞĚďǇĂŶĐĞƌĂƌĞKŶƚĂƌŝŽϳ͘
dŚĞĨĞĞƐĨŽƌƚŚĞƉƌŽǀŝƐŝŽŶŽĨƚŚĞƐĞƌǀŝĐĞƐĂƌĞƐĞƚĂƐĨŽůůŽǁƐ͗
• <ϳϬϴDWĂƌƚŝĐŝƉĂŶƚ͕ƉĞƌƉĂƚŝĞŶƚ;Ψϯϭ͘ϯϱͿΎ
• <ϳϬϵDŚĂŝƌƉĞƌƐŽŶ͕ƉĞƌƉĂƚŝĞŶƚ;ΨϰϬ͘ϰϱͿΎ
• <ϳϭϬDZĂĚŝŽůŽŐŝƐƚWĂƌƚŝĐŝƉĂŶƚ͕ƉĞƌƉĂƚŝĞŶƚ;Ψϯϭ͘ϯϱͿʹƌĞƐƚƌŝĐƚĞĚƚŽŝĂŐŶŽƐƚŝĐZĂĚŝŽůŽŐǇ;ϯϯͿ
ƉŚǇƐŝĐŝĂŶƐŽŶůǇ
Ύ <ϳϬϴĂŶĚ<ϳϬϵĂƌĞŶŽƚĞůŝŐŝďůĞĨŽƌƉĂǇŵĞŶƚƚŽƉŚǇƐŝĐŝĂŶƐĨƌŽŵƚŚĞĨŽůůŽǁŝŶŐƐƉĞĐŝĂůƚŝĞƐ͗ZĂĚŝĂƚŝŽŶ
KŶĐŽůŽŐǇ;ϯϰͿ͕ŝĂŐŶŽƐƚŝĐZĂĚŝŽůŽŐǇ;ϯϯͿĂŶĚ>ĂďŽƌĂƚŽƌǇDĞĚŝĐŝŶĞ;ϮϴͿ͘
WĂǇŵĞŶƚZĞƋƵŝƌĞŵĞŶƚƐ
dŚĞĨŽůůŽǁŝŶŐĐƌŝƚĞƌŝĂŵƵƐƚďĞƐĂƚŝƐĨŝĞĚŝŶŽƌĚĞƌƚŽďĞĞůŝŐŝďůĞĨŽƌƉĂǇŵĞŶƚ͗
• dŚĞĐŽŶĨĞƌĞŶĐĞŵƵƐƚďĞƉƌĞͲƐĐŚĞĚƵůĞĚ
ϲ
K,/W^ĐŚĞĚƵůĞ͕KĐƚŽďĞƌϭ͕ϮϬϭϱ͕ƉĂŐĞϮϬ
ĂŶĐĞƌĂƌĞKŶƚĂƌŝŽϮϬϬϲDƵůƚŝĚŝƐĐŝƉůŝŶĂƌǇĂŶĐĞƌŽŶĨĞƌĞŶĐĞƐƚĂŶĚĂƌĚƐ
ŚƚƚƉƐ͗ͬͬǁǁǁ͘ĐĂŶĐĞƌĐĂƌĞ͘ŽŶ͘ĐĂͬĐŽŵŵŽŶͬƉĂŐĞƐͬhƐĞƌ&ŝůĞ͘ĂƐƉǆ͍ĨŝůĞ/Ěсϭϰϯϭϴ
ϳ
4
•
•
dŚĞƌĞŝƐĂŵŝŶŝŵƵŵŽĨϭϬŵŝŶƵƚĞƐƚŽƚĂůƚŝŵĞŽĨĚŝƐĐƵƐƐŝŽŶƌĞŐĂƌĚŝŶŐŽŶĞŽƌŵŽƌĞƉĂƚŝĞŶƚƐ;ĨŽƌĂ
ƉĂƌƚŝĐŝƉĂŶƚŽƌĐŚĂŝƌƉĞƌƐŽŶŵĂŬŝŶŐĂĐůĂŝŵͿ͘dŚĞƉŚǇƐŝĐŝĂŶŵƵƐƚďĞĂĐƚŝǀĞůǇƉĂƌƚŝĐŝƉĂƚŝŶŐŝŶƚŚĞ
ĐĂƐĞĐŽŶĨĞƌĞŶĐĞ͕ĂŶĚƚŚĞŝƌƉĂƌƚŝĐŝƉĂƚŝŽŶŝƐƚŽďĞĚŽĐƵŵĞŶƚĞĚŝŶƚŚĞƌĞĐŽƌĚ
DŵĞĞƚƐƚŚĞŵŝŶŝŵƵŵƐƚĂŶĚĂƌĚƐ͕ŝŶĐůƵĚŝŶŐĂƚƚĞŶĚĂŶĐĞĂŶĚĚŽĐƵŵĞŶƚĂƚŝŽŶƌĞƋƵŝƌĞŵĞŶƚƐ͕
ĞƐƚĂďůŝƐŚĞĚďǇĂŶĐĞƌĂƌĞKŶƚĂƌŝŽ͘dŚĞƐĞŵĂǇďĞĂĐĐĞƐƐĞĚĂƚ
ǁǁǁ͘ĐĂŶĐĞƌĐĂƌĞ͘ŽŶ͘ĐĂͬĐŽŵŵŽŶͬƉĂŐĞƐͬhƐĞƌ&ŝůĞ͘ĂƐƉǆ͍ĨŝůĞ/Ěсϭϰϯϭϴ
WůĞĂƐĞŶŽƚĞƚŚĂƚƚŚĞƚŝŵĞƐƉĞŶƚƉĞƌƉĂƚŝĞŶƚĚŽĞƐŶŽƚŚĂǀĞƚŽďĞϭϬŵŝŶƵƚĞƐ͘&ŽƌĞǆĂŵƉůĞ͕ŝĨƚŚĞ
ƉŚǇƐŝĐŝĂŶƉĂƌƚŝĐŝƉĂƚĞƐŝŶĚŝƐĐƵƐƐŝŽŶĂďŽƵƚƚŚƌĞĞƉĂƚŝĞŶƚƐĂŶĚƉĂƚŝĞŶƚŝƐĚŝƐĐƵƐƐĞĚĨŽƌϱŵŝŶƵƚĞƐ͕ƉĂƚŝĞŶƚ
ŝƐĚŝƐĐƵƐƐĞĚĨŽƌϭϱŵŝŶƵƚĞƐĂŶĚƉĂƚŝĞŶƚĨŽƌϭϬŵŝŶƵƚĞƐ͕ƚŚĞƚŽƚĂůƚŝŵĞŽĨĚŝƐĐƵƐƐŝŽŶŝƐϯϬŵŝŶƵƚĞƐĂŶĚ
ĂĐůĂŝŵŵĂǇďĞƐƵďŵŝƚƚĞĚĨŽƌĞĂĐŚŽĨƚŚĞƚŚƌĞĞƉĂƚŝĞŶƚƐ͘dŚĞƚŝŵĞƐƉĞŶƚĂƚƚŚĞDƐŚŽƵůĚďĞƌĞĐŽƌĚĞĚ
ĂƐϯϬŵŝŶƵƚĞƐ͘>ŝŬĞǁŝƐĞ͕ŝĨƚŚĞƉŚǇƐŝĐŝĂŶƉĂƌƚŝĐŝƉĂƚĞƐŝŶĂĚŝƐĐƵƐƐŝŽŶĂďŽƵƚĨŽƵƌƉĂƚŝĞŶƚƐĂŶĚƚŚĞƚŽƚĂů
ƚŝŵĞŽĨĚŝƐĐƵƐƐŝŽŶŝƐϮϬŵŝŶƵƚĞƐƚŚĞƉŚǇƐŝĐŝĂŶƐŚŽƵůĚŽŶůǇƐƵďŵŝƚĂĐůĂŝŵĨŽƌƚǁŽƉĂƚŝĞŶƚƐϴ͘
DĞĚŝĐĂůZĞĐŽƌĚZĞƋƵŝƌĞŵĞŶƚƐ
/ŶŽƌĚĞƌƚŽĨƵůůǇƐĂƚŝƐĨǇƉĂǇŵĞŶƚƌĞƋƵŝƌĞŵĞŶƚƐ͕ƚŚĞŵĞĚŝĐĂůƌĞĐŽƌĚŵƵƐƚŝŶĐůƵĚĞƚŚĞĨŽůůŽǁŝŶŐ
ĞůĞŵĞŶƚƐ͗
• ŝĚĞŶƚŝĨŝĐĂƚŝŽŶŽĨƚŚĞƉĂƚŝĞŶƚĂŶĚƉŚǇƐŝĐŝĂŶƉĂƌƚŝĐŝƉĂŶƚƐ
• ƚŽƚĂůƚŝŵĞŽĨĚŝƐĐƵƐƐŝŽŶĨŽƌĂůůƉĂƚŝĞŶƚƐĚŝƐĐƵƐƐĞĚ
• ƐƚĂƌƚƚŝŵĞĂŶĚƐƚŽƉƚŝŵĞŽĨƚŚĞĚŝƐĐƵƐƐŝŽŶƌĞŐĂƌĚŝŶŐƚŚĞƉĂƚŝĞŶƚ͕ĂŶĚ
• ƚŚĞŽƵƚĐŽŵĞŽƌĚĞĐŝƐŝŽŶŽĨƚŚĞĐĂƐĞĐŽŶĨĞƌĞŶĐĞƌĞůĂƚĞĚƚŽĞĂĐŚŽĨƚŚĞƉĂƚŝĞŶƚƐĚŝƐĐƵƐƐĞĚ
KŶĞĐŽŵŵŽŶŵĞĚŝĐĂůƌĞĐŽƌĚƚŚĂƚŝŶĐůƵĚĞƐĂůůƚŚĞŶĞĐĞƐƐĂƌǇŝŶĨŽƌŵĂƚŝŽŶǁŽƵůĚƐĂƚŝƐĨǇƚŚĞŵĞĚŝĐĂů
ƌĞĐŽƌĚƌĞƋƵŝƌĞŵĞŶƚƐĨŽƌďŝůůŝŶŐƉƵƌƉŽƐĞƐ͘
ŝƚŚĞƌƚŚĞŵĞĚŝĐĂůƌĞĐŽƌĚŽƌĂƐĞƉĂƌĂƚĞƐŝŐŶͲŝŶƐŚĞĞƚƐŚŽƵůĚďĞƐŝŐŶĞĚͬŝŶŝƚŝĂůĞĚďǇĂůůƉĂƌƚŝĐŝƉĂƚŝŶŐ
ƉŚǇƐŝĐŝĂŶƐ;ŝŶĚŝĐĂƚŝŶŐǁŚĞƌĞĂƉƉƌŽƉƌŝĂƚĞŝĨĂŶĂƚƚĞŶĚĞĞ;ƐͿǁĂƐŶŽƚƉƌĞƐĞŶƚĨŽƌƚŚĞĐŽŵƉůĞƚĞDͿ͘
WĂǇŵĞŶƚǆĐůƵƐŝŽŶƐĂŶĚ>ŝŵŝƚĂƚŝŽŶƐ
• DŝƐŶŽƚĞůŝŐŝďůĞĨŽƌƉĂǇŵĞŶƚƚŽƉŚǇƐŝĐŝĂŶƐŝŶƚŚĞĨŽůůŽǁŝŶŐƐƉĞĐŝĂůƚŝĞƐ͗ZĂĚŝĂƚŝŽŶKŶĐŽůŽŐǇ
;ϯϰͿ͕ŝĂŐŶŽƐƚŝĐZĂĚŝŽůŽŐǇ;ϯϯͿĂŶĚ>ĂďŽƌĂƚŽƌǇDĞĚŝĐŝŶĞ;ϮϴͿ
• WŚǇƐŝĐŝĂŶƐƌĞĐĞŝǀŝŶŐŽŶĐŽůŽŐǇͲƐƉĞĐŝĨŝĐĂůƚĞƌŶĂƚĞĨƵŶĚŝŶŐƵŶĚĞƌĂƐĂůĂƌǇ͕ƐƚŝƉĞŶĚ͕WWŽƌ&W
ŵŽĚĞůĂƌĞŶŽƚĞůŝŐŝďůĞƚŽĐůĂŝŵĨŽƌƚŚĞƉƌĞƉĂƌĂƚŝŽŶĂŶĚͬŽƌƉĂƌƚŝĐŝƉĂƚŝŽŶŝŶĂD
• EŽŽƚŚĞƌŝŶƐƵƌĞĚƐĞƌǀŝĐĞƌĞŶĚĞƌĞĚĚƵƌŝŶŐĂŶDŝƐĞůŝŐŝďůĞĨŽƌƉĂǇŵĞŶƚ
• ^ƉĞĐŝĨŝĐůŝŵŝƚĂƚŝŽŶƐǁŝƚŚƌĞƐƉĞĐƚƚŽDƐĞƌǀŝĐĞƐĂƌĞĂƐĨŽůůŽǁƐ͗
o <ϳϬϴĂŶĚ<ϳϭϬ;WĂƌƚŝĐŝƉĂŶƚƐͿĂƌĞĞĂĐŚůŝŵŝƚĞĚƚŽĂŵĂǆŝŵƵŵŽĨϱƐĞƌǀŝĐĞƐƉĞƌƉĂƚŝĞŶƚ
ƉĞƌĚĂǇ͕ĂŶǇƉŚǇƐŝĐŝĂŶ;ŝŶĚŝĐĂƚŝŶŐƚŚĂƚŶŽŵŽƌĞƚŚĂŶĨŝǀĞƉŚǇƐŝĐŝĂŶƐŵĂǇĐůĂŝŵĨŽƌƚŚĞƐĞ
ƐĞƌǀŝĐĞƐĨŽƌĂŶŝŶĚŝǀŝĚƵĂůƉĂƚŝĞŶƚŽŶƚŚĞƐĂŵĞĚĂǇͿ
o <ϳϬϵ;ŚĂŝƌͿŝƐŽŶůǇĞůŝŐŝďůĞĨŽƌƉĂǇŵĞŶƚŽŶĐĞƉĞƌĚĂǇƉĞƌƉĂƚŝĞŶƚ͕ƚŽĂŵĂǆŝŵƵŵŽĨϴ
ƉĂƚŝĞŶƚƐƉĞƌĚĂǇ
o <ϳϬϴ͕<ϳϬϵ͕ĂŶĚ<ϳϭϬĂƌĞĞĂĐŚůŝŵŝƚĞĚƚŽĂŵĂǆŝŵƵŵŽĨϴƐĞƌǀŝĐĞƐ͕ƉĞƌƉŚǇƐŝĐŝĂŶ͕ƉĞƌ
ĚĂǇ͕ŵĞĂŶŝŶŐƚŚĂƚĂƉŚǇƐŝĐŝĂŶŝƐĂůůŽǁĞĚƚŽďŝůůĂŵĂǆŝŵƵŵŽĨϴDƉĂƚŝĞŶƚĚŝƐĐƵƐƐŝŽŶƐ
ƉĞƌĚĂǇ
o /ƚŝƐŶŽƚƉŽƐƐŝďůĞĨŽƌƚŚĞƐĂŵĞƉŚǇƐŝĐŝĂŶƚŽďŝůůĨŽƌŵŽƌĞƚŚĂŶŽŶĞĐŽĚĞ;<ϳϬϴ͕<ϳϬϵĂŶĚ
<ϳϭϬͿŽŶƚŚĞƐĂŵĞĚĂǇĨŽƌƚŚĞƐĂŵĞƉĂƚŝĞŶƚ
ϴ
&ŽƌĂĚĚŝƚŝŽŶĂůĐůĂƌŝĨŝĐĂƚŝŽŶ͕ƌĞĨĞƌƚŽƚŚĞ͚DŝŶŝŵƵŵdŽƚĂůdŝŵĞŽĨŝƐĐƵƐƐŝŽŶ͛ƚĂďůĞŽŶƉĂŐĞϮϭ͕K,/W^K͕KĐƚŽďĞƌϭ͕ϮϬϭϱ
5
^ƵŵŵĂƌǇdĂďůĞŽĨĂƐĞŽŶĨĞƌĞŶĐĞ&ĞĞŽĚĞƐ
&ĞĞŽĚĞ
ůŝŐŝďůĞWĂƚŝĞŶƚ
,ŽƐƉŝƚĂůŝŶƉĂƚŝĞŶƚŝŶĂŶĂĐƵƚĞ
ĐĂƌĞ͕ĐŚƌŽŶŝĐĐĂƌĞŽƌ
ƌĞŚĂďŝůŝƚĂƚŝŽŶŚŽƐƉŝƚĂů
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6
ĚĚŝƚŝŽŶĂůZĞƐŽƵƌĐĞƐ
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ĐĂƐĞĐŽŶĨĞƌĞŶĐĞƐĞƌǀŝĐĞ
9 dŚĞƌĞŵƵƐƚďĞĂŵŝŶŝŵƵŵŽĨϭϬŵŝŶƵƚĞƐŽĨƉĂƚŝĞŶƚƌĞůĂƚĞĚĚŝƐĐƵƐƐŝŽŶ
9 ĂƐĞĐŽŶĨĞƌĞŶĐĞŵƵƐƚďĞƉƌĞͲƐĐŚĞĚƵůĞĚ
9 ƚůĞĂƐƚŽŶĞŽĨƚŚĞƉŚǇƐŝĐŝĂŶƉĂƌƚŝĐŝƉĂŶƚƐŝƐƚŚĞƉŚǇƐŝĐŝĂŶŵŽƐƚƌĞƐƉŽŶƐŝďůĞĨŽƌƚŚĞĐĂƌĞŽĨƚŚĞ
ƉĂƚŝĞŶƚ
9 ĐĂƐĞĐŽŶĨĞƌĞŶĐĞĨĞĞĐĂŶŶŽƚďĞďŝůůĞĚĨŽƌĞĚƵĐĂƚŝŽŶĂůƉƵƌƉŽƐĞƐƐƵĐŚĂƐƌŽƵŶĚƐ͕ŽƌĐŽŶƚŝŶƵŝŶŐ
ƉƌŽĨĞƐƐŝŽŶĂůĚĞǀĞůŽƉŵĞŶƚ͕ŽƌĂŶǇŵĞĞƚŝŶŐǁŚĞƌĞƚŚĞĐŽŶĨĞƌĞŶĐĞŝƐŶŽƚĨŽƌƚŚĞƉƵƌƉŽƐĞƐŽĨ
ĚŝƐĐƵƐƐŝŶŐĂŶĚĚŝƌĞĐƚŝŶŐƚŚĞŵĂŶĂŐĞŵĞŶƚŽĨĂŶŝŶĚŝǀŝĚƵĂůƉĂƚŝĞŶƚ
9 KŶĞĐŽŵŵŽŶŵĞĚŝĐĂůƌĞĐŽƌĚŝŶƚŚĞƉĂƚŝĞŶƚΖƐĐŚĂƌƚĨŽƌƚŚĞĐĂƐĞĐŽŶĨĞƌĞŶĐĞƐŝŐŶĞĚŽƌŝŶŝƚŝĂůĞĚďǇĂůů
ƉŚǇƐŝĐŝĂŶƉĂƌƚŝĐŝƉĂŶƚƐǁŽƵůĚƐĂƚŝƐĨǇƚŚĞŵĞĚŝĐĂůƌĞĐŽƌĚƌĞƋƵŝƌĞŵĞŶƚƐ͘
This document was prepared by the OMA’s
Economics, Research & Analytics Department.
Questions can be forwarded to [email protected].
This document was last updated February 17, 2016.
7
HEALTH POLICY REPORT
A summary of current health legislation and policy developments
• Update on OMA Activities: Primary Health Care Reform
• Zika Virus
• Registered Nurse Prescribing
• End of Life Planning and Care in Ontario: Seminar to be held April 29;
National Advance Care Planning Day Online Toolkit
by OMA Health Policy Department
Update on OMA Activities: Primary
Health Care Reform
At its February 2016 meeting, the OMA
Board of Directors approved the formation of an Advisory Group to help
identify and provide advice on issues
related to the Ontario government’s
proposed changes to the primary
health care system.
The Advisory Group will serve for a
12-month term that is renewable by
the Board. It consists of seven OMA
members selected at large, the Chair
of the Section on General and Family
Practice, and a Board-appointed member to chair the group.
The Advisory Group members were
selected based on a need to seek
advice and input from a broad crosssection of OMA members. The composition of group members reflects the
different types of practices, geographic
locations and experiences of physicians
in Ontario.
The Advisory Group’s scope of
authority includes:
• Making recommendations to the
OMA Board of Directors regarding
issues within the Advisory Group’s
mandate.
• Informing the work to be undertaken by staff.
• Keeping OMA leadership informed
on current and upcoming issues
within the Advisory Group’s mandate.
In addition, to support members, a
section of the OMA website has been
developed to provide resources, information and updates on issues and
activities related to the government’s
plans and engagement activities. This
information can be found at https://www.
oma.org/benefits/pmcphyresources/
Pages/default.aspx.
OMA Contact: Peter Brown (ext. 2989)
Zika Virus
On February 1, 2016, the World Health
Organization (WHO) declared a Public
Health Emergency of International
Concern after a significant increase in
cases of microcephaly and GuillainBarré syndrome following infection by
the Zika virus. The heightened level of
concern follows the recent cluster of
microcephaly cases and other neurological disorders reported in Brazil
since the beginning of the outbreak.
42
Experts have not yet established a
direct causal link between Zika virus
infection and microcephaly or GuillainBarré syndrome. However, pregnant
women, or those considering becoming pregnant, are advised to be aware
of the health risks associated with travel
to affected countries and to take measures to prevent mosquito bites.
The Public Health Agency of Canada
(PHAC) issued a public health notice
and a travel health notice concerning the Zika virus in January, recommending that all travellers exercise
caution and take individual protective
measures to prevent mosquito bites if
visiting an area where the virus is circulating. There is no vaccine that protects
against infection and there is no curative treatment.
Although Zika virus is usually spread
through an infected mosquito, in rare
instances transmission is possible
through sexual contact or blood transfusion. At the time of writing, three
instances of possible sexual transmission of Zika have been reported and are
being investigated.
The Ontario Minister of Health and
Long-Term Care and the Acting Chief
March 2016
HEALTH POLICY REPORT
A summary of current health legislation and policy developments
Medical Officer of Health issued a joint
statement on January 29 indicating
that the Ministry of Health and LongTerm Care and its national and international partners continue to monitor and
assess Zika virus infection.
The risk to Ontarians at this time is
very low, as the mosquitoes known
to spread the virus are not found in
Canada and are not well suited to the
colder climate. Testing for Zika virus is
available. Specimens will be received
by Public Health Ontario laboratories
and forwarded to PHAC and Centers
for Disease Control and Prevention
laboratories.
Since testing guidelines may change
as the outbreak continues, up-todate information can be found on
the Public Health Ontario website at
http://www.publichealthontario.ca/en/
ServicesAndTools/LaboratoryServices/
Pages/Zika-Virus.aspx.
Expert knowledge of the Zika virus
is evolving on a daily basis and the
OMA will continue to keep members
updated on any important developments.
End of Life Planning and Care in Ontario
Seminar to be held April 29 in Niagara Falls
During the upcoming Annual General and Council Meeting, the OMA will host
an End of Life Planning and Care (EOLPC) seminar tailored to build comfort
and promote awareness among family physicians and community-based
specialists in their understanding and use of advance care planning and
palliative care terminology, communication tools, billing information, local
resources, and much more. The seminar has been approved by the College
of Family Physicians of Canada (CFPC) for up to 2.5 Mainpro-M1 credits.
The seminar will be held on April 29, from 8 a.m. to noon, at the Sheraton on
the Falls. Space is limited! To register, or for more information, please email
[email protected].
National Advance Care Planning Day Online Toolkit
In preparation for National Advance Care Planning (ACP) Day on April 16,
2016, the Advance Care Planning in Canada Team, Hospice Palliative Care
Ontario, has released the ACP Day 2016 Toolkit. The materials in the toolkit
align with the Ontario Framework and include posters/postcards, news
releases, blogs, social networking messages, an email/letter template for
community outreach, conversation starters, and three professional videos — all to be used in your communication regarding ACP Day 2016. To
access the toolkit, please visit http://advancecareplanning.ca/resource/
acp-day-campaign-kit/.
For inquiries regarding End of Life Planning and Care, please contact [email protected]
OMA Contact: Juhee Makkar (ext. 2978)
Registered Nurse Prescribing
The Minister of Health and Long-Term
Care recently directed the Health
Professions Regulatory Advisory
Council to conduct public consultations
to assess three potential models for
registered nurse prescribing in Ontario:
independent prescribing, supplementary prescribing, and use of protocols
in prescribing. In its response, the OMA
emphasized that registered nurses currently possess independent prescriptive authority through the Extended
Class Registered Nurse or Nurse
Practitioner.
Given the highly specialized knowledge and graduate level training needed
to diagnose and prescribe medication,
the OMA advised that caution should be
exercised in deciding whether or not a
group of practitioners should independently prescribe medication.
OMA Contact: Ada Maxwell-Alleyne (ext. 2942)
43
March 2016
IN MEMORIAM
The OMA would like to express condolences to the families and friends of the following members.
Ahmed, Aftab
Finkel, Kenneth Clive
Moir, Vivian M.
Long Sault
Dundas
Sutton West
Nishtar Medical College, 1954
University of Dublin, Trinity College,
University of Toronto, 1985
December 2015 at age 83
1950
Barr, Margaret Nina
Palmer, John Thomas
Nanaimo, BC
Glassman, Max M.
Niagara Falls
University of Edinburgh, 1951
Toronto
Queen’s University, 1968
November 2015 at age 91
Basian, Herbert
Ramprashad, Claudius Arthur
Toronto
Houtman, Siert Goozen
Toronto
Kingston
University of West Indies, 1963
University of Utrecht, 1955
September 2015 at age 78
Bauset, Richard
Ritchie, Alexander Charles
Aurora
Jones, William Meredith
Toronto
Sherbrooke University, 1983
Toronto
Otago Unversity, 1944
McGill University, 1954
January 2016 at age 85
Chan, Andrew Chi Shing
Smith, Maurice William James
Peterborough
Leacy, James William Buckly “Bill”
Toronto
University of Liverpool, 1988
Kingston
University of Glasgow, 1957
Queen’s University, 1960
Crawford, John Sinclair
Teferi, Amde Michael
Collingwood
MacDonald, Avril Maria
Guelph
Chatham
Addis Ababa University, 1976
Crowne, Sandra
Drumbo
University of London, 1978
The OMA publishes brief notices about deceased members as a service to their colleagues. Information concerning these members should
be sent to [email protected]. If you know a colleague or a relative of a deceased member who has practice-related questions and
needs advice, or would like an information package on winding down a practice, please have them contact Practice Management and
Advisory Services at 1.800.268.7215, or email [email protected].
44
March 2016
Classifieds
GENERAL INFORMATION
Advertisements are accepted by mail, email or
fax. Copy deadline, notice of cancellation and/
or changes to existing advertisements must
be submitted in writing no later than the 10th
of the month prior to the month of publication. A proof copy of your classified ad will be
faxed to your attention for approval prior to
publication.
Payment: Payment is accepted by VISA, Mastercard or American Express. Please provide
credit card information by phone only to Vita
Ferrante 416.340.2263 or 1.800.268.7215,
ext. 2263, at time of booking.
Rates: $55 for first 4 lines (minimum), each line
approximately 35 characters; $5 per line thereafter; $5 for each line of contact information.
Spot colour billed at $20 per issue.
A Classified Advertisement Insertion Order
Form is posted online: www.oma.org/
Resources/Documents/AdOrder.pdf
OFFICE SPACE AVAILABLE
418 Eglinton Ave. West (Forest Hill):
Fantastic, gorgeous new medical, health
care/residential building ready for
occupancy. Four storey, 16,000 sq. ft.,
serviced by elevator. Granite facade,
high ceiling, surrounded with bright
windows, plus basement. Medical professionals, pharmacies or full-service
clinics who want the best, needed.
Attractive lease terms. Parking, amenities nearby, next to the Eglinton Grand,
easy access to TTC, Hwy. 401. Drawings and floor plan available on our
website.
Contact: Nikki
Tel. 416.750.4644, ext. 28
Website: www.418eglintonavew.ca
1 4 5 0 O ’ C o n n o r D r i v e , To ro n t o :
Medical professionals needed. Join
our team and our community. Victoria
Park/Eglinton Avenue East, new medical one-storey bldg. with existing dental, pharmacy, walk-in clinic, radiology,
physiotherapy, GPs, and health care
products. Attractive lease terms. Free
parking, close to TEGH, TTC, highway.
Contact: Nikki
Tel. 416.750.4644, ext. 28
Send advertisements to:
Vita Ferrante
Ontario Medical Association
150 Bloor Street West
Suite 900
Toronto, Ontario M5S 3C1
Tel. 1.800.268.7215, ext. 2263 or
416.340.2263
Fax: 416.340.2232
Following are the classified
advertising deadline dates
for the next six issues.
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ISSUE
DEADLINE
May 2016
April 11
June 2016
May 10
Added Value
Classified ads are posted online and accessible to OMA members and the general public:
https://www.oma.org/Pages/OMR.aspx
September 2016
August 10
October 2016
September 9
November 2016
October 10
July/August 2016 June 20
2333 Dundas St. West, Toronto: Newly
renovated clinic space in a multidisciplinary medical building, six exam rooms
plus offices. Close proximity to lab, Xray, ultrasound, physio, pharmacy.
Steps from Dundas West TTC station.
Negotiable lease and/or split and wages
available.
Contact: Kaushil Shah
Tel. 647.444.2568
AAA location: Brand new medical
clinic located right at the intersection
of Victoria Park and Lawrence. Area is
extremely dense in population. Lots of
apartment buildings around. Looking for
a physician who would like to relocate
their existing practice or start a new
practice. New graduates are welcome.
Pharmacy on-site. Very attractive terms.
2721 Jane Street walk-in/family
practice: Beautiful clinic with eight
exam rooms and four offices on the
corner of Jane & Sheppard. Extremely
busy area, in the same plaza as TD
Bank & Price Chopper. Great incentives
for relocation, very low negotiable rent
available! Vietnamese speaking an
asset. Please call.
Tel. 416.270.5976
Bayview/Eglinton Medical Centre:
From 500 to 800 sq. ft., net rent free
first year to general practice based on
a five-year lease. For inquiry or site visit,
please call or email.
Tel. 416.821.8148
AAA — four rooms left for family doctor
and walk-in clinic at Don Mills & Sheppard. Beside TTC subway. Very busy
residential & business area. Close to
major hospital, indoor free parking.
Tel. 647.818.2192
46
Boxgrove Medical Centre: For lease.
Four storey, 60,000 sq. ft. medical
building located at 9th Line & Hwy. 407.
X-ray, lab, rehab & urgent care on-site.
Tel. 416.357.7509
March 2016
Classifieds
Brampton & Oakville, ON: Clinic space
available for specialist & GP physicians
in an outpatient practice to work P/T or
F/T, clinics are within close proximity to
BCH and OTMH hospitals. Low overhead rates with full support staff and
EMR.
Contact: Dr. Dhillon
Tel. 647.801.9323
Brantford medical space available:
Turnkey medical clinic located within a
boutique professional building, with
visible advertising from highway and
neighbourhood streets. Family physician
retiring after 15 years in this location.
An ideal space for family practice or
medical specialist. Complete with new
floors, four exam rooms, and secured
reception area, this unit is clean and
bright. Extensive free parking with
convenience of pharmacy, dentists and
other physicians in building. Attractive
and flexible lease terms with relocation
incentive.
Contact: Dr. Mehdi
Brantford, ON: Unserviced, brand new
subdivision with over 7,000 homes
already built, with 3,000 more homes
to be built in the next few years. We
are in the process of constructing a
35,000 sq. ft. retail plaza (occupancy
March/April 2017), in a premium located
neighbourhood (one high school and
two elementary schools in the area). The
plaza will have a 15,000 sq. ft. wellness
centre with multidiscipline professionals
— doctors, dentist, physiotherapist and
a pharmacy. We are seeking doctors for
our wellness clinic and for the walk-in
clinic. Phone or email for information.
Contact: Isaac
Tel. 647.883.8524
Etobicoke, Dundas & Kipling: At
Islington Village. Street level. Modern
medical office, lots of parking.
Tel. 416.220.9792
Burlington, ON — specialists wanted:
Turnkey office with EMR, EMG & nurse.
Attractive overhead rates available. Free
health club membership!
Tel. 905.681.7577
Physicians – Part Time Opportunities
Supplement your income with a low-stress and highly rewarding part-time position helping people
overcome obesity and related disease.
Improve your quality of life while improving the lives of others – without the stress of administrative
duties or working nights and weekends.
We have part-time physician opportunities available and are seeking personable and enthusiastic
physicians to work 1 to 2 days per week, generally from 6:30 am to 2:30 pm.
The Bernstein Diet & Health Clinics is a medically supervised weight-loss organization with a stellar
40-year track record of patient success. Our patients achieve consistent, healthy, rapid weight loss
of up to 20 lbs. every month. Our program combines medical supervision, nutritional counseling,
EHKDYLRUPRGL¿FDWLRQFRXQVHOLQJDQGDJRRGVHOHFWLRQRIZHOOEDODQFHGJURFHU\VWRUHIRRGFKRLFHV
We never use diet pills, appetite suppressants or surgery.
2XUSK\VLFLDQV¿QGWKHLUZRUNUHZDUGLQJERWKSURIHVVLRQDOO\DQGSHUVRQDOO\7KH\HQMR\WKHEHQH¿WV
of having much less administrative work, so they can spend their time engaging motivated patients
whose health is improving as they lose weight.
To learn more about this opportunity, please contact me at your earliest convenience.
Michael McGuire
Bernstein Diet & Health Clinics
Director – Human Resources
Tel: 416.447.3438 ext. 232 Fax: 416.447.0835 Email: [email protected]
47
Clinic for sublease, north of
Richmond Hill (Toronto): Busy clinic,
operating since 2005, fully loaded, renewed and expanded up to 2,500 sq. ft.
in prime location with big potential. Great
for group of physicians. For more info.
Tel. 416.873.9080
Clinic space available for specialist
physicians, Toronto: Need clinic space
just to see patients? Come work parttime in our clinic designed by awardwinning architects. Fully equipped exam
rooms available at competitive rates.
Located in a busy family medicine clinic,
close to major downtown hospitals, and
accessible by transit. Contact us at our
website to learn more.
Website: www.magentahealth.ca
East Mississauga: Medical office/
walk-in, fully furnished, turnkey. Available
immediately. Low rent plus incentive.
High density area. Pharmacy next door.
Free ample parking. Please call or email.
Tel. 416.829.1875
Email: medicaloffi[email protected]
ENT preferred to move into already
existing ENT location (30+ years).
Phone to arrange appointment.
Tel. 416.834.1841
Guelph, ON: Physicians/specialists
needed for growing medical centre.
Bring a group, create a FHG! A 22 exam
room turnkey family practice. Full-time
practice space available, using Practice
Solutions EMR. Knowledgeable, flexible
staff, great modern work environment.
Very congenial progressive-minded
group, part of the Guelph Family Health
Team. Currently seven practices in wellestablished medical centre, in addition
to a medical centre located within The
Village by the Arboretum, Guelph.
Contact: Darren
Website: www.arbourfamilymedical.com
Location, location, location: AAA brand
new medical office in Toronto (Dufferin &
St. Clair). Move-in ready medical clinic;
ideal for physicians looking to relocate
or start a new practice, walk-in or family.
Very dense neighbourhood. Established
pharmacy on-site. The clinic has four
furnished exam rooms, physician office,
staff room and beautiful reception. For
inquiry or site visit, please call or email.
Tel. 647.686.9466
March 2016
Classifieds
Looking for a pharmacy space
to lease or sublease in Ontario:
A pharmacist is looking to lease or
sublease a space at a family doctor’s
office that is suitable for a pharmacy/
dispensary anywhere in Ontario. The
space must be 200 sq. ft. or more. Will
pay a lucrative rent. Open to partnership
with doctors.
Contact: Sam
Tel. 416.618.8454
Medical Centre at The Boardwalk on
the west side of K-W, a local initiative
for integrated health care. Exceptional
building with turnkey space for grads and
GPs new to the region, specialist clinic,
and essential medical services (cardiac
testing imaging, lab, pharmacy). Now
open.
Contact: Cynthia Voisin
Tel. 519.744.6464
or [email protected]
Medical clinic available immediately:
Eglinton Ave. E./Victoria Park. Family
doctor has retired. Ample, free parking
space, very low rent plus incentives,
pharmacy next door. Please call or email
to discuss further.
Tel. 647.405.7338
Medical office space in Caledon East,
ON: Approximately 1,300 sq. ft. suited
for family doctors/walk-in located in
strip plaza with Foodland & pharmacy.
Under renovation, move in fall 2016.
New residential development, low rent &
ample parking.
Tel. 905.584.2238
Medical suites available: Akron
Medical Building (Lakeshore Blvd.
— Parklawn). Souther n Etobicoke
(Mimico), high density, rapidly growing,
underserviced area of Toronto. All
services on-site including walk-in clinic.
Turnkey, risk-free rent.
Contact: Domenic Rando
Tel. 416.985.1396
Mississauga — excellent medical
office/walk-in: Fully furnished recently
renovated suites. Private underground
parking. Units have three-to-six spacious exam rooms, private reception
and common patient waiting area.
Great location inside a medical centre,
close to Credit Valley & Trillium Hospitals in a dense residential highrise and
commercial area. Lab services and
pharmacy on-site. Very low rent and
relocation incentives.
Tel. 416.587.9430
Mississauga: Specialists needed for
medical office/walk-in close to Square
One mall. Available immediately. Turnkey,
fully furnished, ample parking. Low rent
plus incentive. Pharmacy next door.
Tel. 416.829.1875
Niagara Falls is in need of family physicians: Take your family practice where
it’s needed! Come check out our professional medical buildings in Niagara Falls.
Currently available units range in size from
754-1,600 sq. ft. There are many benefits
right on-site such as medical laboratories, X-ray, ultrasound, group practices,
specialists & pharmacies. Let us work
with you in designing the most suitable
office space for your needs. We offer
attractive terms. Call for more information.
Contact: Alvin Schellenberg
Tel. 289.292.0526, ext. 31
N o r t h We s t H e a l t h c a re P ro p e rties REIT (TSX: NWH.UN) — Canada’s healthcare landlord: We own
full-service, professionally managed
medical office buildings in Ontario
and across Canada. Turnkey construction management available.
Competitive lease rates and attractive
building amenities. We help you help
your patients.
Contact: Dave Casimiro
Tel. 416.366.2000, ext. 4302
Website: www.nwhp.ca
Oakville, ON: Lease/sale — great suites
available in the heart of Old Oakville.
Three-storey medical building, GPs and
specialists welcome. Landlord will build/
renovate to suit.
Contact: Ron Agostino or Michael Ricci
Rentex Realty Inc., Brokerage
Tel. 905.850.3300
48
Office space for lease: Rejuvenated
medical arts building, 358 Reynolds St.,
Oakville, ON. Still time to choose your
colours. Lots of free parking, pharmacy
on-site, great rates. Perfect for a family
physician or walk-in clinic.
Contact: Lee Ann Coveyduck
Sales Rep. Royal LePage State Realty
Tel. 905.978.0548
Own your office, build long-term
wealth: Don’t pay off someone else’s
mortgage! Ideal for physicians with
privileges at the New Humber Regional
Hospital. New Class “A” office tower
under construction at Finch Ave. &
Keele St., ready Q2-2017. Suites from
500-15,000 square feet. Potential
financing up to 100%. Steps from the
new Keele & Finch subway station and
on-site patient parking. Imaging and
diagnostic labs tenancies on-site.
Contact: Carolyn Laidley Arn
Sales Representative
Lennard Commercial Realty, Brokerage
Tel. 416.649.5923
PAR-Med Realty Ltd.: Specializing
in medical office building leasing,
property management, and building
sales. We have over 70 medical office
buildings in our portfolio throughout
Ontario. For leasing inquiries:
Contact: Brad Stoneburgh
Tel. 416.364.5959, ext. 403
Website: www.par-med.com
Prime medical clinic opportunity in
the heart of Kitchener: The available
unit is 2,350 sq. ft. located at the Forest
Glen Plaza, southwest intersection of
Strasburg Road and Brock Line. Centre
includes No Frills, Dollar Tree, TD Bank
and Shoppers Drug Mart. Unit has built
out washrooms, examining rooms,
and reception area. Landlord offering
incentives toward tenant’s leasehold
improvements. Unit is available for
immediate possession. Grand Rapid
Transit bus terminal directly on-site
bringing over 5,300 daily commuters
and making the shopping centre highly
accessible to the neighbourhood and
surrounding community.
Contact: Avi Batalion
Centre Corp Management Services
Tel. 905.968.3232
March 2016
Classifieds
Room for rent in family doctor’s
office: Located in Richmond Hill (Yonge
Street/16th Line). Ideal for specialists.
Shared medical office space for lease
in a busy medical and surgical centre
and pharmacy. Consists of four private
offices with a dedicated reception area.
Fitting all specialists, practitioners,
optometrists, etc. A beautiful waiting
area and lobby. Yonge Street exposure
and address. Great walk-in traffic
and close to major highways (Hwy.
404/407/400/7). Rent includes: utilities,
Internet and maintenance.
Contact: Peyvand Jalali
Tel. 416.837.0637
Space for lease in busy health centre
surrounded by new subdivisions in
Stouffville: 794, 962, 1,700 and 1,800 sq.
ft. units available. Health centre tenants
currently include walk-in, family practice,
pharmacy, dental, physiotherapy clinics.
Health centre is open 7 days/week.
Large daycare also on same site. Close
to retirement community. Please phone.
Contact: Sara
Tel. 905.479.2571
Super location — near Trillium Health
Centre (near Sherway Gardens): 1,200
sq. ft. ground floor in a plaza, high density. Ideal for orthopedic, optometrist,
physiotherapy, medical laboratory, MRI,
dental, chartered accountant, financial
services, law office. $2,700/month net.
Contact: Fabio Capobianco Real
Estate Ltd., Brokerage
Tel. 416.252.7266
Thornhill walk-in clinic near Bathurst
Street & Centre Street is looking for
specialists to join our team. Beautifully
renovated, moder n, and spacious
office. Very busy streetfront location.
Full administrative support. Best EMR.
Attractive split and other high-income
benefits. Close to TTC. Ample parking.
Relocate current practice or build a new
one. New grads welcome. We create a
great environment to provide the best
health care possible.
Contact: Karen
Tel. 416.893.1472 or 905.763.6333
Email: karen@pureflowhealthcare.com
Website: www.pureflowhealthcare.com
Thunder Bay turnkey medical suites
available: For independent or group
practices in a professional building. Physicians, specialists, and all health care
service providers can be accommodated.
On-site pharmacy and diagnostics services available. For details or to arrange
a site visit, call or email.
Tel. 807.476.6979
Website: www.tbaymedicalcentre.com
Turnkey central Toronto medical
space: Medical office space in attractive upscale townhouse near Yorkville,
with established family physician. Perfect for family physician or specialist.
Experienced staff, OSCAR EMR, onsite MD parking. Close to public transit
and parking. Highly-rated medi-spa and
gym/pilates on-site. Space available
FT/PT. Mutually satisfactory financial
arrangement.
Contact: Dr. Deborah Fisher
Tel. 416.929.9943
LOCUM TENENS
Locum position: Busy walk-in clinic
in Richmond Hill area looking for a
physician for a two-to-three week period
from July 26, 2016. Possibility of joining
the group.
Tel. 905.884.0977
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Locums, P/T, F/T physicians needed
for walk-in clinics across the GTA. To
inquire, please email.
REAL ESTATE
Mortgages from 1.90%: Secured lines
of credit, 1st & 2nd mortgages. Pay
off mortgage & tax arrears. Investment
opportunity available in secured 2nd
mortgages. High yield, secured on real
estate. 3-12 month terms, 10% to 14%
return upfront.
Contact: Shawn Allen (Broker)
Matrix Mortgage Global Lic# 11108
Tel. 1.888.907.5166
Website: www.matrixmortgage
global.com
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49
March 2016
Classifieds
Brampton — full-time, part-time
physicians and specialists required
for a very busy family practice/walk-in
clinic. Very modern and computerized
exam rooms, paperless. $200/hour
billing guarantee available.
Contact: William
Tel. 647.627.4170
Email: chinguacousy-medical@
hotmail.com
$300 per hour minimum: Inter nal
medicine (general and subspecialist),
pediatrician, surgeon in busy outpatient
clinic in Mississauga.
Contact: Dr. Stein
Tel. 416.464.0238
for overhead expenses. Education/
professional qualifications required:
medical degree; the candidates must be
eligible for registration with the College
of Physicians and Surgeons of Ontario
and specialist accreditation by the Royal
College of Physicians and Surgeons
of Canada, certified or eligible. Skills
required: education and work experience
in the medical profession as a physician
with specialist training in rheumatology.
Ability to work effectively, independently,
and in a multidisciplinary team. Effective
written and verbal communication
skills in English. Required experience:
experience in rheumatology, 5 years+.
Contact: Sandy Prescott
Office Manager
Tel. 416.800.0800
Fax: 416.800.0802
Agillant Health Clinic is in need of
family physicians: Currently running
clinic with two doctors. Physicians
required for walk-in shifts as well as
opportunity to relocate an existing
practice or build a new practice. Flexible
hours and very attractive split. We offer
attractive terms (four-to-six month
overhead free). Call or email for more
information.
Tel. 647.528.6606
Attention academic physicians: We
are an online test preparation service
for the Medical Council of Canada
licensing exams. We are hiring physicians to write high-quality cases
for the MCCQE Part 1 and MCCQE
Part 2 for our online question banks.
Please contact us or visit our website
for more details.
Website: www.canadaqbank.com/
careers.php
An extremely busy modern family
practice: Suburban area in Winnipeg is
seeking physicians to join this dynamic
clinic. Remuneration and working
hours negotiable, a no-cost transfer of
ownership in a short perspective. We
have a lab, EKG and massage therapists
on-site. Please email your inquiries.
Bayview Physiotherapy & Sports
Medicine Clinic (Aurora) is a wellestablished, expanding, multidisciplinary
clinic with modern facilities in a prime
location. We are looking for a part-time
doctor who has experience working with
sports-related injuries/dysfunctions.
Our team currently consists of three
physiotherapists, two chiropractors,
two RMTs and one psychotherapist.
The office space comes equipped with
an examination table, computer, and
phone and storage space.
Email: johnpendlebury@bayview
physio.ca
Canadian Mental Health Association
— York & South Simcoe: Psychiatric
opportunity for three programs. Flexible
Support Program: Creates housing
stability within a housing first model.
Early Psychosis Intervention Program:
14 to 35 year old people experiencing
psychosis for the first time. Rapid
Access Mood & Anxiety Program:
Provides support to referring primary
care providers for people with low mood
and anxiety through initial assessment
and a group medical visit format.
Consider joining our multidisciplinary
team and our dynamic organization.
The time a psychiatrist works is flexible
and we are open to explore scheduling
possibilities.
Contact: Neil Howard
Tel. 905.841.3977, ext. 2202
RNPG contract available in Spanish
township with a four bedroom, two
bath, beautiful executive country home
for sale on 6.9 acres, lakefront property.
Tel. 705.844.2263 or 705.227.0530
POSITIONS VACANT
$250/hour: GP required immediately at
Mississauga outpatient clinic. Hours
8 a.m. to 11 p.m. seven days a week.
Contact: Angela
Tel. 905.897.8928
Athletic Edge is currently looking to
fill a position for a rheumatologist:
Job duties: the physician will be
providing consultations and ongoing
followup care for patients referred to
the clinic, including diagnosing and
treating medical disorders, interpreting
medical tests, prescribing medications,
performing procedures for which the
physician is qualified including joint
injections under ultrasound guidance,
and making referrals to other specialist
physicians as appropriate. The terms of
employment: This is a permanent, full
time, fee-for-service position. Physician
and the clinic will share fee-for-service
billings, 75% (physician)/25% (clinic),
Beautiful Kanata clinic (FIG): One
opening for a full-time family physician
ready to build up a practice. The clinic is
supported by well-trained staff (RN onsite), and is fully integrated with EMRPractice Solutions. Free parking. Overhead
25%+ HST. Locum available to try out the
clinic. Details discussed when contacted.
Contact: Dr. Morariu
Tel. 613.850.1565
50
Brampton, Ontario: Full-time/parttime family physicians and GP psy cho thera pist required for busy family
practice/walk-in clinic. Attractive modern
office. Option to join FHG. High fee-forservice split or flat monthly rate. Best EMR.
Tel. 416.949.3830
Fax: 647.340.2586
Email: bramptonfamilyhealth@
gmail.com
Citrus Medical Centre Toronto: Family
and walk-in physicians at two locations
in south Etobicoke (398 Royal York
Road, 2240 Lakeshore West).
Renovated, modern office, EMR, full
nursing/billing support. Pharmacy/lab/
physio/chiropractor on-site. Competitive
overhead in well-run clinic in an
area surrounded by new condos and
townhouses.
Contact: Dr. Hinal Sheth
Tel. 416.570.7297
March 2016
Classifieds
D o w n t o w n To ro n t o , B a r r i e a n d
Mississauga: Lifestyle health, weight
management and chronic disease
management clinics are looking for
doctors with a particular interest in
lifestyle and preventive medicine, or
psychotherapy to join our growing
practice, F/T or P/T. Work with a
multidisciplinary team prescribing
a broad range of evidence-based
nutrition, exercise, stress management
and other interventions to promote
optimal physical, psychological and
social well-being. Training will be
provided. Flexible hours. Turnkey. We
provide bright, modern offices, tools,
and all support systems. New grads
welcome. Competitive compensation.
Practise progressive medicine!
Tel. 905.595.3482
Etobicoke: Family physicians required
for an established medical clinic that is
expanding into a new, well-equipped
office in a prime mall location. Full-time,
part-time, walk-in and locum positions
available.
Contact: Dr. B. Pich
Tel. 416.239.6122
Fax: 416.239.4895
Etobicoke, ON: F/T or P/T family
physician and walk-in clinic. Wellestablished modern office, excellent
condition.
Contact: Ash
Tel. 416.220.9792
Etobicoke: Seeking family physician
for established practice. Modern office,
EMR, full administrative and nursing
support, lab on-site. Part of FHG. Flexible
hours, competitive split.
Contact: Mary
Tel. 416.219.4063
Family health team position available
to replace retiring physician: Brampton,
ON. Excellent career opportunity to
practice in well-organized, professional
family health team. Retiring physician
has 1,800 active FHO patients registered
on Practice Solutions EMR. Office in
free-standing medical building with lab,
X-ray, U/S, physio and pharmacy. Free
parking. Close to Hwy. 410 and William
Osler Hospital. Opportunity for hospital
privileges.
Contact: Anne Marie Lang-Berkowitz
Executive Director, North Peel FHT
Tel. 905.459.2181
Contact: Dr. H. Manning
Tel. 905.791.5822
Family physician (guaranteed pay) —
Scarborough: Opportunity for a parttime/locum/full-time family physician
in a multispecialty clinic with internists,
endocrinologists, cardiologists and respirologists. Ideal location with ample free
parking available and one of the best
EMRs in Canada. This is a fully managed
practice and a great setting to establish
a practice or to work part time. This is
also an ideal setting for moving your current practice; you would be responsible
only for seeing patients and we would
fully manage everything else including staffing/billing/accounting/IT/EMR.
Fee split is very competitive at 80-20,
or guaranteed minimum pay of $125/
hour for the first two months while the
practice is building (we can discuss the
details). Multicultural area serving East
Asians, South Asians, Middle Easterns
& Caucasians. Physicians who speak
Mandarin/Cantonese would be an asset
as well. Supervision for CPSO pathway
programs is not available.
Family practice/walk-in/psychiatrist/
neurologist/pain specialist needed to
join our well-established medical centre
with 40 plus doctors in Scarborough.
Extremely busy and congenial work
atmosphere. Full EMR.
Contact: Dr. Thomas Van
Tel. 647.227.5088
Full-time or part-time medical doctors
required for a busy walk-in located in
downtown Mississauga.
Contact: Adel
Tel. 416.904.2929, 905.897.6160 (office)
GP psychotherapists: Busy Bloor/
D u n d a s We s t c l i n i c n e e d s P T / F T
active/semi-retired MDs. Excellent
computerized billing system. MCEDT
or diskette under your CPSO #. Billings
include last day before deadline. 100%
proof of submission/RA. You get paid for
all your services. Excellent services and
financial arrangements structured to
your requirements.
Tel. 416.516.6969
51
Housecall physicians PT/FT: MedVisit
Doctors Housecall Service. Greater
Toronto/Ottawa/Oshawa/Ajax/Whitby/
Pickering/Mississauga/Brampton.
$200-$250/hour net plus bonus.
Afternoon, evening or weekend shifts.
Choose when and where you work.
No overnight calls. Drivers available
t o a c company physicians. Enjoy a
professionally rewarding experience
while providing a much needed medical
service for your community.
Contact: Dr. Tom Burko
Tel. 416.631.0298 or 1.800.355.6668
Website: www.medvisit.ca/doctors
Internal medicine and/or subspecialties required immediately for outpatient
coverage in Mississauga. FT/PT locum.
No on-call. Top take-home pay.
Contact: Dr. Sekely
Tel. 416.464.0238
Medical clinic in Hamilton: Wellestablished clinic looking for physician
(part & full time). 70/30 fee-for-service
split. All administration costs taken care
of with your 30%. No GST payment.
Contact: Meena
Tel. 905.308.0659
Medical psychotherapy clinic: Our
clinic continues to thrive. We must be
doing something right! Physicians needed
— enjoy medicine more. Enjoy medicine
again! If you have an interest in this
important clinical area, we would like
you to join our busy clinic. We need family doctors, GPs, GP psychotherapists,
psychiatrists, semi-retired, part time or
full time. We are open weekends and
weeknights. We provide comfortable
offices, professional staff, excellent financial arrangements, professional supervision, and CME programs are available.
Contact: Dr. Michael Paré
Tel. 416.229.2399
Website: www.medicalpsychclinic.org
Medical psychotherapy: For lifestyle
health and chronic disease clinics. We
need family doctors, GPs, GP psychotherapists, psychiatrists, semi-retired,
part time or full time. Work with a multidisciplinary integrated health and wellness team to help people improve their
lives. Practise progressive medicine!
Tel. 905.595.3482
March 2016
Classifieds
Methadone physician needed: We are
currently recruiting methadone physicians to take over and expand existing
practices. Multiple sites available. To discuss opportunities, please email.
Contact: Jameet Bawa, MD
New graduates welcome: Supplement
your income with a low stress and
highly rewarding position. We have
opportunities available all across
Ontario. Work as much or as little as you
like with hours that are convenient to you.
We provide exceptional compensation
that far exceeds the industry average.
No experience required, no set up, no
overhead. Start earning extra income
immediately. Our team will handle
everything from booking to billing.
Contact: Brian Warner
Tel. 647.271.4441
North York & Scarborough clinics
located inside Loblaws and very busy
shopping mall. Very busy walk-in clinics/family practice seeking family physicians and specialists. Physicians
required for walk-in shifts as well as
opportunity to relocate an existing
practice or build a new practice. Flexible hours and very attractive split.
Tel. 647.206.0790
North York: Part-time medical doctors
required to oversee cosmetic injections
in med spa. Please contact for details.
Contact: Anaida
Tel. 647.839.1374
Oshawa, ON — dermatologist — full
time or part time: The Oshawa Clinic
Group, Canada’s largest multispecialty
group practice, has a unique opportunity
for a dermatologist who is interested
in an office-based consulting practice.
Full turnkey setup is available. Facilities
available include diagnostic testing
and imaging (X-ray, ultrasound, ECG,
echocardiography, laboratory services,
sleep clinic), and physical therapy clinics.
Contact: Harry Horricks, CEO
Oshawa Clinic, 117 King Street East
Oshawa, ON L1H 1B9
Tel. 905.721.3500
Website: www.oshawaclinic.com
Oshawa, ON — physiatrist — full
for a physiatrist who is interested in an
office-based consulting practice. Full
turnkey setup is available. Facilities
This is an opportunity to complement
the practice of the group’s two current
physiatrists. Practice opportunities
include the assessment and treatment
of musculoskeletal and neurological
conditions electro diagnostic test (nerve
conduction test/electromyography),
and interventional procedures
(musculoskeletal injections, neurotoxin
injections).
Oshawa, ON L1H 1B9
Tel. 905.721.3500
Oshawa, ON — rheumatologist — full
for a rheumatologist who is interested
in an office-based consulting practice.
Full turnkey setup is available. Facilities
Oshawa, ON L1H 1B9
Tel. 905.721.3500
Physician recruitment service: Global
Medics Canada have been successfully
placing family physicians in roles across
Canada for the last six years and are
currently working with many Canadian
and CFPC-eligible physicians from the
United Kingdom, Ireland and Australia
looking for short, medium, longterm and permanent roles in Ontario.
Company and service overview, plus
references available on request. We
can help you recruit the perfect family
physician for your clinic and in the most
efficient and hassle-free way possible.
No money is due upfront, and no
exclusivity is required. Our placement
52
fee is only payable once the (recruited)
physician has arrived and started work
for you. If you’re interested or just keen
for further information, please contact us.
Contact: Phil Martin, Business Manager
Tel. 250.307.4352
P i c k e r i n g — V ! VA R e t i r e m e n t
Community: We are looking for a
community physician. Position available
immediately. Hours: Full day once per
week. Monthly stipend to be provided in
addition to OHIP billing. Physician that is
accepting new patients is preferred.
Contact: Maggie Plaunt
Community Director
Tel. 905.831.2088
Psychiatrist needed for a busy
sleep clinic: Six-bed lab providing
comprehensive sleep disorders medicine
services for Kelowna, B.C. An interest in
cognitive behavioral therapy for insomnia
(CBTi) would be an asset. Experience not
necessary as training is provided. Stateof-the-art lab and office equipment with
electronic medical record (EMR) system.
Minimal on-call. Friendly and supportive
work environment. Excellent remuneration
in a popular vacation destination with
world renowned wineries, ski resorts,
lakes, golf courses and other great
activities. Please phone or email for more
information about this unique opportunity.
Contact: Dr. Ron Cridland
Tel. 250.862.3050
Radiologist required with an interest
in ultrasound and women’s imaging.
Midtown Toronto, state-of-the-art
equipment.
Respirology clinic in North York
is looking for a P/T or F/T associate
respirologist. Full PFT and sleep lab
on-site. For further information, please
email.
Richmond Hill, Ontario: Richmond Hill
After-Hours Clinic requires phy sicians
for daytime shifts 9 a.m. to 5 p.m.,
as well as evenings and weekends.
Guaranteed minimum 70:30 split.
Contact: Dr. Ian Zatzman
Tel. 289.553.7711
Fax: 289.553.7722
March 2016
Classifieds
Specialists — Brampton, Ontario:
Dermatologist, pediatrician, internist,
and psychiatrist required for medical
centre with several GPs and large
patient base. Attractive modern office with
seven days/week reception service. Feefor-service split or low flat monthly rate.
Tel. 416.949.3830
Fax: 647.340.2586
Email: bramptonfamilyhealth@
gmail.com
Specialists for medical cannabis
clinic (GTA): Integrated medical cannabis clinic offering comprehensive patient
services. Part-time opportunities with
flexible hours, competitive compensation, and telemedicine capabilities. Call
or email.
Contact: Todd Christie
Tel. 416.923.4567
Email: tchristie@northernfnhealth
care.com
Website: www.cannabisdocs.ca
St. Thomas, ON: Central Community
Health Centre is currently recruiting for
one full-time family physician and one
part time. Our client base is currently
2,145 and growing. We offer salary, no
overhead costs, and an excellent benefit
package including a pension plan and
paid vacation/statutory holidays. St.
Thomas is centrally located in the
middle of southwestern Ontario and just
minutes from the 401 corridor. It’s a
community known for friendly people
and inexpensive living with superb
recreational, health and educational
facilities.
Contact: Jackie Harris
Primary Care Co-ordinator
Central Community Health Centre
Tel. 519.633.6930, ext. 437
Stouffville medical centre requires
family physicians to join team of
p h y s i c i a n s f o r w a l k- in and famil y
practice. This new medical centre
h a s a m u l t i d i s c i p l i n a r y a p p ro a c h
managed by medical doctors.
E M R . F l e x i b l e h o u r s . P h a r m a c y,
physiotherapy, and dentist on-site.
Please call.
Contact: Sara
Tel. 905.479.2571
The Safety, Licensing Appeals and
Standards Tribunals Ontario (SLASTO)
has a challenging and interesting
opportunity for those interested in an
adjudicative appointment. SLASTO’s
mandate is to resolve and decide
matters arising from over 30 statutes
relating to public protection and safety
— including compensation claims and
licensing, policing, parole, fire safety,
and animal care orders. SLASTO is
seeking part-time medical practitioners
for the Licence Appeal Tribunal (LAT),
one of SLASTO’s five constituent
tribunals, to adjudicate appeals of
driver’s licence suspensions for medical
reasons as defined under the Highway
Traffic Act. LAT’s specific mandate
is to adjudicate and resolve appeals
concerning compensation claims and
licensing decisions made by a variety
of regulators under laws that protect
consumers and the public, and ensure
the integrity of the regulated businesses
and occupations. Appointment for a
position is by Order-in-Council for a two
or three-year term, subject to renewal
for a maximum of 10 years. To apply
for the position, please see advertised
positions on the Public Appointments
Secretariat website at: https://www.pas.
gov.on.ca/scripts/en/advertPositions.
asp. Application deadline is April 19,
2016. To learn more about the Licence
Appeal Tribunal and appeals from
medical suspension of driver’s licences,
please visit our website.
Website: www.lat.gov.on.ca
Thornhill family practitioner required
to replace an established physician in a
full-service medical building at Bathurst
St. north of Steeles Ave.
To r o n t o — f a m i l y p h y s i c i a n
(permanent or locum): There is an
opening in our family health group. One
of our five physicians is leaving Toronto.
An incoming colleague would be invited
to participate in some, or all, of the
following: office-based primary care,
nursing home, retirement home, home
visits for elderly and disabled, work
with our community outreach nurse
treating marginalized populations.
We are hopi n g f o r a n i m m e d i a t e
replacement. Expenses initially would
be a percentage of gross billings.
Please email your C.V.
Contact: Miranda
53
Toronto — we are currently recruiting
family physicians for walk-in shifts
and family practice. We have four fully
equipped and busy walk-in centres
that include EMR, labs, pharmacy, and
imaging. We offer a competitive split with
a financial incentive to join our team. To
discuss opportunities, please email.
Contact: Jameet Bawa, MD
Tw o F H O p o s i t i o n s a v a i l a b l e
immediately in southwestern Ontario:
Established general practice with full
roster. Hospital and ER available but not
mandatory. Full specialist and ER backup.
Locum physician would be considered.
Upper Village Walk-In Medical Centre
is currently looking for a family physician to
work full time and join our team. Our clinic
is conveniently located in the Toronto
area, parking included. Attractive split.
Contact: Kenzy
Email: kktruenorthgroup.kenzy@
gmail.com
Contact: Vanessa
Email: kktruenorthgroup.vanessa@
gmail.com
We are seeking a medical doctor
to join our team in Vaughan: Our
multidisciplinary clinic is well established
with walk-in and family medicine. The
new doctor will be fully rostered within a
few months. To discuss opportunity and
compensation, please contact us.
Contact: Pindy
Tel. 416.731.6828
Work close to home — Toronto,
N o r t h Yo r k , Va u g h a n : M u l t i p l e
locations available. High traffic, high
visibility locations, modern and fully
equipped, full EMR. Work alongside
orthopedic surgeons, sports medicine
doctors, physiatrists. Ideal for F/T or
P/T GPs looking to start or move their
practice and/or build a walk-in practice.
Full admin. and marketing support, very
attractive split.
Tel. 416.479.8699
March 2016
Classifieds
World renowned hair transplant
clinic currently looking for a physician
to become part of our Toronto-based
facility. Experience in hair transplantation/
cosmetics an asset but full training will
be provided. Flexible working schedule,
excellent compensation potential. We
are expanding our services and this is
an opportunity to take a leading role in
a well-established and highly respected
hair transplant centre. Please email for
further details.
Yonge/Major Mackenzie: Richmond
Hill area medical clinic looking for
specialists/family practice doctors to
join existing busy clinic with EMR and
support staff on turnkey operation. Inhouse pharmacy. Office space available
to start your own clinic/laboratory/
chiropractors/physiotherapists.
Tel. 905.884.0977
PRACTICES
Busy and lucrative family medicine
practice — (FHG) for sale in Brampton,
Ontario. To inquire, please email.
Busy solo FHO family doctor in Bay
of Quinte Region, ON: Looking for
doctors to take over fully-established
practice in September 2016. EMR in
place, good support from specialists.
Tel. 613.394.1726 (after 7 p.m.)
Dr. Jaya Islur seeks a pediatrician to
join his practice with the possibility to
eventually take it over. This practice,
located in the east end of Toronto near
Pape & Danforth, is well established. Dr.
Islur has served this community for 43
years in general pediatrics with a special
interest in infectious diseases. If you are
interested in learning more about this
opportunity, please contact his office.
Tel. 416.425.0605
Email: [email protected] or
[email protected]
Dundas & Neyagawa, Oakville: New
medical centre in Fortinos plaza, near
hospital. Free parking. RX on-site. Move
your practice or start new.
Tel. 647.389.7635
Exceptional opportunity — Saskatoon: Turnkey practice for sale. Established modern family practice in respected neighbourhood, over 8,000+
active patients. EMR stations, adjoining
pharmacy, long sublease, 4,200 sq. ft.
with 12 examination rooms plus receptionist area, meetings room, kitchen,
admin. office. Lab and digital X-ray, free
parking. Current physician-owner retiring and willing to provide transition and
training to new owners. Please email direct inquiries.
FHO position and rostered practice
— Brantford, ON: FHO family physician
retiring with well-established family practice of 2,400 active patients. Access
to other allied HCPs on-site. Leased
clinic space is bright with street and
highway visibility, ample free parking.
Easy commuting distance to Toronto.
Doctor is happy to stay on for smooth
transition.
Contact: Dr. Mehdi
FHO practice in Corunna on the St.
Clair River: 2,000+ patient roster, EMR,
call/once a month. Large two-MD office
with shared staff and expenses.
SERVICES AVAILABLE
A+ professional accounting and tax
services: Specially designed for medical
professionals. Special rate for incorporating medicine professional corporation.
Contact: Syed Raza, CPA, CGA
Tel. 647.999.5536
Website: www.cpa4medicalpro.com
Accountant (CA) GVP LLP: Medicine
professional corporations for doctors,
including tax planning, tax minimization,
income splitting, investment holding co.
Tel. 416.220.5717
Accountant in Toronto for physicians:
Jonathan Ruben, CPA, CA, LPA, CFP.
U.S. CPA (New York, Illinois, Michigan)
professional entrepreneurs count on us.
Website: www.jruben.com
54
Arya & Sher, health lawyers: Practice
focused on representing medical
practitioners, clinics, hospitals, and healthcare companies. Business and regulatory
issues, including professional incorporations, business registrations, contracts,
partnership/shareholder issues, tax and
estate planning, employment, leasing,
medical real estate, and regulatory matters.
Contact: Kashif Sher, LLB, MBA
Tel. 416.218.8373
Website: www.aryasher.com
Billing agent — electronic data
transfer to MOHLTC for all practices,
specialties and locums. Medical Billing
and Secretarial Services.
Contact: Edith Erdelyi
Tel. 416.576.6788
Billing services: MOHLTC billing agent.
Comprehensive, efficient and reliable
service for all specialties. Competitive
flat rate fee. Based in London, serving
SW Ontario.
Contact: Melissa Cervinka
Website: onmedicalbilling.ca
Closing your practice? DOCUdavit
Medical Solutions provides free paper
or electronic storage and practice closure services with no hidden costs.
DOCUdavit Solutions has achieved ISO
9001:2008 and ISO 2700:2013 certification validating our commitment to quality
management, customer service, and information security management systems.
Contact: Sid Soil
DOCUdavit Solutions
Tel. 1.888.781.9083, ext. 105
Free record storage for closing practices: RSRS is Canada’s #1 and only
physician-managed paper & EMR medical records storage company. Since
1997. No hidden costs. Call for your free
practice closure package: everything
you need to plan your practice closure.
Tel. 1.888.563.3732, ext. 2
March 2016
Classifieds
Medical Billing Clerks: Getting you
paid — on time, every time! Professional
and efficient. Specializing in OHIP
and all other types of medical claims
s u b m i s s i o n i n a l l p r a c t i c e a re a s .
Reasonable rates. Contact us today to
get your billings underway.
Contact: Kami
Tel. 416.888.6076
Medical transcription service s :
Te l e p h o n e d i c t a t i o n a n d d i g i t a l
recorder files. PIPEDA compliant;
excellent quality, next business day
service. All specialties, patient notes,
letters, reports, including medical-legal
and IME reports.
Tel. 416.503.4003 or 1.866.503.4003
Website: www.2ascribe.com
Moving or moved to EMR? Still have
lots of paper? RSRS scans your records
and offers full electronic access to your
active patient records. It’s easy and
affordable. PHIPA compliant.
Tel. 1.888.563.3732, ext. 2
Website: www.RSRS.com
OHIP billing specialist: Dynamic
Medical Services provides OHIP billing
with free setup in our OHIP billing
program with no initial costs and
no yearly fees. OHIP billing review/
re c o v e r y s e r v i c e s a n d p h y s i c i a n
information sessions provided by our
OHIP billing specialist with over 25
years of experience.
Tel. 519.851.1184
Website: www.Dynamicmedical.ca
Online OHIP billing $500 per doctor
per year, unlimited 2nd login. EMR $500
extra.
Tel. 416.855.6888, ext. 80
Tax planning and financial advice:
Clark Westcott, CPA, CA, and his team
at Clark Westcott Professional Corporation, serves medical professionals and
their families. Our goal is to help you
maximize your wealth. Our services are
cost efficient, professional and confidential.
Tel. 705.645.1692
Publisher’s Notes (continued from page 5)
UPCOMING EVENTS
Unique guided tours: New experiences await in destinations such as
Newfoundland, New York City, Las
Vegas and the canyons, Milwaukee/
Chicago and others including those on
the “Blue Jays’ Trail.” For information
contact your planner and escort, John
Swatridge of Verstraete Travel (Reg.
#4245411) by phone or email.
Tel. 519.742.2205
Keith Communications Inc.
1464 Cornwall Road, Unit 8, 2nd Floor, Oakville, ON L6J 7W5
Tel. 905.849.7777 or 1.800.661.5004
Fax: 905.849.1055
REPRINTING OF ARTICLES
Material in the Ontario Medical Review may not be reproduced in whole or in part without the express written permission of the Ontario Medical Association. Requests for
reprinting or use of articles should be forwarded in writing
to the OMA c/o the Editor.
CLASSIFIEDS ADVERTISING
Classifieds advertising inquiries should be directed to:
Vita Ferrante
Tel. 416.340.2263 or 1.800.268.7215, ext. 2263
Fax: 416.340.2232
SUBSCRIPTION RATES
The Ontario Medical Review is distributed to all members of
the Ontario Medical Association. Others may subscribe to the
Review at the following rates: in Canada $55; in the United
States $62; in other countries $79 (Canadian funds). Single
copies are $6, back issues $7. HST applicable.
The Ontario Medical Review is required to comply with the
provisions of the Ontario Human Rights Code 1990 in its
editorial and advertising policies, and assumes no responsibility or endorses any claims or representation offered or
expressed by advertisers. The Ontario Medical Review
urges readers to investigate thoroughly any opportunities
advertised.
DISPLAY ADVERTISING
Current display advertising rate card, effective January 1,
2016, available on request. Advertising representative:
Marg Churchill
Wo o d b ri d g e — are yo u l ook ing
to retire or close your practice?
Concerned about the transitioning of
your patients and who will take care
of their medical needs? Our family
health team is a well-established and
progressive medical office who can help.
Succession arrangements possible.
Please call or email.
Tel. 905.893.8085, ext. 202
55
March 2016
Copyright: Randy Glasbergen
Medec
“I’m too young for Facebook.
I’m on Head-Shoulders-Knees-and-Toes Book.”
Advertisers’ Index
AHIP (Hear55+) ................................. IBC
Record Storage and Retrieval
Services .............................................. 25
OMA Insurance Services ...................... 2
OMA Physician Health Program ......... 14
Canadian Medical Association .................4
Sea Courses Cruises ........................... 43
Ontario Medical Student Bursary
Fund (OMSBF) ...................................... 8
Cowichan Valley Division of
Family Practice.......................................49
Dr. Bernstein Diet and
Health Clinic......................................... 47
OMA Programs and Services
Klinix Software....................................IFC
OMA 17th Annual Women’s Health
Care Seminar..................................... 13
Peter Lantos Mortgage
Investments......................................... 45
OMA Advantage Program
(Affinity and Discounts) .................... OBC
56
March 2016
OMA ADVANTAGES
Special offers & rates for you!
OMA Advantages is committed to supporting Ontario’s doctors.
OMA members now have more options and benefits from more companies
than ever before. Enjoy preferred rates and services on travel from the
following vendors:
Corporate
Hotel Directory
OMA Advantages discounts and services are available for Wireless Communications, Travel & Leisure,
Auto, Fitness & Health, Moving & Relocation, Corporate Hotels, Entertainment, Office Services & Support.
Discount codes, rates and a
feedback tool are all available
at www.oma.org/advantages

Ontario Physicians Supporting Patient Self-Care

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