2012-OctDoctorsNS-t - Doctors Nova Scotia

Transcription

October 2012 | Volume 12 | Number 5
doctorsNS
The official magazine of Doctors Nova Scotia
( )
Focus on
physician
wellness
HERE TO HELP
Professional Support
Program to offer physician
wellness, prevention
• New privacy law coming
• New medical students welcomed
• Physician’s manual needs flexibility
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through my professional
group rates.”
– Bob Raposo
Satisfied client since 2005
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with your organization. You’ll also benefit from great coverage and outstanding service. We believe in making insurance easy to
understand so you can choose your coverage with confidence.
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Saturday, 9 a.m. to 4 p.m.
Preferred Provider Program
of Doctors Nova Scotia
The TD Insurance Meloche Monnex home and auto insurance program is underwritten by SECURITY NATIONAL INSURANCE COMPANY. The program is distributed by Meloche Monnex Insurance and Financial Services Inc.
in Quebec and by Meloche Monnex Financial Services Inc. in the rest of Canada.
Due to provincial legislation, our auto insurance program is not offered in British Columbia, Manitoba or Saskatchewan.
*No purchase required. Contest organized jointly with Primmum Insurance Company and open to members, employees and other eligible persons belonging to employer, professional and alumni groups which have an agreement with
and are entitled to group rates from the organizers. Contest ends on January 31, 2013. 1 prize to be won. The winner may choose the prize between a Lexus RX 450h with all basic standard features including freight and pre-delivery
inspection for a total value of $60,000 or $60,000 in Canadian funds. The winner will be responsible to pay for the sale taxes applicable to the vehicle. Skill-testing question required. Odds of winning depend on number of entries received.
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The TD logo and other trade-marks are the property of The Toronto-Dominion Bank or a wholly-owned subsidiary, in Canada and/or other countries.
ON THE
COVER
A monthly publication of
Doctors Nova Scotia
Drs. Carolyn Thomson (left) and Tracy Scott are
coordinators of Doctors Nova Scotia’s Professional
Support Program. In existence since 1988, the program
is expanding its focus to provide a more proactive and
comprehensive model of care. (Photo by Marnie Gillis)
FRONT OF THE BOOK
5 President’s message: The value of a balanced life
7 CEO’s message: Reshaping academic funding plans
Copy editor
Lourdes Fowler
AFFECTING MEMBERS
Graphic designer
Marnie Gillis
10 Physician navigators ready to support colleagues
Distribution assistant
Sonia Abi-Ajab
President
John Finley, MDCM, FRCPC
Chief executive officer
Nancy MacCready-Williams
8 Physicians on standby for new privacy legislation
11 Physicians stressed by patients seeking narcotics
13 Professional Support Program expanding services
14 Mental illness awareness takes centre stage at Atlantic Fringe Festival
15 Doctor takes own advice about fitness
16 Project aims to determine EMR needs of specialists
16 College registrar to address challenges of continued practice
17 Revised physician’s manual to have flexibility for changes
Tel
902.468.1866
1.800.563.3427
19 Reception welcomes new medical students
Fax
902.468.6578
PROVINCIAL MATTERS
email
[email protected]
Website
www.doctorsNS.com
Mail
25 Spectacle Lake Drive
Dartmouth, NS B3B 1X7
The opinions expressed in doctorsNS and
the advertisements, as well as flyers or
inserts, are those of the authors and do
not necessarily reflect the opinions of
Doctors Nova Scotia, its members or its
Board of Directors.
Mailed under Canada Post
Publications Mail Sales Agreement
#40069552
Return all undeliverable mail to:
Doctors Nova Scotia
25 Spectacle Lake Drive
Dartmouth, NS B3B 1X7
doctorsNS
Production coordinator
Melissa Murray
20 Form 8/10 an important communication channel
21 Dr. Gus Grant: NS planning medical quality assurance changes
22 Flu vaccine free for all Nova Scotians
23 Dr. Rhonda Church: New patient billing depends on circumstances
24 NS sport programs hoping to help combat childhood obesity
25 Dr. Gerri Frager: Sailboat offers place of refuge, calm and quiet
OF INTEREST
26 CMA president sees strength in numbers
26 New allergen, gluten labeling regulations in place
27 Canadians paying more for inferior health care
BACK OF THE BOOK
29 Practice opportunities
31 Events calendar
32 Electronic Bookshelf: Awareness of physician health issues on the rise
33 Web round-up
34 STATistics: Dr. Ivan Wong
October 2012 | doctorsNS
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Jun-13-12 12:00 PM
President’s
Message
Dr. John Finley
President, Doctors Nova Scotia
As physicians, our daily
encounters can often be
overwhelming, challenging
and demanding.
P
hysicians are often their own worst enemy when
it comes to their own health. We frequently fall
victim to our work and put others’ care before
our own. Not because we care less, but because we
assume we know better.
Physician wellness is more than ensuring all Nova
Scotian doctors have their own family physician. It’s
more than getting our annual flu shot, or taking sick
days when we need them. Physician wellness can be
achieved by making it home for dinner with your family, incorporating daily exercise into your life, holding
on to your hobbies and passions, and taking time to
spend with your family and loved ones.
In my own practice I have seen the great value of a
balanced life but recently I’ve been learning about physician mindfulness and the importance of being present
in the moment and paying attention to the silence we
often ignore.
Meditation, at whichever level you’re most comfortable with, can be an effective way to manage stress and
chaos in your life. As physicians, our daily encounters
can often be overwhelming, challenging and demanding. It’s critical we make time to process these events
and find peace at the end of the day.
The Medical Society of PEI hosted a special presentation, during its recent annual meeting, on physician mindfulness in coping with stress. In addition,
Dalhousie Medical School students in New Brunswick
are learning about the concept through a workshop
program. I encourage my colleagues across the province
to consider this and other powerful stress management
theories.
At Doctors Nova Scotia, we’re fortunate to have the
Professional Support Program (PSP) at our fingertips.
This program offers confidential counseling to physicians and their families who are experiencing problems
– whether they are personal or professional, financial or
psychological, psychiatric or addictive.
The coordinators of the PSP have extensive experience in working with physicians in need of help. A
network of the best treatment providers in the province
has been assembled to help in the above-mentioned
areas. These resources are available to support members
with their specified difficulty.
While the PSP is here to support you, I encourage
you to make it a priority to focus on prevention and
stress management techniques to establish and maintain
balance in your own life. Seek leadership training,
utilize the Doctors Nova Scotia Business of Medicine
program to increase efficiencies in your business, spend
time with family and friends, maintain a full social
calendar, hang on to your
hobbies and put yourself
first once in a while.
Our patients expect a
sound mind and spirit to
While the PSP is
provide their care. We owe here to support
it to them and it we owe it
you, I encourage
to ourselves.
you to make it a
priority to focus
on prevention and
stress management
techniques to
establish and
maintain balance in
your own life.
5
Fee application deadline approaching
Applications for new fees, fee adjustments or preamble changes is Oct. 31.
A reminder that the next deadline for applications for new fees, fee adjustments or preamble changes is Oct. 31. Please note
that ALL documentation must be submitted by the deadline, this includes O.R. reports and records where indicated. If the
documents are received after the deadline your application will not be reviewed with the Oct. 31 intake but will be considered
for the March 2013 deadline. For more information about the fee application process, contact:
Jennifer Girard
Health policy advisor
Tel: (902) 468-8935 ext. 231
[email protected]
CEO’s
Message
Nancy MacCready-Williams
CEO, Doctors Nova Scotia
While the implementation specifics are
still being developed, the benefits of a
new AFP model are clear.
F
rom my first day on the job I’ve been closely
involved in the massive project of reshaping how
academic funding plans (AFP) are negotiated,
administered and managed. While the changes are
desired by government, district health authorities,
Dalhousie Medical School and physician administrators, I suspect some of you may be asking ‘Why should
I be interested?’
While the implementation specifics are still being
developed, the benefits of a new AFP model are clear.
Department heads, administrators
The benefits are plentiful for AFP department heads
and administrators. They can be confident that the
information they provide to government meets expectations, and there are supports in place for managing the
contracts and reporting deliverables. They’ll have more
confidence in the comparative data being used for
negotiations and will know the negotiations schedule.
They’ll have a better process and structure in place to
resolve issues that arise between formal negotiations.
And there will be more clarity on expectations from all
parties (government, districts and medical school) in
return for the funding.
Working within an AFP
Those working within an AFP but not closely involved
in administering it will also see benefits – although
they may be more subtle. If it’s done right, the transition to the new model should be seamless. This will
allow for those working within an AFP to put continued focus on their patients, students and research. The
behind-the-scenes improvements in the management
of the contract should increase confidence that all contracts are managed in a consistent, transparent and fair
fashion. Equally important is the increased confidence
in a more responsive system to resolve arising issues.
Working outside an AFP
Physicians working outside of AFPs may also have an
interest in the development of the new funding model.
There are currently 15 AFPs with over 500 physicians
remunerated in this fashion. About 20 per cent of
practicing physicians in the province are within an
AFP, equating to about 28 per cent of the physician
services budget. From a holistic perspective, it’s important they know how these funding programs work
and also understand to what Doctors Nova Scotia is
dedicating its time and resources. Many fee-for-service
physicians refer patients to colleagues working within
an AFP. They want a better understanding of how the
funding supports the care provided to their patients, as
well as the instruction given to their future colleagues.
Consistency, clarity and formal processes – these words
best sum up the changes and goals of the new model.
Doctors Nova Scotia’s role
Every single one of you may be interested in knowing what role Doctors Nova Scotia plays in the new
AFP model. While we will continue to be the sole
bargaining unit for all AFPs representing physicians’
interests with government, we will work collaboratively to manage the AFP model with our partners
(Department of Health and Wellness, Capital Health,
IWK Health Centre and Dalhousie Medical School).
This collaborative management, similar to how the
Master Agreement is managed, will ensure a consistent
approach to issue resolution and negotiations. Every
decision-making table is populated by both physicians
and Doctors Nova Scotia employees.
To support a much more pro-active
and responsive model, Doctors Nova
Scotia is in the process of hiring three new
employees to the Physician Compensation
Subscribe to
and Negotiations team. This will make it
the CEO’s Blog at
much more achievable to appropriately
doctorsNS.com
divide the resources of this previously taxed
team between fee-for-service and alternative
funding arrangements. The team should be
at full capacity by the end of the month.
Until next time...
NEW!
7
Board of Directors update
Physicians on
standby for new
privacy legislation
Expected to go into effect early 2013
By SAMANTHA HOLMES
Staff writer
T
he impact of the province’s
new Personal Health
Information Act, which is
expected to become law when the
House of Assembly resumes late
this month, was explained during
the September meeting of the
Doctors Nova Scotia Board of
Directors.
Maria Lasheras, health privacy and access director with
Department of Health and
Wellness, presented information
about the act which will govern the
collection, use, disclosure, retention, disposal and destruction of
personal health information.
Board members were informed
of the legislation’s intent, who
it will impact, and what will be
expected of physicians in order to
comply.
The legislation will eventually replace the current national
Personal Information Protection
and Electronic Documents Act
(PIPEDA).
The Personal Health
Information Act is expected
to go into effect early in 2013.
Communication and education
tools are being prepared to support
physicians through the compliance
process.
Caffeinated beverages
The Board asked its Policy &
Health Issues Committee to
consider motions made at the 2012
annual conference about caffeinated
beverages. During the conference,
Doctors Nova Scotia was asked to
8
play a role in introducing policy
to deter youth from consuming
energy drinks and the use of energy
drinks with alcohol.
The Policy & Health Issues
Committee will make a recommendation on how the association
should proceed.
Physician recognition
campaign
As part of the 2012-16 strategic
plan, Doctors Nova Scotia has
begun work to create a long-term
physician recognition strategy to
promote the innovative and reputable work of its members across
the province. Board members were
encouraged to share success stories
with their colleagues to be considered for a campaign.
2012-13 Board of Directors
Five new members round out the 2012-13
Doctors Nova Scotia Board of Directors
Drs. Lynn Johnston and Elwood MacMullin won seats
during the annual Board election last spring while
Philip Davis and Bob Farmer will serve as the representatives for PARI-MP and the Dalhousie Medical
Student Society, respectively. The fifth new member
is Dr. Jackie Kinley, who was appointed to a one-year
term as a regional representative.
Returning members appointed to one-year terms as
regional representatives are Drs. Kathy Gallagher,
Celina White and Greg Clarke.
Drs. Lisa Bonang and Heather Johnson both were
elected to three-year terms last spring.
All other members are serving existing terms.
Executive
Dr. John Finley: President
Dr. Mike Fleming: President-elect
Dr. John Chiasson: Chair and Past President
Dr. Celina White: Audit Committee chair
Nancy MacCready-Williams: CEO
GPs inside Metro
Dr. Lisa Bonang (Section Forum chair)
Dr. Kathy Gallagher
GPs outside Metro
Dr. Elizabeth MacCormick
Dr. Michelle Dow
Dr. Heather Johnson
Specialists inside Metro
Dr. Jason Williams
Dr. David Milne
Dr. Lynn Johnston
Dr. Jackie Kinley
Communication and
education tools are
being prepared to
support physicians
through the
compliance process.
Specialists outside Metro
Dr. Mike Silver
Dr. Elwood MacMullin
Dr. Greg Clarke
Representatives
Dr. Jane Brooks, CMA
Bob Farmer, Dalhousie Medical Student Society
Dr. Philip Davis, PARI-MP
Across the Country
Medical association comparisons
This infographic compares the membership benefits, size and dues
of 12 Canadian medical associations’ full-time members
happy, healthy and productive.
Many of the benefits and services
are unique to Nova Scotia when compared to medical associations across
Canada.
Full members of Doctors Nova
Scotia receive a complete health and
dental plan, access to a confidential
Doctors Nova Scotia knows the
importance of offering benefits and
services that respond to the needs
of its members. To this end, the
association offers a robust package of
benefits and services. Each program or
service is designed to ensure that the
province’s physicians continue to be
physician health program, leadership
and business training, access to
thousands of online clinical tools, and
electronic medical record support, just
to name a few.
In addition to the products and
services offered by Doctors Nova
Scotia, membership with the Canadian
Medical Association (CMA) offers additional products and services designed
to meet physicians’ personal and
professional needs.
For more information on the benefits
and services available to members
of Doctors Nova Scotia, visit www.
doctorsns.com/members.
Health association dues by provincal association (Full member)
*Dues reflect conjoint membership with CMA.
MSPEI*
$2980
AMA*
$2745
SMA*
$2190
NWTMA* BCMA*NLMA*OMA YMA* DM*NBMS* DNS QMA*CMA
$2130 $2073$2030
$1910 $1765 $1575$1555$1350$730$430
Comparison of services
Product/Service Offered
CMA OMA DNSMSPEIAMA BCMA SMA NBMSNLMA DM YMA QMANWTMA
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Financial/Incorporation advice
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of Medicine courses
• Register for physician
leadership workshops
Northwest Territories (56)
Yukon Territories (71)
Prince Edward Island (277)
Newfoundland (1,326)
New Brunswick (1,774)
Saskatchewan (2,048)
Nova Scotia (2,492)
Manitoba (2,673)
Alberta (8,150)
British Columbia (11,001)
Quebec (17,922)
Ontario (27,223)
Number of practising physicians by province
• Review the electronic
bookshelf
• Read the doctorsNS
magazine
• Check the latest policy
positions
9
During stressful times
Physician navigators
ready to support colleagues
A helpful but under-used support program
By Eden Boutilier
Staff writer
Contact a
physician
navigator
Current volunteer physician
navigators and their contact
information are:
Dr. John Chiasson, program
chair
(902) 863-4070
[email protected]
Dr. Carol Critchley
(902) 567-0556 or
(902) 567-0555
[email protected]
Dr. Donna Gilmour
(902) 470-6787
[email protected]
Dr. Renee Lutwick
(902) 835-2266
[email protected]
Dr. Don Rowe
(902) 895-3444
[email protected]
10
D
ealing with a complaint can
be a lonely and difficult time
for a physician. Throughout
an investigation by the College of
Physicians and Surgeons of Nova
Scotia stress can grow and it may
seem like nobody understands.
The Physician Navigator
Program, an initiative of Doctors
Nova Scotia, was introduced in
2008 to provide moral support and
guidance to physicians undergoing
an investigation. Navigators are
physicians who volunteer to help
colleagues “navigate” through a
potentially difficult and stressful
time in their medical careers.
“As a navigator I have the
personal satisfaction of using my
skills to help my colleagues,” said
Dr. John Chiasson, a general practitioner from Antigonish and chair
of program.
“With our heads down working
we seldom ask for help from one
another and it is a privilege to
be able to do something to assist
another in our profession without
looking for compensation,” he
added.
The program was developed
under the leadership of Dr. Don
Wescott during his term as Doctors
Nova Scotia President in 2008-09.
“Dr. Wescott had served the
College of Physicians and Surgeons
of Nova Scotia and had excellent insight into the needs of the
members as they are served by both
organizations,” said Dr. Chiasson.
With their knowledge of the
complaint process, navigators can
maintain a neutral position and
have understanding of boundaries
and the role of a support person.
They are a readily available, courteous, honest and non-judgmental
voice of reason.
Two surveys conducted by the
college determined that physicians
who had gone through the complaint process would have benefitted from a physician navigator. The
surveys found that physicians are
often unfamiliar with the complaint
process, which can add to their
stress. It was also found that some
physicians deal with complaints
alone and find the experience
isolating.
While talking with a physician
navigator may reduce the isolation and stress some physicians
experience when going through the
disciplinary process, the program is
underused.
“I’m aware that statistics released
by the college indicate there are
approximately 150 to 200 complaints from the public regarding
our members every year,” said Dr.
Chiasson. “We only receive a handful of inquiries from members as
navigators so there is a measurable
gap between what is being delivered
and the potential need.”
Dr. Chiasson said being a physician navigator is a lot like being
a firefighter – he’s not hoping for
trouble but is ready to volunteer
when needed.
He said the volunteer physician
navigators and Doctors Nova Scotia
would like to see the program bet-
ter utilized.
More information on the
Physician Navigator Program is on
doctorsNS.com in the ‘Services’
section.
With our heads
down working
we seldom ask
for help from one
another and it is a
privilege to be able
to do something
to assist another
in our profession
without looking for
compensation.
Dr. John Chiasson,
Physician Navigator
Program chair
Pressure to prescribe
Physicians stressed by
patients seeking narcotics
Recommendations on spotting potential
misuse of prescription drugs
By KATIE MALLAM
Staff writer
I
dentifying drug-seeking patients
can be a challenging and stressful experience for physicians.
The Canadian Medical
Protective Association (CMPA)
regularly receives calls from physicians uncomfortable with new
patients requesting prescriptions
for narcotics. Physicians working
in walk-in clinics and emergency
departments frequently call the
CMPA to ask if they can refuse to
provide narcotic refills.
“Making the decision to
prescribe or not to prescribe a
controlled substance can be a
lengthy and stressful process,” said
Dr. Tracy Scott, a coordinator with
Doctors Nova Scotia’s Professional
Support Program (PSP).
The PSP works with physicians,
dentists, veterinarians and their
families who are experiencing
personal or professional, financial
or psychological, psychiatric or
addictive problems.
“Patients who seek narcotics can
be very persistent, calling the office
multiple times, even trying to steal
triplicate prescription pads,” said
Dr. Scott.
“I believe this is a significant
stress for physicians as it can be
in any situation in which a doctor
feels pressured to write a prescription, even one for antibiotics, by
the patient. It can take longer to
explain to a person why they don’t
need a medication than to write a
prescription, and the patient may
become angry or upset,” she added.
Dr. Scott said writing a “quick”
prescription, particularly for pain
medications, can land both doctor and patient in trouble. When
there’s no pre-existing therapeutic
relationship between a physician and patient, writing such a
prescription can enable a patient’s
addiction or cause harm to others
suffering with addictions through
the redirection of controlled substances in a community.
Nova Scotia’s Prescription
Monitoring Program showed in its
2011-12 annual report that 7,894
people who received prescriptions
for monitored drugs received them
from more than three prescribers.
Information on how to obtain
prescription drugs is readily available online.
“There are directions circulating on the Internet that detail the
process of getting your doctor to
prescribe narcotics for you,” said
Dr. Scott. “It essentially tells the
patient how to behave, not to look
too eager to get the prescription,
and to even say they really would
rather not have a narcotic.”
In an online discussion, entitled
How to get a script for Oxycodone,
hosted by www.topix.com, several
users share techniques for getting
prescriptions.
One user writes, “I usually just
bring up the fact that I use to be
in a pain clinic and they had me
on Roxicets 30mg one tab, every
three hours, and this just about
eliminated the pain. You may also
want to mention a muscle relaxer
or anti-inflammatory pill that also
worked well for you just to make it
all look legit.”
According to the Prescription
Monitoring Program, Oxycodone
was the third most prescribed
narcotic group in the province
last year at 21 per cent. Codeine
and Hydromorphone took the top
spots at nearly 37 and 30 per cent,
respectively.
To help reduce the stress of
such narcotic prescription requests
and to better identify which are
legitimate, several organizations
have created recommendations to
spot potential misuse. For example,
the American Academy of Family
Practitioners recommends tactics
such as involving an entire team to
offer multiple opinions, recognizing
suspicious behaviour, obtaining a
thorough history of present illness,
looking for consistency in exam,
conducting appropriate tests,
prescribing non-pharmacological
treatment, and proceeding with
caution.
CMPA recommends that physicians working in emergency departments prescribe only a small carrying dose sufficient for a holiday
periods or weekend until patients
can contact their usual prescriber.
It also suggests physicians should
be especially skeptical if patients are
unable to identify their prescriber.
The Nova Scotia College of
Physicians and Surgeons has
developed the “Good Pill, Bad
Pill” campaign that recognizes the
important role medications play
in some patient’s treatments but
also that they can be misused. The
college suggests the use of opioid
treatment agreements be used by
doctors to identify the joint responsibility of physicians and patients to
ensure that prescriptions are being
use appropriately.
For more information on prescribing for controlled substances,
contact:
Professional Support Program
Tel: (902) 468-8215
[email protected]
Patients who seek
narcotics can be very
persistent, calling
the office multiple
times, even trying
to steal triplicate
prescription pads.
Dr. Tracy Scott
PSP coordinator
11
Confidential help available
Professional Support
Program expanding
services
Physician wellness, prevention strategies to be offered
BY KIM BOTTOMLEY
Staff writer
D
octors Nova Scotia is expanding the focus of its Professional
Support Program (PSP) to
provide a more proactive and comprehensive model of care to those it
serves.
The PSP has been offering confidential help to physicians, dentists,
veterinarians and their families who
are experiencing problems – whether
they are personal or professional,
financial or psychological, psychiatric
or addictive– since 1988.
The current PSP model relies on
those it serves to identify a problem
and seek support. It also accepts referrals from the College of Physicians
and Surgeons of Nova Scotia.
Both forms of accessing the PSP
will continue but the expanded model
will use various communication
vehicles to educate physicians on wellness and prevention strategies.
The PSP will have a more fully
developed presence on doctorsNS.com
including self-assessment strategies,
links to other resources, seminars and
workshops, and educational videos
and reading materials.
In addition, PSP coordinators will
write regularly for doctorsNS on topics
such as finding balance, fatigue management, building resilience, burnout,
medical marriages, and challenges for
international medical graduates. It
will also provide outreach support by
meeting with physicians in various
communities across the province.
The expanded program will target
all physicians, dentists, and veterinarians in Nova Scotia. There will be a
strong focus on the at-risk populations which include rural physicians,
women, medical, dentistry and veterinary students and residents, minority
groups, professionals with disabilities,
and family members.
Dr. Carolyn Thomson, a PSP coordinator, said stress-related disorders
like anxiety and depression are common among physicians.
“Physicians tend to struggle with
achieving a steady work-life balance,”
said Dr. Thomson. “This is especially
true for younger physicians and residents who are concerned with evaluations, self confidence and starting a
family,” she said.
Seasoned physicians often experience stress related to workplace issues,
frustrations with the health-care
system or regulatory complaints.
The 2012 Doctors Nova Scotia
membership survey revealed that
many physicians expect the expanded
PSP to support physicians throughout
the complaint process of the College
of Physicians and Surgeons of Nova
Scotia. Forty-six per cent of respondents said this service is critically
important.
In the same survey, 58 per cent
of respondents said educational sessions on physician wellness, burnout,
stress-management, and work-life balance was an important focus for the
expanded program.
An expanded PSP will aim to teach
physicians how to effectively cope
with pressure and stress to achieve
greater personal satisfaction, higher
productivity and improved patient
outcomes.
“Physicians often assume that they
should know better and be able to fix
their issues on their own,” said Dr.
Thomson.
“Our hope is through education
and outreach we can help provide
the tools and knowledge they need to
process and manage their stress in a
healthy way, and increase awareness of
the support we offer in case they need
a hand to guide them,” she added.
Dr. Thomson said members of
Doctors Nova Scotia can expect
improved communication and educational opportunities, better program
visibility, and access to support. Along
with fellow program coordinator Dr.
Tracy Scott, the team of two is working to improve resources for physicians to learn about stress prevention
and physician wellness as part of their
continued medical education.
Dr. Thomson said practicing
Physicians tend
to struggle with
achieving a steady
work-life balance.
This is especially
true for younger
physicians and
residents who are
concerned with
evaluations, self
confidence and
starting a family.
Dr. Carolyn Thomson
PSP coordinator
healthy self-care, making family time
a priority, being physically active, and
eating a healthy diet are all great ways
to manage stress levels and maintain
work-life balance.
“It’s also important that we
improve collaboration among our
colleagues so we have flexibility in our
schedules and the amount of hours we
work,” she said.
“We want to lend strategies to help
improve resilience in physicians given
the challenging experiences they face
each day,” she added.
Dr. Thomson said the PSP is a
safe and confidential place for physicians to seek guidance, support and
resources if they are experiencing these
issues.
PSP contact info
The Professional Support Program responds to all inquiries
within two business days.
All conversations or messages left for coordinators are
confidential.
Tel: (902) 468-8215
professionalsupport@
doctorsns.com
Signs that
support is
needed
Professional Services Program
coordinator Dr. Carolyn Thomson said physicians don’t
always recognize their own
need for support. Signs that
a physician might in need of
support include:
• A slower or less efficient
workplace performance
• Increased conflict with
colleagues
• Less professional satisfaction
• Withdraw from social
events
• Increased unhealthy
behavior
• Expressions of concern
from colleagues
13
Athena in Love
Those involved with
Athena in Love are
pictured during an
August rehearsal at the
OE Smith Auditorium,
IWK Health Centre. Front
row, l-r: Allan Tidgwell,
Michael Smith, Dr. Julie
Strong, Kim Parkhill and
Kayleigh Sheehan. Back
row, l-r: Keelin Jack and
Garry Williams. Missing
from photo: Hugo Dan,
Andrew Kasparzak, and
Mike Tobin.
Mental illness awareness
takes centre stage at
Atlantic Fringe Festival
Play written by Dr. Julie Strong raises money for Laing House
By EDEN BOUTILIER
Staff writer
T
he curtains rose not only
for entertainment, but for
funds and awareness of
mental illness when Athena in Love
premiered at the Atlantic Fringe
Festival on Sept. 1 in Halifax.
The production, written by
Halifax family physician Dr. Julie
Strong, literally brought to centre
stage a story of healing from mental
illness.
Athena in Love is a comedy that
tells the story of Pallas, a friend of
the goddess Athena. Pallas is dying
and Medusa’s blood is the only
known cure. But Pallas doesn’t
want it so her friends try other
methods to save her.
“I would definitely say the fundraising and mental illness awareness
efforts of Athena in Love were
successful,” said Dr. Strong.
“The theatre space was designed
to seat 40. On three of the four
14
performances they had to bring in
extra chairs to seat 70,” she added.
The entire proceeds of $1,100
were donated to Laing House, a
centre for youth with mental illness
in Halifax. The funds are designated for its art program.
“One of Athena’s actors is an
alumnus of Laing House. At the
conclusion of the play, he paid tribute to the assistance Laing House
has given him in dealing with
his own mental illness,” said Dr.
Strong.
She said she originally planned
to have only youths from Laing
House’s drama club perform in the
play so they would be directly
involved with fundraising for
the organization that is assisting
them. When only two youths
attended the audition, Dr. Strong
looked elsewhere for actors. The
cast consisted of actors from the
Dalhousie Theatre Program and
College in Dublin. She’s also an
other Halifax youth. award-winning writer who holds
Dr. Strong said the funds raised
a bachelor of arts in classics from
through the play will help to reduce Dalhousie University. She won the
the poverty often experienced by
2010 Atlantic Writers Federation
youth living with mental illness.
prize for short story and has had
“The play provided an excellent
several essays published in the
opportunity to reach new demoMedical Post.
graphics and reduce stigma associDr. Strong worked for eight
ated with mental
years to write Athena in
illness,” she said,
Love, collaborating in
adding it helped
2004-05 with Neptune
bring to the public
Theatre’s Playwright’s
The play provided
the challenges and
Assembly to make the
an excellent
experiences of
final revisions. Dr.
people living with opportunity to reach Strong’s efforts won the
new demographics award for best playwright
mental illness.
Dr. Strong,
at this year’s Fringe
and reduce stigma
who practices at
Festival.
associated with
Lacewood Medical mental illness.
Doctors Nova Scotia
Walk in Clinic in
was a sponsor of Athena
Dr. Julie Strong in Love.
Halifax, obtained
playwright and family
her medical degree
physicain
from Trinity
Physically active physicians
Dr. Stephanie Langley and her family after the 2012 Cape Breton Fiddlers Run
5k race. L-r: Dan Bunbury, Eve Bunbury, Emma Bunbury, Maggie Bunbury, Dr.
Stephanie Langley and Sophie Bunbury.
Dr. Stephanie Langley and her daughter Eve Bunbury racing to the finish
line at the Johnny Miles 5km run 2012.
Dr. Stephanie Langley competing in
the 2011 Ingonish Try-a-Tri.
Doctor takes own
advice about fitness
Dr. Stephanie Langley explains importance of work, life and fitness
By Eden Boutilier
Staff writer
A
physician’s advice to lead a
healthy life isn’t something
Dr. Stephanie Langley
reserves just for her patients. She
leads a busy lifestyle, juggling a
career and a family, but still carves
out time for her own physical
fitness.
“One message I would like to
get out to people is that there is
always time for exercise. That is
the biggest excuse people tell me
in my practice when I encourage them to get active,” said Dr.
Langley, a general practitioner from
North Sydney and mother to four
daughters.
“I had my twins in a running
stroller and, in the early days,
would have my other two daughters
on their bikes,” she added.
Growing up, Dr. Langley was
involved in swimming, biking and
basketball, but during her university years she admits exercise wasn’t
a major focus. After graduating
from medical school she quickly
established a practice and began
her family. It wasn’t until after the
birth of her twins that she decided
she needed to get back into shape.
“Staying fit is a great way to
manage the ‘middle-age spread,’
but more importantly I feel exercise
is a wonderful stress reliever. There
is nothing better than after a stressful day at the office to come home,
throw your sneakers on, plug in
your iPod, and head out for a run.
All the stress of the day is instantly
washed away and you return home
again full of energy and positive
vibes for your family,” she said.
Dr. Langley and her daughters – Eve, Emma, Maggie and
Sophie – often participate in 5k
runs together. She believes leading
by example will teach her kids the
benefits of healthy, active lifestyles.
The doctor and her husband
Dan Bunbury competed in the
Guysborough County Triathlon in
2010 and the Ingonish Try-a-Tri
Doug Watt. This entire group of
in 2011.
Northside-Cape Breton doctors set
“My goals for the future would
the bar by competing in triathlons,
be to work up to a half marathon
competitive swimming, skiing and
and to do a sprint discycling.
tance triathlon,” said
Dr. Langley’s tip
Dr. Langley. “After
on getting started is
all, I have to keep up
to purchase a pair
with the other docs in One message I
of sneakers and start
would like to get
town who are a very
moving.
out to people is that
athletic competitive
“Move more than
bunch!”
there is always time you have been doing
Dr. Langley’s
for exercise. That is and make time for it
competitive colleagues the biggest excuse
most days,” she said,
include Drs. Eugene
adding she believes that
people tell me in
Ignacio, Paul Hickey
with dedication anyone
my practice when I can be an athlete.
and Irina Ghenea.
She joined them last encourage them to
“Your health is the
month to participate get active.
most important thing
as a team in the Cape
Dr. Stephanie in your life. If you
Breton Fiddlers Run
don’t have your health
Langley,
5k. Other North
you don’t have much,”
North Sydney general
Sydney physicians
said Dr. Langley. practitioner
taking their commitment to fitness to the
next level are Drs. Peter Poulos and
15
Feedback gathered from physicians
Section of Senior and Retired Doctors
College registrar
Project aims to
determine EMR
to address
needs of specialists challenges of
continued practice
Evaluation of current EMR
solutions in province underway
By KATIE MALLAM
Staff writer
By DR. MARGARET CASEY
Section of Senior and Retired Doctors
D
octors Nova Scotia is head“That’s why we reached out to
ing in the right direction
this group specifically. We wanted
with electronic medical
to make sure that we better underrecord (EMR) requirements for
stood their EMR requirements.
community-based specialists.
The comments and feedback we
Over 300 community-based
received have been quite helpful in
specialists provided feedback
this regard,” he added.
in August on a
The requirements
preliminary list of
summary will now
EMR requirements
provide the basis by
developed by the
which Doctors Nova
association.
Scotia, DHW, and
We believe
A summary of more
the district health
community-based
than 80 requirements
authorities will
will be used to inform specialists have
evaluate how current
a joint Doctors Nova some unique EMR
EMR solutions in
Scotia, Department of needs. They practice Nova Scotia are
Health and Wellness differently from their meeting the needs
(DHW), and district colleagues working of community-based
health authorities proj- as family doctors
specialists.
ect aimed at determinThe evaluation
and those specialists
ing how communitywill help inform the
specialist EMR needs who treat hospital
decision on how to
can best be met in the patients only.
proceed with meetprovince.
Stewart Gray ing requirements.
The identified
Information technology The options are
requirements were
director to continue using
derived from processes
existing systems or to
critical to specialist
seek a new specialistpractices including management of oriented solution.
referrals, wait lists, scheduling and
Planning for the current EMR
billing. The importance of EMR
evaluation is underway. Doctors
integration with specialized equipNova Scotia members will be kept
ment and other health information informed of progress and results.
systems was also captured.”
For more information on the
“We believe community-based
community-based specialists EMR
specialists have some unique EMR
needs,” said Stewart Gray, Doctors project, contact:
Stewart Gray
Nova Scotia’s information techIT director
nology director. “They practice
Tel: (902) 468-8935 ext. 235
differently from their colleagues
[email protected]
working as family doctors and
those specialists who treat hospital
patients only.”
16
Dr. Gus Grant’s talk expected
to generate great interest
S
ome of the difficulties
encountered by senior physicians in practice will be
discussed at the annual meeting of
the Section of Senior and Retired
Doctors, set for Wednesday, Nov.
28 in Halifax.
Dr. Gus Grant, registrar of
the College of Physicians and
Surgeons of Nova Scotia, will
address the meeting on issues
related to senior physicians in
practice. Many senior physicians
don’t want to retire from practice
and there’s currently some work
being done around incentives
that may assist them to continue
working.
Dr. Grant’s address is expected
to generate great interest. He will
speak at 5 p.m. The venue and
additional information will be
provided as the date approaches.
Appropriate end-of-life care
The section’s panel discussion on
appropriate end-of-life care is set
for 7 p.m. in Theatre A of the
Sir Charles Tupper Building in
Halifax. The panel will be chaired
by William Lahey, former director
of the Health Law Institute and
associate professor at the Schulich
School of Law. Lead speaker will
be professor Jocelyn Downie,
research chair in health law and
policy at the Health Law Institute,
and a professor at the Schulich
School of Law.
Palliative care will be represented on the panel as will the
public.
End-of-life care presents
complex challenges as technical
expertise increases. The Canadian
Medical Association will spend
the next two years exploring how
the country can provide the most
appropriate care and support to
those who are at the end of life. It
will develop policies around care.
The panel is expected to be a
stimulating introduction to the
discussions which will occur over
the next two years.
Many senior
physicians don’t
want to retire from
practice and there’s
currently some work
being done around
incentives that
may assist them to
continue working.
MSI Physician’s Manual more than fees
Revised physician’s
manual to have
flexibility for changes
Doesn’t reflect current practice or
patient/service complexity
Modernization
project
important work
By Jennifer Girard
Staff writer
T
he ongoing project to scope
reflects the current state of healthout a plan on how to modcare delivery. Assigning values to
ernize the MSI Physician’s
these descriptors will come at a
Manual, commonly referred to the
later phase. While it’s essential that
fee schedule, has identified both
the work should be assigned a fair
problem areas and opportunities for value, at this point it’s more critical
improvement.
to identify the services that reflect
More than 60 interviews
best clinical practices and which,
with physicians, Medavie Blue
therefore, should be insured.
Cross/MSI employees, health
The intent is to also ensure
administrators and provincial
the data be used not only for
counterparts were conducted by
physician compensation but for
RKL Consulting, the group hired
human resource planning, practice
to recommend an approach to
planning, research, and policy
overhauling the physician’s manual. development.
Main themes from the input
The existing manual no longer
gathered are:
accurately reflects the reality of
• Manual doesn’t reflect current
how a physician spends time carpractice or patient/service
ing for patients. In addition to
complexity
many outdated fees, its rules and
• Uncertainty in the data’s
language is often complex and
quality and expectations that
unclear thus creating opportunities
it could be abundantly used,
for billing errors or inconsistent
including sharing data with
interpretations.
physicians
The goal of the modernization
• Challenges with the audit
project is to create a physician’s
process
manual that addresses concerns
• Complex rules and modifiers,
outlined by physicians and health
difficult interpretation
administrators. A revised manual
• Detail too
must have the flexibility
specific for
to evolve with changes in
some, too
practice, technology or
general for
patient needs so it can be
A revised manual
others
used effectively both now
must have the
Interview feedand in the future.
back validates that flexibility to evolve
RKL Consulting
with changes in
the early phase of
worked with a steering
the modernization practice, technology committee that includes
project should
physicians representing
or patient needs
focus entirely on
Doctors Nova Scotia and
so it can be used
ensuring the cliniDepartment of Health
effectively both now and Wellness staff. The
cal diagnoses and
service description and in the future.
committee guided the
development of the report and
recommendations presented to the
association’s Board of Directors
during its September meeting.
Input from physicians who were
interviewed has added value to
the project to date. Doctors Nova
Scotia and physicians will continue to play a critical role in the
development of a new physician’s
manual. There will be numerous
opportunities for interested physicians to get involved.
For more information on the MSI
Physician’s Manual modernization
project, contact:
Jennifer Girard
Health policy advisor
Tel: (902) 468-8935 ext. 231
[email protected]
Project to take five
years to complete
The MSI Physician’s Manual
modernization project is
viewed by the Doctors Nova
Scotia Board of Directors as
the most significant piece of
work the association will do in
the next five years.
That was the message from
Board members during their
September meeting following
a presentation from Robyn
Kuropatwa of RKL Consulting,
the company hired to map out
a plan on how to approach the
modernization project.
The work to update the physician’s manual for the first time
in 30 years is expected to take
five years.
The project is co-sponsored
by Doctors Nova Scotia and
the Department of Health and
Wellness (DHW).
The project’s success is
contingent on a long-term
commitment from Doctors
Nova Scotia, MSI, and government. While the current
government is fully committed
to the modernization project,
Board members hope the commitment endures the entire
length of the project.
Discussions have begun
between Doctors Nova Scotia
and the DHW to secure funding and resources.
17
Doctors Nova Scotia members
PAGE 18 and 19: New Dalhousie Medical School students mingled with members of the Doctors Nova Scotia Board of
Directors and association staff during the annual First-Year Medical Student Reception on Sept. 20.
18
Reception
welcomes new
medical students
Université de Sherbrook medical students attend online
BY KIM BOTTOMLEY
Staff writer
N
ew Dalhousie Medical
School students were
welcomed as members of
Doctors Nova Scotia during the
2012 First-Year Medical Student
Reception held at the Doctors
Nova Scotia offices in Dartmouth
last month.
Several members of the association’s Board of Directors met
and mingled with more than 80
students in attendance. Association
President Dr. John Finley addressed
the group, welcoming each member
to the medical profession.
“It’s your time to begin to add
your talents to the pool of wonderful medical professionals here in
Nova Scotia – the people who will
mentor you in your studies over the
next four years,” said Dr. Finley.
“I hope you will discover that
your greatest teacher will be your
patients,” he added.
The annual welcome event aims
to encourage students to become
involved with their professional
association and to inform them of
the benefits of membership. Nova Scotian students studying medicine at the Université de
Sherbrooke in Quebec attended the
event via GoToMeeting. Several
students watched and listened to
Dr. Finley as he spoke to the physicians in training.
“Including our members studying in Quebec was an important
step in building collegiality and
understanding of how Doctors
Nova Scotia supports the province’s
future physicians,” said Dr. Finley.
The highlight of the evening
was the presentation of a welcome
gift bag which included a Littman
stethoscope branded with the
Doctors Nova Scotia logo, and
other medical equipment that will
prove useful during training. The
gift was sent in advance to the three
students studying in Quebec.
Information on the 2012-13
Medical Student Bursary Program,
life and disability insurance,
Canadian Medical Association
membership for medical students is
on doctorsNS.com in the ‘Services’
section.
For more information on student
benefits with Doctors Nova Scotia,
contact:
Catherine Carnegy
Membership officer
Tel: (902) 468-8935 ext. 234
[email protected]
It’s your time to
begin to add your
talents to the pool of
wonderful medical
professionals here
in Nova Scotia – the
people who will
mentor you in your
studies over the next
four years.
Dr. John Finley
Doctors Nova Scotia
President
19
Workers’ Compensation Board of Nova Scotia
Form 8/10 an important
communication channel
Supports patient’s recovery, return to full work duties
By DENNITA FITZPATRICK
Workers’ Compensation Board of Nova Scotia
T
he Physician’s Report, or
Form 8/10 as it’s commonly
known, is the primary communication channel between a
treating physician and the Workers’
Compensation Board of Nova
Scotia (WCB).
Proper completion of this form
when a patient has a work-related
injury is necessary to ensure the
patient receives the support, benefits and services to which they are
entitled. Effective communication
supports the patient’s recovery and
their return to full work duties.
Here’s a closer look at Form
8/10, and why it’s so important.
WCB claim number
An injured worker may already
have a claim number when they see
a physician and may have multiple
claims so this field is important to
ensure correct claim assignment in
the WCB electronic claim file.
Worker information
The worker’s name, address and
other information verifies the claim
number. It also helps the WCB
look up or register the worker in its
system.
The employer’s name helps link
the claim and associated healthcare costs to the correct employer
account. The WCB can only cover
costs for insured workplaces, and
it’s important to know which
employer a worker was working for
when the injury or illness occurred.
The worker’s job title/occupation
is used with the type of injury to
estimate how long a worker should
be off work for the condition,
20
based on the medical disability
advisor. This information allows
the WCB to assess the risk and
level of service the worker needs.
Injury information
Information such as the date of
injury, diagnosis, and findings are
compared with the employer’s
injury report to help the case
worker adjudicate the claim. The
WCB can only cover an injury or
illness that is caused by work.
The diagnosis helps the WCB profile claims based on severity, assign
a standard drug formulary based
on the type of injury, and assess
the treatment plan. The diagnosis
should be as specific as possible.
Subjective and/objective findings
are what the WCB case worker
uses to monitor progress and make
decisions about coverage for other
services, treatments, or diagnostics.
The case worker consults with a
medical advisor, if required.
Return-to-work plan
The expected return-to-work date is
when a worker must be off due to
an injury. This date is used to help
create a realistic plan, often including transitional duties, toward a full
return to work with the employer.
Most employers are willing and
able to accommodate.
If there’s no medical risk to the
worker participating in transitional
or modified duties, the doctor
should check “transitional” and
enter the current date.
Most workers are able to
participate in transitional work
that matches their physical ability
immediately following the injury.
Keeping the worker’s routine as
normal as possible helps prevent the
onset of disability and increases the
likelihood of full return-to-work.
Pre-existing or current problems
are occasionally non-work-related
factors that can be barriers to full
return-to-work. Telling the WCB
case worker about these factors
allows them to be considered in
the plan.
Treatment plan
The treatment plan is integrated
into the worker’s broader return-towork plan. Physicians who want to
speak with the WCB case worker
or medical advisor can note it in
this section.
Most documents are faxed to the
WCB where they are electronically
captured and routed. Type-written
documents are preferred. Forms
that are completed manually should
be written neatly with black ink.
Proper completion
of this form when
a patient has a
work-related injury
is necessary to
ensure the patient
receives the support,
benefits and services
to which they are
entitled.
The Physician’s Report (Form
8/10) is on www.wcb.ns.ca. Click
on ‘I am a service provider’ then
click on ‘Forms.”
For more information regarding the Physician’s Report (Form
8/10), email: [email protected]
Medical
disability
advisor
The WCB uses Presley Reid’s
medical disability advisor
(MDA), one of the world’s
most comprehensive set of
disability management guidelines, to assist in assessing
and managing occupationalrelated injuries and illnesses.
The injured worker’s job demands are assessed against
the injury to estimate how
long the worker is expected to
be off work, if at all.
It also provides information on
complications and treatment
approaches. Case workers,
medical advisors, and all contracted physiotherapy providers are required to utilize MDA
in assessing, planning and
managing WCB claims.
For more information on the
medical disability advisor visit
www.mdguidelines.com
College of Physicians
and Surgeons
of Nova Scotia
NS planning
medical
quality
assurance
changes
Following BC recommendations
By DR. GUS GRANT
CPSNS registrar/CEO
C
Dr. Cochrane’s recommendations for British Columbia
Health Authorities included province-wide implementation
of a timely peer-review system for diagnostic imaging,
the College of Physicians and Surgeons of BC,
hanges to Nova Scotia’s medical credenand the Ministry of Health Services. His recomtialing and quality assurance are being
mendations included province-wide implementaplanned, following recommendations
tion of a timely peer-review system for diagnostic
made in British Columbia.
imaging, starting with greater oversight of newly
The College of Physicians and Surgeons of
privileged radiologists; the creation of a comNova Scotia will collaborate with the district
mon, electronic provincial physician registry
health authorities (DHAs) in responding to the
accessible to the college and health authorities
medical quality assurance recommendations outto track current information about physician
lined in a report from Dr. Douglas Cochrane, chair
licensing, credentials and privileges; and develof the BC Patient Safety and Quality Council.
opment and implementation of consistent rules
The report followed the 2010 discovery of
around communication and patient
numerous misread CT scans and
notification in the event of adverse
ultrasounds that led indirectly to
events.
the death of at least one patient
There have been similar reviews
in BC.
involving diagnostic imaging and
Dr. Cochrane’s report focused
Dr. Cochrane’s
pathology in other provinces in
on the state of specialist medireport focused
recent years. It’s fortunate that no
cal credentialing and quality
on the state of
such situation has occurred in Nova
assurance in BC. He found the
specialist medical
Scotia. Nevertheless, the college, the
privileging and credentialing
DHAs, and the Department of Health
processes within BC health
credentialing and
and Wellness are approaching the
authorities inadequate to protect quality assurance
recommendations in Dr. Cochrane’s
the public from physicians
in BC.
report to limit the possibility of any
entering into a scope of practice
occurring. Other Canadian jurisdicbeyond their training or expertions are following suit.
tise. The essential communicaThe college enjoys a close, collabtion between the BC college’s
orative relationship with each of the
licensing function and the health
DHAs and the IWK Health Centre. The
authorities’ privileging functions
essence of the Cochrane recommenwas also found to be lacking.
dations is that there need to be more
Dr. Cochrane’s recommendacohesion between each of these
tions were directed toward the
bodies, whose respective spheres
province’s health authorities,
have considerable overlap. College licensing and
registration aren’t terribly dissimilar to privileging. Further, regardless of whether it’s done at
the college or DHA level, discipline processes
involving physicians share the same difficult and
sometimes painful challenges.
The college respects that the DHAs are in the
best position to oversee the delivery of medical
care within their districts. The college is more
than content to serve as a resource for the DHAs,
stepping in only when asked or when issues of
public safety arise. Nova Scotia courts support
this approach as evident in two recent decisions
involving the sponsorship of a defined licensee
within one of the province’s DHAs.
I believe the Cochrane recommendations make
sense on many levels. I also believe Nova Scotia
is compelled to respond, and any response must
be a collaboration between the college, the DHAs
and the province.
While the specifics and timelines for the
upcoming changes are still being worked out,
Nova Scotia physicians will be updated as the
initiative proceeds.
( Dr. Douglas (Gus) Grant, MD,
is the registrar and CEO of
the College of Physicians and
Surgeons of Nova Scotia.)
21
Public Health
Flu vaccine free for
all Nova Scotians
Annual immunization program begins
By DEE MOMBOURQUETTE and DR. ROBERT STRANG
Department of Health and Wellness
F
or the second year in a row
influenza vaccine is free of
charge for all Nova Scotians,
and is recommended by Public
Health as its annual immunization
program begins.
Physicians can play a key role in
heightening awareness of the burden of illness from influenza and of
emphasizing influenza prevention
through annual immunization.
The literature shows that a clear
recommendation from a health-care
provider is a significant factor in
determining whether individuals
receive influenza vaccine. As clinical
leaders in district health authorities
and other health organizations,
physicians can play a role in ensuring flu vaccine is offered at all
clinical encounters. By receiving the
flu vaccine themselves, physicians
protect their own health as well as
the patients they come into contact
with during influenza season.
For the 2012-13 flu season in the
Northern Hemisphere, the World
Health Organization recommends
that the trivalent vaccine contain
A/California/7/2009(H1N1)
pdm09-like virus, A/
Victoria/361/2011(H3N2)-like
virus, and B/Wisconsin/1/2010like virus (B Yamagata lineage)
antigens.
The B component and A
(H3N2) have changed from the
2011-12 seasonal TIV. The A
(H1N1) component is unchanged
from last season.
While all Nova Scotians are
encouraged to be immunized, the
National Advisory Committee on
Immunization annual influenza
immunization statement emphasizes that the traditional high-risk
groups remain the top priority for
influenza immunization.
These groups are:
• all pregnant women
• adults and children with
chronic heart or lung
disease, diabetes mellitus
and other metabolic diseases,
cancer, immunodeficiency,
immunosuppression (due
to underlying disease
and/or therapy), renal
disease, anemia, and
hemoglobinopathy
• adults and children with
any condition that can
compromise respiratory
function or the handling
of respiratory secretions or
that can increase the risk of
aspiration
• children and adolescents (six
months to 18 years) with
conditions treated for long
periods with acetylsalicylic
acid (e.g., rheumatoid arthritis
patients)
• people of any age who are
residents of long term or
chronic care facilities
• all children from six months
to five years
• those 65 or older
• those who live or care for
someone in the above groups
• health-care workers [all staff
and volunteers in acute or
long-term care facilities,
home care/home support
agencies, community-based
offices (including physicians,
pharmacists, dentists and
physiotherapists) or other
community settings] and
students in a health-care
profession educational
program
• first responders (EHS, fire and
police)
• people living in a home that
is expecting a newborn during
the regular influenza season
• anyone who lives with or
cares for children less than 24
months of age
Detailed information on influenza vaccine and Nova Scotia’s
immunization program is available
to all health-care providers and
organizations requesting influenza
vaccine from Public Health.
(Dee Mombourquette, RN, is an
immunization coordinator with the
Department of Health and Wellness.
Robert Strang MD, MHSc, FRCPC, is
chief medical officer of health with the
Department of Health and Wellness.)
Physicians can
play a key role
in heightening
awareness of the
burden of illness
from influenza and
of emphasizing
influenza prevention
through annual
immunization.
MSI billing code info
Immunization Health service code Modifier MSUs Diagnostic code
Influenza - Pregnant 13.59L RO=INFL 6.0 V221
Influenza - 13.59L Males and non-pregnant females
RO=INFL 6.0 V048
MSI billing code details for influenza shots are in the Aug. 31, 2012 issue of the MSI Physicians’ Bulletin.
Download the bulletin from doctorsNS.com in the ‘Physician payment > fee-for-service’ section.
22
A visit may be billed
at a “meet and greet”
appointment provided
that Preamble requirements for a visit are
satisfied.
Office visits
New patient
billing
depends on
circumstances
Download MSI Physicians’ Bulletins
MSI Physicians’ Bulletins can be downloaded from doctorsNS.com
Go to the ‘Physician payment > Fee-for-service’ section.
Based on complaint,
circumstances of visit
Unattached Patient Bonus Initiative details
Details on the Unattached Patient Bonus Initiative are on doctorsNS.
com Go to the ‘Physician Payment > Master Agreement > New funding
programs’ section.
By DR.RHONDA CHURCH
MSI consultant
W
hen family physicians see a new patient
in their office for the first time, questions sometimes arise about how to
optimally bill for the visit. The answers depend
on the nature of the patient’s complaint and the
circumstances of the visit.
Unattached Patient Bonus
When a new patient is seen in the office for the
first time and the family physician has accepted
an unattached patient subsequent to an inpatient or emergency department hospital visit, the
physician may bill a one-time unattached patient
bonus incentive of $150.
Details about the hospital encounter that
resulted in the patient being accepted into the
practice must be included in the clinical record.
The physician must have been in their current
community-based practice for at least one year,
and must agree to maintain an open chart on
that patient for one year. It’s also important that
the hospital visit was medically necessary –
meaning that the patient must have attended the
hospital for a health-related concern.
A complete summary of the requirements
for billing this initiative is in the March 2011
Physicians’ Bulletin.
Visit code
A visit may be billed at a “meet and greet”
appointment provided that Preamble requirements for a visit are satisfied. As with all insured
services, the visit must be medically necessary.
The patient must have come to the physician
with a health concern.
advice, smoking cessation, and
In the absence of an evaluation of
healthy heart advice.
a health concern, the encounter is
Both of these codes require
uninsured and may not be billed to
documentation of the content of
MSI. Issuing a prescription without
As with all health
the discussion with the patient
an evaluation of the patient is also
service codes,
including the advice given by
uninsured as outlined in Preamble
good knowledge
the physician. As well, start and
section 4.2.
of Preamble
stop times for the encounter must
Most visits a family physician will
be documented directly on the
requirements
bill are limited visits meaning the
patient encounter for both codes.
history and examination are limited
and careful
Preamble definitions don’t
to relevant body systems. Less fredocumentation is
permit these health service codes
quently, a comprehensive evaluation
important.
to be used in other situations such
may be claimed when the patient’s
as lengthy discussions regarding
complaint is serious, complex or
medical problems or for routine meet and greet
obscure. When a comprehensive evaluation is
appointments.
claimed, the physician must conduct and docuAs with all health service codes, good knowlment a full history and examination.
edge of Preamble requirements and careful
On occasion, MSI Monitoring has found situdocumentation is important.
ations in which physicians bill comprehensive
evaluations for each new patient without meetMedavie Blue Cross/MSI Medavie Blue Cross is the private
company currently contracted by the Department of Health and
ing the Preamble requirements for this health
Wellness (DHW) to administer the Medical Service Insurance
service code. Billing requirements for limited and
(MSI) program for government. The responsibilities of Medavie/
comprehensive visits are outlined in section 7 of
MSI include implementing and managing the physician fee
the Preamble.
schedule, issuing fee-for-service and contract payments to
Counseling codes
Counseling is a time-based code that may be
billed for addressing acute adjustment reactions
or bereavement reactions (Preamble Section
8.8).
Lifestyle counseling, as outlined in Preamble
Section 8.9, is a prolonged discussion in which
the physician attempts to direct the patient in the
proper management of health-related concern.
This can include lipid or dietary counselling, AIDS
physicians, and conducting compliance reviews (audits) to
ensure the negotiated billing rules are followed. It’s not the role
of Medavie/MSI to approve fees, change payment rates or set
policy. Medavie/MSI acts only as directed by the DHW.
(Rhonda Church, MD, is a medical consultant in MSI Monitoring
at Medavie Blue Cross.)
23
Sport Nova Scotia
NS sport programs
hoping to help combat
childhood obesity
In alignment with province’s new Thrive! plan
By CAROLYN TOWNSEND
Sport Nova Scotia
T
he statistics are alarming.
One in three Nova Scotia
youth, age two to 17, are
overweight or obese. And many
more young people are at risk for a
lifetime of health issues because of
unhealthy lifestyles.
Today’s generation of children
join an adult population already at
high risk of developing preventable
chronic conditions. Nova Scotia
has the highest rates of chronic
disease in the country.
Change is clearly required. Both
Sport Nova Scotia and Doctors
Nova Scotia are supportive of the
provincial government’s childhood
obesity prevention strategy –Thrive!
A plan for a healthier Nova Scotia
– released last June.
The plan has four key directions:
1. Support a healthy start for
children and families
2. Equip people with skills and
knowledge for lifelong health
3. Create more opportunities to
eat well and be active
4. Plan and build healthier
communities.
Sport Nova Scotia is leading
programming aimed at achieving
some of the very same objectives
outlined in Thrive!. Here are a few
examples:
Milk Sport Fair
Milk Sport Fair provides a spectacle
of sport stations, allowing children
from grades 3-8 to try their hand
at as many as 35 different sports.
Sport Nova Scotia hosts two Milk
Sport Fairs in different parts of
the province every year. Since its
24
inception in 2002, the Milk Sport
Fair has seen more than 44,000
students, teachers and parents pass
through its doors.
KidSport
KidSport helps children overcome
the financial barriers preventing
or limiting their participation in
organized sport. In Nova Scotia,
KidSport is run by Sport Nova
Scotia, providing funding of up to
$300 per year per child for sport
registration and/or equipment.
This past year, KidSport allocated
$510,683 to 1,949 children from
Sydney to Yarmouth. Sport Nova
Scotia is constantly fundraising for KidSport and the Nova
Scotia Department of Health and
Wellness contributes heavily.
Parasport
Sport Nova Scotia continues to
aid in the expansion of parasport
opportunities within the province.
Since the parasport coordinator
position was created last year, the
number of parasport programs has
doubled from eight to 16. For a
link to parasport opportunities and
information, visit www.sportnovascotia.ca.
Community sport development
In partnership with the
Department of Health and
Wellness, Sport Nova Scotia’s community sport development coordinators cover every region of the
province: Cape Breton, Highlands,
Fundy, Central, South Shore, and
Annapolis Valley. The coordinators
work with community sport organizations, schools, municipalities and
community groups to identify and
support the expansion and creation
of sustainable sport opportunities
in their region.
Youth Leadership Program
The Youth Leadership Program
completed its eighth year of supporting youth as they overcome
barriers to education and employment. The program has assisted 80
young people with employment
opportunities, on-the-job mentoring and various skills development
training, all in a sport
setting.
Provincial sport
bodies
As a federation of
provincial sport bodies, Sport Nova Scotia
has over 55 member
organizations. Details
of all of these options
are online at www.
sportnovascotia.ca.
For those interested in
becoming more active
or exploring sport
opportunities, this
listing is a great place
to start.
Today’s generation
of children join an
adult population
already at high
risk of developing
preventable chronic
conditions. Nova
Scotia has the
highest rates of
chronic disease in
the country.
health & healing
Sailboat
offers place
of refuge,
calm and
quiet
Physician well-being has clear,
direct consequences
By DR. GERRI FRAGER
Medical Humanities-HEALS program
M
y new boat “floats” right along with
this month’s doctorsNS issue that
focuses on physician well-being. This
summer, I became co-owner of a sailboat named
Querencia. As boats “come” with a name, once
we researched the origins, we decided to retain
her name. This Spanish word refers to a place of
refuge. When I spend time on the Eastern shore
and use some of it to go sailing, I do find refuge.
Within our health-care framework, there are
responses and supports for physicians when
they are in crisis. At the other end of the spectrum, there are a growing number of workplace
campaigns promoting healthy nutrition and exercise habits. However, resources which provide
physicians with the skill set to sustain the energy
and excitement with which they started their
careers are scarce.
Ensuring physician well-being can positively
impact patient care, work satisfaction, career longevity, and personal growth. This isn’t simply a
declaration to “feel good” but one that recognizes that physician well-being has clear and direct
consequences. As Derek Puddester, chair of the
Canadian Association of Medical Education and
lead for its Physician Wellness Committee, and
his colleagues have recognized, the erosion of
physician well-being results in decreased quality
of care, increased sick days, higher turnover
rates and, ultimately, lack of sustainability of our
health-care system.
The Canadian Medical Association shared the
Dr. Gerri Frager’s new sailboat, Querencia.
frightening statistics that 46 per cent of Canadian
physicians are in an advanced stage of burnout,
77 per cent feel unable to get everything done in
the allocated time, with 47 per cent expressing
feeling they have a balanced life.
Despite the frequency and the fairly ubiquitous presence of distressed physicians, a
National Review of Medicine article reports on a
culture of “silence” within the medical community. The distress tends not to be voiced, listened
to, or addressed in practical, helpful ways.
One approach promotes physician resiliency.
Having worked in paediatric palliative care for
over 20 years, I appreciate that difficult situations can fill our work lives and spill over into our
personal lives. Engineers describe resiliency as
the capacity of a given material (such as metal)
to “bounce back” after an impact. This valuable
approach acknowledges that difficult impacts
occur but helps us to examine what ingredients
enable us to “bounce back” after an insult.
There’s actually more to querencia than being
a place of refuge. It actually refers to the calm,
quiet energy the bull seeks before entering the
ring for the bullfight. Every time I face a difficult
clinical situation, I can’t go for a sail. What can
I do to prepare myself, to support the patients
in my care, and recover following these difficult
times? I have many tools that I have found helpful over the years. What is your querencia? What
works for you?
On Nov. 23-25, Dalhousie’s Humanities-HEALS
Program and the Professionalism Committee are
co-hosting a Symposium on Physician Well-being
and Professionalism, with the focus for the
professionalism component on Bullying in the
Workplace. Visit http://humanities.medicine.
dal.ca or read the newsletter from Dalhousie’s
Faculty of Medicine for further details.
Ensuring physician
well-being can
positively impact
patient care, work
satisfaction, career
longevity, and
personal growth.
(Dr. Gerri Frager is a Dalhousie
University professor and
paediatrician with a longtime
interest in the arts and health.
She is a regular contributor to
doctorsNS.)
25
Understanding the significance
CMA president sees
strength in numbers
New allergen labeling
regulations in place
Physicians’ pensions, drug shortages,
health-care rights among issues of interest
Expected to make life easier for celiac disease
patients, those on gluten-free diets
By PATRICK SULLIVAN
By DR. MOHSIN RASHID
Canadian Celiac Association
S
ince it was formed in 1867,
the same year as the country’s
confederation, the Canadian
Medial Association (CMA) has
served as the national voice of the
medical profession across a vast
nation.
“There is strength in numbers,”
said CMA president Dr. Anna Reid.
“The more members we have, the
louder medicine’s voice becomes.”
The Ottawa-based association
has more than 75,000 members in
10 provinces, three territories and
50 countries around the world. It’s
the only national physicians’ body
to regularly receive intervener status
before the Supreme Court of Canada,
where over the years it has represented
the profession’s interests on issues
ranging from injection drug use to
tobacco regulations.
Its lobbying expertise makes the
CMA one of the most effective
national organizations in Ottawa. An
indicator of this impact is the fact
that CPAC, the parliamentary channel, broadcasts the CMA’s General
Council deliberations every year.
Another sign is the numerous invitations the CMA receives to appear
before House of Commons and
Senate committees and party caucuses
to discuss everything from physicians’
pensions to shortages of prescription
drugs.
The CMA is also vocal in defending the health-care rights of those
whose voices often go unheard, such
as refugees. CMA past president Dr.
John Haggie explained why in a June
speech to the Economic Club of
Ottawa.
“We cannot leave the most vulnerable people in our society to fend for
themselves,” he said.
Among national medical associations, the CMA stands alone in offering financial and investment services
developed solely for and aimed solely
at physicians through MD Physician
Services. This group provides CMA
26
members with access to a full, and
free, financial plan. MD Physician
Services offices are located in Halifax
and Sydney.
The strength-in-numbers concept
also allows the CMA to negotiate
access to dozens of clinical resources,
which are offered to members through
www.cma.ca.
The association also dedicated
resources to supporting physician
health. This month, it will co-sponsor
the International Conference on
Physician Health in Montreal.
Through its Centre for Physician
Health and Well-being, the CMA
works with Doctors Nova Scotia’s
Professionals’ Support Program, which
provides assistance to physicians, their
families, and physicians-in-training.
Finally, the CMA is a source of
reliable and trusted data. Its Canadian
Collaborative Centre for Physician
Resources (www.cma.ca/c3pr) is a
source for data on any and all aspects
of physician human resources.
Benefits of CMA
membership
• Free access to BMJ Best Practice,
which covers more than 10,000
diagnoses, 3,000 diagnostic
tests and 4,000 diagnostic and
treatment guidelines. This costs
non-members $258 annually.
• Free access to the CMA’s guide
to Determining Medical Fitness
to Operate Motor Vehicles, which
costs non-members $44.95.
• Free subscriptions to CMAJ,
Canada’s leading medical journal,
which cost non-members $299
annually.
• Access to discounts on everything from GoodLife Fitness memberships to Porter Airlines flights.
A
fter decades of struggle,
allergen advocacy groups
like the Canadian Celiac
Association had their day last
August when Canada’s new
allergen and gluten labeling regulations (regulation 1220) went
into effect.
The regulations have great
significance for people living with
allergic disorders.
Three aspects of the new labeling regulations are:
Hidden allergens: Mustard
has been added to the list of priority food antigens. The foods or
protein derived from one of the following are considered priority food
allergens in Canada: Peanuts, eggs,
milk, tree nuts, wheat, soy, sesame
seeds, seafood (fish, crustaceans and
shellfish) and sulphites.
Sulphites: Sulphites must be
declared when directly added to a
food, or when the total amount of
added sulphites contained within
the food is 10 parts per million or
more.
Gluten sources: The gluten
source must be declared when a
food contains gluten protein or
modified gluten protein from
barley, oats, rye, triticale or wheat,
including kamut or spelt.
It should be noted that oats are
in the list of gluten-containing
grains. This is primarily to protect
consumers because commercially
available oats are cross-contaminated with gluten-containing
grains. Pure and uncontaminated
oats, which are grown and marked
with appropriate measures, are
considered safe for most patients on
a gluten-free diet.
In Canada, food and drug regulations continue to require that a
complete and accurate list of ingredients appear on the label of most
prepackaged foods. Components of
ingredients, which were previously
exempt from declaration in the list,
will now need to be declared. For
example, previously if flour was
used as an ingredient in a prepackaged food product its components
(or source) weren’t required to
be included in the list. This flour
could be from any grain and could
have been unsafe for people with
gluten intolerance. Seasoning and
flavoring are other examples.
The new regulations cover
food allergens, gluten sources and
sulphites that have been deliberately
added to food products. They don’t
cover the inadvertent presence
of these substances as a result of
cross-contamination and don’t
address the issue of precautionary statements (“may contain”).
Precautionary statements are
appropriate when a food may have
inadvertently come into contact
with a food allergen or there’s
potential for cross-contamination
that couldn’t have been avoided.
It isn’t permissible to use a “may
contain” statement for priority
food allergens. If the priority food
allergen is added as an ingredient, it
must be declared.
The beer industry was exempted
from this new labeling regulation
despite protests from the celiac
advocacy groups. Most beers are
made from barley and contain
gluten. However, beers made from
gluten-free grains are available in
Canada. Individuals with gluten
intolerance should check this carefully when purchasing the product.
The new regulations are expected
to make life easier for patients with
celiac disease on a gluten-free diet.
However, they don’t obviate the
need for careful label reading.
For information, visit
www.celiac.ca
(Dr. Mohsin Rashid, FRCPC,
is with the Faculty of Medicine at
Dalhousie University; and is a member
of the Canadian Celiac Association’s
Professional Advisory Board.)
Opinion
Canadians paying
more for inferior
health care
A truly national system is needed
By DR. TARUN GHOSE
Retired pathologist
C
ontrary to the alarm raised
by Canada’s premiers,
the Harper government’s
abdication from its leadership role
in health care doesn’t constitute a
crisis. Canada’s health care has been
under provincial jurisdiction since
the 1867 Constitution Act, and the
federal share of health-care funding
has now dwindled to 20 per cent
from the initial 50/50 sharing.
The real crisis of Canada’s health
care is its deteriorating quality visà-vis rising spending as highlighted
by recent surveys
by the Organisation
for Economic
Development and
A national healthCooperation, the
World Health
care system
Organization, and
would establish
others.
pan-Canadian
The Conference
standards and
Board of Canada
programs, eliminate awarded the counredundancy
try’s health care a
and wasteful
B grade and ranks
Canada 10th among
inter-regional
17 peer countries
competition, and
help optimal health- even though its
health care covers
care planning
only 70 per cent
and resource
of health-related
management. This
expenses in contrast
would enhance
to 90 per cent
coverage among
access, and
the peer counthe quality and
tries. This means
efficiency of care.
Canada pays more
for inferior care.
Embarrassingly,
the UN ranks Canada 24th in
infant mortality (an indicator of a
country’s level of health care) below
Portugal and South Korea.
None of the goals of former
Prime Minister Paul Martin’s
$41 billion health-care accord have
even been half fulfilled. A recent
Wait Time Alliance Report reveals
that nation-wide wait times have
soared – most precipitously in
Nova Scotia, Manitoba and PEI.
Nationally, 31 per cent of sick children wait too long for surgery.
The optimal resolution of this
health-care crisis is an integrated,
national system instead of the
current 14 decentralized, publiclyfunded health authorities (i.e.
13 provincial/territorial and one
federal) plus privately-funded
health-care which covers 30 per
cent of expenses.
A national health-care system
would establish pan-Canadian
standards and programs, eliminate
redundancy and wasteful interregional competition, and help
optimal health-care planning and
resource management. This would
enhance access, and the quality and
efficiency of care.
Canada’s premiers and territorial leaders are fully cognizant of
this. The working group, created
by the premiers last January, was
given the task to “identify the
innovations in health delivery.” BC
Premier Christy Clark added, “We
need to not just innovate, but also
be sure that we are sharing those
innovations all across the country.”
In the words of Saskatchewan
Premier Brad Wall, “Here is a great
opportunity for us to be able to
collaborate together.”
In the 1970s, Canada’s regional
governments started to subsidize
many health-care services not
covered by Medicare. These include
long-term care, home care and
prescription drug plans for seniors
and the poor. These were moves in
the right direction but the objective
of Canada’s national health-care
system will be the promotion of
health and prevention of illness for
all Canadians and, when required,
will provide equitable access to a
seamless continuum of high quality
care. This goes far beyond what is
currently insured and provided by
Medicare.
The challenges facing the proposed national health-care system
include Canada’s distinctive geography and demography, history and
social conditions, and the accelerating rate of growth of its health-care
spending. Some of the models of
health-care delivery described by
the working group, including Nova
Scotia’s collaborative emergency
centres, are tailored to overcome
the problems posed by Canada’s
demography .
(Tarun Ghose, MB BS, PhD, FRC
Path (London), is professor emeritus in
pathology at Dalhousie University.)
27
Advertorial
Corporate-owned
permanent life insurance:
a review of the benefits
By MD Physician Services
M
ost people are aware that life
insurance can be a tax-effective
way of ensuring a lump sum
is paid to your estate or your heirs upon
your death. But did you know that permanent life insurance also offers benefits
while you are alive? In this article, we’ll
provide a quick review of three possible
benefits of corporate-owned permanent
life insurance.
Reducing the cost
First, you can save a great deal in premium costs over the life of your policy if
your corporation owns it, as it’s generally
much less expensive to make deposits to
the policy from corporate funds than from
personal funds.
Tax-advantaged growth
Secondly, under the Income Tax Act, you
can make deposits to your permanent life
insurance policy that exceed the amounts
necessary to keep the policy in force (subject to limitations), and invest that extra
money in interest-bearing accounts or
accounts linked to indices or well-known
mutual funds. Then, earnings and growth
on these investments accumulate on a
tax-exempt basis while the investments
remain in your policy.
can pay most or all of it tax-free to your
estate or heirs as surviving shareholders—
significantly increasing the after-tax value
of your estate. (Most other corporate
investments can’t be paid out to your
estate or heirs on a tax-free basis.)
When you add up these three benefits,
it’s clear that a permanent life insurance
policy can be a highly tax-efficient asset
within your professional corporation. It
allows you to save on the cost of insurance, enhance asset growth within your
policy, and provide liquidity to your heirs
in a tax-efficient manner.
Whether you have made the decision to add permanent life insurance to
your overall wealth-building and risk
management strategies, it can be useful
to understand how holding permanent
life insurance in your corporation can
benefit incorporated professionals. If you
are interested in learning more, a certified financial advisor can provide helpful
insights to apply to your specific situation
and preferences.
Tax-free cash for your heirs
Finally, upon your death, your corporation receives the death benefit tax-free and
MD Physician Services provides financial products and services, the MD family of mutual funds, investment
counselling services and practice management products and services through the MD group of companies.
For a detailed list of these companies, visit md.cma.ca.
28
Practice
Opportunities
To submit a practice opportunity contact:
Melissa Murray
Tel: (902) 468-8935 ext. 229 or 1-800-563-3427
[email protected]
Deadline for next month’s issue is October 15
CUMBERLAND HEALTH AUTHORITY
The Cumberland Health Authority
(CHA) has jurisdiction for the provision
of health care in the northern part
of Nova Scotia. The CHA is actively
recruiting specialty and family medicine positions in beautiful Cumberland
County. For more information on the
following opportunities, telephone
Shirley Symes at (902) 661-1090
ext. 4865, email: shirley.symes@
cha.nshealth.ca, or visit www.cha.
nshealth.ca
Internal medicine: A general internist
with special interest or training in
endocrinology and pulmonary disease
would be welcome. Our current
complement consists of two internal
medicine physicians, one responsible
for gastroenterology and one responsible for cardiology.
Palliative medicine specialist:
Immediate opportunity for a palliative
medicine specialist to provide consultation services. This is a full-time,
alternate payment plan opportunity,
based at the Cumberland Regional
Health Care Centre in Amherst. This
position involves the provision of
consultation services to all care environments in the CHA including home,
nursing home, and hospital. The palliative medicine physician is supported
by an interdisciplinary team consisting
of consult nurses, a continuing care
coordinator, and social worker, as well
as full-time secretarial support.
Family physician (Pugwash):
Cumberland North Rural Practice
Network services the communities of
Pugwash and surrounding areas has
an immediate family physician opening. The physician will join two family
doctors, a nurse practitioner, and a
family practice nurse (RN). The main
clinic is located in Pugwash.
Family physician (Parrsboro):
Cumberland South Rural Practice
Network, serving the communities
of Parrsboro, Advocate and River
Hebert, immediately requires a
family physician. The physician will
join two other family doctors, three
nurse practitioners, and a family
practice nurse (LPN). The main clinic
is located in Parrsboro with satellite
offices in Advocate and River Hebert.
Clinics work on a team concept with
shared EMRs through Nightingale.
The CSRPN is part of the first collaborative emergency centre (CEC)
in Nova Scotia, located in Parrsboro.
For more information on the role of
CECs, visit www.gov.ns.ca/health/bettercaresooner. The CEC operates 8:30
a.m.-8:30 p.m., seven days per week,
year round. Monday through Friday the
CEC will be staffed by two health-care
providers while Saturday and Sunday
it will operate with one health-care
provider. It’s anticipated the transition
to the new model will allow physicians
to have greater control over their work
hours.
Family physician (Springhill) - The
collaborative emergency centre (CEC)
serving the community of Springhill
has a immediate family physician
opening. The physician will join three
other family doctors and nurse practitioners. This clinic work on a team
concept with shared EMRs through
Nightingale. The CEC operates from 8
a.m. to 8 p.m., seven days per week,
year round. Monday through Friday
the CEC will be staffed by two physicians. Saturday, Sunday and holidays
the CEC will operate with one physician. It’s anticipated that this new
model will enable physicians to have
greater control over their work hours.
The aim of a CEC is to enhance access
to high quality comprehensive primary
health care that is capable of dealing
with unexpected illness or injury in
addition to helping with prevention
and management of chronic illness in
a timely fashion. For more information
on the role of CECs in the future of
health care in Nova Scotia, visit www.
gov.ns.ca/health/bettercaresooner
DARTMOUTH
Family physicians: immediately
Albro Lake Medical Clinic is seeking two full-time family physicians.
Freedom to work at your own pace in
a relaxed work environment with three
full-time physicians. Furnished office
with two furnished exam rooms each.
Low overhead. Telephone (902) 4654444 or email: [email protected]
Family physicians: full or part-time
Pleasant Street Medical Group, a well
established family practice located
close to Dartmouth General Hospital,
is seeking full or part-time family
physicians to provide comprehensive
care to a full scope of patients. Ideal
for someone who wants to do some
office work as well as hospital, emergency or obstetrics. New office with
EMR. Reasonable overhead. Telephone
Pamela Hughes (902) 469-2445 or
email: [email protected]
LUNENBURG
Medical director: immediately
Harbour View Haven is a 144-bed
accredited long-term care facility.
The services of a qualified medical
director are sought to provide medical
services to residents. Regular visits
are required to assure review and
treatment of acute medical conditions,
chronic health conditions and medication management. The physician will
be an integral part of the inter-disciplinary team that oversees the health
and well-being of residents, and to
ensure compliance with the Home
for Special Care Act, Accreditation
Canada, and all other applicable legislations and regulations. Remuneration
is fee-for-service according to the Nova
Scotia fee code for continuing care
services. No overhead is required and
a stipend for administrative services
is provided. Travel costs are covered.
This is an excellent opportunity to
work two days per week in a challenging and dynamic environment. Key
qualifications include being licensed
to practice medicine in Nova Scotia;
maintaining appropriate professional
liability insurance; and eligibility to
apply for privileges with South Shore
District Health Authority. Telephone Dr.
Al Doucet, district medical director for
continuing care, at (902) 523-1543 or
email: [email protected]
SACKVILLE
Family physician: immediately
Lockview Medical Clinic is seeking a
family physician to join or practice at
its new office, just 20 minutes from
Halifax. Busy practice with low overhead and automated with electronic
medical record (Nightingale). Flexible
hours; on-call not required. Telephone
Cindy (902) 252-3011 or email: [email protected]
WINDSOR
Family physician(s): full-time
An opportunity is available for one
or two physicians to start full-time
practice. Centrally located within easy
access to Halifax, South Shore and the
Annapolis Valley. The area has excellent recreational facilities and academic resources. Local hospital includes
inpatient and outpatient departments,
lab, X-ray, and physiotherapy. Hospital
privileges and emergency work are
available. No obstetrics. On-call
optional. Opportunity to work in a
walk-in clinic. Recent loss of two
doctors and a large amount of orphan
patients. Incentive package available.
Telephone Dr. E. Grandy, between 9
a.m. and 3 p.m., at (902) 798-8600.
Submit a practice opportunity
Members of Doctors Nova Scotia
may list practice opportunities
which are posted online in 60-day
segments and are included in the
magazine on an issue-by-issue
basis. Practice opportunities are
listed at no charge.
Hospitals, district health authorities, recruitment agencies, and
members of Doctors Nova Scotia
may purchase advertising space
for available hospital positions,
office space, etc., at a cost
of $200 (HST included) each.
Advertisements are posted online
in 60-day segments and are
included in the magazine on an
issue-by-issue basis.
29
Continuing Medical Education
Upcoming Events
Oct 10 – 12
Specialists
Oct 13
Transplant Atlantic 2012 Collaborative
Care in Transplantation and Donation
Update in Rheumatology
Oct 14
Pediatric Emergency Care Conference
Oct 19
Nov 17
15th Ann. Cape Breton Cancer Symposium:
“Conquering Cancer One Step at a Time”
Introduction to Clinical Epidemiology
Workshop
Care by Design Long Term Care
Conference
Pain Assessment & Management
Nov 29 – Dec 1
86th Annual Dalhousie Refresher Course
Family Physicians,
Specialists and Others
Family Physicians,
Family Physicians,
Family Physicians and
Others
Family Physicians,
Family Physicians
Feb 14 – 16
39th Annual February Refresher:
Emergency Medicine
Family and Emergency
Physicians
Nov 2 & 16
Nov 2
Family Physicians
Janet Hartnett, 473-6193
[email protected]
Kim Lake, 902.494.1588
[email protected]
Stefanie Sheppard, 902.470.7570
[email protected]
Dawn Carey, 902.567.8074
[email protected]
Janet Gallant, 902.473.2118
[email protected]
Kim Lake 902.494.1588
[email protected]
Tanya Dunn 902.752.7600 x 3312
[email protected]
Mary Ann Robinson, 902.494.1459
[email protected]
Mary Ann Robinson, 902.494.1459
[email protected]
Events are in Halifax unless otherwise indicated. Registration normally opens 6 – 7 weeks before the program.
For updates on these and other Dalhousie CME activities, visit cme.medicine.dal.ca
Nova Scotia Community Hospital Programs
Supported by Doctors Nova Scotia
The following presentations are confirmed as of September 8.
Additional programs will be offered.
Most programs are
recommended for 1-2 credit hours for MAINPRO-M1 and / or
Maintenance of Certification Section 1. Dates may change, so please
watch for notices, sent several weeks before each program, or visit
cme.medicine.dal.ca/chp.htm. For information, contact 902.494.1484,
[email protected].
Amherst
Parkinsonian Syndromes in Older
Adults
Bridgewater Capacity/Competency after Decline
Halifax
Dysfunctional Uterine Bleeding
Palliative Care
Inverness
Stroke Management
Guidelines for Concussion
Management
Liverpool
Anticoagulation & Antiplatelet Agents
New Glasgow The Child with a Murmur
North Sydney Review of Joint Injections
Sydney
Dermatology Show and Tell
C Difficile Update
Truro
Leukemia, Lymphoma…
Yarmouth
Depression Under 18 yrs
Webinars
Supported by Doctors Nova Scotia
01-Nov-12
17-Oct-12
21-Nov-12
05-Oct-12
16-Nov-12
These programs, scheduled on Wednesday and Thursday evenings
at 8:00 pm, are available to all Nova Scotia physicians. We are
pleased to offer these opportunities to learn at home, and look
forward to your participation and feedback.
Webinars are announced via email to all Nova Scotia family
physicians in the two weeks preceding the event. If you have not
recently been receiving our email communications, please contact
[email protected] to update your email address. Because firewalls,
spam filters and temporarily full mailboxes can interfere with your
receipt of these announcements, we urge you to also check our
website cme.medicine.dal.ca/Webinars.htm. Details of upcoming
webinars are posted as soon as they are confirmed, usually several
months before the event. For information, contact 902.494.1484,
[email protected]. Webinars confirmed as of September 8
include:
17-Jan-13
01-May-13
15-Oct-12
10-Oct-12
12-Dec-12
25-Apr-13
18-Dec-12
Treatment of Menopause HRT
Headache: Practical Solutions
Management of Urinary Incontinence
Dizziness and Vertigo
Fibromyalgia: Diagnosis and Mgmt
DVT and Factor V Leiden
Rational Prescribing in the Elderly
Anemia
29-Nov-12
Continuing Medical Education • C106, 5849 University Avenue • PO Box15000 • Halifax NS B3H 4R2
Fax: 902.494.1479 • cme.medicine.dal.ca
10-Oct-12
25-Oct-12
07-Nov-12
22-Nov-12
05-Dec-12
31-Jan-13
13-Feb-13
23-May-13
Events
Calendar
October-November 2012
OCTOBER
Oct. 18-20, Halifax
The Brain Repair Centre Symposium
New Horizons in Spinal Cord and
Brain Repair: From Discovery to
Therapeutic Development is a symposium of research and industry
opportunity, connection and collaboration. Visit www.brainrepair.ca
Oct. 19, Dartmouth
Doctors Nova Scotia Board of
Directors meeting
The Board of Directors is the
directing and governing body
that works on behalf of the association between annual meetings.
Invitation only. Visit www.doctorsns.com/members/governance/
boardofdirectors
Oct. 19, Halifax
Canadian Medical Protective
Association 2012 Symposium
CMPA members will participate in
discussions with physicians and
legal experts, learn from experiences reported to the CMPA, and
get advice on managing risk in their
practice. Attendees obtain CME
credits. Visit www.cmpa-acpm.ca
Oct. 24-26, Halifax
Childhood and Adolescent Obesity
Conference
Pre-conference: Oct. 24 Main confer-
ence: Oct. 25-26. This fourth annual
conference will bring together an
interdisciplinary group of professionals and policy makers working in the
field of childhood and adolescent
obesity. The conference will focus on
strategies and solutions, from practice to policy. The theme recognizes
that obesity is a complex problem
requiring a complex solutionoriented approach to its prevention
and management. Visit www.interprofessional.ubc.ca/Obesity
Oct. 25-26, Halifax
Atlantic Canada Thoracic Oncology
Conference
This 4th annual conference, “Recent
advances in diagnosis and management of thoracic malignancies,”
includes a pre-meeeting dinner on
Oct. 25 with guest speaker. Call
(902) 275-8819 or email: Atlantic.
[email protected]
Oct. 30-31, Toronto
Summit on Sustainable Health and
Health Care
This event will bring together this
broad range of stakeholders and
facilitate a more holistic view of the
entire health system. Learn about
the latest issues on governance,
finance, human capital, organizational performance, patient-centred
care, drug management, mental
health, service delivery, and new
technology. Visit www.conferenceboard.ca/conf/12-0146
NOVEMBER
Nov. 2, Halifax
Long Term Care Conference
The target audience for the 2nd
Annual Care by Design Long Term
Care Conference includes physicians, nurses and other health-care
professionals, pharmacists and
long term care facility administrators.
It will be an opportunity to learn in a
multidisciplinary setting, offer input
into new programs and services, and
share information with colleagues.
The conference will focus on key
issues in today’s long term care sector, including diabetes, wound care,
ethics and management of end stage
chronic diseases. Visit cme.medicine.
dal.ca/2nd_ltc.html
Nov. 2-3, Halifax
Atlantic Respirology and Critical
Care Conference
Presented by the Lung Association
of Nova Scotia, this conference is a
great opportunity for medical professionals to learn more about the latest
advancements in respirology and
critical care. The conference offers
world class professional development. World renowned educators
provide education and professional
development in the areas of adult
respirology, critical care and allied
health. Visit www.ns.lung.ca/arcc
Nov. 8-11, London, ON
Canadian Association of Wound
Care 2012 Conference
The focus of this year’s conference
is A Canadian Healthcare Crisis:
Chronic Wounds. It will feature
educational sessions on: the transition from institutional to home care;
integrating the interdisciplinary
team; dealing with the changing
demographic; and, managing the
complex and complicated wounds.
Visit cawc.net
Nov. 21-23, Halifax
Conference on Aging Research
The theme is Our Future is Aging:
Current Research on Knowledge,
Practice and Policy. Hosted by the
Nova Scotia Centre on Aging, this
one-time conference will bring
together researchers, academics,
service providers, decision makers,
artists, students, policy analysts
and members of the community
to share the diversity of perspectives and approaches to aging
research within the Atlantic region
and throughout Canada. Visit
www.msvu.ca/home/community/
Centres_Institutes/centreonaging
Welcome to Doctors Nova Scotia’s newest members
Dr. Sharon E. Clarke - Diagnostic radiology, Halifax
Dr. Christopher Hinkewich - Anaesthesia, Halifax
Dr. Madelaine Marie Plourde - Thoracic surgery, Halifax
Dr. Anurita Singh - Psychiatry, Valley
Dr. David Tang - Plastic surgery, Halifax
31
Electronic bookshelf
Awareness of physician
health issues on the rise
Tips for finding physician health and wellness info
By PAT LEE
Librarian
T
here has been a welcome
increase in awareness of doctors’ health issues in recent
years.
A Canadian Medical Association
(CMA) news report illustrates how
the Canadian medical community
is working hard to promote health
among doctors. The Sept. 4 article
by Patrick Sullivan noted that,
“MD burnout south of the border
is at an alarming level.”
Mr. Sullivan outlines the results
of a recent American survey of
7,288 physicians, published in
August by the Archives of Internal
Medicine. They show that 45.8
per cent of respondents reported
at least one symptom of burnout.
The study was led by Dr. Tait
Shanafelt of Rochester, Minn.
He’s one of the keynote speakers
at the International Conference on
Physician Health the CMA is hosting in Montreal this month.
Dr. Shanafelt’s study was
completed nine years after a CMA
survey of 8,172 Canadian MDs
found that 45.7 per cent of respondents were in the “advanced stages
of burnout.” Those results were
released in 2003, the year the CMA
launched its Centre for Physician
Health and Well-being.
Dr. Derek Puddester, director
of the Faculty Wellness Program
at the University of Ottawa, said
burnout among physicians is not
“a fact of life.” Positive change is
taking place.
“The entire Canadian medical
culture is making serious and
sustainable changes to promote
physician health,” he added.
However, he acknowledged
there’s much work to do on both
sides of the border.
Physician wellness searches
To find information on programs
and services promoting physician
wellness, a simple tip and search
strategy are described below to
provide guidance. Part or all of the
search can be carried out on your
own, or contact me for help.
Electronic Bookshelf Workshops
October – November 2012
Four simple steps to literature searching
The workshop provides a step-by-step approach to literature searches – from question formation to effective reference
management. Get an update on the clinical resources offered through the doctorsNS.com Electronic Bookshelf, develop key
concepts, and use Boolean logic and truncation, and document results. CME credits apply.
To register, telephone 1-866-890-5563 or email: [email protected]
October
Tuesday, Oct. 9
Wednesday, Oct. 17
Tuesday, Oct. 23
6:30-8:30 pm
6:30-8:30 pm
6:30-8:30 pm
Chipman Building Hants Community Hospital
South Shore Regional Hospital
Coldbrook
Windsor
Bridgewater
6:30-8:30 pm
6:30-8:30 pm
6:30-8:30 pm
6:30-8:30 pm
6:30-8:30 pm
St. Martha’s Regional Hospital
Cape Breton Regional Hospital
Aberdeen Hospital
Dartmouth General Hospital
IWK Hospital, 4th fl Link
Antigonish
Sydney
New Glasgow
Dartmouth
Halifax
November
Monday, Nov. 5
Tuesday, Nov. 6
Wednesday Nov. 7
Tuesday, Nov. 20
Monday, Nov. 26
CME credits: As an accredited provider, Dalhousie University CME designates this continuing medical education activity for two credit hours
for MAINPRO M-1 of the College of Family Physicians of Canada and reciprocally for the American Academy of Family Physicians. This event is
an accredited group learning Section 1 activity as defined by the Maintenance of Certification Program of the Royal College of Physicians and
Surgeons of Canada and reciprocally for AMA Category 1 of the Physician’s Recognition Award.
32
Web round-up:
Pat’s Pick
Tip: Use quotation marks
when doing a search for a
phrase like “physician health.”
Otherwise each word is
searched separately and the
relevance of results retrieved is
reduced. Using this phrase in
PubMed, the following article
was found:
Physician wellness: a
missing quality indicator.
Jean Wallace, Jane Lemaire,
William Ghali,
Lancet, Volume 374, Issue
9702, 14–20 November 2009,
Pages 1714–1721
To explore this idea, Medline
and the Cochrane Library were
searched for review articles
from January, 1985-July, 2009.
Original articles were sought
between January, 2004–July,
2009.
Search terms used:
• physician demographics
internship and residency,
health personnel, medical
staff, women physicians,
medical students, general
practitioners, internist,
paediatrician, surgeon)
• wellness indicators (anxiety,
burnout, cognition,
depression, fatigue, impaired
or psychological distress, stress
or wellbeing, suicide, work
hours, work shifts, workload);
• negative medical consequences
of physician impairment
(professional or diagnostic
errors, fatigue, medical errors,
Well-being
resources
The CMA Centre for Physician
Health and Well-being gives
links to a wealth of resources
such as:
Physician Health Resources
CMA Guide to Physician
Health and Well-being, 2003
www.cma.ca/living/centrephysicianhealthwellbeing
doctorsNS.com
International
Conference on
Physician Health
POPULAR PAGES
Dues & payment
options
172 page views
(member site:
Membership)
The International Conference on Physician Health
takes place in Montreal Oct.
25-27.
Several hundred doctors
who specialize in treating their colleagues are
expected to gather for the
world’s largest conference
on physician health, cosponsored every two years
by the CMA, American Medical Association and British
Medical Association.
For more information, visit
www.cma.ca/physicianhealthconferences
sick leave, sleep deprivation,
work schedule tolerance);
• health-care organizational
perspectives on physician
wellness ( occupational
health, personnel staffing
and scheduling, personnel
turnover).
Reports published in the past
five years were the focus, but
frequently referenced reports
published more than five years ago
were included.
Reference lists of relevant reports
identified by this search strategy
were also searched. From the extensive number of studies identified,
a subset of relevant studies was
selected.
For help finding health
information, contact:
Pat Lee
Librarian
Tel: (902) 468-8935 ext. 222
1-866-890-5563
[email protected]
CEO’s blog: Proposed
legislation not
supported
48 page views
(member site: CEO’s
blog)
WEB EDITOR’S PICK
Alternative funding plan changes
Academic funding plans (AFP) will be managed differently in Nova Scotia beginning
in the spring of 2013. A new AFP model is
expected to clarify the expectations of all
parties, provide more comprehensive data
to support comparative compensation, and
streamline negotiations and issues resolution
processes.
(member site: Physician payment > Alternative
funding)
Twitter
@Doctors_NS (Sept. 10)
New residency program a response to need
for more family physicians http://buff.ly/
SkcJGz #meded #nshealth #NovaScotia
@Doctors_NS (Sept. 14)
Congrats Dr. Chris Milburn for winning the
half marathon at @CBFiddlersRun this
weekend! And congrats to the volunteers on
a great event!
POPULAR
FILES
Membership dues
rebate
29 downloads
(member site:
Membership > Dues &
payment options)
Pre-authorized payment plan: form
21 downloads
(member site:
Physician payment >
Fee-for-service)
CEO’S BLOG
Moderator’s pick
$30,000 for medical
students
Sept. 11
Supporting the
educational goals of
our medical students
is one way the
association supports
the province’s future
physicians.
33
Statistics
Taking the pulse of Nova Scotia’s physicians
Hometown
Summerside, PEI
Dr. Ivan Wong
What I wish I knew 20 years ago:
How to paddle K1
My favourite flavour of ice cream:
Limone
My favourite place: Hawaii
If I wasn’t a doctor, I would be: A
pilot
My favourite book: Who Moved My
Cheese?
I feel healthy when: I keep
exercising
34
My biggest regret: I don’t have one
My greatest fear: Heights
Specialty:
Orthopaedic surgery/sports
medicine
Years in practice
Four
Introduce
yourself!
To take the STATistics
survey, email:
melissa.murray@
doctorsns.com
Insurance Solutions
Designed exclusively for physicians, medical students and
residents.
• Portability: OMA plans move with you wherever you go
• Cancellation protection: Unlike other group plans, your plan cannot be
cancelled by the insurer
• Premium refund: Money not used to pay claims and expenses for certain
plans may be refunded to our members
• Non-commissioned Insurance Advisors: We provide education,
information and advice
Alban Moran
1.877.836.8222, [email protected]
Elizabeth Gillis
1.800.268.7215, ext. 3283, [email protected]
Una Barnes
1.877.782.5113, [email protected]
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2012-OctDoctorsNS-t - Doctors Nova Scotia

Transcription

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