2012-OctDoctorsNS-t - Doctors Nova Scotia
Transcription
2012-OctDoctorsNS-t - Doctors Nova Scotia
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 “I got huge savings through my professional group rates.” – Bob Raposo Satisfied client since 2005 See how good your quote can be. At TD Insurance Meloche Monnex, we know how important it is to save wherever you can. As a member of Doctors Nova Scotia, you can enjoy preferred group rates on your home and auto insurance and other exclusive privileges, thanks to our partnership 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. Get an online quote at www.melochemonnex.com/doctorsns or call 1-866-269-1371 Monday to Friday, 8 a.m. to 8 p.m. 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. Complete contest rules available at www.melochemonnex.com/contest. ®/ 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 3 The First. The Best. The only one. 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COR-12-00284 DOC NS HalfPage colour 7.5x5.indd 1 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. October 2012 | doctorsNS 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! October 2012 | doctorsNS 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 October 2012 | doctorsNS 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 Lobby government • • • • • • • • • • • • • Member Involve/commitees • • • • • • • • • • • • • Negotiator prov/terr gov • • • • • • • • • • • • Online clinical tools • • • • • • Members only section website • • • • • • • • • • • Online newsletter/publication • • • • • • • • • Magazine/Journal • • • • • • • • • • Social Media • • • • • • • • Welcome kit to new members • • • • • • • • • • • Health/Dental for families • • • • • • • • • Connect on CMPA rebate program • • • • • • • • • • • www.doctorsNS.com Leadership training • • • • • • • • • • Follow @Doctors_NS on Twitter Physician health program • • • • • • • • • • • Practice management support/advice • • • • • • • • • • • • • Subscribe to the CEO’s blog Financial/Incorporation advice • • Insurance aliance • • • • • • • • • • Register for Business 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 October 2012 | doctorsNS 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 October 2012 | doctorsNS 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 October 2012 | doctorsNS 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 October 2012 | doctorsNS 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 October 2012 | doctorsNS 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 October 2012 | doctorsNS 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 October 2012 | doctorsNS 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. October 2012 | doctorsNS 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 October 2012 | doctorsNS 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 October 2012 | doctorsNS 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 October 2012 | doctorsNS 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.) October 2012 | doctorsNS 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 October 2012 | doctorsNS 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.) October 2012 | doctorsNS 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 October 2012 | doctorsNS 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.) October 2012 | doctorsNS 25 Canadian Medical Association 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 Canadian Medical 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 October 2012 | doctorsNS 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.) October 2012 | doctorsNS 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 October 2012 | doctorsNS 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. October 2012 | doctorsNS 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, Specialists and Others Family Physicians, Specialists and Others Family Physicians and Others Family Physicians, Specialists and Others 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 October 2012 | doctorsNS 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 October 2012 | doctorsNS 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. October 2012 | doctorsNS 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 October 2012 | doctorsNS 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] www.omainsurance.com ES UNDERSTATED OVERACHIEVER. 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