Alberta Doctors' Digest May June 2012 by Alberta Medical Association

May/June 2012

THE ALBERTA DOCTORS’

AMA launches a new website

www.albertadoctors.org is revamped, revitalized and ready for you!

“Honored to be in your company” Alberta’s Dr. Louis Hugo Francescutti heads to the Canadian Medical Association.

Patients First®

Break Free: Write a book (or manuscript)

Alberta Medical Students’ Conference and Retreat (AMSCAR) 2012

Volume 37, Number 3

From The Editor

When the will is ready, the feet are light Dennis W. Jirsch, MD, PhD Editor

Each year in January, three of my colleagues and I – tired of our indolence and tight belts and wary of full-length mirrors – head for the local running track. We start off two or three times a week, shuffling around the track and muttering that we’re glad we’re back running. But we don’t last long. After a week, perhaps two, we begin to falter by degrees, with three of the four of us showing up, then two, then just one, then zippo. We dwindle. By late February we’ve pretty much all lapsed and we don’t talk about it much, or if we do we reckon we’ll be better off next year. It seems we lack “willpower.” For sure we have excuses – they’re easy enough to come by – and I’m prepared to admit that we all lead pretty full lives. Even so, I wonder why it is we don’t have the energy or the resolve to persist. One of my pet themes has to do with the increasing “techno-pace” of lives that have become possibly more stimulating, but also more exhausting. As one author puts it, “The intricate economic and social machinery in which we are

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enmeshed makes ever more insistent demands on our energy, our mental functions and our will.”1 I’m prepared to admit that inherited or innate differences in willpower exist, that heroic figures such as Gandhi and Martin Luther King or the eccentric fellows that sail around the world solo may have been born with prodigious willpower. As well, I’m prepared to admit that our resolve may sag with age. As an octogenarian neighbor tells me, “I just don’t have the gas anymore.” So the four of us have once again failed our New Year’s resolution – a common enough occurrence – but this time we sit down at coffee and talk about it. There have been a couple of recent books about willpower,2, 3 and we read them. We decide to approach things systematically. We make a plan.

I’m prepared to admit that inherited or innate differences in willpower exist.

First of all we talk about what it is we’re trying to accomplish. With discussion, three of the four of us affirm that our

weight, our avoirdupois if you will, becomes more tractable with exercise and that a running regimen is one means of looking a little more acceptable in a full-length mirror. One of us opines that yoga has more appeal in becoming limber, and somewhat reluctantly we part company with him. We are left as a trio of would-be runners. Success will look like this: we want to be able to run or jog five kilometers three times a week around the local track. Here’s our plan. We reckon that we’ll edge into things slowly, that for a full month we’ll walk round the track, though we can jog a little if we are in high spirits. After a month of walking, we’ll begin to run by degrees, building into things slowly, so that by the end of six months we’ll have a routine, doing our five kilometers three times a week. We won’t be too punitive though: if one of us misses a session it can be made up at any time. Recording our progress seems like a good thing and we’ll do this with shareware. Of course, we’ve told everyone far and wide that this time we’re going to succeed. There are even plans to post our progress record in our respective coffee rooms. Rewards seem to be important. We’re each going to pony up twenty bucks a week into a kitty, held by Tom, our treasurer. If we’re a success by, say, next February, we’re off to Vegas for an old

boys’ weekend, and we can’t help but grin just thinking about it. “Whatever happens in Vegas stays in Vegas.” If a reward is important, its opposite – an anti-reward – seems called for too. If we’re not running thrice weekly come fall, we’ll give the lucre away to charity. We’re not planning on this. “Inner fervor” is what we’re looking to build, I suppose. We’ve bought a subscription to Runner’s World that we’ll share. A local marathoner will come and talk to us about proper technique, pacing, hydration and injuries. He has even promised to run with us for a month after start-up, and of course we’ll share our results with him as we go.

Willpower or self-control is a process, psychologists argue. It’s like a mental muscle that needs a workout.

Consider the experimental work I’ve been reading about. How long, for instance, can children control themselves before reaching for a candy or an Oreo? How long will college students defer gratification, reaching for $5 right now when they might expect $20 after a year's wait?

That’s our plan, so far. I’ve written it up for the three of us and I have to say it looks impressive – three neatly packaged manila folders, three stubby red pencils and a calendar.

Willpower or self-control is a process, psychologists argue. It’s like a mental muscle that needs a workout. More than that, it’s a process that can be perfected like a golf swing or a tricky dance step.

My son passes my desk as I’m finishing and I tell him what I’ve been working on. I ask him – possibly tongue in cheek – if he thinks it will work this time. Will we get into the habit, the routine of running?

The willpower gurus are prescriptive. Avoid distractions, except those that keep you from temptation. Limit your choices. Get enough sleep. Monitor things and track them. Be with like-minded people. Stay positive.

“You will if you want to,” he says.

Fair enough, I think, but perhaps my boy is onto something. I wonder whether we have been “too clever by half.” Perhaps it is our objectives that deserve the work, the scrutiny. Maybe

we’re barking up the wrong tree, attending to a porridge of techniques that promise self-control. Could it be the hurly-burly of our lives and our self-absorption that distract us from better goals, ones more replete with meaning – ones that we need fret less about, and ones that are in fact more sturdy, more compelling? The proverb seems to bear this out: “When the will is ready, the feet are light.” Back to me and my buddies. We have a backup plan. There’s always curling in winter, bocce ball in summer. We’ll see. References 1. Assagioli R. The Act of Will, Viking Press, New York, 1973.

I’m taken aback at this, even gobsmacked, as they might say in the United Kingdom.

2. Baumeister RF, and Tierney J. Willpower: Rediscovering the Greatest Human Strength, Penguin Books, London, 2011. 3. McGonigal K. The Willpower Instinct: How Self-Control Works, Why it Matters, and What You Can Do To Get More of It, Penguin Books, London, 2012.

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TABLE OF Patients First ®

DEPARTMENTS

Patients First ® is a registered trademark of the Alberta Medical Association.

The Alberta Doctors’ Digest is published six times annually by the Alberta Medical Association for its members.

Editor: Dennis W. Jirsch, MD, PhD

Co-Editor: Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP

Editor-in-Chief: Marvin Polis President: Linda M. Slocombe, MDCM, CCFP President-Elect: R. Michael Giuffre, MD, MBA, FRCP, FRCPC, FACC, FAAC Immediate Past President: Patrick J. (P.J.) White, MB, BCh, MRCPsych Alberta Medical Association 12230 106 Ave NW Edmonton AB T5N 3Z1 T 780.482.2626 TF 1.800.272.9680 F 780.482.5445 amamail@albertadoctors.org www.albertadoctors.org July/August issue deadline: June 15

The opinions expressed in the Alberta Doctors’ Digest are those of the authors and do not necessarily reflect the opinions or positions of the Alberta Medical Association or its Board of Directors. The association reserves the right to edit all letters to the editor.

CONTENTS

2 12 14 16 17

18 Insurance Insights 24 Health Law Update 30 Mind Your Own Business 33 Letters 36 From the Editor

Residents' Page PFSP Perspectives Web-footed MD In a Different Vein Classified Advertisements

FEATURES 6 AMA launches a new website www.albertadoctors.org is revamped, revitalized and ready for you! 11 “Honored to be in your company”

Alberta’s Dr. Louis Hugo Francescutti heads to the Canadian Medical Association.

20 Alberta Medical Students’ Conference and Retreat (AMSCAR) 2012

Medical students focus on wellness and collegiality.

22 Message not received!

Do your patients understand your office signage?

28 Break Free

Write a book (or manuscript). As a physician, you have a perfect topic to write about – yourself!

The Alberta Medical Association assumes no responsibility or liability for damages arising from any error or omission or from the use of any information or advice contained in the Alberta Doctors’ Digest. Advertisements included in the Alberta Doctors’ Digest are not necessarily endorsed by the Alberta Medical Association. © 2012 by the Alberta Medical Association Design by Sarah Tiemstra at Backstreet Communications

Cert no. XXX-XXX-000

AMA Mission Statement The AMA stands as an advocate for its physician members, providing leadership and support for their role in the provision of quality health care. Alberta Doctors’ Digest

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May/June 2012

C o ve r F ea t u r e

AMA launches a new website Kathy Garnsworthy Website Manager, Alberta Medical Association

website developers call the “build.” So, what went into the build of your new electronic AMA home?

what did members want?

to the association, and to share relevant information. Before starting production, the AMA carried out several surveys and focus groups with members. The consensus? Members told us that they wanted: • Faster and easier access to services and benefits. • More easily accessible news about negotiations and advocacy campaigns.

Dr. Pauline Alakija, member, AMA Board of Directors

www.albertadoctors.org is revamped, revitalized and ready for you! Find out more about the new site: • Learn how we built the AMA website. • Access a user’s guide to the site to help you find your most visited pages. • Explore the site’s features (e.g., Online Billing Advice, a podcast and e-reader version of Alberta Doctors’ Digest, Patients First® for over 100 years). • Get information about the login process and login help. • Learn about the team that produced the website.

Building the new AMA website The process that goes from initial concept to launched website is what

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“We were hoping for a more user-friendly website – one that allows more active participation, recognizes the different groups and range of physician members, and shows how member oriented our organization is.” Dr. Linda M. Slocombe AMA President

Members were always central to the new website design. Right from the beginning, we had two key objectives: • An updated and redesigned AMA website that would better reflect the AMA’s stature as the united voice for Alberta physicians and as advocates for quality health care. • A website that made it easier for members to access AMA benefits and services online, to participate in and contribute

• A more attractive and modern graphic design. • Ways to communicate their views to the president and Board of Directors. Resident physicians and medical students said they wanted to see themselves more clearly on the new site and they wanted information targeted more directly to their needs. Our old website was 13-years-old – ancient in web terms. Its technology was wearing out, and it was top heavy with archival material that members no longer needed. All of this extra content made it hard for members to find essential information. During my first months on the project, I carried out content creation meetings with all AMA business areas. Together, we reviewed each business area’s current website content and talked about what should move to the new site, what should be left behind and what new information we needed to create.

The content you see on the new website has two main sources: • Member surveys and focus groups. • The content creation meetings with all AMA business areas.

creating content My colleague, RuthAnn Raycroft, Coordinator, Public Affairs, and I then rewrote nearly 50 different website sections to make them more relevant and accessible for our members. With help from the AMA business areas, we also created a significant amount of new content. Some examples include expanded sections for medical students and physician residents, member engagement sections, stories of pioneering Alberta doctors and primary care network (PCN) success stories. The next step was to work out a simpler way to arrange all of this information on the new site. (For more information, see the “User’s guide to the new site” below.) I’m very grateful to the AMA members and staff who participated both in a “card-sorting” exercise (i.e., sorting the content into topic areas) and the later usability testing to make sure we had the categories right. The site has many new features (and others are coming soon). A few examples include searchable Online Billing Advice, audio podcast versions of the Alberta Doctors’ Digest and a new historical section highlighting the contributions of Alberta’s physicians. For more about these new features, see the “New features” section below.

“The new website will encourage members to interact with their organization and allows for more immediate and timely communication with members.” Dr. Linda M. Slocombe AMA President

The systems That keep it functioning

Calling the website production a “monumental process,” Joel is proud that his group has had a chance to “directly and positively affect our members’ experience.” In the future, ISG will be heavily involved in maintaining the new site and in developing new features such as a member dashboard – a website area where members can access personalized information about their AMA benefits and services. Special thanks to Joel and his team – Kurt L. Reifferscheid, Greg Weinrauch, Gavin R. Bray and Scott Koladich – for their excellent work in developing the new site!

Joel McGovern, Director, AMA Information Systems Group

The coding that underlies a website is a bit like the electrical, plumbing and heating systems in your house. Without them, you wouldn’t be able to live in your home. The AMA’s Information Systems Group (ISG) has been involved in the project since the start. ISG Director, Joel McGovern, and his team have done a fabulous job of making sure the systems underlying the new website work exactly as they should. ISG set up a hosting environment for the site at the AMA and customized the new content management system tools (which allow AMA staff to manage content). Most of the new website features (e.g., the Online Billing Advice and the Favorites list) rely on ISG coding. The group also plays a critical role in safeguarding the confidentiality of members’ information on the website.

“The new website benefits members by bringing a lot of useful information together in a very user-friendly site that members will be able to tailor to their own needs in the near future. Members want to get the information quickly and easily. This new website does that.” Dr. Linda M. Slocombe AMA President

a new graphic design Graphic design is the “curb appeal” of the website. Designer James Shrimpton of Helix Designs came up with a vibrant design for the site (with blue and gold colors that echo the AMA logo), that encourages members to explore the site. A new photo carousel on the home page brings color and interest to the home page, as well as showcasing our most important news.

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We’ve used photos throughout the site. I’m really pleased that so many members have allowed us to include their photographs. Instead of stale stock photos of “fake” doctors, you will see your friends and colleagues on the new site.

So, enter! Explore your new website. Try out its new features. The “Website feedback” webpage allows you to contact us directly with comments about the new site. Send me both your positive and negative comments. The AMA is all about our members, and we would definitely like to hear from you. I’ve really appreciated the enthusiastic support for the new website from the AMA’s Board of Directors, senior management and business areas. Throughout the whole process, the focus has been on creating the information and features that members need most.

User’s guide to the new site Question: How do I find the information I need on the new website? Answer: Choose one of four ways!

1. Use the navigation bar With the navigation bar at the top of the site, find your information using six easy entry points. About the AMA • AMA leaders. • Awards, scholarships, bursaries and grants.

Alberta Doctors’ Digest

• Zone Medical Staff Associations. • Canadian Medical Association (CMA) services. • Careers at the AMA.

Enter!

• The AMA in medical history (including Patients First® for over 100 years).

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Member Services

Medical students: • Manage your membership. • Engage as an active AMA member both in the AMA and CMA.

Matthew S. Karpman, medical student

• Access insurance and financial services and scholarships.

Physicians: • Manage your membership.

• Learn how to protect your health.

• Engage as an active member (opportunities to participate both in the AMA and CMA).

• Learn about becoming a doctor in Alberta's health care system.

• Get updates on negotiations and compensation agreements, access programs and services through the “Practice help” and “Protect your health” sections. • Review clinical Dr. Carolyn A. Lane, resources. family physician Resident physicians: • Manage your membership. • Engage as an active member (opportunities to participate both in the AMA and CMA). • Access insurance and financial services and scholarships. • Learn how to protect your health and make the transition to practice.

Advocating for Patients First® • Learn what we mean by Patients First®. • Follow our “Let’s talk about health care” campaign. • Watch Alberta physicians describe the challenges in their working lives in the “Prescription Alberta” videos. • Find out about our stand on health information privacy and our advocacy campaigns for patients. Publications • Read our regular member publications: Alberta Doctors' Digest, MD Scope, Section News, etc. Media • Find media contacts.

Dr. Chris Fung, resident physician

• Read the President’s Letter – the "voice of the AMA" (letters from our leadership about issues of critical importance to AMA members).

Contact Us Contact information for: • Senior management. • Services and programs. • Publication managers. • Website administrators. • The Canadian Medical Association.

Patients First® for over 100 years, Dr. Mary Percy Jackson, Notikewan AB (source: Glenbow Museum).

2. Create a favorites list After you login, you’ll find yourself on the “My AMA” page. The Favorites list is an easy way to create your own list of the pages you visit most often. Click on the “How to use this feature” page to find out how to add and delete your Favorites.

• Patients First® for over 100 years: Read the stories of pioneering Alberta doctors.

• Favorites list:

3. USE SEARCH Enter a search word or phrase in the Search box (top right of the site).

4. VISIT THE SITEMAP Find the webpage you need in the Sitemap (at the bottom of every webpage).

New features Find out about some great new features on the website such as: • Searchable Online Billing Advice. • A Favorites list that lets you collect your most visited pages in one place. • Comment on President's Letters. Learn more about these and other new features below: • Searchable Online Billing Advice: Use this feature to navigate through complex fee codes and modifiers.

› After you login to the site, you will see a gold Favorites bar at the bottom of each webpage. Simply click on the gold bar to add the webpage to your Favorites list on the My AMA page.

• Primary care network (PCN) success stories: Find out how Alberta PCNs are improving primary care in six key areas.

Logging in to the site We’ve tried to make it easy for you to login, while at the same time protecting your personal information and the security of confidential information on the website.

› Your Favorites list helps you to easily access these pages from one spot on the website, and you can return to the My AMA page from anywhere on the website. • Podcast and e-reader versions of Alberta Doctors’ Digest: Listen to a podcast version of our flagship magazine or take it mobile with your e-reader. • Resident physicians: Find more information tailored to your needs, including AMA services and benefits for you and a useful transition-to-practice section. • Medical students: Access targeted information on AMA services and benefits for you and tips for making the leap from student to resident physician.

First-Time Login • Using the gold Member Sign-in box, login to the new site for the first time using your current AMA member number and password.

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• After logging in, you will be prompted to change your password (we’re moving to a system of stronger passwords to better protect the security of your personal information).

The AMA Website Team Need help? Forgot your password?

Good websites are always collaborative. Many people have contributed to the new website.

• If you don’t remember your current password, click on “Forgot your password.” We’ll ask you to answer some security questions, and then we’ll email your password to you.

Heartfelt thanks to the following for their support during the production of this new site: • AMA Senior Management Team: Michael A. Gormley, Verlin R. Gwin, Dr. William S. Hnydyk, James A. Huston, Ronald A. Kustra, Dr. Lyle B. Mittelsteadt, Cameron N. Plitt, Sean T. Smith and Victor A. Taylor.

• Complete login help is also available on the “Login help” webpage (www.albertadoctors.org/ services/membership/log in-help.org). • If you’re still having trouble logging in, please contact us at 1.877.538.8076.

McGovern, Cameron N. Plitt, Kurt L. Reifferscheid and Shannon E. Rupnarain. • Public Affairs: RuthAnn Raycroft and the Public Affairs staff who reviewed the entire website before launch (Daphne C. Andrychuk, Ava L. Butterworth, Alexis D. Caddy, Barb Green, Janice H. Meredith and Jung-Suk Ryu). • Information Systems Group: Gavin R. Bray, Scott Koladich and Greg Weinrauch. • Graphic design: James Shrimpton, Helix Designs. Special thanks to all AMA business areas, who were enthusiastic participants in creating and testing new content for the site to make it more relevant and useful for our members.

• Website Operational Team: Kathy Garnsworthy, Joel

AMA Physician Locum Services®

Locums needed. Short-term & weekends. Family physicians & specialists.

Contact:

Experience:

Barry Brayshaw, Director AMA Physician Locum Services® barry.brayshaw@albertadoctors.org T 780.732.3366 TF 1.800.272.9680, ext. 366 www.albertadoctors.org/services/ physicians/practice-help/pls

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Flexibility – Practice to fit your lifestyle.

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Variety – Experience different Alberta practice styles.

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Provide relief – Support rural colleagues and rural Albertans.

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Travel costs, honoraria, accommodation and income guarantee provided.

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F ea t u r e

“Honored to be in your company” Alberta’s Dr. Louis Hugo Francescutti heads to the Canadian Medical Association An Edmonton-based physician is the elected nominee for Canadian Medical Association (CMA) President-Elect 2012-13. Dr. Louis Hugo Francescutti is an emergency medicine physician, well known in his community and across the country for his many contributions to health care. In Yellowknife August 12-15, Dr. Francescutti will be presented to the CMA General Council and stand for election by delegates. One year later, he then becomes president when Alberta proudly hosts General Council in Calgary, August 18-21, 2013. “These are exciting times in health care,” wrote Dr. Francescutti in his message to CMA members before his election. “The pressures that we face seem to increase daily. Yet with appropriate resolve, I strongly believe we can tackle the challenges before us and create opportunities to improve the health care system. Our governments are looking to physicians to lead the process of re-engagement, recommitment and re-engineering of health care delivery. As physicians, we know we can do better. The CMA is ready; its new strategic plan is robust and well-aligned for the future.” Dr. Francescutti is currently president of the Royal College of Physicians and Surgeons of Canada, with his term ending in 2013. He has appointments with the emergency department at the Royal Alexandra Hospital and Northeast Community Health Centre. He is a professor of epidemiology at the University of Alberta (U of A) School of Public Health and director emeritus of the Alberta Centre for Injury Control and Research. His many leadership and governance roles include the Board of Governors of the U of A and the Alberta Medical Association Representative

Forum. In 2011, Alberta Venture magazine recognized him as one of 50 Most Influential Albertans of the Year. “One person cannot change things single-handed,” wrote Dr. Francescutti. “I will work with you to find solutions at all levels of health care delivery and show that physicians can lead, innovate and collaborate with all stakeholders. I am honored to be in the medical profession, but more so in the company of its people.”

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Insurance Insights

Making a claim on AMA Commercial Office Insurance

What you should know – and how it all works Phil Cunningham, BA (Hons), CIP Vice President, Mardon Group Insurance

Mardon Group Insurance became broker for the Alberta Medical Association’s (AMA’s) Commercial Office Insurance program in 2006. We have seen strong support from AMA members for this program, which is underwritten by Aviva Canada, Royal Insurance and Intact Insurance. At the end of 2011, 234 Alberta clinics were enrolled. Recently we began providing more information about our claims process to members. We now include the following information as an insert in all policies we send to new policy holders.

What should I do if I have a claim? If you need to report a claim during regular business hours of 9 a.m. to 5:30 p.m., please call us toll-free at 1.866.846.4467. We will take down some basic information and contact numbers and have an insurance adjuster call you, usually within 30 minutes. If you need to report a claim outside of these hours please call Granite Claims toll-free at 1.800.668.6100. 12

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How do I get help to understand the claims process?

time. We are here to assist you in any way we can during this process.

The insurance adjuster will be able to explain the claims process to you. This could include identifying items lost or damaged, the replacement value and where to purchase new items.

Whom do I call if I am not happy with the way my claim is being handled?

What does an independent adjuster do? An independent adjuster is retained to investigate, negotiate and resolve your claim. The investigation entails finding the cause of loss and determining whether your policy of insurance will cover that cause and the property involved. As well, the adjuster works with you to quantify your loss. This may include listing contents or writing a scope of damage. Once coverage is confirmed, the adjuster assists in the restoration of the damage. He or she may refer a restoration contractor or provide guidance in obtaining estimates for contents replaced. The last step is to tabulate the claim amounts and present your claim to the insurer with settlement recommendations.

Whom do I talk to if I have general questions about my claim? If you have any questions about the claim, including coverage, the amount of loss settlement being offered, how long it will take for the claim to be closed or for you to receive payment, please call your adjuster. If you still have questions, please call us at any

If at any time during the claims settlement process you are not happy, please do not hesitate to call us. We are here to help in any way we can with the process and to bring the claim to a satisfactory conclusion. As your broker, we represent you, not the insurer. We can talk to the insurance adjuster on your behalf.

Does my policy pay replacement cost? Most policies pay replacement cost, subject to some limitations. First, the insurer usually requires replacement of the item. Second, typically the replacement value is based on the cost to replace an item with an item of like kind and quality.

Can I upgrade my restoration or replacements? There is no problem with upgrading the structure or contents. Insurers will pay the value of the like kind and quality replacement and the policy holder pays for the upgrade portion.

What if I do not replace something? If an item is not replaced, most insurance policies are responsible to pay its actual cash value. This is the current market value taking into

account depreciation for age, wear-and-tear and obsolescence. There is no science or set formula to an actual cash value calculation – it is a value based on a reasonable consideration of the replacement cost, less depreciation.

Who obtains estimates to quantify my claim? In the case of building restorations once the project has been scoped, the adjuster will request repair estimates based on that scope. Often these are submitted by restoration contractors, but the policy holder is entitled to have a contractor of his or her choice submit a bid. Contents work differently due to their unique features. The adjuster can assist with items that are common and easily identifiable, such as electronics. For more unique items, the policy holder is asked to secure written estimates or receipts to ensure that the replacement item represents an accurate like kind and quality replacement.

What is co-insurance? Co-insurance is a provision found mostly in commercial policies or personal policies with guaranteed replacement costs. It is a method insurers use to ensure that the appropriate amount of insurance is purchased. When the claim is filed, if the amount of insurance purchased is not enough to cover the claim, then the policy holder is assessed/pays a penalty of a proportionate amount of the claim. This would be expressed as a percentage of the replacement cost or actual cash value of the insured property. For example, imagine that a property valued at $500,000 was only insured for $400,000. If the insurer requires 100% co-insurance, then the property owner should have carried $500,000

coverage. The difference of $100,000 – or 20% – is then the responsibility of the property owner who would have to self-insure the 20%, i.e., that portion of the claim would not be reimbursed by the insurer. The rate of co-insurance typically ranges from 80-100%. In a homeowner's loss, not insuring to full replacement value can nullify a guaranteed replacement-cost provision. In that case, an insured might be faced with paying costs over the policy limit.

Business interruption losses When a loss to a business occurs, efforts are made to continue operations. When this is impossible, a loss of income can occur. This loss of income is compensated under one of two forms of insurance. The first is called a Gross Earnings Form. It provides indemnity until restoration is complete. The second is a Profits Form, which pays until the business reaches the same level of income that preceded the loss. Both forms are subject to time limitations, usually 12 months. With a policy intended to replace lost income, the insurer requires the policy holder to establish and substantiate the income being claimed. Most often this can be accomplished by producing billing records, or even bank statements. As well, the most recent financial statement helps support the claim. Once the income loss has been established, the adjuster must determine whether there are any usual expenses that have ceased due to the shutdown. These are considered non-continuing expenses and can be determined by looking at the financial statement. They often include cost of sales, wages, electricity and other expenses not needed during the time the business is not operating.

Often, the business is able to continue operation, but only after incurring additional costs. These are known as extra expenses. These are compensated if they are reasonable and necessary and they reduce lost income.

How long do I have to complete my claim? Traditionally, insurance policies gave one year to complete a claim. This limitation was overturned by the Supreme Court of Canada. Essentially, you now have one year from when it is reasonably practicable to prove your loss. Proving your loss includes things such as establishing a scope of repair, establishing a schedule of loss, listing items damaged and perhaps even quantifying values. However, it is valuable to move through your claim as expeditiously as possible. Insurance policies can be quite complex and difficult to understand for the layperson. This reinforces the important role Mardon plays as your insurance broker to help you understand your policy, and to assist during the often confusing and stressful time following an event that has damaged and possibly closed your clinic for an extended period of time. Mardon Group Insurance is based in Vancouver BC, and is endorsed by the AMA as well as the British Columbia Medical Association and the Saskatchewan Medical Association for commercial office insurance for their members. Mardon can be reached by calling toll-free at 1.866.846.4467 or you can link to their website by following the directions in the “Commercial Office Insurance” section on the AMA website (https://web.albertadoctors.org/services/ physicians/practice-help/prof-insurance/ commercial-office).

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Health Law Update

Negligence 101 Jonathan P. Rossall, QC, LLM Partner, McLennan Ross LLP

There are few things that get a physician’s heart racing more than being accused of negligence in the course of providing medical treatment. Webster’s Dictionary defines “negligence” as: “… want of due care; carelessness; habitual neglect.” But in the medical-legal world, the word means much, much more. It is a term that many feel is synonymous with the word “malpractice,” although the latter is more all-encompassing, yet more difficult to define. The law of negligence is complex and evolving, as the courts are continually challenged with new fact situations, new principles and, of course, the evolution of medical care itself. What follows is a very simple, broad overview of the key principles that may assist a physician in better understanding this intersection between the legal and medical worlds. In common-law jurisdictions1 the term “negligence” has evolved to include four separate, yet intertwined, requirements. First, the party accused of negligence must owe what is referred to as a “duty of care” to the (allegedly) injured party. Essentially, it means that the physician

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or other health provider owes a duty to take reasonable care in providing medical treatment to a patient. In medical negligence cases, that duty typically arises out of the doctor-patient relationship and usually is not in issue in a lawsuit, although the scope of the duty may be.

a normal, prudent practitioner of the same experience and standing.”

In common-law jurisdictions the

Third, the person to whom the duty is owed must have suffered an injury. This may seem obvious, but the courts have spent plenty of time trying to characterize exactly what an “injury” is. The word can include physical damage, emotional trauma, financial loss, or a combination thereof. The injury suffered must have some significance – in the absence of a measurable loss, the affected party has no redress before the court.

term “negligence” has evolved to include four separate, yet intertwined, requirements.

Second, the party accused of negligence must have breached the standard of care required of him/her which otherwise would satisfy that duty of care. The standard of care is typically that of a “reasonable person” and therefore not one of perfection. The classic judicial description of “standard of care” is found in a 1956 decision of the Ontario Court of Appeal2 and reads as follows: “Every medical practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. He is bound to exercise that degree of care and skill which could reasonably be expected of

The question of whether a given health care provider has met an accepted standard of care is a question of fact for the judge or jury to determine, based generally on expert testimony from a respected medical practitioner of similar qualifications and experience.

Fourth, the actions of the party accused of negligence must be the actual and legal cause of the injury suffered. The demonstration of this “causal link” between the conduct of the caregiver and the loss suffered by the patient can be the most hotly contested and contentious part of medical-legal litigation. Essentially, the injured party must show that the injury would not have occurred “but for” the conduct of the health care provider. In rare cases, it may be sufficient if the injured party shows that the actions of the health care provider “materially contributed” to the damage suffered.

In addition to showing that the actions of the health care provider were the “cause in fact” of the injury, the plaintiff in a medical-legal action must also show that the actions were the “proximate cause” of the injury. In other words, the caregiver should only be liable to the patient for injuries that were foreseeable to a person in the caregiver’s position.

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Not every action that results in an injury to a patient is “negligence.”

All four of these requirements must be proven to a civil standard (“balance of probability”) in order for a plaintiff to succeed in an action in negligence. The important thing to take from this is: not every action that results in an injury to a patient is “negligence.” Many, if not most times, those actions are likely the result of the careful exercise of clinical judgment with the benefit of diagnostics, as well as personal interaction with the patient, all combined with experience and training. Errors in judgment occur which unfortunately can result in injuries, but as seen herein, so long as the judgment was a reasonable one in the circumstances, the health provider’s actions should be defensible in law. End Notes 1. That is, legal jurisdictions where the law evolves based on judicial decisions, as opposed to civil law jurisdictions where legal practice is governed by a written Judicial Code,

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2. Crits v. Sylvester (1956), 1 D.L.R. (2d) 502, affirmed by the Supreme Court at [1956] S.C.R. 991.

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Mind Your Own Business

Don’t lose your head about overhead: Are you balancing cost and value? PMP Staff

The overhead percentage dilemma can be illustrated with a parable: Fred walks into a Lexus dealership to buy a vehicle and says, “I’d like to pay 30% for this vehicle.” Puzzled, the salesperson asks, “30% of what?” Fred says, “Well, I earned $100,000 last year so I’ll pay 30% of next year’s earnings.” The salesperson is not comfortable with a percentage of an unknown number but for the sake of continuing the conversation responds, “I can’t sell this vehicle to you for $30,000, it’s worth $70,000.” Fred says incredulously, “That works out to 70%! The auto dealership across the street offered to sell a car to me for less than 30%. I’m taking my business there.” Shaking her head the salesperson says, “Sorry sir, but I guess I can’t help you. Have a good day.” So Fred leaves the Lexus dealership, walks across the street and into the Lada dealership …

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This scenario is meant to be humorous, but does it sound a little familiar? One of the most common formulas used to share clinic overhead among physicians is a fixed percentage of billings. This method tends to be favored because it is easy to apply and has become standard vernacular for physicians. A large determinant in the decision to join a practice is the answer to the question: “What is the overhead percentage?” However, as in our parable, this method is often not well understood either by clinic owners or associates. Here are some critical points to consider when setting or accepting an overhead percentage: 1. Relationship to actual costs. From the perspective of an owner, a key element (often not adequately considered) is the cost of operations. To be a viable business there must be more revenue (overhead contribution) coming into the practice than costs expended. Simple, right? In some instances, however, owners get caught up competing to meet an expectation of an overhead percentage without understanding the real costs of the business. It’s fine to say you will offer a 30% overhead to associates, but if your collective annual billings for the clinic are $1.2 million and your cost

to run the clinic is $500,000, you are losing money. It doesn’t matter that others might be offering a 30% rate; you need to either find ways to lower your costs or raise your overhead contributions. 2. Covering incremental costs. Occasionally, an owner will say it’s better to have some contribution toward overhead than none at all. That is not always true. In the short term, it is advantageous only if the additional contribution exceeds the additional costs (e.g., medical office assistants, supplies) incurred as a result of adding the new physician. In the long run, however, to be a break-even or profitable business, the contributions of each physician must cover the incremental costs plus a fair portion of the fixed costs of the business (e.g., lease, insurance, utilities, clinic manager, etc.). 3. Uncertainty of future billings. Occasionally owners will take on too much risk with respect to the billings of an associate physician. When you offer an overhead percentage, you have made an assumption about the future billings of that associate. Without a written practice agreement that sets out some minimum financial obligations, the owner risks not being able to cover clinic costs if the new physician decides to decrease his/her clinic hours or takes an

extended leave. Using a straight percentage formula, lower billings equal lower contribution to overhead. 4. Contribution far exceeding costs. The opposite situation can become problematic as well. In a clinic where there is a large discrepancy in physicians’ billings, you may also run into a situation where a percentage formula results in a physician paying an overhead amount that exceeds reasonable costs. In such a case, without a provision for a maximum amount, the clinic risks losing the physician as his/her contribution is not

proportionate to what he/she is getting out of the relationship. If the discrepancy is significant, he/ she could instead choose to set up his/her own clinic at a much lower cost. Why would you pay $300,000 for a Lexus? 5. Value received for the contribution. From the perspective of an associate, the key element that is often overlooked is value. What are you getting in return for the overhead contribution? Of course, you will pay less overhead in an aging clinic in a strip mall with worn equipment, no trained

clinical staff, and a bucket in the corner to catch the roof leaks! But recognize that a nicer surrounding, current equipment and qualified staff cost money and if that is how you choose to practice, the overhead needs to reflect the costs of delivering that additional value. There is nothing inherently wrong with the fixed percentage of billings method of sharing overhead. However, it needs to be evaluated in light of the financial context of each situation. Remember these two words in evaluating overhead sharing arrangements: cost and value.

Letters To AMA: I appreciate the hard work that you are doing for us at this time of very considerable uncertainty for Alberta’s physicians. However, in the middle of all of this there is an ongoing problem for general internists, which has existed possibly for as long as 10 years. There have been gross and growing fee inequities between members of the general internal medicine section particularly over this time. An inequity has been more creeping in onset but probably even more significant. Traditionally the consultation fees were intended to cover the cost of maintaining an office and a practice as well as rewarding the physician, but not both! Increasingly hospitals have been hiring general internists directly as well as other internists who then work out of the hospital having virtually no overhead costs, but still using the same fee schedule as those of us who are community based and paying anywhere from $30,000 (a very lean operation) to $100,000 or more a year to maintain our offices. We provide very important services. We keep people out of hospitals, and we prevent them from being readmitted. A typical new patient in my office would take a minimum of 30 minutes and as much as 90 minutes of my time. Follow-up visits would range from an absolute minimum of 15 minutes to as long as 60 minutes. Seriously ill patients may be seen as often as two and three times a week. When unstable

patients are discharged from the hospital, we provide the care that prevents them from showing up again in emergency and/ or provide the back up to the family doctors who are doing the same. I am certain that my practice is quite similar to every other community-based internist. To my knowledge, there has not been a single new community-based internist in Edmonton in the last 10 years, for very obvious reasons. This trend is grossly unfair to us and it is detrimental to the health care system. It simply must be addressed, now. Given how busy most internists are, I suspect that many community-based internists have no idea of how grossly they are being discriminated against in the fee schedule. Yours sincerely, Arnold J. Voth, MD LMCC, FRCP (CAN), FACP Edmonton AB The Alberta Medical Association (AMA) welcomes open letters and comments about Digest articles and suggestions for future topics. Please contact Communications Assistant, Daphne C. Andrychuk, daphne.andrychuk@albertadoctors.org, or write her c/o Public Affairs, Alberta Medical Association, 12230 106 Ave NW, Edmonton AB T5N 3Z1. The association reserves the right to publish and/or edit all letters.

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Residents' Page

Treating my patients as family Dr. Brian J. Nadler I nternal medicine resident physician

Medical residents aspire to apply a holistic model of patient care. However, with so many competing demands on our time between care provision, educational requirements, family obligations and personal wellness, providing holistic care can be challenging. One of the strategies I have developed to meet this challenge is to frame the nature of the relationship that I want to have with my patients.

Beginning in medical school, I tried to think of each patient as if he or she was a member of my own family. This strategy has helped me to become a better and more understanding physician.

Beginning in medical school, I tried to think of each patient as if he or she was a member of my own family. This strategy has helped me to become a better and more understanding physician. When your last patient of the night is “family,” the demands of the case rarely overshadow the innate concern that we must have for our patient’s well being. With this conceptualization, I am better able to understand my patients’ needs and answer their many questions. I often discover an extra boost of energy from adopting this connection with my patients! 18

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The devotion I traditionally reserve for my family is the same that I offer my most serious patients. Last year, neurologists told one of my young patients that he may never again move on his own as a result of a complication from a severe illness. In response, this patient was understandably disappointed, angry and frustrated and lost his temper with everyone, including his family. Of course, it is challenging to deal with verbally aggressive patients, but it is also easy to understand the emotion behind the aggression. Over time, with the same persistence I would employ with a loved one, I gradually introduced my patient to some basic cognitive behavior therapy techniques. I helped him recognize how much energy he was wasting on unproductive emotions. With support and understanding, he was able to direct and use his anger constructively toward his strength training. Shortly before I completed my rotation, I told him what I would have wanted someone to tell my own father in the same situation: “Never let anyone tell you what you cannot do.” Just two months later, I was informed by one of my preceptors that this individual succeeded in walking, unassisted, into his outpatient clinic. His success meant a great deal to me because of the time I had spent with him and the connection we developed. I have been lucky to see this type of empathy modeled by my colleagues. They have also found a way to ensure they build that connection with their patients and have shown me time and again the profound effect a trusting relationship with patients can provide. A trusting relationship can influence outcomes by helping patients sustain hope.

Early in my residency, I witnessed one of my preceptors with a patient who became paralyzed on one side of her body. Days prior to a planned operation to remove a brain tumor, she was admitted to our internal medicine service after her condition worsened. Palliative care was consulted and, as a result, the patient became hopeless and depressed. Seeing how she was feeling, my preceptor reopened her case. As my preceptor attended to this patient and her husband, the connection between them deepened. After further consults, my preceptor was able to provide information to the patient that suggested the operation could still improve and possibly extend her life. The patient brightened considerably with this information. The surgery took place one week later and, because of the connection developed between my preceptor and this patient, she was able to sustain hope and approach the surgery with much less worry.

A trusting relationship can influence outcomes by helping patients sustain hope.

Perceiving my patients as family has become ingrained into my medical practice through time and intention. I believe that building this connection with our patients as illustrated in these examples can help contribute to the comprehensive care provided by all health care professionals. Moreover, this approach can support how we develop, sustain and maximize the potential of the physician-patient relationship.

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F ea t u r e

Alberta Medical Students’ Conference and Retreat (AMSCAR) 2012

Medical students focus on wellness and collegiality Mara Tietzen Daniel Zimmerman AMSCAR 2012 Organizing Committee

As snow was falling across Alberta early in February, first and second year medical students from across Alberta eagerly packed their bags for the 8th Annual Alberta Medical Students’ Conference and Retreat (AMSCAR). This annual event provides a unique opportunity for medical students to escape to the gorgeous setting of Banff for time to focus on their wellness and collegiality. The event provides a venue for future medical professionals from both the University of Alberta (U of A) and University of Calgary (U of C) to mix and mingle with future colleagues, and to develop new clinical and professional skills in a setting removed from the everyday stressors of medical school. An entirely student-run initiative, AMSCAR is extremely grateful for the support of sponsors such as the Alberta Medical Association (AMA), who are integral to AMSCAR reaching its goal of being financially accessible to as many students as possible.

AMSCAR 2012 was the biggest event yet, bringing together more than 340 medical guests at the Banff Conference Centre. Among those attending were 135 U of C and 152 U of A medical students, 12% in their second year of study and 88% in their first year. Others in attendance included 60 keynote speakers, session speakers, booth moderators, and/or sponsor organization representatives (plus one delightful yoga instructor). The weekend’s schedule kept students busy with a variety of activities and sessions, the majority of which were aimed at educating attendees on a wide range of topics that contribute to medical student wellness. After arriving Friday night, attendees enjoyed a welcome reception and then had the option of a night out in downtown Banff. Saturday began with an extremely well stocked breakfast buffet enjoyed against the backdrop of stunning natural and man-made architecture of the Rockies and the conference centre. “I’ll show you how to deal with an unruly breakfast!” exclaimed one student, elated at the sight of the chef’s delicious spread. The day continued with sessions that included yoga, clinical skills, clay sculpture, financial planning, photography, nutrition and much more. The mid-day lunch banquet did not disappoint, and attendees had the pleasure of hearing a keynote address from AMA President, Dr. Linda M. Slocombe. On Saturday evening, students came out in their finest slacks, suspenders and dresses for the semi-formal banquet. After enjoying another delicious meal while hearing addresses from some of AMSCAR’s top sponsors and other entertaining speakers, students ripped up the dance floor to the tunes of a fellow student DJ.

The AMSCAR 2012 Committee.

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The conference concluded Sunday with breakfast and an afternoon of free time during which students skied at nearby Sunshine Village ski resort, relaxed in Banff or enjoyed the swimming pool and other amenities of the Banff Conference Centre before returning to their respective cities. Each year since its inception, AMSCAR has striven to provide medical students with a fun, educational and relaxing experience that stands out in their journey through school and development as health professionals. This would absolutely not be possible without the support of sponsors, including the AMA. For more information on AMSCAR visit www.amscar.ca (soon to be updated) or contact AMSCAR President Mara A. Tietzen (mtietzen@ualberta.ca). Watch for the next AMSCAR January 18-20, 2013!

Left to right: Peter Vetere and Dave Waldner. Clinical skills supercenter: suturing.

Left to right: Rajan Minhas, Rachel Lim and Leanna Tsang. Airway management and intubation.

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F ea t u r e

Message not received! Do your patients understand your office signage? According to one study, 60% of Canadians lack the necessary literacy skills to adequately manage their health and health care needs. A volunteer-led initiative is tackling the issue right at the heart of primary care: doctors’ offices. Can doctors’ offices be “literacy friendly?” According to the Northeast Edmonton Literacy Network, they can and they should. When members of the literacy awareness group visited several doctors’ offices in a nearby shopping mall last December, they were concerned that the signs being used in these offices may pose difficulties to individuals with literacy challenges. “When we visited the offices, we noticed signs that were in all-capital letters and used words that may be difficult to understand,” says Susan Skarett of the Learning Centre Literacy Association, a not-for-profit organization that initiated the Literacy Network. “We knew that a large portion of the population won’t or can’t read them.” The group decided to take action by working with physicians and their staff to create signs and visual aids that would be easier to read and understand. Bev Burke, a communications consultant and member of the Literacy Network, offered to volunteer her time and expertise to lead the project. “Both physicians and patients were looking for simpler signs,” says Bev. “I thought it was a wonderful opportunity for me to help out.”

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With a background in developing clear language materials, Bev understood the value of consulting with not only physicians, but with individuals who have experienced difficulty with literacy. This input was used in her initial designs which were presented to members of the Literacy Network in January. “The feedback we received was one of the most important aspects of this project,” says Bev. “We went back to the drawing board to adjust the wording and also create more types of signs.”

“Great job on the signs,” wrote the clinic’s staff in a testimonial. “Good photography, very professionally done and graphically informative. They are already being used in our office of seven physicians!” Dr. Lyle B. Mittelsteadt, Senior Medical Advisor, Alberta Medical Association, can see why this would benefit both the physician and the patient.

“It was also important for participants in the consultative process to see that they had made an impact on the final product.”

“The ability to communicate with patients is a cornerstone of any medical practice,” says Dr. Mittelsteadt. “This is an excellent initiative which shows there are little things that can make a big difference.”

Doctors begin using signs

How to make easy-to-read signs

The signs – 13 in total – can be downloaded free of charge from the Northeast Edmonton Literacy Network’s blog (http://literacyfriendly. wordpress.com). They address a wide range of issues that commonly affect doctors’ offices, including:

The Northeast Edmonton Literacy Network has a few tips for physicians or staff who are interested in making their own easy-to-read office signs:

• Food restrictions. • Uninsured services. • Flu shot information. • Sanitary requests (wear a mask, use hand sanitizer). • Appointment information. The Abbotsfield Medical Group, part of the Edmonton North Primary Care Network, was one of the first medical clinics to use the new signs.

• Make the signs large enough so readers can see them from a distance. • Don’t use a glossy finish. Choose a matte finish if laminating. • Choose a simple, easy-to-read font. Reviewers of the sign project preferred a sans serif font for signs with a small amount of text. • If possible, use color to liven up signs and convey meaning.

• Reverse type is hard to read (i.e., white text on a black or colored background). Use sparingly. • Most text should be black on a white or very light background. • Don’t use all-capital letters. They are more difficult to read. For emphasis, use bold or colored text.

Moving forward The Literacy Network plans to make changes or add other types of signs as they receive feedback from physicians and patients. For Susan, the project is a first of many steps to address the issue of health literacy. The organization hosted a well-attended workshop in January about the issue, exploring the challenges many patients face in all aspects of health care – from reading instructions for medication to understanding the language used by a physician during an appointment. “Literacy and health are so important for patients to access information, access physicians and communicate effectively,” says Susan. “This ultimately empowers patients to ask the questions they need in order to be healthy.”

Left to right: Dr. Derek D. Borowka, family physician; Bev Burke, communications consultant; Corinna Ruhl, communications consultant; Elizabeth Haile, volunteer with the Learning Centre; Marilyn Dymchuk, volunteer with the Learning Centre; Susan Skaret, coordinator of the Learning Centre.

A 2007 survey conducted by the Canadian Council on Learning shows that 60% of Canadians lack the necessary literacy skills to manage their health and health care needs adequately. The report also reveals that those with the lowest levels of health literacy are more than 2.5 times likely as those with the highest levels to report being in poor or fair health.

“I hope this project will help the medical field be more aware of the people who may be seen as non-compliant but actually may have literacy challenges.” For more information or to comment, visit: • The Learning Centre Literacy Association – http://tlcla.org. • The Northeast Edmonton Literacy Network – http:// literacyfriendly.wordpress.com. • Or email Bev Burke – bev@simplyput.ca. Left to right: Corinna Ruhl, Bev Burke, Susan Skaret.

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PFSP Perspectives

Preparing for retirement: It’s not just about the money Dr. Vincent M. Hanlon PFSP Assessment Physician

Dreaming about retirement? To help concentrate your thinking on the topic, see if you can answer the following three questions about retirement – in a minute or less. 1. When? 2. Where? 3. With whom? I purposely excluded the familiar “How much do I need?” question. Recognizing the importance of financial issues (especially in these days and years of stock market turbulence), put the dollar concern aside for as long as it takes to read this essay.

For most physicians, the transition to retirement is a slow train coming. Besides, many of us have already devoted a disproportionate amount of time trying to answer the money question. Contemplate what it will be like not being a doctor and not doing medical work, and answer the questions, “Who will I be in retirement?” and “What will I do then?” 24

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In 2000, Martin in the Canadian Medical Association Journal (CMAJ) declared that “Freedom 55” is closer to age 65 for physicians. Pong, in his 2011 review, “Putting Away the Stethoscope for Good? Toward a New Perspective on Physician Retirement” says the average age of retirement for physicians is closer to 70. One-third of physicians over the age of 65 in 2009 were working full time, and almost another one-third were working part time. Nearly 40% of Canadian physicians in 2012 are 55 years or older. Very few of them will exercise the “Freedom 55” option. Physicians find it hard to walk the talk of retirement. While 3% of a group of physicians surveyed in 2007 reported they planned to retire the next year, less than 1% actually left practice. We know many physicians continue to find their work, especially patient care, very satisfying. Few physicians find themselves in full-time practice one day and retired the next. For most physicians, the transition to retirement is a slow train coming. Pong calls this “retirement deferral.” Many physicians restructure and redefine the kind of work they do, and gradually reduce their hours of work before they finally stop seeing patients. Where will we retire? Some will choose to “get out of town” lest the temptation be too great to continue working in some capacity in familiar medical environments. You may choose to relocate to be closer to family. Do you plan to maintain winter and summer residences? Who

will be part of your network of old and new friends and acquaintances?

We spend at least a decade training to become a physician, so plan to devote at least a few hours preparing for what may be years or decades of post-medical life.

Retirement promises major changes for most of us. Forethought and planning – barring sudden illness, unexpected injury, or natural disaster – should be an integral part of such a significant life transition. We spend at least a decade training to become a physician, so plan to devote at least a few hours preparing for what may be years or decades of post-medical life. Psychiatrist Dr. Robert Klitzman cautions us that, “Reinventing or reconstructing oneself takes energy and creativity.” During our extended years of training, many of us learned to delay personal gratification. The corrective to that strategy vis-à-vis retirement is apparent every day in clinical practice, as we witness patients surprised and dismayed by the appearance of serious illness. Our patients teach us not to assume that a healthy, lengthy and happy retirement awaits us at the time of our choosing. In the career transition literature, experts like Barbara Moses and

Gigi Hirsch propose breaking down a successful career transition into a number of parts. Here are four questions to reflect on as you anticipate retirement: 1. Why change? 2. Who am I? 3. What do I want? 4. How do I get there? In contemplating the transition to a life beyond medicine, ask yourself what is driving this change and what is holding you back? Are you actively seeking different challenges and developing new interests for the years ahead, or are you reacting to personal health challenges, an increasingly stressful workplace, decreasing energy or professional boredom? Physicians report a number of barriers to retirement, among them insufficient savings, family responsibilities, attachment to physician identity, or inability to find a replacement to look after their patients. Our notion of who we are evolves over the life span. Who were you before medicine, who did you become during your medical career and who will you be after medicine? Can you sum up yourself in six words or less? Try Googling your name. If you are dissatisfied with the first six words that pop up in response to your name, write down the six words you would prefer to see. Alternatively, write the story of your life in six words.

Retired friends, family or colleagues can be sources of wisdom about how to do retirement well. They can also share cautionary tales about retirement plans gone awry. Career counsellors, MD Physician Services, and a “stuff coach” may be helpful in dealing with such practical matters as closing a practice, drawing up a realistic monthly budget, and smart-sizing your retirement dream home and accumulated possessions. Some ongoing education may also be necessary to determine the best use of your plethora of digital devices. How about using a checklist as we plan for retirement? Surgeon Dr. Atul Gawande is an advocate for the checklist as a valuable tool for ensuring the safety of airplanes taking off and landing, and for getting patients into and out of operating rooms safely. Although retirement isn’t normally a matter of life and death, use of a checklist may be life-enhancing in retirement. As our medical work comes to an end, don’t forget the end-of-career party. According to Dr. Dianne B. Maier:

“While there are oaths and celebrations at the beginnings of our medical careers, frequently there are not explicit markers, rituals or celebrations at the end .... Many times, we do not celebrate the retirement of a colleague as colleagues. We have the most knowledge regarding his or her service to patients, to community, and the mentorship and collegiality they extended to us .... As a profession, perhaps there ought to be consideration of a retirement ritual, a celebration for the next life stage and a respectful acknowledgement of what medicine has meant to us.” References available upon request.

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Still haven’t found what you’re looking for in this life? Austrom et al. report a number of “predictors of satisfaction in retirement” for physicians and their spouses. These factors include good health, optimism, purpose in life, financial security, hobbies and a good sexual relationship.

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Play in the best doctors’ golf tournament of the year Register now and join the fun on July 23! You’re invited to play in Alberta’s longest-running golf event. The 85th Annual North/South Doctors’ Golf Tournament brings together physicians, health care leaders, and medical students and residents for a day of competition, networking and fun. The College of Physicians & Surgeons of Alberta and the Alberta Medical Association co-host the tournament, which raised more than $34,000 for medical student bursaries last year alone.

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F ea t u r e

Break Free:

Write a book (or manuscript) Dr. J. Robert Lampard

Dr. Vincent M. Hanlon’s article “Break free: Read a book” (Alberta Doctors’ Digest November/December 2009) caught my attention, particularly a quote therein on how “our sense of identity is held captive by the judgments of those we live among.” As physicians, we all have a unique life to write about. That’s the nature of medicine. I recommend, instead of spending an hour or three reading a book, why not write one, or at least a manuscript? It’s easier than you think. With a little forethought, an outline and a set of headings as a guide, it can take less time that you expect. And you have the perfect topic – yourself. If we add our experience with thousands of patients, that’s a book itself. So why not write a “discharge summary” on our own lives? And we have the perfect target audience – our grandchildren. In my search for medical material on doctors in Alberta, I have uncovered only 25 or 30 physician manuscripts. They are all gems. The writers were observant, truthful and their stories colorful. Often, there was a stimulus, but that varied. Dr. George A. Kennedy wrote of the Cree/Blackfoot battle in 1870, under the Lethbridge bridge. Dr. Hugh Arnold wrote proudly of his teachers and colleagues, Dr. Frank Mewburn and Dr. Peter Campbell. Dr. George Prieur wrote because Dr. Earle Scarlett gave him a deadline of one article of his own choosing every three years for the bulletin. An unusual stimulus was the observation by Dr. Garner King, that Dr. Russell F. Taylor needed to focus his attention on something other than his terminal illness. Dr. King asked him to write about the polio epidemic of 1953. Dr. Taylor attacked the task with predictable enthusiasm describing the care and treatment he and his team had provided at the Royal Alexandra and University of Alberta hospitals. Other team members joined him, reflecting on the 24/7 care they gave to the increasing number of iron lung patients – Drs. J. Frank Elliott, Nelson Nix and Brian J. Sproule –

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resulting in the only book to describe clinical care during an epidemic in Alberta. Dr. Taylor died satisfied that he had left a legacy and a story. When I think of clinical accomplishments that ought to be personalized, many haven’t been: the first islet cell transplant case; the administration of Lamivudine to the first Hepatitis B positive patient and his subsequent liver transplant; the first heart transplant; and the first conjoined twin operation by Dr. Eardley Allin. I know there are privacy issues, but Dr. W.G. Bigelow was able to write of his experiences with cold hearts, hypothermia and pacemakers, putting the record straight. So did Dr. D.B. Leitch with Dr. James B. Collip on the first case of tetany treated with parathyroid hormone. While Dr. Henry George and his wife both left biographies, they wrote little of his attendance at Chief Crowfoot’s death. So his son picked up the story from a veterinarian-physician, and ruined his father’s reputation by erroneously attributing the authorship of Crowfoot’s last words to him. In fact, they were written five years before by Ryder Haggard. Some of our colleagues are sensitive to the need for some of us to write. When Drs. Donald R. Wilson and W.B. Parsons were asked to write a book for the 75th anniversary of medicine in Alberta, they formed a committee and delegated the chapters for a book. In the end they wrote 12 of the 26 articles themselves, never quite finishing the task. Dr. Harry W.V. Letts has, on pathology and laboratory medicine in Canada. For Dr. Earle Scarlett it was the love of his profession and a desire to infuse humanity into the art of medical practice that drove him. His clinic published a quarterly journal for 23 years – the Calgary Associate Clinic Historical Bulletin. Afterwards he wrote columns simultaneously in three journals, about medicine and his observations on it. One column was published in the Alberta Medical Bulletin. The audience, however, need not be the world or the profession, but just the world around us. To many it never gets beyond a thought or an entry on the bucket list. Fortunately, electronic innovations are making it easier.

We can dictate into an iPod and have it printed out on our computers. That does make lengthy manuscripts, or even books, much easier – at least to write the first draft. Dr. Bill Cochrane wrote his letter to his grandchildren in 20 minutes. Augmented by transcripts of his speeches, it dramatically expedited writing the chapter on him in my book. The end result was a nomination for his induction into the Canadian Medical Hall of Fame, which was successful. Other colleagues have found fruitful events in their life to write about, like Dr. Donald R. Wilson’s manuscript on his “Life with my Father.” It is full of amusing anecdotes. I have uncovered two manuscripts by medical wives. Mrs. J.O. Baker wrote one full of humor, to complement her husband’s serious reflections on his own life. Had it not been for Drs. Tom Aaron and Ben Wheeler who asked her, that essay would never have been written. Our best humorist was Dr. G.D. Stanley, who wrote Fun in the Foothills in 1949. He could take any house call and see the amusing side of it, including cutting 39 wire fences on one, or averaging 110% payment of his bills, often with a bottle of scotch thrown in, during the early 1900s in High River. Other colleagues were natural writers who planned to write of their lives from the start, like Dr. Morris Gibson. Still others have written enjoyably about their younger years, like Dr. Bill Callaghan’s three books on his youth. And there have been several novelists. Dr. Paul Hardy has written of his surgical experiences, suitably disguised. Dr. Bill Taylor wrote The Yellow Fever as a novel extension of his love of the Rocky Mountains. Dr. Heber Jamieson teamed up with Richard Gordon to write a chapter each week, leaving the key character in suspense, to see how the other author would extricate him. To avoid any aspersions on their reputations, they used a pseudonym as the author and had the books published in England. Even fewer amongst us are diarists like the University of Alberta (U of A) Faculty of Medicine’s second Dean, Dr. J.J. Ower. He proudly spent 20 minutes every day recording his impressions of the day. The 30 volumes of books reside in the U of A archives and are a window on

his life and the U of A. Dr. Richard B. Nevitt wrote so many letters to his future wife, and she in return (23 arriving in one mail), that two books have already been written on him. Dr. Nevitt was perhaps the only physician to uniquely record one-of-a-kind events – like the signing of Treaty 7 – as an artist. One hundred of his canvases have been acquired by Glenbow Museum in Calgary. With little forethought, a memoir can be as easy as a speech. The U of A’s Dr. Al Holly found once he started he couldn’t put his pen down and produced a book full of delightful anecdotes from his surgical practice in Prince George, British Columbia. Dr. Si Siwak entered politics as the mayor of Camrose and looked back on his experience with enough satisfaction to write his own book, instead of leaving it to the newspaper editor. Postponement or waiting for a prompting event can be fatal or nearly so. Dr. Sid Cornish of Claresholm found that the stimulus of waiting for bypass surgery was enough to get him to write a book, just in case he didn’t survive the procedure. Still others have facilitated the experience by retaining an interviewer/writer as Dr. Mary Percy Jackson did. It made a good book she could have written, even better. Dr. Walter Anderson took a course in writing from Elsie Park Gowan and used her guidance to pen his recollections, with exceptional quality. Some of our colleagues have seen voids as opportunities and filled them with books. An example is Dr. Gerald W. Hankins with four separate titles including A Heart for Nepal: The Dr. Helen Huston story; The Flaming Arrow: The story of Art Jenkyns, Founder of Operation Eyesight Universal; Sunrise Over Pangnirtung: The story of Dr. Otto Schaefer; and Rolling On: The story of the Amazing Gary McPherson. There is a bottom line. If I can do it, you can do it. I struggled for 12 years to get an English mark over 50% . I wasn’t prepared to leave my epitaph to a few lines in an obituary, written lovingly but after the fact, and in limited fashion because of the cost of a newspaper column. Dr. J. Robert Lampard is the author of Alberta's Medical History: “Young and Lusty, and Full of Life,” (2008).

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Web-footed MD

MD Consult is a very useful resource for textbooks, journals and more J. Barrie McCombs, MD, FCFP

Canadian Medical Association Website cma.ca The Clinical Resources on the Canadian Medical Association (CMA) website were discussed in the March/ April Alberta Doctors’ Digest. MD Consult is one of the most useful of these, since a single search can locate information from textbooks, full-text journals, clinical practice guidelines and patient education materials. The information is updated whenever new textbooks or journal issues become available.

MD Consult Home Page The major items on the home page are the main menu that lists each section and the search controls. Other useful links, such as how to contact the CMA librarian and how to manage your individual account, are described later in this article.

Search Controls The default is to search all sections. You may save time and effort if you limit a search to a specific section, such as textbooks. When planning your search terms, give some thought to what words are most likely to appear in

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an article or chapter about your chosen topic. A recent addition is the Translate Query button, which allows the user to enter search terms in a language other than English and have them translated. In some cases, a “Refine Your Search” box will appear on the right side of the screen. An example of this can be seen by typing in the general search term “carcinoma.”

Books Textbooks are available in most specialties. The list of books can be searched by specialty or by title. The books in any given specialty may change from time to time, as newer editions from different publishers are featured. In the search results, the book with the most matches to a search term is listed first.

Journals Full-text articles are available from journals published by the MD Consult partners, or those journals that provide free full text, such as the Canadian Medical Association Journal (CMAJ). Abstracts from other journals are available if the article is indexed in MEDLINE. Searches limited to the Journals section can be further limited by author name, journal name, date, article type or subject age.

The Clinics A search can be limited to the Clinics publications, such as “Medical Clinics of North America.” Search criteria are the same as for journals.

Patient Education Patient information handouts are available, in both English and Spanish. These can be customized to suit your own practice.

Drugs The drugs section can be searched by drug name, indications, contraindications or adverse reactions. Information about unique Canadian brand names, dosages and indications may be limited.

Clinical Practice Guidelines The clinical practice guidelines are mainly from American sources. Links to Canadian guidelines are available in the “Clinical Resources” section of the CMA website.

Images It is possible to limit a search to only images from the textbooks available on MD Consult, including photographs, tables and graphs.

News News items are displayed if relevant to the specialties you have selected in “My Account.” Most of the items listed will be from American sources.

CME Continuing Medical Education (CME) credits from the Cleveland Clinic are available for using MD Consult. At

best, these would be considered as “self study” credits by the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada, so it might be better to keep your own record of the time spent and the topics studied.

Ask a CMA Librarian A unique feature of the CMA subscription is the ability to click on this link to seek search assistance from the CMA librarian.

Help and Resource Centre New users will save time and effort if they first read the section on how to conduct searches. The “Advanced

Searching Techniques” section provides additional information for conducting efficient journal searches.

My Folder For any search, the results window displays an “Add To My Folder” link, which allows you to save a search strategy for later use or to create a bookmark to a particular item.

My Account Here you can set up a personal profile on the MD Consult computer. You can specify what specialties interest you. You can also set up what personalized information will appear on patient handouts.

Log Off The CMA requests that you always use this link when you are finished using MD Consult. It frees up the resource for other members to use.

Your comments and suggestions are welcome. Please contact me: bmccombs@ucalgary.ca T 403.289.4227

Alberta Doctors’ Digest

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May/June 2012

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In A Different Vein The rise of political hubris:

Thoughts before an election Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP Co-editor

Hubris often stalks successful people. How can these people be so smart in one area and yet ill-informed in another? Linus Pauling was a Nobel Prize-winning quantum chemist who could not understand why physicians could not get his Vitamin C treatment to work for cancer. Steve Jobs, a consummate businessman, seemed to think he had powers to control his operable, slow-growing pancreatic cancer using unproven methods. He did regret his decision, but it was metastatic by then. Albert Einstein died of an acute aneurysmal dissection of the cystic artery (presenting with symptoms similar to cholecystitis). He refused surgery and died.1 A professor of physics I knew seriously believed his lung cancer had been removed by “bloodless surgery” in the Philippines. Is it egotism, arrogance – or does hubris infect most people at some point? I had the privilege of getting to know the late author W.O. Mitchell for a short time some years ago. We got on well, swapping yarns in the evening over a whiskey, although it was W.O. who did most of the talking. He’d say between snorts of snuff, things like: “Plagiarism? Everyone does it. After

the second or third telling of a story, it becomes your own.” Or, “Great artists are always selfish bastards. They have to be, pursuing their art over-rides everything.” Another story of his that he told as though it were his own was: “I was at a party a few years ago in Calgary and this neurosurgeon fella got chatting to me. He knew I was a writer and he said he was thinking of retiring soon. ‘And when I retire,’ he said, ‘I think I’ll do a bit of writing.’ So I bloody well said to him, ‘Boy, you know, when I retire, I‘ve been thinking about doing a bit of neurosurgery….’”

Is it egotism, arrogance — or does hubris infect most people at some point?

I thought of W.O.’s story when I learned that the retiring chairman of Canadian Natural Resources was now going to do a bit of “preventive health care” by setting up the Pure North S’Energy Project with $15 million, possibly annually. While going along with conventional medicine, he believes, among other things, that we haven’t done enough about investigating levels of heavy metals in the blood. This is a laborious, complex piece of work which ordinarily should extend

over many years with multiple control populations before coming to any conclusions over their relationship to poor health. But one of my patients told me last week that her blood was being sent to the United States of America (USA) for levels of “heavy metals and stuff” for “correcting.” She asked what I thought of this. With slight despair I briefly talked about scientific evidence, clinical trials involving controls and proper laboratory standards, then gave up and shrugged. A few years ago, one well-known oil and gas man (now deceased) offered a big donation to cancer research on the condition that it be used to find the bacterium that causes cancer, because he knew this was the cause and we just hadn’t tried hard enough to find it. In some of our politicians, the pinnacle of the “I know as much as you, if not more, because I’m a successful kind of person” is occurring more frequently than in Alberta Doctors’ Digest

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the past. We had our fill in April with the provincial election. At the time of writing this article, I did not know the outcome, but I’m struck by the promises and porkies flying thick and fast and the lack of any consultation with those who know what they’re talking about.

In some of our politicians, the pinnacle of the “I know as much as you, if not more, because I’m a successful kind of person” is occurring more frequently than in the past.

As the French saying goes, “Il y a trois fois qu’on peut exagerer: après la chase, pendant l’amour et avant l’election." From La Redford, our doctor-baiting lawyer, came 140 “family care clinics” – one for every small town in the province – and with no consultation with those who have devoted their lives to providing this service! Medical

graduates will be thinking twice before setting up a family practice in Alberta. And fast-track emergency rooms? Hello? That’s triage. Didn’t they talk to the people who know about emergency management? Fast-track law courts might be helpful. Imagine changing the judicial system without consulting lawyers.

Mrs. Thatcher) smiling and sunny under pressure, putting her hand up to speak and coming in with an apt sarcastic remark when needed. She’s the darling of the ranchers and oilmen down here and I suspect the premiership of the province will be a stepping-stone to greater things. But, hang on, she’s far right isn’t she?

And from La Smith, surgeries out-of-province or even – gasp – in a private clinic here or – horrors – elsewhere? This is an extension of what we’ve been doing for years, sending people out-of-province to the USA or elsewhere when the situation demands. It’s our little secret – the Out-of-Province Health Care Committee and its political punch-bag, the Out-of-Province Appeals Committee.

The right wing, left wing division thing annoys me. It’s a lazy way of binning people, originating from revolutionary France when the royalists sat on the right side of the chamber of the National Assembly and the revolutionaries sat on the left.

I watched the leaders’ debate in April. Our Raj did well. His media training has paid off: look in the camera as much as possible, plug the message often and clearly, trot out a few memorable quips and never answer a question directly. He was good on health care but of course he has inside information, the only way to make big bucks these days. And bro Brian? He was so reasonable that I can’t recall any new proposal except the tongue lashing he gave La Redford as she invaded traditional NDP territory with more government control, spending and freebies. La Redford was chillingly competent but I will not hire her as my defense counsel. I suspect she would not be interested in defending mundane crimes such as cream pie throwing. It was interesting to see the grimaces when our Raj tore into her. There was a lot being suppressed there.

South Health Campus and nearby prairie land in Calgary.

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And La Smith? She was graceful, definitely school captain material, talking in a low voice (learned from

Most people hold conflicting views which defy pigeon-holing into right and left. And nowhere in the world is this truer than in Alberta where NDP can mean a real respect for the land and family values and far right can mean up-holding pioneer traditions of self-responsibility and family values. People hold contradictory views all the time – the anti-abortion trade unionist, the Gucci socialist. Some Liberal supporters I know are quite authoritarian. Many Conservatives drink down at the pub. And working folk can be quite militaristic when it comes to defending the realm.

With the current incumbents it’s not clear where the advice is coming from. But it’s not coming from those who know the workings of health care. I flirt with communism when I find my access to a beach is cut off by an overpaid banker’s cottage and I

have dark, fascist thoughts when I think of Clifford Olsen. Issues, even religion, can change wings. At the time of Oliver Cromwell, the religious right was actually the religious left (the “roundheads”). And in the French National Assembly, capital punishment, now thought to be a right wing proclivity, quickly became an enthusiastic activity of the left wing of the Assemblée Nationale. What has been happening within the Progressively Bigger Government Party is not pretty for doctors. We have lost heavily in Calgary with the great leap forward (GLF) and the dissolution of the Alberta Cancer Board – we’ve lost one expert research pathologist and two clinical researchers at the Tom Baker Cancer Centre as a direct result of the GLF. These people are hard to replace, unlike politicians. Most docs are unaware of the Ronald Liepert/Ken Hughes/Alison Redford connection which goes back to days when Rocking Ron and Ken were go’fers in Premier Peter Lougheed’s office. Rocking Ron is a close advisor to La Redford and Ken Hughes was chairman of the superboard that has saved billions. This triad has high regard for themselves but little respect for you, doctor. There’s been no talk of a new cancer centre for Calgary – something that’s been promised for eight years and announced six times. We do, however, have a brand-new general hospital – the $1.3 billion South Health Campus – which you can see in the distance from the outskirts of south Calgary rising from the prairie like Ayer’s Rock. At $400 million a year running costs, the Progressively Bigger Government Party seem to think this

And just as I am writing this comes a call from a polling company. It’s a breezy recorded message: “Press one for Raj Sherman’s Liberal Party. Press 2 for Alison….” I pressed a button in a poll for the first time in my life.

is an election winning building. Yes, and a dingo ate my baby. With the current incumbents it’s not clear where the advice is coming from. But it’s not coming from those who know the workings of health care. But then it seems these days, anyone can dabble in health care and be an instant expert. Senior politicians have taken to proceeding with policies without taking careful informed advice. There was a time when Peter Lougheed used to listen to Dr. Walter C. Mackenzie on topics medical and surgical. There’s more hubris around than there used to be.

I have not yet received a recorded message telling me that the location of my polling station has been changed, but I do wonder if the Goddess Nemesis will be flying in shortly. Reference 1. Chandler JJ. The Einstein Sign. New England Journal of Medicine, June 7, 1984; 310: 1538.

CONSIDER CRITICAL CARE MEDICINE in Calgary, Alberta The Department of Critical Care Medicine is currently recruiting Clinical Associates for the Intensive Care Units at all adult sites within the Calgary Zone. We require clinical associates to provide service from 1700 to 0800 hours, seven days a week in the 3 multisystem ICUs of the Region and day shifts (0800-1700) in one of these ICU’s. Physicians will be integrated into the current physician healthcare team, including bedside physicians, residents and attending intensivists. As part of a specialized multidisciplinary team, the clinical associates’ role, in addition to patient care responsibilities in the unit, will be to provide tier one responses for all ICU Outreach Team calls within the institution. These teams were created as a patient safety initiative to advance the “ICU without walls” concept. Activation of the outreach team can occur by any concerned staff member on any unit of an acute care facility. The team is expected to rapidly assess and stabilize the patient, assist with communication, educate and support staff who have activated the team and assist with transferring the patient to the ICU when necessary (25 – 30% cases).

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QualIfIcatIons: Physicians must be eligible for a Practice Permit from College of Physicians and Surgeons of Alberta, CHR Medical Staff Privileges, appropriate Canadian Medical Protective Association coverage, and ACLS certification. Interested physicians should forward their CV with references and address all inquiries to: Jeannie Shrout, DEPARTMEnT MAnAgER Critical Care Medicine Alberta Health Services Room 0452 – McCaig Tower, 1403-29 St. n.W. Calgary, AB T2n 2T9 jeannie.shrout@albertahealthservices.ca

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Innovations Health Clinic (IHC) is recruiting general practitioners and specialists to our new medical facility strategically located in close proximity to the South Health Campus. Start date is June 1. IHC is positioned to provide medical service to the Douglasdale and surrounding communities.

Physician requirements include: conduct medical assessments to determine and understand medical issues, work related restrictions, and suitability for OrionHealth programs; determine and recommend assessments, investigations, medication and treatment as required; liaise and consult with family physician, specialist(s) and other external care providers; document clients’ medical status and progress, and work with the interdisciplinary treatment team. Qualifications include: doctor of medicine; experience in addictions, physical medicine or sports medicine would be an asset; licensed to practice or eligibility to practice in the Province of Alberta; sound understanding of musculoskeletal medicine; understanding of occupational rehabilitation; ability to write clear and comprehensive reports and other correspondence, and proven ability to work within a multidisciplinary team. Thank you for taking the time to submit your application. Quote the position in the subject line of the email. Contact: olastimoza@orionhealth.ca www.orionhealth.ca

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May/June 2012

Contact: nreddy@telusplanet.net CALGARY AB Westbrook Medical Clinic is recruiting part- and full-time physicians for our busy clinic in southwest Calgary to join three family physicians. The clinic is computerized but willing to accommodate doctors who are computer shy, 70/30 split. International medical graduates who are eligible to practice in Alberta: I am willing to sponsor you. Contact: Dr. Lota or Roseli (office manager) T 403.246.0877 shashi.lota@hotmail.com CALGARY AB Celebrating more than 30 years of excellence in serving physicians, MCI The Doctor’s Office™ has opportunities in northwest Calgary for both family practice and walk-in shifts. We’ll move your practice or help you build a practice. We offer flexible hours and schedules, no investment, no financial risk, no leases to sign, and no administrative or human resource

burdens. MCI Medical Clinics (Alberta) Inc. provides quality practice support in nine locations throughout Calgary. Contact: Margaret Gillies TF 1.866.624.8222, ext. 433 practice@mcimed.com CALGARY AB Med+Stop Medical Clinics Ltd. has immediate openings for part-time physicians in our four Calgary locations. Our family practice medical centers offer pleasant working conditions in well-equipped modern facilities, high income, low overhead, no investment, no administrative burdens and a quality of lifestyle not available in most medical practices. Contact: Marion Barrett Med+Stop Medical Clinics Ltd. 290-5255 Richmond Rd SW Calgary AB T3E 7C4 T 403.240.1752 F 403.249.3120 msmc@telusplanet.net EDMONTON AB Family/walk-in physicians needed for Castledowns Medical & Wellness Centre (CMWC). CMWC is looking to add two full-time family or walk-in physicians to a well-established, high patient volume, family practice relocating to a brand-new site. New grads are welcome. Physicians would have their own office plus two (minimum) examination rooms. This is an ideal opportunity to quickly build your own practice with all the benefits of a group practice with friendly support staff and allied health professionals. CMWC is affiliated with Edmonton North Primary Care Network,

offers electronic medical records, flexible hours and a 70/30 split plus incentives. Contact: Ramadan Hochaimi Administrative Director T 780.907.3472 castledownswellness@gmail.com EDMONTON AB Two positions available at the West End Medical Clinic for part- or full-time general practitioners. Walk-in and family practice clinic. Physicians will enjoy no hospital on-call, paperless clinic and friendly staff. Clinic is in a busy area of west Edmonton and has four physician offices and eight examination rooms. Contact: Dr. Gaas T 780.893.5181 westendmedicalclinic@gmail.com EDMONTON AB Dr. Lal is looking for a full-time physician to join his busy family practice at 3504A 137 Avenue. Clareview Medical Clinic is in a residential area with high patient volume. The clinic was recently renovated and is next to a pharmacy. This is a fee-for-service opportunity offering a 70/30 split. Additional starting incentives are available such as guaranteed monthly income. Hospital privileges preferred. Office hours are 9 a.m. to 6 p.m., Monday to Friday and 9 a.m. to 4 p.m. on Saturday. Extended hours are a possibility; walk-ins welcome. Contact: Dave Galon T 306.536.4642 or Aileen Jang T 780.232.9297 EDMONTON AB Edmonton doctor is looking for a full-time physician to join her

family practice. Successful applicant will be replacing a retiring female physician in a well-established central-Edmonton, two-doctor clinic. With over 30 years in service, this practice offers a great lifestyle with no evenings or weekends, ample space and parking in a quiet, older Edmonton neighborhood. Investment opportunity in clinic building is also available. Contact: Dr. Helen Sachs 8808 92 St Edmonton AB T6M 3R1 T 780.906.8291 helensachs@shaw.ca EDMONTON AB Family clinic immediately requires a part- or full-time physician to replace departing physician. Two-doctor office, fully computerized, affiliated with Edmonton Southside Primary Care Network. Excellent location near Southgate, beautiful offices, excellent, experienced long-term staff. Contact: T 780.940.3865 srurms@telus.net EDMONTON AB The Links Clinic, a 19-physician group with family practice, pediatrics and internal medicine, has been in business since 1955. We are currently seeking a full-time family physician who wishes to work in an appointment-based practice. The Links Clinic offers excellent patient volume, work hours and has been on electronic medical records for 20 years. The Links Clinic is part of the Edmonton Oliver Primary Care Network which provides a large range of allied health services. All these services are offered in the Mira Health Centre, 11910 111 Ave, where the clinic is centrally located. DynaLIFE Dx Diagnostic Laboratory Services and CML HealthCare Imaging Inc.

are also on site, along with other health-related services. There are no clinic management responsibilities or capital investment required. You can devote your time to medicine. Please give me a call if you may be interested and I would be happy to answer any questions. Contact me if you would like a tour. Contact: Dianne Walker, CA Business Administrator T 780.453.9467 dwalker@thelinksclinic.com LACOMBE AB Mainstreet Medical Services is looking to recruit part- and/or full-time physicians to join a well-established, busy family practice with a long-term presence in rural Lacombe. Physicians with interest in obstetrics are in high demand. Approximately seven on-call shifts and two walk-in clinic shifts per month (more available if desired). For more information, go to www.albertaphysicianlink. ab.ca>Physician Jobs>Current Vacancies Listing>Central Zone where you will find our job posting. Contact: Leah Nieuwenkamp, Manager T 403.782.6717, ext. 225 F 403.782.4240 mainstreetmedicalservices@shaw.ca LETHBRIDGE AB Newly renovated primary care clinic in Lethbridge is actively seeking a physician to join our team of four doctors. Very easy-going group of physicians and staff, offering generous split in a well-equipped and bright atmosphere with pharmacy, pain specialist, mental health specialist, physiotherapist and chiropractor on site. Lethbridge is a beautiful city of 75,000, close to the mountains,

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May/June 2012

great university and college, excellent recreational and art facilities, and nice climate. Contact: Shari Lethbridge Medical Clinic 300 3rd St S Lethbridge AB T1J 5Y9 T 403.394.2002 lethbridgemedicalclinic.com STRATHMORE AB Excellent practice opportunity in a rural setting only 50 kilometers from Calgary. Invest in yourself and your family. Join four established physicians in a true family practice and have a life as well. Strathmore is a town of 12,000 people situated on the prairies, but is close to all the amenities of the Rockies and a big city. Our hospital has a 23-bed acute-care ward, long-term care and a busy ER (more than 30,000 visits per year). Emergency and acute-care skills are preferred, but not essential. Earning potential is limitless. Expenses are 30% of office billing. We are part of the Calgary Rural South Primary Care Network and have a robust chronic disease program. The group stresses team work and collegiality. Contact: Dr. Ward Fanning T 403.934.5205 (office) T 403.934.3934 (home) WHITECOURT AB

Hospital, laboratory and diagnostic imaging are in close proximity. An interest in obstetrics would be required. AMC offers excellent support staff and on-call schedule is one-in-seven. Currently there are three

Alberta Doctors’ Digest

Contact: Dr. L. Venter T 780.778.2285 lizanne.venter@albertahealthservices.ca KELOWNA BC Medi-Kel Clinics seek physicians from across Canada for well-established family practice. International medical graduates welcome. Two new medical clinics in excellent locations, fully equipped, well organized with electronic medical records, outstanding staff with integrated health network nurse. Flexible hours, convenient scheduling and excellent associates willing to cover vacation leave. No administrative hassles. No GST. No on-call, no obstetrics or hospital privileges. Split is 65/35 with potential for ownership. Group benefits. Will help with moving expenses. Kelowna is in the heart of the Okanagan in south-central BC with excellent schools, winter and summer recreational facilities, restaurants and wineries. Truly a great place to live and work. Contact: Belinda Harris officemanager@medi-kel.net

Physician and/or locum wanted EDMONTON AB

Associate Medical Clinic (AMC) is looking to recruit full-time physicians to join a well-established busy family practice. Whitecourt is a vibrant, fast-developing community in a scenic valley, population of 10,000 and offers many outdoor recreational activities.

vacancies which urgently need to be filled.

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May/June 2012

Summerside Medical Clinic requires part- and/or full-time physician(s). Locums are welcome. The clinic is in the vibrant, rapidly growing community of Summerside. Examination rooms are fully equipped with electronic medical records, printers in all examination rooms and separate procedure rooms. Contact: Dr. Nirmala Brar T 780.249.2727 nimmi@theplaza.ca

SLAVE LAKE AB Slave Lake Family Medical Clinic is urgently looking for a full-time family physician to work clinic and on-call hospital schedule. Paperless clinic, Netcare available. Urgently need locums to work Monday to Friday, 8:30 a.m. to 4:30 p.m. Contact: Daniel Payne T 780.849.2860 (office) T 780.849.4009 (home) danielsl@telusplanet.net

Space available VICTORIA BC Run your own practice or join a clinic managed by a professional corporation. Ideal for family practice and/or walk-in clinic in the only densely populated and attractive neighborhood left in Victoria with limited family practice service. Highly attractive terms to work in the clinic or substantial rent-free period and nominal rent for own practice. Contact: Dr. Singh T 250.818.1468 har@sparklit.com

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Services ACCOUNTING AND CONSULTING SERVICES EDMONTON AB Independent consultant, specializing in managing medical and dental professional accounts, to incorporating PCs, full accounting, including payroll and taxes, using own computer and software. Pick up and drop off for Edmonton and areas, other convenient options for rest of Alberta. Contact: N. Ali Amiri, MBA Financial and Management Consultant Seek Value Inc. T 780.909.0900 F 780.439.0909 aamiri.mba1999@ivey.ca www.seekvalue.ca BETTER MANAGE PATIENTS’ COMPLEX CARE REQUIREMENTS INTERxVENT Canada provides evidence-based programs and technology tools that assist physicians to better manage their patients’ complex care requirements. We stratify your patient base into those who qualify for and require complex care; auto-populate the completion of the complex care template prior to the patient visit; supply detailed reporting for billing/audit purposes and help you to provide great outcomes. We have helped physicians identify and manage up to 20% of their patients who qualify for the 03.04J billing code. For a free three-month trial period with no obligation or to learn more about how INTERxVENT can help your practice and your patients, contact us. Visit www.intervent.ca/binder to view a list of our over 100 peer-reviewed published abstracts of the proven efficacy of our programs.

DOCUDAVIT MEDICAL SOLUTIONS Retiring, moving or closing your family or general practice, physician’s estate? DOCUdavit Medical Solutions provides free storage for your paper or electronic patient records with no hidden costs. We also provide great rates for closing specialists. Contact: Sid Soil DOCUdavit Solutions TF 1.888.781.9083, ext. 105 ssoil@docudavit.com RECORD STORAGE & RETRIEVAL SERVICES INC. RSRS is Canada’s leader in medical records storage and scanning services since 1997. Free services for closing primary care practices. Physicianmanaged and compliant. TF 1.888.563.3732, ext. 221 www.recordsolutions.ca

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Daphne C. Andrychuk Communications Assistant, Public Affairs Alberta Medical Association T 780.482.2626, ext. 275 TF 1.800.272.9680, ext. 275 F 780.482.5445 daphne.andrychuk@albertadoctors.org

Contact: Mel Barsky TF 1.888.794.7822 mel@intervent.ca www.intervent.ca

Alberta Doctors’ Digest

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May/June 2012

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