Welcome to the Alberta Medical Association’s Section News – an opportunity for sections to report on their challenges and objectives. This service helps sections communicate with all AMA members as well as physicians in their own specialties. Your feedback is encouraged. Please contact Agnes E. McIntyre, Administrative Assistant, Section Services: T 780.482.2626; TF 1.800.272.9680; email agnes.mcintyre@albertadoctors.org.
April 2013
Section of Generalists in Mental Health Dr. Raju Hajela, President Update of recent Annual General Meeting The section had its Annual General Meeting in November 2012 in Canmore, where we held a successful workshop on Motivational Interviewing for Addiction, Mental Health and Chronic Pain Patients. This workshop was accredited for 8.0 MAINPRO-C credits by the College of Family Physicians of Canada. An additional seminar was held March 22-23 at the Health Upwardly Mobile office in Calgary.
Section Executive Committee members Dr. Nathaniel Day moved to the position of past‑president as Dr. Raju Hajela became president this year. Dr. Janette Hurley was acclaimed to become president-elect. Dr. Monica Hill agreed to continue as the secretary-treasurer. We are grateful for the ongoing leadership of Dr. Martinus Reedyk for our section. He was honored by the Alberta Rural Physician Action Plan with its 2012 Award of Distinction. Please visit http://www.kiboodle.ca/threehills/ videos/featured-videos/player/19/89
Meeting update regarding service delivery for addiction, mental health and chronic pain patients Dr. Raju Hajela attended a meeting with Alberta Health Services (AHS) and Alberta Medical Association (AMA) colleagues in leadership positions, on February 4, to review the situation about service
delivery for addiction, mental health and chronic pain patients. Although there has been some progress in communication, service gaps remain as highlighted by Dr. Ian Forster (Addiction Medicine) and Dr. Doug Watson (General Psychiatry). Training issues for counselors and physicians were discussed in the context of access and quality of care. We discussed the challenges of people in the community having to pay for mental health and addiction services, which does constitute a “two-tiered” health care system for these patients. Dr. Allan Garbutt, President-Elect, highlighted the paucity of services in rural areas of our province. These issues were discussed further at the Representative Forum in March; Dr. Raju Hajela attended.
Your comments are welcome Section members are invited to send comments, questions and suggestions about our activities and other generalists are invited to join our section as we strive to deliver and improve mental health services in Alberta.
Section of General Practice Dr. Ann R. Vaidya, President T 403.873.2352 F 403.873.2364 gppres@albertadoctors.org Election Information The Section of General Practice is calling for nominations for three members-at-large (2-year term) positions on the executive committee.
All nominees must be active section members. The nomination deadline for these positions is 9 a.m. Thursday, April 25. For the members-at-large nomination form, click here. The election for the members-at-large is by mail-in ballot. An election package, which includes a ballot, will be mailed to all active section members by no later than Thursday, May 9. All ballots must be returned to the AMA by Thursday, May 30. In addition, the executive committee will be looking to fill the position of secretary-treasurer. The official call for nominations for this position will take place in July and the election will take place at the annual general meeting in September.
Tarrant Scholarship
Section of Rural Medicine Dr. Tobias N.M. Gelber, President srmpres@albertadoctors.org
We had nine students participate in the day-long Enhancement Program in December, and of these students only two got interviews at the universities to which they applied.
Promotion for the 2013 Tarrant Scholarship began earlier this year. An email announcing the scholarship was sent to all medical students from AMA President Dr. R. Michael Giuffre in late January. An article about the scholarship was also included in the February 7 issue of MD Scope. SRM and AMA will continue to promote the scholarship until the May 6 deadline. If you know of any third-year students who may be eligible to apply, please encourage them to do so. More information can be found on the AMA website. The scholarship recipients will be selected during the summer and an awards ceremony will take place in the fall.
Enhancement Program
Please send any comments on this submission to Nella Papaianni, Manager, General Practice Liaison (nella.papaianni@albertadoctors.org).
In addition, several rural physicians contacted SRM in February and March for requests to help students in their communities who had gotten an interview. An additional eight students participated in the Enhancement Program, bringing the total number of participants to 17.
Changes to the Medical Examiner’s Office As you know, beginning January 1 all rural medical examiners were dismissed as a result of changes to the Medical Examiner’s Office. Many of you shared your concerns about the impact of these changes with the Alberta Medical Association (AMA). Dr. Allan S. Garbutt, Dr. Brian D. Willis, Dr. Lyle B. Mittelsteadt, and I met with Dr. Anny Sauvageau, Chief Medical Officer, to discuss these concerns. Here’s a quick overview of our meeting: • The primary reason for the change was to ensure consistency in the quality of exams as rural medical examiners conduct a low volume of exams compared to specialist pathologists in urban centers. • A cost analysis indicated that moving all exams to two major urban centers would not be higher even with the increased transportation costs. • There should not be any delays for funeral services resulting from centralizing exams. At the end of the meeting, we were satisfied that our concerns have been sufficiently addressed. However, if you have any questions or experience difficulties as a result of the changes, please contact Dr. Mittelsteadt by email. Alberta Medical Association
We will not know how many of these students were admitted into medical school until mid-May when the students hear back from the universities.
General Practice/Rural Medicine ◊ Section of General Practice Dr. Ann R. Vaidya, President T 403.873.2352 F 403.873.2364 gppres@albertadoctors.org ◊ Section of Rural Medicine Dr. Tobias N.M. Gelber, President srmpres@albertadoctors.org Please send any comments on this submission to Nella Papaianni, Manager, General Practice Liaison (nella.papaianni@albertadoctors.org). Spring Representative Forum The Alberta Medical Association’s (AMA’s) Spring Representative Forum (RF) was held in Calgary on March 15-16. The meeting tackled many topics, but 2
April 2013 Section News
was dominated by discussions regarding negotiations. Agenda items included:
The development of PCN 2.0 has some potential to provide some infrastructure resources which could reduce overhead if implemented correctly. However, we have not discussed funding yet and despite Minister Horne’s commitment to adequately resourcing this project, with the recent developments in negotiations it calls into question the likelihood of this actually happening. Actions speak louder than words.
• AMA board report – Update from the AMA board by reviewing the disposition of the Fall 2012 and Special RF resolutions, update regarding activity since and governance requirements and a highlight of the issues and challenges facing AMA. • CMA report/update – An overview of events from the national perspective; an update from the CMA and an opportunity to provide feedback on issues of mutual concern. • Patient- and family-centered care – A presentation to gain a detailed understanding of the concept of patient- and family-centered care. • Primary care update – An update on work being done by the Primary Care Alliance and associated issues/activities. • Negotiations – An update on master agreement negotiations; discussion about next steps. ○ Priority outcomes of RF as related to negotiations. i. UNITY OF THE PROFESSION. ii. AMA investigate legal means available. iii. Launch campaign/communication plan to inform public of the effects of a $275 million reduction. iv. All negotiated agreements between government and physicians must fall under ONE master agreement.
The minister must also table a financial position with the AMA in negotiations.
Minister’s Advisory Committee on Primary Health Care The AMA representative on this committee is Dr. Ann R. Vaidya, President, Section of General Practice. Further to last month’s Section News submission, the committee continues to meet and its most recent meeting was in March. To date, four to five meetings have taken place. Topics covered during these meetings include: • Supporting the primary health care system. • Reporting on family care clinics (FCCs) progress. • Conducting a province-wide needs assessment for primary care and readiness for FCCs. • Enhancing community engagement. At the last meeting, Dr. Vaidya gave a presentation on PCN 2.0 and Dr. Robert J. Wedel gave a presentation on work conducted by the Primary Health Care Strategy Working Group. The minister of health continues to promise resources to ensure that the initiatives on the table move forward.
Negotiations The recent developments and ultimate termination of negotiations between the AMA and the government is very disappointing. It calls into question our ability to effectively negotiate any future improvements to the health care system.
PCN 2.0 The Primary Care Alliance (PCA) Board gave an update about the scope of this project. The PCA Board developed a primary care framework which includes important components such as:
We fully expect we will have another imposition on us, this time in the amount of a $275 million rollback. This is in addition to the 0% we have had for the last two years and the projected 0% for the next three years. Overall, things look pretty grim for physicians. If government really wants to keep us flat like the teachers, we need to have cost-of-living increases at a bare minimum so that we aren’t losing against our overhead. Having said that, there may be opportunities down the road that would allow us to practice in more efficient and rewarding ways.
Alberta Medical Association
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community engagement response to family care clinics alternate payment models PCN evolution formal patient attachment PCN accreditation
This work must continue despite the current environment. It is important to note that the paper is only in draft at the moment and input from membership will be requested in the coming months.
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April 2013 Section News
Revenue from section membership dues allows for increased leadership capacity in the areas of general/family practice and helps increase your section’s visibility and influence within the primary care landscape. Most importantly, your section can advance Patients First® and promote positive medical practice environments. Negotiations with government and the proposed changes to primary care are at the forefront of most physicians’ minds. Now, more than ever, we need support to better represent you. In order to vote at the Annual General Meetings of the sections of General Practice or Rural Medicine, you must be an active member of that section. Let your voice be heard: Become an active section member today!
Family care clinics We are still awaiting further clarification from government on the role of family care clinics and how they will work within Alberta’s current primary care environment. Our understanding is that the roll out will be limited and focused on high needs areas.
SGP and SRM executive input Your SGP and SRM executives are often asked to provide input to various draft documents, standards, policies, etc. Over the last few months, both executives have provided input on: • PCN Evolution: A Vision of PCNs for Tomorrow: A blueprint and action plan for an enhanced PCN program in Alberta. • A Potential Formal Attachment Model for Alberta: A draft model outlining a potential model for formally attaching patients to PCNs. • Primary Care Accreditation Position Paper: A document outlining potential requirements for accrediting PCNs. • Feedback on Alberta Health Services Physician Working Group for Pandemic Planning. • Alberta Blue Cross Special Authorization process: How to improve the electronic application process. • College of Registered Psychiatric Nurses of Alberta’s draft Code of Ethics and Standards of Psychiatric Nursing Practice: A document to ensure registered psychiatric nurses in Alberta provide safe, competent and ethical care. • CARNA Registered Nurse Competencies Prescribing and Ordering Diagnostic Tests: A document which outlines the expected competencies for prospective registered nurse prescribers. • Statement on Life Saving and Sustaining Interventions (Canadian Medical Association): A document intended to provide guidance for the development of policies regarding life-saving and sustaining interventions.
Family Docs Rock The Alberta College of Family Physicians (ACFP) launched its Family Docs Rock campaign earlier this year. They have asked the public to help them promote the value of the family physician by sharing their stories of physicians who have gone above and beyond the call of duty. Patients can also nominate their doctor for an ACFP award.
Primary Care Alliance ◊ Section of General Practice Dr. Ann R. Vaidya, President T 403.873.2352 F 403.873.2364 gppres@albertadoctors.org ◊ Section of Rural Medicine Dr. Tobias N.M. Gelber (Chair), President srmpres@albertadoctors.org ◊ PCN Leads Executive Dr. Phillip W. van der Merwe, Chair pcnexec@albertadoctors.org The PCA issues a joint Section News submission about issues affecting general practitioners. Please send any comments and feedback on this submission to Linda Ertman (Program Coordinator, Practice Management Program) at linda.ertman@albertadoctors.org.
Support your section Your section membership dues fund a wide range of work, from dealing with allocation increases to the Physician Services Budget to influencing the direction of negotiations. In addition, with your support, section executives work within the AMA on issues such as:
Primary Care Alliance (PCA) Board In January, the minister of health asked the PCA Board to develop a blueprint and action plan for the evolution of PCNs in Alberta.
• physician compensation • primary care landscape • patient care Alberta Medical Association
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April 2013 Section News
The PCA Board and the PCN Physician Leads Executive are working with Alberta Health on the overall conceptual framework. This framework will build on the strengths of the existing PCNs and their associated clinics to enhance the delivery of primary health care. To develop the framework, several working committees are being formed to look at: • Health system integration. • Social and community integration. • Innovation in service delivery, performance measures, standards and evaluation. • Governance and patient attachment. The PCA Board continues to work on the priorities outlined in the Primary Care Action and Project Plan.
PCN Physician Leads PCN Physician Leads Forum The PCN Physician Leads Forum was held on March 8-9, with 58 PCN physicians and 26 PCN executive directors representing 30 PCNs across the province. PCN evolution was the main focus. Attendees received an overview (highlighting the elements essential to evolve primary care and PCNs) of the scope of the minister’s request. Sessions included discussions on: • • • • • • • •
formal patient attachment team-based collaborative care service agreement/tier concepts evaluation and accountability access primary care accreditation PCN governance change management
The PCN Physician Leads Executive and PCA Board will consider the information gathered from the forum in further developing the primary care framework. Future forum dates are: • October 18-19 (Calgary) • March 7-8, 2014 (Edmonton) • October 3-4, 2014 (Calgary) For questions about the forum, please contact Linda Ertman at 780.733.3632 or linda.ertman@ albertadoctors.org.
Alberta Medical Association
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April 2013 Section News