WINTER2013

The Pulse

PEI physicians are known for their generosity and compassion. The outpouring of MSPEI contribu-tions to the CBC Christmas Turkey Drive is a tes-tament to this. Now that the season of profound charity is no longer top of mind, and families who were the recipients of a wonderful turkey dinner this holiday season are back to their food insecure lives, what can we do, as physicians, and as a Medical Society, to affect change?

Doctors spend their days and nights working for the betterment of individuals and communities, sacrificing personal time and space on a regular basis. We know that we will always have work: there will always be illness and poor health, and our role as “fixers” will always be needed. But what if we could take a larger role as “preventers” of disease and illness? What if we could con-tribute our time and energy to the single most valuable form of disease prevention and health promotion?

The social determinants of health are the greatest influence on health and mortality. The wealthier you are, the healthier you are. Poverty is the single most-detrimental factor in health outcomes.

Consider this fictional, yet all-too-plausible, case from a website developed by the Food Security Projects of the Nova Scotia Nutrition Council and the Atlantic Health Promotion Research Centre, Dalhousie University called Thought About Food? A Workbook on Food Security & Influencing Policy. The example demonstrates how the multi factorial social determinants affect the health of an individual (the social determinants affected by each state-ment are in brackets):

Amber’s co-worker had to drive her to the hospital because she passed out at work this afternoon.

But why did she pass out? Because she has been skip-ping meals. (personal health practices and coping skills)

But why does she skip meals? Because she doesn’t have much food in her house. (social and physical environ-ments, food insecurity)

Why doesn’t she get more food to eat? Because she only has $30 left until her next pay cheque and she doesn’t have transportation to get to the grocery store, which is far from her house. (income and social status, physical environments)

But why is the grocery store so far away? There used to be a grocery store within a few minutes’ walk from Am-ber’s house, but it closed down a few months ago after a big all-in-one supermarket opened several miles away. (physical environments)

But why doesn’t she have more money for food or transportation? Because she’s a single parent and she

only works part-time. (employment/working conditions, gender)

But why doesn’t she work more hours? Because she can’t find affordable childcare for the whole day. (social environments, employment/working conditions)

Why doesn’t she have a family member or friend to help her with child-care? Because she hasn’t lived in the city for long and doesn’t know many people, and all her family lives in a smaller rural community outside the city. (social support networks)

But why did she move to the city? Because there are not many jobs in her home community, the fish plant closed down and many of the shops are closing too. (social environments, employment/working conditions, physical environments)

But why did the fish plant close?

“Feeding hungry people is important in the short run, but in the long run you’ve got to realize that powerful forces are cre-ating those hungry people. Those people don’t just choose to starve. Our job is to look at those forces and deal with them.”Harry Chapin - Folk singer/song writer

Hunger Returns

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Hunger ReturnsThe MSPEI unanimously passed a resolution at the 2012 AGM with regards to food security as a determinant of health. Specifically,

The Medical Society of PEI calls on the Government of Prince Edward Island to oversee research on the cost of a healthy diet in PEI and to use food costing data to ensure that minimum wage and social assistance rates are sufficient to improve food security for Islanders.

The World Food Summit of 1996 defined food security as existing “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life”. Commonly, the concept of food security is defined as including both physical and economic access to food that meets people’s dietary needs as well as their food preferences. Food security also includes being able to make a living by growing and producing food in ways that protect and support both the land, sea and the food producers, and that en-sure that there will be healthy food for our children’s children. Food security is the goal we are working toward.

Food insecurity is the opposite of food security. It means not being able to get enough food or enough healthy foods that you like and enjoy. It means wondering about where your food comes from or worrying about where your next meal will come from. It means wondering if there will be less food

in the future because of the way we are growing and producing food now.

Food insecurity is caused by, and has effects on, important areas of our lives—our families, children, environment, economy, communities and health.

What can physicians do? At the ground level, you can explore the role of social determinants of health with your individual patients. Consider their income and financial status, employment, education and level of food in/security when you discuss their diagnosis, treatment plan, and specifically, medication choices. If you have more time to commit to this issue, write a letter to the newspaper and your MLA, giving your personal opinion and ex-periences. Letters from physicians are powerful and respected.

If you wish to be even more active in the area of food security, please consid-er contributing your time to the PEI Food Security Network, http://peifood-security.wordpress.com/a grassroots organization of volunteers from broad, multidisciplinary backgrounds and careers, from food producers to univer-sity professors.

Submitted by Jenni Zelin, MD Member, MSPEI Healthcare & Promotion Committee Member, Food Security Network of PEI

Social determinants of health, physician extenders, allied health professional, scope of practice, best practice, fiscal accountability, quality initiatives, key performance indicators, models of care; the language of health care has exploded with new words, titles and catch phrases that make many wish for a simpler time when healthcare was just about the physician-patient relationship. Whether we are nostalgic or not this is the new reality and the environment we practice in is changing at a dramatic pace.

In PEI our healthcare system is being shaped by significant fiscal and resource challenges and it is self- evident to me that the Medical Society must evolve to successfully engage in this new austere and competitive environment. We must strengthen our advocacy role, be present at the beginning of the conversation on critical issues, and find our collective voice in this system as we proceed forward. In short, we need to be relevant.

Your Medical Society Board is embarking on an exercise of comprehensive Strategic Planning to be completed early this year. We can expect this to be the foundation of an expanding process to re-energize the Society. We intend to put our house in order so that we can be in the best position of strength and relevance.

These are ambitious goals but the landscape is changing and the Society must be prepared to stand for the best interests of our members, our system and the patients we serve.

The MSPEI is your organization and the Board is there to represent all members’ interests. In order to accomplish the goal of evolving the Society we have to hear from you in substance and promote the conversation to a complete understanding of where we want to go. I look forward to this work and encourage all those who wish to invest their energy to make it known and we will be pleased to hear your thoughts, ideas or make use of your generous time and talents. The exercise of Strategic Planning is just the beginning.

Best wishes for a Happy and productive New Year.

Dave BannonPresident, MSPEI

IN A WORD OR PHRASE.....

Dear Member,

From time to time I am contacted by a physician wondering what their rights are when they feel unfairly dealt with, or note that their rights as an employee have been violated by their employer. Fortunately these calls/ emails happen infrequently!

It is extremely important to remember that if terms of the Master Agreement are violated and affect you or a colleague, you must inform me, other Society staff, or members of the Joint Consultation Committee (JCC) ASAP. This is due to tight time limits established in the Master Agreement: B4.2: Within ten (10) calendar days of an event giving rise to a grievance, a physician with the written approval of the Medical Society, shall submit the grievance in writing to the Employing Authority’s designate. The written grievance shall state the facts giving rise to the alleged grievance, identify the provisions of the Agreement alleged to be in violation by specific reference, and state the contention of the physician with respect tothese provisions, and shall also indicate the specific relief requested. The Employing Authority’s designate shall reply in writing within ten (10) calendar days of receipt of the written grievance.

B4.3: If the grievance is not resolved at step one, the Medical Society acting on behalf of the physician, may within ten (10) calendar days of receiving the written reply as required at step one, refer the grievance to the Joint Consultation Committee for resolution. The Joint Consultation Committee shall hear from both parties in an effort to resolve the grievance.

Hopefully you will never be in a situation where this article needs to be triggered, but if you are, please adhere to these timelines.

If you have any questions about the grievance process or anything else in the Master Agreement please don’t hesitate to contact me at your convenience.

Regards,

Sandy IrwinExecutive Director

GRIEVANCE PROCESS

As you know, the CWI underwent revisions this Master Agreement. Effective 1-October-2012 productivity thresholds were implemented and, if eligible, the CWI increased to 24%. Now that the quarter has been completed you may or may not receive CWI payments. Thresholds are outlined in Article C5.3. Physicians who meet the requisite threshold for a quarter shall be paid the clinical work incentive for that quarter. If a physician fails to meet the requisite threshold for a quarter, he/she shall not be paid the clinical work incentive for that quarter. However if the physician meets the annual thresholds, he/she shall be entitled to a reconsideration and reconciliation on the calendar year as a whole. If you have any questions please do not hesitate to contact Sandy Irwin (airwin@mspei.org).

CLINICAL WORK INCENTIVE (CWI)

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PhysiciAn recruitment

UPDATE SEPTEmbEr, 2012 -JAnUAry 2013Sheila MacLean, RPR Physician Recruitment Coordinator Recruitment and Retention Secretariat Department of Health and Wellness.,

new PhysiciansDr. KAtherine Burleigh Family Medicine - W est Prince September, 2012

Dr. Jocelyn Peterson Family Medicine - Charlottetown September, 2012

Dr. hAl mAcrAe Family Medicine - Summerside October, 2012

Dr. AngelA mAclAren Family Medicine - Charlottetown October, 2012

Dr. Jeremy BecK Internal Medicine - QEH January, 2013

committed to Begin Practice (signed letters of offer)Dr. mohAmmeD hAssAn Anesthesia - QEH February, 2013

Dr. christine Aucoin Psychiatry - Charlottetown July, 2013

Dr. PAtricK chAn Family Medicine July 2013

Dr. nicole murPhy Family Medicine July, 2013

Dr. lAurA hogAn Family Medicine July, 2013

site Visits:Dr. mohAmmeD hAssAn Anesthesia - QEH October 29-31, 2012

Dr. KhAliD AlzAin Internal Medicine - Summerside November 22-23, 2012

Dr. AmAnDA fiAnDer Neurology - Charlottetown December 2, 2012

Dr. PAtricK mccreA Surgery, Summerside December 14, 2012

APMPR assessors over the years have reported that they can usually tell after examining the first few patient charts whether the physician being reviewed is providing good patient care and appropriately documenting it. There are also demographic factors which can point toward success or failure with peer review including physician age, hours invested in CME, the number of patients seen each week, and whether or not the physician works alone or has the benefit of “corridor consults” with colleagues. APMPR’s Offsite Assessment utilizes both patient charts and demographic factors in a process which is less time-consuming for the physician involved and less costly for us. It has been a part of our process since 2002 after a year-long pilot project confirmed our belief that demographics and a limited chart review were valid offsite predictors of onsite review results. Each year roughly 40% of APMPR assessments are done through the offsite process.

Offsite assessment involves having the physician being reviewed complete a physician questionnaire, write a brief autobiography, and send five patient charts representing approximately one year of patient care to our office. The Physician Questionnaire provides a snapshot of the physician’s background, experience, CME, scope of practice and number of patients seen weekly. We are often asked why we request a short autobiography written by the physician. It’s not our intention to pry into one’s personal life, but it is important to us to know that you have one! The physician who reports that he or she is in a solo practice seeing a high volume of patients weekly, has no outside interests and “hasn’t had time for a vacation” may be at risk for physician burnout and an onsite review is probably a better approach.

“From Peer to Peer” - Atlantic Provinces Medical Peer ReviewA peer assessor considers the patient charts sent for offsite assessment, and these are specific to the type of practice being reviewed. For example, Family Physicians are requested to send one chart each from Type II Diabetes Mellitus and Chronic Pain, and three of the following four: Heart Failure, COPD, Hypertension, or Dyslipidemia - a total of five charts only, five different disease entities. Obstetricians & Gynaecologists are asked to send one chart each from Abnormal Uterine Bleeding, Uterine Prolapse, Dysmenorrhea, Spontaneous Miscarriage, and Vaginal Bleeding, again a total of five charts from five disease entities. In addition to Family Medicine and Obstetrics/Gynaecology, APMPR also utilizes offsite assessment in the review of some physicians practising in Paediatrics, Internal Medicine or Cardiology.

Offsite review is not designed to completely replace onsite review, and in some cases, it is not an option. Hospital-based practices, where the charts do not belong to the individual physician, do not lend themselves to offsite review. And those physicians who have not done well on previous peer assessments are not likely to be offered offsite review until an onsite review has indicated that all is well in the practice. It is also important to note that we recognize the limitations of a review which only examines a few charts. If the assessor doing the chart review has the slightest concern that there may be deficiencies in the practice, an onsite review is scheduled for the next assessment year.

Jean-Marie Auffrey. M. D. - Atlantic Provinces Medical Peer Review, December 2012

February 9th at 2pm

“Sometimes we wonder who is having more fun - the kids or the adults!”

RSVP to heather@mspei.org for location information. Space is limited.

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WhAT WAS olD iS nEW AgAin!

yoU nEED To “hEAr” yoUr mEDicAl SociETy

The Medical Society of PEI 158th Annual General Meeting will return to its former late spring two-day event. Reserve friday, June 21 – saturday June 22, 2013. The event will be centrally located in Dalvay at Dalvay by the sea hotel.

The format combines last year’s June and September MSPEI events to include: the Annual General Meeting; professional development options; golf; Fun Night; President’s Dinner, Family Activities....so stay tuned!

AGM Format/Location

book your time off now!!golf TournamentFriday - June 21, 2013Shotgun start -1pmStanhope golf & country club(alternative activity TbA)

Emailed notices from MSPEI should be something you value; we work hard to keep your finger off the DELETE button!

The MSPEI email policy provides a mechanism to ‘filter” ALL requests to circulate information via email. We even go one step further and ask that a member sanction each request to ensure relevancy and or usefulness.

Policy on electronic informAtion to memBersElectronic information issued via email to individual members or items posted on www.mspei.org are reviewed for content and appropriateness.

Due to the volume of requests to relay information to the medical profession, information intended for circulation to physicians is considered if made at the request of members of the Medical Society or its national organization, the Canadian Medical Association.

Medical Student & Residents

BAR-B-QBook your Friday afternoon off now for July 12, 2013. Lunch starts at noon and everyone enjoys

a relaxing afternoon in the beautiful Medical Society gardens. Hosted by MSPEI & HealthPEI

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Thanks to your generosity this year, the Medical Society of PEI collected enough money to provide a complete holiday turkey dinner (turkey, potatoes, carrots, turnips,onions and cranberry sauce) for 320 Island families who might otherwise do without. We wish to recognize our providers: Cavendish Produce for their donation of potatoes; turkeys were purchased through Larkin Bros. Inc., cranberries discounted by Sobeys, wholesale priced vegetables from Harvest Wholesale and Brookfield Gardens.

Once again, Dr. Charlie Trainor is thanked for his willingness to make the ask - and YOU for your charity.

THANK YOU!

Roisin Mullen (daughter of Heather Mullen, MSPEI Staff) created this painting for our donation and gave it to the Food Bank “to help make people smile”.Chief Turkey Collector Dr. Charles

Trainor at CBC Turkey Drive

Success!

Our thanks to:

This year’s reception drew record numbers with shoulder-to-shoulder attendance. Was it the awesome

potato bar (so very PEI) and cleverly adorned cup cakes? Or maybe the event was a welcome opportunity to

escape last minute holiday chores! Whatever the case, it was a hit - and most especially for door prize winners Dr.

Jane Hennessey (Resident) who won an iHome speaker from TD Insurance and Ben Cameron (Dal Med I) who

won the MD Financial Backpack! See you next year.

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The Canadian Medical Association (CMA) is a successful organization because it listens to and understands its members – physicians like you. As we look forward to a new year, we are witnessing many positive changes at the CMA that will help improve your practice, balance your life and advance your profession.

Here are just a few of them.

Clinical Tools and Resources – The CMA provides exceptional point-of-care resources, such as MD Consult and Lexicomp. We have continued to expand this package of online tools – which is provided free to all members – by adding DynaMed and BMJ Best Practice. The CMA is presently undertaking a major initiative to provide members with access to customized clinical, leadership and practice knowledge resources. For instance, CMAJ is now available as a mobile app for use on iPads, iPhones and the iPod touch.

MD Physician Services – Helping Canada’s physicians achieve greater financial security is the sole focus of MD. Its salaried consultants provide personalized, expert advice and best-in-class solutions to meet all your financial and practice needs. Whether you need financial advice, investment and portfolio management, incorporation assistance, insurance and banking solutions, or retirement and estate planning, MD has the answers. In the annual investor satisfaction survey by J.D. Power and Associates, MD was one of only two financial companies deemed worthy of a five-out-of-five “power circle rating,” and it is the only company in Canada to receive this rating two years in a row.

Advocacy – Being a member of the CMA ensures that the concerns of Canadian physicians are heard on the national stage. It is our mission to keep health care at the forefront of the public policy agenda and to help ensure that you can provide your patients with accessible, high-quality care. At the local level, the CMA can assist you in your advocacy efforts through its MD-MP Contact program, a grassroots initiative that matches CMA members with their local Member of Parliament.

Member Discounts – You have access to unique savings programs, offers and value-added services on CME/CPD seminars and cruises, car rentals, travel, cellular plans, business services, mobile software, fitness and more in a member-discount list that is constantly growing.

In other words, the CMA is committed to providing Canadian physicians with more relevant resources – and more value – than ever before.

There’s Never Been a Better Time to be a CMA Member

MSPEI ART SHOW - JUNE 2013This year’s physician art show, “Right Brain Released” has been approved by The Guild and will run for FIVE (5) consecutive weeks June 4 – July 1, 2013!

The show has been very well received ever since its inaugural launch three years ago when the Medical Society halls displayed the works of its artistic members. Since then The Guild has played host most willingly.

You are invited to participate in this wonderful event and opportunity. Your participation is most welcome as an

accomplished or budding artist and, of course, as a patron of the arts! Invite family, friends, and acquaintances to appreciate that there is more to physicians than the art of medicine.

This new spring launch will not only attract more patrons but allow artists time to work on submissions. Co-ordinators, Dr. Jenni Zelin and Heather Mullen are thrilled and will be in touch to encourage and promote your participation!

it’s confirmed!

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