Adoption of the recreational cannabis act

Banniere AMQInfo page web JUIN2018 ENG

Bandeau pageContenu CollineParlementaire EN

Adoption of the recreational cannabis act

On June 12, 2018, the National Assembly of Québec adopted Bill 157: An Act to constitute the Société québécoise du cannabis, to enact the Cannabis Regulation Act and to amend various highway safety-related provisions.

Québec needed to produce a legislative framework because of the federal government’s move to legalize the use of non-medical cannabis during the summer of 2018.

“Cannabis legalization must not be perceived as a message that trivializes use nor as a sign of normalization, in fact it is quite the contrary. It is precisely because cannabis presents health risks that it must be regulated,” pointed out Lucie Charlebois, Minister for Rehabilitation, Youth Protection, Public Health and Healthy Living, at the press conference that followed adoption of the Act.

Bill 157 was adopted with 61 votes for, 46 against and no abstentions. The members of the Québec Liberal Party and Québec solidaire voted for, while members of the Parti québécois and Coalition Avenir Québec voted against. The PQ members wanted to prohibit the use of marijuana in public places and wanted Québec, not Ottawa, to manage the production of cannabis. In addition, the PQ leader stated that he was “very concerned” by the potential links between the owners of cannabis production companies and tax havens. CAQ members did not agree that the legal age for cannabis consumption should be set at 18 rather than 21, as it had wished.

The study of Bill 157 involved 136 hours of parliamentary work, led to the adoption of 138 amendments and required close to 7 months of work.

While Québec legislation prohibits growing recreational cannabis at home, the federal government proposes allowing Canadians to have up to four plants at home. The Senate recommended that federal legislation adopt an amendment that recognized the right of the provinces to ban home grows. However, the Prime Minister of Canada, Justin Trudeau, confirmed that cannabis home grows will be authorized throughout the country in the Cannabis Act (C-45) adopted on June 19, 2018. Lucie Charlebois affirmed that Québec is ready to defend its position before the courts on this point of contention.

Depositphotos 16975317 originalKey points of Bill 157:

  • Creation of the SQDC (Société Québécoise du Cannabis) to ensure that public health and safety objectives are achieved;
  • Minimum financing of $25 million per year, over five years, for cannabis-related activities involving prevention and research;
  • Prohibition against minors possessing cannabis;
  • A limit imposed on the amount that a person can possess at home (150 grams of dried cannabis or equivalent regardless of the number of residents);
  • Prohibition against growing non-medical cannabis for personal use;
  • Restrictions on the use of cannabis in certain places;
  • Creation of an oversight committee to advise the Minister of Health and Social Services regarding this new phenomenon;
  • Zero tolerance for driving a vehicle after consuming cannabis;
  • Legal age for the possession and purchase of cannabis and to be admitted to a cannabis retail outlet is set at 18 years.

 

 

Back to top

Call for candidates for the Professional Affairs Committee

Banniere AMQInfo page web JUIN2018 ENG

Bandeau pageContenu AMQAction EN

Call for candidates for the Professional Affairs Committee

Are health care issues important to you? Would you like to be more involved in this area? If so, then this is a chance for you to participate to positively influence medical professionalism and the quality of health care for the whole of society.

The Professional Affairs Committee will be expanded to 7 members in order to better reflect the various practices, environments and generations. It is attached to the Board of Directors of the Québec Medical Association (QMA) and reports directly to it.

Its mandate is to monitor emerging issues and to advise the Board on these issues. Its members can communicate the expectations of their environments and assess receptiveness to the QMA’s messages. In addition, jointly with the Board, the committee is responsible for identifying issues that require more detailed research and consultations. The committee’s study of such issues helps the Board define the QMA’s medium- or long-term positions.

To learn more or to submit your name for the Professional Affairs Committee, contact Catherine Hamel at catherine.hamel@amq.ca.

Back to top

Decrease in CMA-QMA membership fees

Banniere AMQInfo page web JUIN2018 ENG

Bandeau pageContenu ServiceMembres EN

Decrease in CMA-QMA membership fees

Several members recently expressed concern or surprise at the CMA’s decision to sell MD Financial Management to Scotiabank. However, one of the direct consequences of this transaction is a decrease in QMA membership fees.

QMA members who join in June or a subsequent month will pay the new rates when they renew their memberships.

Fee:

  • Full member: Any member not covered by another category.  $510
  • First year of practice: Year following the end of residency.  $190
  • Part-time practice: Member who practices/invoices fewer than 20 hours per week.  $363
  • Post-graduate: Non-practising member engaged in a research or teaching fellowship.  $291
  • Retired/honorary retired member: Retired member not receiving professional income.  $138
  • Resident: Member registered in a residency program.  $91
  • Student: Member registered in a medical school in Québec.  Free
  • Maternity: Members on maternity leave are asked to contact us.  Reduction

For more information, contact the Québec Medical Association’s Membership Services by website,or by telephone at 514-866-0660 or toll-free at 1-800-363-3932.

Back to top

Resident and Medical Students Contest

Banniere AMQInfo page web JUIN2018 ENG

Bandeau pageContenu Partenaires EN

Resident and Medical Students Contest

Are you a medical student or a resident? Are you using DynaMed Plus (online or app) or the CPS RxTx mobile app? Show us the creative ways in which you use these clinical tools and you could win one of three $1,000 cash prizes.

To enter, take a picture of yourself showing how you use these resources and share it via Twitter, Instagram, or email and use the hashtag #JouleAllAccessContest, before July 26th, 2018. Full contest rules and details available here.

If you don’t know DynaMed or the CPS Plus, now is the time to learn more about these clinical resources.

DynaMed Plus provides evidence-based treatment options, drug information from the Micromedex database, Canadian and international guidelines, thousands of clinical images, and is updated daily with new information identified through a systematic review of medical literature. 

The CPS, updated weekly, offers more than 2000 monographs, written by manufacturers, for drugs, vaccines and natural health products. This app also provides Health Canada advisories (within 48 hours of their publication) and interactive medical calculators.

Dynamed

 

Back to top

Family physicians adopt the Choosing Wisely Canada recommendations

Banniere AMQInfo page web JUIN2018 ENG

Bandeau pageContenu Babillard EN

Family physicians adopt the Choosing Wisely Canada recommendations

May 25 was the annual research and quality improvement day presented by the Department of Family Medicine and Emergency Medicine at Université de Sherbrooke.

At this event, family and emergency medicine residents and professors had an opportunity to present the results of their research project and/or assessment of the quality of professional practice. In total, more than 30 scientific study projects in 3 main categories (research, educational innovation, and quality improvement or assessment) were submitted to the jury for evaluation.

A number of these initiatives reflected the Choosing Wisely Canada recommendations:

tableau choisiravecsoin sherbrooke ENG

 

 

Back to top

Discussions surrounding solutions to health system improvement

Banniere AMQInfo page web JUIN2018 ENG

Bandeau pageContenu AMQAction EN

Discussions surrounding solutions to health system improvement

HUgo 6thEstate7For years, throughout Canada, health care systems have been trying to improve their efficiency and performance. Yet all the reforms introduced seem to have little effect and local innovations that work are not implemented across the country. The Sixth Estate webcast therefore decided to invite four experts to discuss the transformations needed for the situation to change.

Mike Villeneuve, CEO of the Canadian Nurses Association (CNA), started things off by talking about the concerns of his association. He pointed out that we have been encountering the same problems for years and despite all the discussions, there hasn’t been much action. He feels that as time passes, there is a growing mismatch between the needs of the population and the services provided by the health care system. He added that the population doesn’t need just acute rescue treatment care, but increasingly more long-term care, end-of-life care and palliative care. As a result, the CNA has questions about how its members should be deployed effectively to meet those kinds of needs, while also being aware that within the nursing profession, not everything is simple. It is not easy to agree on who is in the best position, registered nurses versus practical nurses and so forth, to provide care for the chronically ill, not to mention the obstacles that nurses can encounter when they want to practise in clinics without physicians. 

For Dr. Hugo Viens, president of the Québec Medical Association, the relationship between physicians and nurses is evolving and the debate about the competencies of each is becoming outdated. The younger generation of physicians is more open to collaborative models for managing patient care, in particular by and with nurses.

Appropriateness and prevention

The main issue now tends to be the cost of health care, which represents more than 50% of the budget in Québec and where we are focused primarily on services and treatment for acute care. Our health care system is not adapted to the aging of the population and chronic disease management. “We feel that we need to shift to the left a bit in the timeline of disease and work together in going more toward… educating people to prevent disease,” stated Dr. Viens.

Another major issue is overdiagnosis and overmedicalization if we want to be able to afford our health system in the future, because we already know that about 30% of interventions today are probably unnecessary. “There are a lot of tests and probably hospitalizations that could be prevented only by doing the right thing at the right moment and not overprescribing, overmedicalizing our way of life… I think we are putting a lot of emphasis on medicine today and not as much on life hygiene and preventing disease,” explained Dr. Viens. “We’re in a model where we think doing more is better, but often less is better,” he added.

For Dr. Viens, the current compensation method puts the emphasis on volume care, but it is also necessary to consider value care. “The more we have technology, the more we want to do to detect cancer at an early stage, for instance. Often we know that detecting cancer early in the stages won’t change much in the outcome.” It is sometimes easier for a physician to prescribe a test than to explain why it isn’t necessary, which is why educating patients is important as well as making people aware of initiatives such as the Choosing Wisely Canada recommendations.

Adapting efficient solutions to implement them everywhere

Maria Judd, Vice-President, Programs, Canadian Foundation for Healthcare Improvement explained that it is important for governments and stakeholders to work together if they want to successfully resolve the problem. The Foundation’s mandate is to identify proven innovations and accelerate their spread across Canada. “We know chronic diseases and managing chronic diseases is a big challenge in Canada, so we identified an INSPIRED program which is a supportive COPD [chronic obstructive pulmonary disease] program developed by Dr. Graham Rocker and team in Halifax and we’re helping to spread that.”

In the first six months, this program had a reduction in readmissions to hospital of 64% and in visits to the emergency room of 52%, “and most importantly, people with advanced COPD told us they got their life back… The big focus… is to understand and identify what’s working in other places and support people in… adapting and implementing it in their local context.” For Maria Judd, educating patients with chronic diseases is essential: “people need to understand their disease and manage it, by themselves, with their families and in their community.”

Furthermore, she thinks that it is hard in Canada to implement and spread efficient initiatives “because our health systems are overloaded and we don’t have the capacity to respond to new ways of doing things. That’s where building capacity for improvement comes in. People in health care really need to have two functions. One is to do their job to provide patient care and the second is to figure out how to do that better.”

Improving rather than trying to transform

Damien Contandriopoulos, Professor, School of Nursing at the University of Victoria, feels it is not so much about having the system change as having the system improve. “We doubled the amount of money… of constant dollars since the 90s… it has been a bit less than 30 years to double the amount of actual money we are investing in the health care system… I would be curious about who has seen an improvement during that time.” For him, it is incomprehensible that in Canada’s history there has never been so much money, and so many physicians and nurses in health care, but still the system is crumbling.

It is important to understand that the source of the problem is complex, particularly because “we are living in a society where being over 50 is a chronic disease!” Damien Contandriopoulos pointed out that a study done 10 years ago showed that currently in North America, if you follow the guidelines, almost 100% of people over 50 years old are “technically sick”. 97% of people over 50 are currently fitting the guideline for at least three of the most common chronic diseases: cholesterol, high blood pressure and diabetes.

For this researcher, another aspect of our difficulty in improving things is that no-one is steering the change within the health care system, but we have interest groups that have the capacity to prevent change every time a transformation requires money to be shifted elsewhere.

Maria Judd believes it is possible to introduce small changes that will bring about improvements. When these changes in the local system start to work and we see the benefits or the savings at a  higher level, it is easier to expand them.

HUgo 6thEstate6For Dr. Viens, while everyone agrees on the problems and solutions, health care professionals still work in silos and to improve the situation, it is necessary to review how services are organized and work on building teams in which health professionals manage patients together, rather than having several professionals trying to do the same things. In addition, he thinks we shouldn’t be surprised if people continue to crowd emergency rooms. Not just because it is not always easy to get an appointment with a family physician, but also because the system is such that patients (and sometimes physicians) are still convinced that they will be treated faster by going to the hospital than by visiting a physician. 

 

Back to top

Provincial election: the 15 solutions collective presents its requests to the political

Banniere AMQInfo page web JUIN2018 ENG

Bandeau pageContenu AMQAction EN

Provincial election: the 15 solutions collective presents its requests to the political parties 

A few months from the elections, on June 19, the Québec Medical Association (QMA), the Alliance des patients pour la santé (APS), Confédération des syndicats nationaux (CSN) and Association des cadres supérieurs de la santé et des services sociaux (ACSSSS) asked that the political parties make firm commitments to health care. 

The collective asked the political parties to include its priority actions that make consensus in their election platform and, if they form the next government, to commit to implementing them in the first two years of their mandate.

This summer, the collective plans to meet with the leaders of the four main political entities in Québec to present its priority actions to them. It will also produce a “report card” for each party based on the actions that will have been included in the election platforms.

Naturally, the collective intends to support the elected government in implementing the priority actions. The government will thus be able to take action in health as soon as it is elected and by starting the work in collaboration with the main stakeholders in the system: patients, physicians, system stakeholders and managers. An unprecedented move!

ACSSSS logo APS logo  AMQ en action    CSN logo

Priority Actions

1)     Organization of front-line services 

  • Expand the scope of practice of the different health care professionals and better define the interrelations to reinforce interdisciplinary work.
  • Maintain the CLSCs and reinforce their role, in particular for coordinating and delivering care and services at home for seniors and vulnerable clienteles, which entails granting the human and financial resources needed for their mission.
  • Develop a real caregiver policy to recognize their vital contribution to delivering care and services.

2)     Prevention: act on the health determinants 

  • Dedicate 5% of health and social services program spending to public health, in compliance with the recommendations of the World Health Organization and the Québec Association of Public Health.
  • Create hubs in each CISSS / CIUSSS area, with a budget large enough to support local initiatives that are initiated, proposed and taken by the community and focused on health prevention and promotion.

3)     Different methods of funding and compensation 

  • Improve the collection, circulation and sharing of anonymized data and identify the recognized indicators to enable assessment of the system’s performance, namely in terms of appropriateness, cost and efficiency.
  • Include alternative methods in the physician compensation system to encourage interdisciplinary work, similar to other Canadian provinces and on the strength of the conclusions of research already done by the Health and Welfare Commissioner.
  • Modernize the funding of the system’s institutions to base it not just on historical data but also according to the services rendered and the positive impacts on the health and well-being of the local population.

4)     Governance 

  • Introduce legislative changes to give the authorities of institutions in the health and social services system real autonomy and thereby promote decentralization.
  • Oblige institutions to hold consultations with the parties involved, which must include patients, users and stakeholders in the system, to ensure better alignment between the services offered and needs.
  • Set up a national patient committee.
  • Create a national board of patient and user associations to advise the Minister of Health and Social Services.

5)     Succession 

  • Encourage the recognition of degrees and experience acquired abroad.
  • Deploy pairing, co-development, coaching and peer mentoring activities to increase staff retention and facilitate integration.
  • Improve work and practice organization and conditions to eliminate insecurity, avoid overloading and ensure a healthy work environment.
  • Conduct public campaigns to acknowledge the contribution, role and work of the professionals and stakeholders in the health and social services system.

To learn more about the Collective, visit 15solutions.org.

 

Back to top

Registration for the QMA Symposium for Physician Executives is now open

Banniere AMQInfo page web JUIN2018 ENG

Bandeau pageContenu AMQAction EN

Registration for the QMA Symposium for Physician Executives is now open

4e Colloque MG Logo

The theme for the Québec Medical Association’s next Symposium for Physician Executives has been announced and registration is now open. The conferences, workshops and case studies will revolve around the topic of conflict prevention, from confrontation to collaboration.

It is impossible for physician executives to avoid all conflicts, but they can certainly hone their ability to anticipate them and introduce good strategies to minimize their negative impact. This is the main objective of this 4th symposium.

The event will take place on Friday, November 30, 2018, at the Hotel Vogue in Montréal. You can see the detailed preliminary program by visiting the colloqueamq.ca Web site. 

The registration cost is the same as last year at $370. Because space is limited, it is recommended that you register quickly if you wish to attend.

To access the registration form (in French), click here or visit colloqueamq.ca.

Back to top

Doctors need to promote successful models

Banniere AMQInfo page web JUIN2018 ENG

Bandeau pageContenu MembresAction EN

Whenever it meets with physicians in their environment, the QMA has observed that many of its members are committed to improving care and services on a daily basis. Great initiatives are taking shape everywhere. Some of them should even be implemented or adapted elsewhere, but for this to happen, we need to know that they exist! 

If you have set up a project that deserves more visibility or if you know of members colleagues who have done so, feel free to contact QMA. We would be pleased to showcase your achievements.

Doctors need to promote successful models

Like many QMA members, Montréal-based family doctor George Michaels believes we need to rethink things if we want to meet the population’s health needs.

Backed by a strong conviction that health care and services should revolve around the patient, Dr. Michaels has always advocated for this type of model, both at St. Mary’s Hospital, where he used to practice and teach, and at Clinic MDCM, a family medicine group (FMG) in Montréal’s Centre-Ouest district, which he currently owns and operates.

DrViens DrGeorgesMichaels

Dr. George Michaels invited QMA president Dr. Hugo Viens to Clinic MDCM
to discuss the importance of doctors rallying together.

“I managed to convince my former colleagues that a teaching hospital could become a patient‑centred environment, and I’m convinced the same goes for an FMG,” Dr. Michaels explained. For Dr. Michaels, continuity of care and services is essential, and an FMG is an organization that is particularly well suited to treating a population, provided all healthcare professionals—specialists and family doctors included—abandon their silos and work together.

Tear down the silos, focus care on the patients

Clinic MDCM became an FMG in November 2016. With its 33 family doctors, it treats more than 37,000 registered patients with an attendance rate of nearly 82%. The clinic also has specialists on staff. Dr. Michaels believes that family doctors and specialists need to collaborate when it comes to patient follow-up: “They need to communicate. A family doctor needs to be able to call a specialist to refer a patient or ask a question, but a specialist also needs to be able to refer patients back to a family doctor.” When Dr. Michaels was practising at St. Mary’s Hospital, 20 to 30 years ago, everyone worked alone, and the wall between specialists and family doctors had to be broken down. Today, the same thing has to be done in FMGs between doctors and other healthcare professionals.

Clinic MDCM, a level 9 FMG, also employs nurse clinicians and nurse practitioners, social workers, a nutritionist, and a pharmacist. In bringing all these professionals together, “we really emphasized teamwork and trust,” pointed out Dr. Michaels, who feels strongly that success breeds success.

Doctors standing together to be heard

In Dr. Michaels’ opinion, doctors need to band together if they want their practice to change for the better. He believes doctors need to convince managers and the population that the FMG model, which is still not very well known, is capable of meeting the health needs of a population. The 14 FMGs in the CIUSSS that encompasses Clinic MDCM have some 265,000 registered patients out of a total population of 320,000—more than two-thirds of the territory’s population. According to discussions by the round table of FMGs in this CIUSSS, if each doctor took on 33 more patients, they could empty out the waiting list for the Québec Family Doctor Finder (GAMF).

The high attendance rates of several FMGs in the CIUSSS Centre-Ouest-de-l’Île-de-Montréal also show that it’s possible to meet the needs of this population, including those of the most vulnerable patients, patients with complex needs, or patients with decreasing autonomy who require home care.

While nearly 80% of Quebecers now have a family doctor, it’s obvious to Dr. Michaels that high attendance rates and physicians’ ability to work through the waiting lists for family doctors are priority front-line issues, which is why he believes that FMGs need to join forces in order to make themselves better heard by decision-makers at the CISSSs, CIUSSSs, and the Ministère de la Santé et des Services sociaux. In fact, FMGs have the potential to become service outlets responsible for the treatment and follow-up of entire populations within a district, provided they are given the necessary regional medical staffing plans (PREMs).

 DrGeorgesMichaels

 

Back to top

Upcoming courses offered by the QMA

Banniere AMQInfo page web JUIN2018 ENG

Bandeau pageContenu Formations EN

Upcoming courses offered by the QMA

logo leadershipmedicalMedical leadership training – PLI

  • Orchestrer le changement et l'innovation (leading change and innovation)
    SAGUENAY – September 19 and 20, 2018 (in French only)

How to align people and organizations to build a shared vision and commitment to act is the central theme of this course. Using change management theories, you will learn to develop strategies to motivate, implement and sustain change, while also overcoming opposition to change. Through the presentation and discussion of issues and concrete exercises, you will cover different topics that include creating a resilient work environment and dealing with the impact of change.
CPD credits: 14

 

  • Connaissance de soi et leadership efficace (self-awareness and effective leadership)
    QUÉBEC CITY – September 26, 27 and 28, 2018 (in French only)

Knowing how to manage your communication is essential. So is self-awareness. This continuing professional development course will give you insight into the personal attributes essential for effective medical leadership. Using the concept of emotional intelligence, you will improve your ability to influence and manage your environment by applying adapted techniques and exercises. At the end of this course, you will have discovered which type of medical leadership best suits you and be able to determine its effectiveness.
CPD credits: 17,25

 

  • Négociation et gestion des conflits (negotiation and conflict management)
    MONTRÉAL – October 17 to 19, 2018 (in French only)

This course will enable you to develop strategies to manage conflict within an organization, avoid the difficulties that conflicts can create, and learn how effective management of conflict can enhance creativity and innovation. Through a negotiation exercise, you will develop a planned approach and practise successful techniques to achieve results in interpersonal relations.
CPD credits: 21

To find out more and to register, go to www.amq.ca/formation or contact QMA.

 

Back to top

Optimizing medical practice, a priority for developing medical professionalism

Banniere AMQInfo page web JUIN2018 ENG

Bandeau pageContenu Babillard EN

Optimizing medical practice, a priority for developing medical professionalism

The Professionalism Tour across the province organized by the Québec Medical Association included a survey conducted among members when the Let's Talk About Professionalism newsletter was published.

The survey was intended to determine the highest priority for physicians for developing medical professionalism. Four choices were proposed:

  • Optimize medical practice (e.g.: tackle overdiagnosis, interdisciplinary work, etc.);
  • Promote the management roles filled by physicians;
  • Support collective management of the population as a whole (population-based responsibility);
  • Encourage better sharing of clinical information between various professionals.

The majority of respondents chose optimizing medical practice. They felt that limiting overdiagnosis and overtreatment, reinforcing interdisciplinarity, reducing administrative complexity, and developing diagnosis tools to help with decision-making are priorities for advancing medical professionalism.

SURVEY RESULTS

Among the avenues suggested, which one do you think is a priority for developing medical professionalism?

Optimize medical practice (e.g.: tackle overdiagnosis, interdisciplinary work, etc.) 40%
Promote the management roles filled by physicians 14%
Support collective management of the population as a whole (population-based responsibility) 23%
Encourage better sharing of clinical information between various professionals 23%
Other 0%

For more information on this topic, read the full report on the Medical Professionalism Tour published last April during the QMA’s annual day.

 

Back to top

Do you think the legalisation of recreational cannabis will affect your practice

Banniere AMQInfo page web JUIN2018 ENG

Bandeau pageContenu Sondage EN

 

Back to top