Have you adapted your practice to advanced access?

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Choosing Wisely Canada National Meeting

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Choosing Wisely Canada National Meeting

Presented in partnership with the Canadian Medical Association and co-hosted with the Québec Medical Association, the 4th Choosing Wisely Canada National Meeting will take place on May 27 in Montréal.

Don’t miss it—several workshops will be given in French.

Dr. René Wittmer, family physician and trainer for the Practising Wisely program, will give a presentation on overuse in the clinical setting in Québec and the best practices for reducing it.

Dr. France Légaré, international expert on implementing shared decision-making in clinical practice, will discuss shared decision-making in primary care settings and how it can help to reduce overdiagnosis and over-treatment.

Dr. Guylène Thériault, member of the QMA Board of Directors, Choosing Wisely Canada Primary Care Co-Lead, member of the Scientific Committee, and trainer for the Practising Wisely program, will teach participants more about using antibiotics wisely.

Finally, the meeting’s keynote address, given by Dr. Cara Tannenbaum, national and international expert in geriatric research, will focus on the phenomenon of deprescribing, or reducing the number of unnecessary prescriptions.

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Note that a request to have this meeting accredited as a continuing professional development (CPD) event has been submitted to a recognized accreditation body.

To register, click here.
You have until April 1, 2019, to take advantage of the early-bird rate ($175).

 

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Training on professionalism for medical students

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Training on professionalism for medical students

On February 16, the QMA’s Students Committee held its second professionalism training course on the topic of future issues facing Québec’s healthcare system.

ACTION FormationProfessionalismeAntonia Maioni, political science professor at McGill University’s Department of Political Science and Institute for Health and Social Policy, gave a synopsis of the history of Québec’s healthcare system. The healthcare system in predominantly Francophone and Catholic Québec was long run as a self-contained entity by the church and charitable organizations; however, along with the education sector, the province’s healthcare system fell under the purview of the state in the 1970s.

Since then, the provincial government has had the difficult task of negotiating with Québec’s physicians. Case in point, when Claude Castonguay implemented the Health Insurance Act, not all doctors were on board with the move. What the government was hoping for, however, was support from physicians in bringing about social change. According to Ms. Maioni, while family physicians grasped the important task being set for them, specialists were another story. Afraid of being short-changed, they called a strike in October 1970. Many specialists also moved out of Québec at the time.

Mr. Castonguay’s vision for the healthcare system was quite modern for the time. As Ms. Maioni pointed out, he was one of the first to understand the importance of social determinants on health, and Québec was the first province to create a system that combined health and social services. The other notable feature of the system was the decentralization of primary care services.

We would be remiss if we didn’t mention another legacy of our healthcare system. When the system was first set up, the federal government committed to covering half the costs under the Medical Care Act. But the rules of the game changed in the 1980s, when Québec started receiving less money from Ottawa for healthcare.

With costs constantly on the rise, the debate that’s been swirling around healthcare for decades has unfortunately become somewhat of a broken record. We question how much money the system costs to operate, but rarely how the money is actually spent. “Yet, money should be seen as a tool or a lever for getting things done. That should be what it’s all about,” points out Ms. Maioni, who also feels the efficiency of the healthcare system should be judged based on population health rather than performance indicators. “However, Québec has made remarkable strides in this area since 1960, when the population really wasn’t all that healthy,” said Ms. Maioni.

Physician engagement

ACTION FormationProfessionalisme2For his part, Dr. Hugo Viens, President of the Québec Medical Association, gave a presentation on physician engagement.

He started by reiterating a few basic principles of professionalism, namely that it’s more than just a competency, it’s a pledge to society.

“The reason students give most often for wanting to become doctors is so they can help patients,” he stressed. “The problem is, once they’re actually practising, doctors tend to focus on their individual relationships with patients and forget that they belong to a profession that has a responsibility to society.”

Dr. Viens went on to list several areas that physicians can concentrate on in their daily practice to increase their level of professionalism:

  • the appropriateness of the care and procedures they administer;
  • educating patients to create a better public perception of healthcare needs (we know expectations are high!);
  • multidisciplinary work with other caregivers;
  • the organization of patient care;
  • shared decision-making; and
  • innovation.

Dr. Viens also explained that the next generation is aware that the social determinants of health play a bigger role than the healthcare systems themselves in guaranteeing good population health, and that they can leverage this knowledge to transform the healthcare system. In fact, that’s why it’s crucial that we improve care trajectories and make them less costly, as well as implement more integrative practices. This is within reach for doctors, who need to step up and be leaders in overhauling the healthcare system, being best positioned as they are to implement a multidisciplinary approach, a review of compensation methods, a reorganization of healthcare systems and, above all, the teamwork model. 

In conclusion, Dr. Viens stressed that in this era of “doctor bashing,” physicians as a whole may be seen in a negative light, but individually they still have sway, and they need to have the courage to have the big conversations: “Our voice still carries weight, so let’s use it to defend our patients.”

 

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Introduction to medical practice management: Understanding and fulfilling your role in the organization

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Introduction to medical practice management: Understanding and fulfilling your role in the organization

The Québec Medical Association offers the Introduction to Medical Practice Management training course to public health institutions that want to give physician executives the opportunity to increase their autonomy and expand their influence.

This comprehensive training course covers basic knowledge about the structural, financial, human and legal aspects of physician executives’ working environments. This knowledge is vitally important to physician executives being able to more effectively take on their managerial role and more easily carry out their assigned responsibilities.

"100% of the physician executives who have completed this training course acquired a better understanding of how their organizations work and, as a result, gained more autonomy in their roles as managers."

The trainers—a management expert and a physician who has worked in management positions—will take the participants through a series of practical exercises, role-playing games, case studies, and theoretical presentations related to their work environments. The training course is tailored to the rules and regulations of each healthcare institution that requests it.

The training is accredited (CPD) and offered only in French.

For more information, visit the Offre de service section in the Physician executives tab of the QMA’s website or email Catherine Hamel at catherine.hamel@amq.ca.

 

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SNPs and diagnoses

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SNPs and diagnoses

On February 22, the Collège des médecins du Québec (CMQ) adopted a resolution to allow specialized nurse practitioners (SNPs) to diagnose certain common health problems related to their specialities, for example, urinary tract infections, ear infections, and sexually transmitted infections. They will also be able to diagnose six chronic diseases: diabetes, hypertension, hypercholesterolemia, asthma, chronic obstructive pulmonary disease, and hypothyroidism.

Since 2007, SNPs have been able to start treatment for these conditions but were not allowed to formally diagnose them; their diagnosis had to be confirmed by a physician within 30 days, which is now no longer necessary.

However, we’ll have to wait another few months before SNPs will be able to make diagnoses. The CMQ and the Ordre des infirmières et infirmiers du Québec (OIIQ) are set to produce a joint draft regulation that will be adopted at the CMQ’s next Board meeting on April 26. The regulation will then be submitted to the Office des professions, after which it must be approved by the Government of Québec.

Note that the National Assembly unanimously passed a motion introduced by the Parti Québécois asking the government “to put a swift end to the compensation of physicians for the general supervision of the front-line medical activities of SNPs.”

A family medicine group receives $30,000 per year for the “supervision” of an SNP by the physicians and $30,000 for the SNP’s use of the office space, equipment and staff.

Minister of Health and Social Services Danielle McCann has promised to follow through on this motion, but the Fédération des médecins omnipraticiens du Québec (FMOQ) is opposed to it. In fact, the two have differing opinions on what the “supervision” of an SNP actually means. The Minister of Health and the CMQ believe that the supervision of an SNP consists in the “general supervision” of the SNP’s medical acts, whereas the FMOQ views it more as “collaboration between professionals,” or case discussions. And according to the FMOQ, physicians need to be compensated for their collaborative work with SNPs, an opinion that is shared by the Association des infirmières praticiennes spécialisées du Québec (AIPSQ).

 

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The Health Commissioner should report directly to the National Assembly

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The Health Commissioner should report directly to the National Assembly

Danielle McCann, Minister of Health and Social Services, has announced that a new Health and Welfare Commissioner is expected to be appointed in June. This is good news! Given that the health and social services system accounts for more than 50% of program expenditures, it is essential that its performance be assessed, and neither the department, nor the network, nor its stakeholders are able to do so independently.

Let’s be honest, who else but the Health and Welfare Commission would have dared to survey the public about the care and services included in the basket of services and therefore covered by the province? Who else could have demonstrated, in one report after another, that there’s a problem with access to data in our healthcare institutions, on the front lines and within the department itself? Who else would have collected unpublished data for Québec from the Commonwealth Fund (CWF) International Health Policy Survey to compare the province’s performance with that of other systems? And finally, who else would have had the courage to fund not just one, but two independent studies to assess the effects of physician compensation payment methods on access to care?

The Commission has proven its worth over the past 10 years

The Health and Welfare Commission was created in 2006 by then Minister of Health and Social Services Philippe Couillard. Over the years, the QMA has been involved in many of the Commission’s initiatives. The QMA is also the only association that worked with the Commission until it was dismantled, making it possible to disseminate the results of the research it funded on physician compensation methods.

Although many people expressed doubts about the creation of the Health and Welfare Commission, it proved to be very productive. The Commission’s thematic reports addressed key issues such as primary care, chronic diseases, mental health, aging, etc. Its performance studies (emergency, CWF, etc.) and opinions on new legislation (medically assisted reproduction, end-of-life care, etc.) helped inform the public on complex issues.

Year after year, while continuing to rely on rigorous studies and conclusive scientific evidence, the Health and Welfare Commissioner demonstrated increasing incisiveness. The Commissioner brought the debate on health care issues into the public domain while addressing increasingly political issues such as the basket of insured services, accessibility, safety in health care, and physician compensation methods.

An essential role whose independence must be safeguarded

It’s not surprising that some people wanted to silence this independent and increasingly influential voice. By cutting off funding to the Health and Welfare Commission, the Liberal government surprised many people in 2016, just as it did again in May 2018, when it announced the reinstatement of the Commissioner just a few months prior to the impending elections.

To avoid seeing the same tactics used by future governments, we must ensure that the Health and Welfare Commissioner reports directly to the National Assembly—a position we’ve held since the very creation of the office. It’s been clearly proven that when the Commissioner and his team are seen to be causing too much trouble, the simple solution is to cut off their funding. Likewise, it’s dangerous to give governments the final say in his appointment—as stipulated in the Act respecting the Health and Welfare Commissioner—as this can expose the Commissioner to political pressure. Because appointments are made by the government, they are always considered to be political. 

However, in order to be relevant, the role of the Health and Welfare Commissioner must be neutral and objective. His independence will enhance his credibility and lend more weight to his recommendations. For that to be the case, the Commission must be protected from political interference. Let’s not forget that the Health and Welfare Commission’s ultimate goal is to improve the health and well-being of the people of Québec. It is therefore in our best interests as caregivers, as well as in the best interests of our patients, that we as physicians demand that the Commissioner be appointed by and accountable to the National Assembly.

Dr. Hugo Viens, B.Sc., M.D., FRCSC 
President, Québec Medical Association

 

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Rules of Moderation for Comments Submitted to QMA-Info

Wishing to promote quality discussions among its members, the QMA welcomes your opinions and invites you to comment on its articles. But first, we would like to lay down a few rules to ensure a tone of moderation in members’ comments.
To begin with, your comments will be read before they are published—not to censure the content, but rather to ensure a friendly forum for discussion.  
So, in order for your comments to be published, we ask you to abide by the following rules:

• Do not overuse capital letters: putting everything you want to say in capital letters is akin to shouting;
• Avoid making discriminatory statements: obviously, statements that may be construed as racist or sexist will not be tolerated;
• Refrain from making aggressive or violent statements: you are free to disagree with something you’ve read, but avoid overreacting;
• Do not insult people: As physicians, we must foster collegiality in our communications with one other.

Our goal, of course, is to promote good discussions.
Thank you for your understanding.

 

 

To comment on this article or view the other comments, click here.
Comments in both languages are grouped in the French version.

Loss of a builder

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Loss of a builder 

Long-standing QMA member Dr. Léo-Paul Landry passed away on March 6. A highly active member of the profession, Dr. Landry devoted his career to advancing and improving health care.

A native of Moncton, NB, Dr. Landry earned his medical degree from Université Laval, where he specialized in internal medicine and pediatrics, and also completed an MBA in 1972.

He served as associate executive director of the Montreal General Hospital, where he implemented an integrated budgeting strategy for the hospital. In 1986, he accepted an invitation to become secretary general of the Canadian Medical Association, and then became CEO in 1996.

“I thought I could bring entrepreneurship and innovation to an organization that had not realized its potential,” he explained in an interview granted on the occasion of his retirement in 1999.

A leader and a visionary, he did indeed breathe new life into the more than 100-year-old institution. Under his influence, the CMA adopted openness, excellence and professionalism as its corporate values.

“Dr. Landry was also the CEO that left the greatest mark on the CMA," recalled QMA Executive Director Normand Laberge. 

Unifying physicians

In fact, he is largely responsible for turning “a small Québec-based investment fund into a company that ultimately became a voluntary pension fund for doctors across Canada,” stated Mr. Laberge. This company, now known as MD Financial Management, was recently sold for close to $3 billion dollars. So, as his legacy, Dr. Landry essentially secured the future of the CMA for centuries to come.

He also helped built strong bridges between the national association and Canada’s various provincial medical associations. Even after his retirement, and until his health no longer permitted, he always attended the QMA’s annual general meetings and conferences, and the meetings of the QMA’s delegation to the CMA.

It was “for his contributions to unifying the medical profession throughout his career” and “for his efforts to raise the profile of medicine in Québec, Canada and internationally” that the QMA honoured Dr. Landry by making him the first recipient of its Prestige Award in 1999. He also received the CMA’s Medal of Service in 2013.

On the provincial scene, Dr. Landry was a medical consultant for the Québec government. He also authored a key report on the provision of medical services in isolated and remote areas, which led to the creation of a government-funded program to attract and retain physicians in these communities.

 

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Jean Pierre Normand: a man of many passions

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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.

Dr. Jean Pierre Normand: a man of many passions

DrNormandWine aficionado and QMA member Dr. Jean-Pierre Normand made a leap when he decided to get involved a few years ago in designing an app for managing wine cellars. Since then, he’s been working as a beta tester to help develop the smart wine cellar app Alfred, l’expert en vin. And for the past two months, in addition to his full-time hospital and clinic work as an interventional radiologist, he’s also served as VP, Business Development for the company that designed the app.

“It’s quite the change of scenery,” the doctor admits, even though it’s not actually that surprising. The radiologist also has a head for business.

After earning his MD from Université Laval in 1986, Dr. Normand completed his speciality in diagnostic radiology in 1993, “at the absolute perfect time,” just as the field hit a major upswing. In fact, the 1990s saw a complete transformation in radiology, which became a mainstay of several diagnostic procedures thanks to important developments that propelled it to the forefront of medicine: CT scan, fluoroscopy, mammography, ultrasound, MRI, PET scan, nuclear medicine, and interventional radiology.

After completing a micro-fellowship in the 2000s at Stanford University with Dr. Michael Dake, a pioneer of interventional radiology in the U.S., Dr. Normand became the first interventional radiologist to perform thoracic endoprostesis in Québec City. However, his fondest memory with Dr. Dake, who even attended two conferences in Québec organized by Dr. Normand, is sharing a good bottle of wine together. At one point, Dr. Dake invited Dr. Normand to his home, where the two men shared a meal over a bottle of Georges de Latour Private Reserve in what proved to be an epiphany for Dr. Normand!

Alongside his illustrious hospital career—notably as Chief of Radiology at Centre hospitalier régional de Trois-Rivières and at the Hôpital de Thetford Mines—Dr. Normand has helped found several radiology clinics over the years. Part owner of four of them (Clinix imagerie médicale et intervention, IRM Québec, Imagix and Radiologix), he has also partnered with the start-up Bodycad, which is poised to market customized prosthetics made from 3D renderings of medical images of patients’ knees.

 

 


 

Alfred, l’expert en vin is a mobile app that helps users manage their wine cellar. Wine lovers use it to scan their bottles and generate water- and fire-resistant stamps containing all the relevant information about each wine, guaranteeing these important details won’t be lost in a flood or fire. This also lets them easily find the wine they’re looking for, even bottles that have spent years in storage. Alfred is also useful for keeping track of the market value of bottles and the best time to drink them, to avoid losses associated with the deterioration of cellared wines. Another interesting feature is that subscribers have access to the inventories of the SAQ and some 450 wine importers and are legally allowed to buy or sell bottles among themselves. They can also live chat with a dozen top sommeliers and use the app to choose which wine from their cellar pairs best with their menu. A pro version has also been developed for restaurant wine cellars.

Discover Alfred : alfredsommelier.com/en

Application Alfred

 

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Twitter and Facebook messages of the month

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Are you interested in the latest medical news, the future of the medical profession and health issues? Then join our community in the social media, where the opinion leaders express their views! Our communities are growing. Follow us and connect with us!

twitter @amquebec

facebook www.facebook.com/AMQ.QUEBEC

Messages on Twitter

 

 

 

 

 

 

 

Messages on Facebook

 

 

 

 

 

 

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The CMA is seeking your participation in an important study

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The CMA is seeking your participation in an important study

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Once again, the Canadian Medical Association (CMA) is asking all practising physicians in Canada to help plan for a future health care system that meets the needs of both patients and providers.

The Québec Medical Association encourages you to respond to this survey so that it reflects your experiences as a physician in Québec. Knowing about your practice – from your thoughts on national licensure to your use of technology and hours you work – will help draw a more accurate picture of the medical profession at the national, provincial/territorial and regional levels as well as by specialty. Knowing about your practice – from your thoughts on national licensure to your use of technology and hours you work – will help draw a more accurate picture of the medical profession at the national, provincial/territorial and regional levels as well as by specialty.

As a token of the CMA’s thanks, all practising physicians can enter a draw for one of five $1,000 cash prizes by completing the ballot at the end of the survey or by clicking here for more information and full contest rules. Additionally, for every 5,000 responses received, the CMA will make a donation of $1000 to Doctors Without Borders.

Once available, aggregated results will be posted on the CMA website and will be used by the CMA and other stakeholders, such as researchers and health human resource planners, to inform policy decisions and advocate for required changes to our health care system. Over 7,000 physicians responded to the 2017 CMA Physician Workforce Survey.

Share your input by completing a short, seven-minute survey: www.cma.ca/workforce2019  

If you have any questions about this survey, please contact Tara S. Chauhan at tara.chauhan@cma.ca

 

 

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The QMA appears on les aventures du Pharmachien

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The QMA appears on les aventures du Pharmachien

PharmachienThe QMA continues to pursue its goal of raising public awareness about overdiagnosis. As such, Dr. Hugo Viens and Dr. Vincent Demers, respectively president and vice-president of the QMA, made an appearance last season on the ICI Explora channel’s Les aventures du Pharmachien to clarify the roles of antibiotics and screening tests and to discuss their appropriateness with the show’s host.

 

Subscribers of ICI Explora can watch the two episodes (#37 - Les antibiotiques, #38 - Les tests médicaux) by clicking here, then selecting Épisodes, and Saison 3. You can then select the episodes that interest you. Enjoy!

Bill to cut the severance pay of health and social services officers in half

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Bill to cut the severance pay of health and social services officers in half

On February 26, Minister of Health and Social Services Danielle McCann introduced Bill 7, An Act respecting certain terms of employment applicable to officers of the health and social services network.

Bill 7 is declaratory and confirms the authority of the Minister of Health to determine the remuneration and working conditions of officers “notwithstanding any judicial decision and any decision of a body of the administrative branch rendered prior to the enactment of the minister’s regulation.” It also allows the minister to enact a retroactive regulation on job stability measures, severance pay, and pre-retirement leaves by officers of the health and social services network.

The Coalition avenir Québec is therefore resurrecting Bill 160 tabled by then Minister of Health Gaétan Barrette in November 2017 to counteract the Superior Court decision that went again employers. In fact, the Court overturned a regulation in Bill 10, which saw severance packages reduced from 24 months to 12 months for 1,300 officers whose positions were abolished.

However, Bill 160 died on the order paper before the October 2018 election.

 

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