Saskatchewan Medical Assocation Reports for the Representative ...

Saskatchewan Medical Assocation 

Reports for the Representative Assembly 

Regina, Saskatchewan | May 14-15, 2010

Mission Statement 

To advance the educational, professional and economic welfare of Saskatchewan physicians, 

To advance the honour and integrity of the profession, and 

To promote promote quality health care practices, quality health services, and advocate for a 

quality health care system for Saskatchewan.

Contents 

2 | Agenda for the Spring 2010 Representative Assembly 

4 | 2009-2010 SMA Representative Assembly Delegates 

5 | 2009-2010 SMA Board of Directors and SMA Staff 

7 | Report from the Board of Directors 

16 | Reports from SMA Committees 

16 | Finance Committee 

18 | Medical Benevolent Society 

20 | Member Advisory Committee 

22 | Primary Care Working Group 

24 | Saskatchewan Physician Support Program 

26 | Legislative Committee 

27 | Report from the Canadian Medical Association 

30 | Reports from Affiliated Committees 

30 | Division of Continuing Professional Learning 

34 | Joint Medical Professional Review Committee 

35 | Practice Enhancement Program Committee 

41 | Financial Statements of the Saskatchewan Medical Association 

41 | Auditor’s Report to the Members 

42 | Financial Statements 

46 | Notes to the Financial Statements 

56 | Schedules 

May 2010 | SMA Reports to the Representative Assembly 1

Agenda for the 

2010 Spring Meeting of the Representative Assembly 

May 14-15, 2010 

Hotel Saskatchewan, Regina 

Section Meetings | Thursday, May 13 - Friday, May 14 - Saturday, May 15 

Welcome Reception | Thursday, May 13 

2000 - 2300 Registration and Reception 

Representative Assembly - Day One | Friday, May 14 

0800 Registration and Continental Breakfast 

0845 Representative Assembly - Call to Order | Dr Stan Oleksinski 

Welcome and Introductions 

President’s Address | Dr George Miller 

0915 Minutes of the November 2009 Meeting 

Review of November 2009 Resolutions 

Board of Directors Report 

0945 Nominating Committee Report 

Finance Committee Report 

1015 Break 

1030 SMA Board’s New Strategic Plan 

1050 Items from RMAs or Sections and Resolutions 

1115 Clinical Practice Redesign (CPR) 

• What is it? 

• How is it working in practice? 

• How do we implement CPR Province-wide? 

1200 Lunch Buffet 

Humanity First: Experiences with Volunteerism and Benevolence | Dr Habib Rehman 

1315 Saskatchewan Surgical Initiative 

• What is it? 

• How will it impact physicians? 

• How can physicians facilitate this Initiative? 

2 SMA Reports to the Representative Assembly | May 2010

1515 Break 

1530 Items from Sections or Regions and Resolutions 

1545 Address by Minister of Health | Honourable Don McMorris 

1645 Elections 

1700 Adjourn 

Hospitality 

1830 Reception 

1930 Annual Dinner and Installation of President 

Representative Assembly - Day Two | Saturday, May 15 

0745 Registration and Breakfast 

0830 Representative Assembly Reconvenes 

• Address by CMA President | Dr Anne Doig 

• CMA Board Report 

• CMPA Board Report 

• Report from MD Physician Services Inc 

0915 Health Quality Council: Strategic Direction | Dr Peter Barrett (Vice Chair), Bonnie Brossart (CEO) 

0945 Physician Health and Wellbeing | Dr Senthil Damodharan 

1015 Coffee Break 

1030 Resolutions 

1100 In Camera - Negotiations Update 

1200 Annual General Meeting 

1215 Adjournment 

RMA President’s Workshop | Saturday, May 15 

1230 – 1530 RMA Presidents’ Workshop (separate agenda to follow) 


SMA Representative Assembly Delegates 

Cypress 

Dr Shamsuddin Fakhir 

Dr Suresh Kassett 

Dr Clare Kozroski 

Dr Dawood Moola 

Five Hills 

Dr Mark Brown 

Dr George Miller 

Dr Brandon Thorpe 

Dr Intheran Pillay 

Heartland 

Dr David Ledding 

Dr Barry Oberleitner 

Dr Lyle Williams 

Keewatin (Athabasca) 

Vacant position 

Kelsey Trail 

Dr Lionel Lavoie 

Dr Gert Pieterse 

Dr Larry Sandomirsky 

Mamawetan (La Ronge) 

Dr Hannes Kleingeld 

Prairie North 

Dr Gordon Craib 

Dr Kevin Govender 

Dr Mahesh Khurana 

Dr Martinus Moolman 

Dr Isaac Thomas 

Prince Albert Parkland 

Dr Mark Arsiradam 

Dr Rohan Cornelissen 

Dr Brenda Hookenson 

Dr Stan Oleksinski 

Dr Joanne Sivertson 

Dr Janna Tumbach 

Regina Qu’Appelle 

Dr Ron Ailsby 

Dr Alan Beggs 

Dr Joseph Buwembo 

Dr George Carson 

Dr Ettiene Crouse 

Dr Chris Ekong 

Dr Adam Gruszczynski 

Dr Siva Karunakaran 

Dr Donald McCarville 

Dr Dhanapal Natarajan 

Dr Terry Ross 

Dr Guruswamy Sridhar 

Dr Bhanu Tikkisetty 

Dr Vijay Trivedi 

Saskatoon 

Dr Vern Bennett 

Dr Dennis Bishop 

Dr Shayne Burwell 

Dr Anne Doig 

Dr Mark Ernst 

Dr Jeff Hunt 

Dr Daniel Kirchgesner 

Dr Karen Laframboise 

Dr Barbara Large 

Dr Crystal Litwin 

Dr Arthur Robinson 

Dr Dalibor Slavik 

Dr Thirza Smith 

Dr Don Stefiuk 

Dr Joel Yelland 

Sunrise 

Dr Philip Fourie 

Dr Adriaan Louw 

Dr Johan Van Zyl 

Vacant position 

Sun Country 

Dr Nicholaas Botha 

Dr Alain Lenferna 

Dr Don MacRae 

Dr Boyd Stewart 

Sections 

Anaesthesia 

Dr Janet Shannon 

General Practice 

Dr Rizqi Ibrahim 

General Surgery 

Dr Joe Pfeifer 

Emergency Medicine 

Dr Mark Wahba 

Internal Medicine 


Neurology 

Dr Christopher Voll 

Neurosurgery 

Dr Joseph Buwembo 

Obstetrics and Gynaecology 

Dr Charles Simpson 

Ophthalmology 

Dr Dustin Coupal (south) 

Dr Kevin Colleaux (north) 

Orthopaedics 

Dr Allan Woo 

Otolaryngology 

Dr James Fritz 


SMA Board of Directors 2009-2010 

Paediatrics 

Dr Tilak Malhotra 

Pathology 

Dr Ed Jones 

Executive Committee 

Dr George Miller, Moose Jaw 

Dr Guruswamy Sridhar, Regina 

Dr Phillip Fourie, Yorkton 

Dr Milo Fink, Regina 

President 

Vice President 

Honourary Treasurer 

Past President 

Plastic Surgery 

Dr Jeff Blushke 

Psychiatry 

Dr Declan Quinn 

Public Health 

Dr Maurice Hennink (south) 

Dr Johnmark Opondo (north) 

Radiology 

Dr Don McIntosh 

Urology 

Dr Peter Barrett 

Others 

Speaker 

Dr Stan Oleksinski 

Deputy Speaker 


Past President 

Dr Joe Pfeifer 

Student Medical Society 

Mr John Dautremont 

Mr Jon Bastian 

PAIRS 

Dr Mary Kinloch 

Dr Nicole Hawkins 

Board Members 

Dr Mark Arsiradam, Prince Albert 

Dr Shayne Burwell, Saskatoon 

Dr Jeff Hunt, Saskatoon 

Dr Clare Kozroski, Gull Lake 

Dr Barbara Large, Saskatoon 

Dr Intheran Pillay, Gravelbourg 

Dr Dalibor Slavik, Saskatoon 

Dr Joel Yelland, Saskatoon (CMA Board Rep) 

Dr Nicole Hawkins (PAIRS Rep) 

Ms Melanie Flegel, Saskatoon (SMS Rep) 

SMA Staff 

Dr. Martin Vogel, Executive Director / CEO 

Scott Donaldson, Communications Director 

Allan Florizone, Economics Director 

Ed Hobday, Administrative Director 

Brenda Senger, Physician Support Programs Director 

Cindy Anderson, Senior Insurance Administrator 

Wendy Boucher (on leave), Executive Assistant 

Elizabeth Cochran, Economics Administrator 

Doré Collett, Communications Coordinator 

Gloria Drever, Accounting Administrator 

Brenda Elliott, Accounting Coordinator / Administrator 

Myrna Ferster, EMR Change Management Advisor 

Betty Freiermuth, Insurance Accounting Administrator / CMPA 

Joelle Kostiuk, Membership Administrator / CME 

Sarah-Jane Olsen, Physician Relief Program Administrator 

Danielle Post, IT Administrator 

Roy Robb, IT Director 

Arash Shadmani, IT Programmer Analyst 

Sarah Vogel, Receptionist 

Kerilyn Voigt (on leave), Communications Administrator 


Report from the Board of Directors 

Negotiations 

After a lengthy break, the SMA and 

Government have returned to the central 

bargaining table, as the work of the five 

Medical Compensation Review Committees 

(MCRC) working groups is nearing 

completion. The SMA bargaining team is 

anxious to conclude this Agreement, as 

it is now almost a year since the previous 

agreement expired and 18 months since we 

initiated bargaining. 

Quality and Access – The working group is 

drafting a proposal to target funding to the 

following areas: 

1. Clinical Practice Redesign 

2. Dedicated quality improvement work 

3. Physician contacts with patients via 

telephone and email 

4. Support for distributed surgical services 

5. Funding for CME directed towards 

Quality Improvement 

At the time of printing, two MCRC meeting 

dates with the Government are scheduled: 

one later in April and one early in May. 

We expect that the first will review the 

reports from the five Working Groups. 

At the second meeting, we will seek to 

discuss moving forward, the Government’s 

bargaining mandate, and a plan to 

conclude these negotiations expeditiously. 

Four of the five working groups are 

nearing completion of their work. The fifth 

group (non fee-for-service bargaining) will 

continue to meet in parallel with the main 

MCRC negotiations. The progress of these 

Working Groups to date is as follows: 

Full Service Family Practice – A proposal 

is being developed that defines pay 

premiums for both urban and rural full 

service family practice. 

Chronic Disease Management – The 

Working Group is refining its proposal 

to reflect that, during the course of this 

agreement, bonus payments will be 

based upon physicians following accepted 

clinical pathways and participating in 

processes with proven positive clinical 

outcomes. It is not expected that physician 

payments would be linked directly to 

clinical outcomes during the period of this 

contract, but this may be considered in the 

future if the initial strategies are successful. 

On Call Working Group – The Government 

and SMA recognize the need to enhance 

both the Specialist and Rural Emergency 

Room Coverage Programs. The SMA 

has strongly advocated for a specific 

metro family physician on call program, 

to remunerate physicians who remain 

available to patients after hours and who 


are available to take telephone calls from 

hospital inpatient staff and nursing home 

staff regarding the care of their patients. 

While the Ministry remains reluctant to 

acknowledge the value of such a program, 

the SMA continues to stress its importance. 

Non Fee-for-Service Working Group – There 

has been some progress in the discussions 

regarding a bargaining framework for non 

fee-for-service physicians. The Government 

has long held that there should be a central 

bargaining table that would negotiate all 

non-fee-for-service rates together (similar 

to the MCRC process). The SMA team has 

indicated that this might be acceptable, 

provided that there is a transition process in 

place to bring several contracts up-to-date. 

There also needs to be a formal mechanism 

to determine appropriate expectations of 

workload, the complement of physicians 

needed to deliver the required services, and 

appropriate payment grids. A binding third 

party mechanism to resolve outstanding 

matters is essential. 

The bargaining team remains hopeful that 

a negotiated settlement can be reached this 

spring so that funding can be allocated to 

sections and a new payment schedule can 

be put in place later this year. The SMA 

bargaining committee would like to be 

ready in case negotiations do not proceed 

as expected. The SMA Board has recently 

agreed to form a Political Action Committee 

to begin developing a strategy to support 

negotiation efforts, and has contacted 

individual Regional Medical Associations for 

their representation on the Committee. 

Negotiated compensation increases in the 

final agreement will be retroactive to April 1, 

2009. Further details will be provided during 

the in-camera session on Saturday morning. 

SMA Strategic Plan 2010 – 2012 

The Board of Directors has approved the 

2010 – 2012 Strategic Plan that will guide 

the SMA for the next three years. The 

Plan consists of four over-arching strategic 

priorities, each with goals and the actions 

necessary to achieve success in each priority 

area. Priorities are now being assigned 

to the appropriate SMA staff along with 

responsibilities and accountabilities for 

implementation of initiatives within the 

three-year timeline. A business plan is being 

developed that bridges existing activities 

with the strategic plan to help steer the 

annual budget process. 

Saskatchewan Surgical Initiative 

(SKSI) 

The Saskatchewan Surgical Initiative Plan 

was released March 29, 2010 in Regina. 

Saskatchewan physicians, surgeons, nurses, 

health care administrators, former surgical 

patients, health sector organizations, 

associations and unions as well as the 

Ministry of Health have all partnered on 

this initiative. The vision of the SKSI is to 

improve the experience of Saskatchewan 


surgical patients; reduce surgical wait times 

to no more than three months in four 

years; ensure that shorter wait times can 

be sustained into the future; and to make 

changes that result in better and safer care 

for surgical patients. The SKSI is guided by 

the cooperative efforts of two important 

advisory groups: the Executive Sponsor 

Group provides strategic leadership, advice 

and direction for the surgical initiative 

and champions the transformation 

of the patient’s surgical experience in 

Saskatchewan; and the Guiding Coalition, 

representing the front line experience, 

developed a series of specific actions and 

initiatives that they believe will improve the 

surgical experience for patients. The CEO 

of the SMA is a member of the Executive 

Sponsorship Group, and two SMA Board 

members as well as numerous other SMA 

members, are part of the Guiding Coalition. 

Primary Care Models and Patientcentred 

Care 

There is a recent resurgence of interest by 

the provincial government to transform 

the primary care model to align with 

recommendations for patient-centred 

care as outlined in the Dagnone Report. 

The Board considered which direction 

the Primary Care Working Group (PCWG) 

should focus on given that there are a 

number of existing successful models for 

primary care in high performing health 

systems. Board members were unanimous 

in that any model chosen should be realistic 

in terms of the situation in Saskatchewan. 

They felt that it would be more prudent 

to look at and adapt ideas from successful 

systems with similar issues to those of 

Saskatchewan such as the South Central 

Foundation in Alaska than it would be 

to look at more utopian facility-based 

models developed under other private 

health care systems in the USA. The SMA 

will work with government to develop a 

model emphasizing full scopes of practice 

and collaborative team based practice, in 

a patient and family-centred setting. The 

SMA is cautiously optimistic that a new 

primary care model will become part of the 

infrastructure that drives success on the 

Saskatchewan Surgical Initiative forward. 

Physician Referral Guide Website 

(PRGW) 

The PRGW has been accessible to 

physicians since last summer and has 

been well received. The SKSI Guiding 

Coalition recommended that the site be 

accessible to the public to help keep them 

better informed about waiting times for 

specialists and surgeries. The Board moved 

to support having the site public as long as 

the information is kept accurate and that 

systemic factors contributing to long waits 

do not portray physicians in a negative light. 


Physician Recruitment Agency 

The provincial government announced the 

establishment of a Physician Recruitment 

Agency on December 7 in Saskatoon with the 

Saskatchewan Medical Association on board. 

The development of the recruitment agency is 

a key component of the physician recruitment 

strategy announced earlier in 2009. 

The agency is led by a nine-member 

board composed of representatives 

from partnering groups, including the 

Saskatchewan Medical Association, 

health regions, the College of Medicine, 

the Professional Association of Internes 

and Residents of Saskatchewan, the 

Saskatchewan Association of Rural 

Municipalities, the Saskatchewan 

Urban Municipalities Association, and 

the provincial government. A patient 

representative will also participate. 

Operational by summer 2010, the physician 

recruitment agency will act as a one-stop 

point of contact for physicians seeking to 

set up practice in Saskatchewan. It will 

enhance and coordinate recruitment efforts 

across the province, working closely with 

physicians, health regions and communities 

to address their need for physicians. The 

CEO of the SMA has been named as the 

SMA Representative on the Board. 

Champions for Quality 

Improvement (CQI) 

Physicians have a key role to play in 

improving the quality and safety of 

health care. In Saskatchewan, there is 

a growing network of doctors with a 

passion for and specific skills in quality 

improvement. They are supported by an 

advisory group, Champions for Quality 

Improvement (CQI) that is co-chaired by 

the Saskatchewan Medical Association and 

College of Physicians and Surgeons. The 

mandate of the group, which also includes 

Representatives from the University of 

Saskatchewan’s College of Medicine, the 

Ministry of Health, and the Health Quality 

Council, is to help doctors play a leadership 

role in improving care for patients. Having a 

critical mass of physicians with knowledge 

and experience in quality improvement 

is one of the keys to creating a highperforming 

health system. 

The CQI is putting together a three-year 

plan for training and engaging physicians 

in leadership and quality improvement. The 

first draft plan identifies four categories 

for physician advancement in QI including 

early adopters, physician champions, formal 

leaders and executive leaders. The CQI has 

asked the participating organizations if they 

approve of the categories and plan. The SMA 

Board expressed that, in principle, they were 

satisfied with the general direction of the 

three year draft plan. The Board further stated 

that in order to determine value for money 


the plan should be re-evaluated in three 

years; accept early failures, but also go to the 

next level to determine what the outcomes 

of success are. A good measure for return on 

investment would be to look at the metrics 

of pre/post course surveys, participation in 

organizations and monitoring system change 

over time. The Board also stated that it is 

important to evaluate more than the early 

adopters, but to also look to the respected 

voices of SMA members in individual fields 

in order to determine successful leadership 

outcomes. The Board’s recommendations 

will be taken back to the CQI for further 

consideration and refinement as the threeyear 

plan continues to take shape. 

Electronic Medical Record 

(EMR) Program 

The Saskatchewan EMR Program was 

created to assist physicians with the 

implementation of EMR systems in their 

clinics. Through a joint funding agreement 

between the SMA and the Saskatchewan 

Ministry of Health, physicians in 

Saskatchewan can receive on-going support 

to adopt one of the approved Electronic 

Management Record (EMR) solutions. 

The SMA and the Ministry of Health have 

adopted a multi-faceted approach to 

change management and funding to assist 

physicians with implementation and use. 

increasing at a faster rate than EMRdedicated 

staff are able to respond. This 

will soon begin to delay implementation 

for some physicians. In order to meet 

growing demand for change management 

services for conversion from paper to 

electronic records, additional EMR program 

team members are needed. The EMR Co- 

Management Committee proposed a twoyear 

boost in capacity to accommodate the 

need to increase services. The incremental 

two year cost of the proposal to hire five 

additional change management advisors 

(the program currently has one), a privacy 

officer, and a vendor management officer is 

$2.5 million. The money will be drawn from 

the accumulated amount in the EMR fund. 

The SMA Board approved the proposal. 

CMA Blueprint for Transformation: 

Patient Quality Charter 

While supporting the principle of a patient 

quality charter, the SMA Board, along with 

other PTMAs, remains unsure of the purpose 

for creating such a charter. The Board has 

recommended that CMA President Anne 

Doig focus her spring address to the SMA 

Representative Assembly on health care 

transformation and the patient charter to 

help give SMA delegates a more thorough 

understanding of the CMA’s intent. 

The EMR Co-Management Committee 

reported to the Board that the program 

is progressing well, but the demand is 


Collaborative Practice 

The SMA is currently advancing the 

collaborative care concept and is working 

with pharmacy, optometry, and nursing. 

Enhanced Prescriptive Authority for 

Pharmacists 

On Wednesday, March 3, 2010 Health 

Minister Don McMorris announced the 

intent to expand prescribing authority for 

Saskatchewan pharmacists by this summer. 

The new legislation recognizes the ability of 

pharmacists to improve health care delivery 

in the province, working in collaboration with 

doctors and other health care professionals. 

The legislation will facilitate the first of 

two levels of prescriptive authority. This 

encompasses activities that are within the 

competency of all pharmacists licensed in 

the province of Saskatchewan. Examples 

are: emergency refills, short term extensions 

and limited renewals until the patient can 

see their physician, and medications for 

self-care where the product monograph 

contains appropriate instructions. 

Collaboration in the relationship between 

the pharmacist and physician involved in 

the care of the patient must be sufficient 

so that the physician can rely upon the 

basic skills of the pharmacist to prescribe 

in the best interests of the patient, 

communicate those decisions back to 

the physician, and refer the patient on 

to them when appropriate. Ongoing 

communication between the pharmacist 

and the physician is expected. 

Subsequent introduction of the second 

level will follow in time. This requires that 

the pharmacist takes additional training, 

has a formal professional relationship with 

a physician and, in some cases, a written 

agreement. Further discussions on defining 

formal written agreements and collaborative 

prescribing agreements will ensue. 

Optometry 

The SMA and the Saskatchewan Association 

of Optometrists have facilitated discussions 

between ophthalmologists and optometrists. 

To date, there is agreement on the concept 

of collaborative practice and the comanagement 

of patients. There are some 

differences of opinion with respect to scope 

of practice. The SMA will continue working 

with ophthalmologists towards a collaborative 

model with optometrists that is similar to that 

achieved with the pharmacists. 

Nursing 

Systemic failures in the existing primary care 

model have lead to difficulties for patients, 

physicians and nurse practitioners - RN (NP) 

s. In a number of rural locations RN (NP)s are 

practising in isolation, with no linkage to a 

physician practice. Under current legislation 

and other regulatory instruments, this is 

causing problems with patient referrals 

to specialists. The SMA has been seeking 

a formal forum to address this issue for 


more than a year. It now appears likely 

that this might happen soon. Recently the 

Ministry’s Chief Nursing Officer and Executive 

Director of Primary Care have reaffirmed the 

government’s commitment to a collaborative, 

interdisciplinary, team-based model of care. 

Furthermore, the Deputy Minister has given 

his reassurance that the systemic policy 

deficiencies will be addressed. 

The SMA Board was very encouraged after 

Past President Dr. Milo Fink, attended the 

SUN Leadership Session on March 17, 2010 

in Regina. He presented to the SUN Board 

of Directors and District Council Chairs on 

patient-centred care from the physician 

perspective. Dr. Fink was very pleased with 

the response from the SUN leadership who 

emphasized the need for more physicians, 

especially in rural Saskatchewan. Attendees 

seemed very open to full scope of practice 

and collaborative practice arrangements. 

The SMA will follow up with SUN to build 

on opportunities to discuss collaborative 

care and patient-centred care. 

Student Medical Society 

Executive Committee 

Recently, the SMA Board had the 

opportunity to host the SMS executive 

committee to discuss their Political 

Awareness Day held March 15 in Regina. 

The students focused their discussion 

with politicians on the shortage of family 

practitioners in rural medicine, and the 

need to take actions that encourage 

medical students to take up practice in 

rural Saskatchewan. The students were 

very encouraged by the participation 

and interest shown by MLAs in medical 

student issues. The SMS plans to make the 

Political Action Day an annual event. SMA 

President Dr. George Miller stated that it 

is important both for government and the 

SMA Board to listen to medical students as 

they will be the physicians that inherit the 

legacy of initiatives currently underway. The 

profession must give medical students and 

interns/residents their rightful voice if we 

expect transformational change to succeed. 

Saskatchewan International 

Medical Graduate (IMG) 

Assessment Committee 

The SMA is working with the Government 

of Saskatchewan, the College of Physicians 

and Surgeons, the College of Medicine, 

and the regional health authorities to 

develop a new assessment process for 

IMGs seeking initial medical licensure 

in Saskatchewan. The committee has 

been gathering information from other 

jurisdictions in Canada to develop a process 

for Saskatchewan that will not only be 

consistent with the national standards as 

agreed to by all the Provincial Colleges 

through the Federal Medical Regulatory 

Authorities of Canada, but will also be 

efficient and cost effective. 


Practice Enhancement Program 

(PEP) 

Currently the program does not have the 

ability to do assessments in a number of 

the specialty areas. PEP would also like to 

secure more assessors for Family Practice. 

The Board agreed to assist PEP in recruiting 

and engaging physicians to become 

assessors for the specialty areas. 

Continuing Professional Learning 

(CPL) 

Dr. Penny Davis made a request for 

additional funding on behalf of CPL. The 

additional funds would allow CPL to expand 

online education initiatives by enhancing 

their website and technical support. The 

Board is supportive of increasing its funding 

support to CPL and has asked the Finance 

Committee to consider this in the coming 

budget cycle. The Board has also asked the 

Physician Benefits Committee to consider 

ways to support CPL through the CME Fund. 

College of Physicians and 

Surgeons of Saskatchewan (CPSS) 

The SMA Board has enjoyed a positive, 

mutually respectful working relationship 

with the CPSS and has been able to resolve 

most issues. A joint meeting of the Executive 

Committees of the SMA and the CPSS was 

held in December. At that time a number 

of outstanding matters were discussed: The 

Board received a report in which some of 

the issues were satisfactorily addressed. 

Competency Assessments 

There was agreement that further work 

be undertaken to examine the College’s 

approach towards and the existing process 

for conducting Competency Assessments. 

The Board has asked Dr. Joel Yelland 

and Dr. Milo Fink to meet with College 

representatives to discuss this matter. 

Rural Practice Redesign 

The SMA has placed a high priority on being 

an active participant in advocating for and 

assisting with the fundamental redesign 

of the way in which primary health care 

services are delivered. The College has 

expressed a desire to partner with the SMA 

in this regard. The SMA has a Primary Care 

Working Group (PCWG) that will be doing 

work in this area. Rather than creating a 

separate joint entity the Board has invited 

the College to have a Representative attend 

the PCWG meetings in an observer capacity. 

The Board has also provided feedback 

which will be considered at the next 

Council meeting. 

Joint Medical Profession Review 

Committee (JMPRC) 

The College had recommended a joint 

working group to review the role and 

functioning of the JMPRC. The Board 

noted that the recommendations in the 

revised billing review protocol done in 

2004 had not yet been fully implemented. 

It was felt that there was little point in 


establishing a working group to start 

a new review when there was still 

work to be done in seeing through the 

implementation of recommendations that 

had previously been agreed upon. 

With respect to the role of JMPRC in the 

non-fee-for-service (FFS) environment, the 

Board noted the stark difference in fiscal 

accountability between FFS payment and 

contract payments to physicians. The SMA 

is actively in dialog with the Ministry to 

establish a provincial framework for the 

management of these contracts when 

disputes might arise. 

Discipline Hearings 

Last year the SMA had objected to the 

CPSS practice, in a Discipline Hearing, of 

using the terminology “not proven” in 

the absence of a “guilty” finding. There is 

concern that, as such, unproven allegations 

might resurface and be used inappropriately 

in subsequent proceedings. The Board 

reaffirmed the SMA’s firmly held belief that 

findings must be either “guilty” or “not 

guilty.” The Board has joined the CMPA 

in its resolve to be vigilant in monitoring 

individual cases for any appearance of 

inappropriate application of past decisions. 

There were residual differences in two areas 

and the Board took the following actions: 

Bylaw 37.1 

Following a comprehensive review of 

CPSS Bylaws there was one matter of 

residual concern to the SMA that could 

not be resolved by mutual agreement. 

The Board reaffirmed the SMA’s objection 

to the inclusion on Certificates of 

Status information related to completed 

investigations where the physician has 

been cleared of wrongdoing. The Board 

acknowledged Council’s right to decide as 

it did and would like to remain apprised 

of any ongoing discussions at the FMRAC 

table on achieving a national consensus. 


Report from the Finance Committee 

Dr Phillip Fourie 

The Committee has met on two occasions 

since the fall session of the Representative 

Assembly, held in November 2009. 

At the December 2009 meeting the 

Committee reviewed base salaries of SMA 

staff and recommended a modest “across 

the board” increase to all staff for the 2010 

year. The Committee also noted that the 

Employment Agreement between the SMA 

and its Executive Director will be coming 

up for renewal in 2010. Both parties have 

indicated that they wish to continue the 

relationship. As well, the Committee 

approved contracting with the firm of 

Koenig & Associates to conduct a market 

related comparative study to benchmark 

all the SMA staff position profiles and 

wages. Included in this review will be 

recommendations to support a salary 

administration policy for the SMA. 

The SMA is currently entering its 4th year 

of a five year lease for its office space. The 

SMA has been in its present location since 

1996. As the demands being placed upon 

the SMA continue to increase, and with 

the ensuing increased staff complement 

required to manage these activities, we 

have been squeezing new staff into the 

“nooks and crannies” around the office. 

We have now exhausted our capacity to 

provide any more additional appropriate 

work stations. Consequently the Board 

has struck an ad hoc Committee with 

representation from the Finance Committee 

and the Board to begin the search for 

appropriate office space. 

At its March 2010 meeting, the Committee 

met with the auditors from KPMG and 

received both the Audit Findings Report and 

the Financial Statements for the year ending 

December 31, 2009. The reports provide a 

“clean” audit report that indicates that the 

financial statements are prepared according 

to generally accepted accounting principles 

and present fairly the financial position and 

the results of the Association’s operations 

for 2009. The financial statements appear 

in the Appendix section of the reports to 

the Representative Assembly. 

During its review of the statements the 

Committee noted that membership 

participation in the SMA remains at an 

all time high. Investment income was less 

than budget, reflecting the global financial 

markets and near record low interest 

rates. It is important to note however, that 

the value of the underlying investments 

themselves did appreciate during the year. 

On the expenditure side, Administrative 

expenses were up recognizing both an 

increase in the number of staff positions 

and an increase in 2009 salary rates. 


Leadership development costs were 

up and adjustments have been made 

in the 2010 budget to accommodate 

this important initiative. Office rent was 

lower in recognition of the appropriate 

cost accounting charges to the SMA 

administered programs. Negotiations and 

related activity costs were under budget 

reflecting the fact that for most of 2009 

the MCRC was “on hold.” The Association 

completed the year’s operations (prior to 

accounting for deprecation) with a modest 

surplus of $264,865. 

At last fall’s session of the Representative 

Assembly approval was given to revise the 

honoraria protocols to pay for Association 

committee activities effective for the 2010 

year onwards. One item of unfinished 

business related to the honoraria protocol is 

the matter of how to appropriately recognize 

the time that members spend on electronic 

meetings and exchanges. The Committee 

will be bringing a proposal to the November 

Representative Assembly meeting. 

Recommendations 

1. That the Financial Statements for the year 

ending December 31, 2009 be approved. 

2. That the accounting firm of KPMG be 

appointed as auditors for the SMA for the 

year 2010. 

Committee Members 

Dr Charles Kowalski 

Dr Robert Shannon 

Dr Dalibor Slavik 


One additional item that the Committee will 

be reviewing prior to setting its 2011 budget 

is the matter of SMA funding to the Division 

of Continuing Professional Learning. 


Report from the Medical Benevolent Society 

Dr Geraldo Fernandes 

The Medical Benevolent Society provides 

financial assistance to physicians, medical 

students, surviving spouses, and/or 

dependent children in need. The Executive 

committees of the Saskatchewan Medical 

Association and the College of Physicians 

and Surgeons of Saskatchewan constitute 

the Board of the Society. A Management 

Committee, made up of members elected 

from the Board of the Society and consulting 

representatives from MD Management and 

the College of Medicine meets as required to 

adjudicate requests for assistance. 

2009 

Donations received $ 58,082.00 

Charitable disbursements $ 10,610.50 

Professional Fees $ 1,848.00 

Once again in November 2009, we 

undertook a mail-out fundraising campaign. 

We implemented a second “reminder” 

mail-out in February. In response to our 

requests, members of the profession, once 

again, generously donated to the Society. 

Physicians should be aware that donations 

to the Society are tax deductible. Please see 

the table (next) for the donations received 

over the past 11 years. 

Year Donations Collected 

2000 $2,179.94 

2001 $10,652.50 

2002 $13,188.75 

2003 $19,901.00 

2004 $22,573.63 

2005 $26,598.75 

2006 $34.866.50 

2007 $48,591.00 

2008 $36,085.50 

2009 $58,082.00 

2010 $7,485.00 (to date) 

In 2009, the Society was asked to provide 

assistance to three physicians and their 

families. 

The Committee continues to work 

diligently to further the mission of the 

Medical Benevolent Society and would 

like to applaud the ongoing generosity of 

the membership. A fundraiser was held 

through the Annual Golf Tournament 

in August – despite cancellation of the 

event due to climate, participants still 

donated $1,825.00. MD Management 

has introduced “Charitable Gifting” as an 

additional option for physicians wishing 

to donate to the Society. Please contact 

your MD Management representative for 

information on accessing this option. 


We wish to extend our appreciation to 

KPMG for providing a decreased auditing 

fee following the request from the 

Representative Assembly. 

The Medical Benevolent Society would like 

to express their sincere gratitude to Kathleen 

Ness from MD Management who sat as a 

consultant to the Management Committee 

for many years. She received early retirement 

from MD Management in December 2009. 

Ms Wendy Johnston began fulfilling her 

responsibilities in February 2010. 

Donations are gratefully received and 

should be addressed to: 

Medical Benevolent Society 

c/o Saskatchewan Medical Association 402 

– 321A 21st Street East 

Saskatoon, SK S7K 0C1 

Management Committee 

Dr Geraldo Fernandes – President 

Dr George Miller – Vice President 

Dr Martin Vogel – Secretary/Treasurer 

Dr Dennis Kendel 

Dr William Albritton (College of Medicine) 

Wendy Johnston (MD Management Consultant) 

Brenda Senger – Director, Physician 

Support Programs 


Report from the Member Advisory Committee 

Dr Anne Doig 

The Member Advisory Committee (MAC) has 

met on one occasion since the fall meeting of 

the Representative Assembly. In the absence of 

Dr J. N. Doig, Dr A. Doig was Acting Chair for 

the meeting of January 28, 2010. The Board of 

Directors subsequently received the resignation 

of Dr J. N. Doig from the committee, and 

formally appointed Dr A. Doig as its Chair. 

MAC was pleased to learn that the Post 

Graduate Medical Education (PGME) 

Committee of the College of Medicine 

had received positively its suggestions 

regarding unsubstantiated complaints 

against residents. The PGME Committee 

agreed that it was inappropriate to allow 

this information to remain on file and has 

changed its procedures accordingly. 

Certificates of Status. MAC had expressed 

its concerns to the Minister of Health prior 

to his approval of Bylaws in this respect. 

The Committee will review this issue if it is 

informed of any such disclosures. 

Similarly, MAC expressed concerns to 

the CPSS regarding its investigation 

of a member’s fitness to practice. This 

investigation resulted from an inappropriate 

and misleading disclosure of a physician’s 

personal health information by a character 

referee at the time of the member’s 

application for licensure. MAC has clarified 

the CPSS policies with respect to fitness to 

practice. MAC reminds members to exercise 

appropriate discretion when providing 

information in letters of reference. 

MAC had asked the College of Physicians 

and Surgeons to revise its letter to physicians 

regarding complaint procedures so that 

physicians would be aware that their responses 

might be disclosed to the complainant. MAC 

has reviewed the revisions to the letter and is 

satisfied that the CPSS process is transparent. 

MAC remains concerned about the 

possibility that unproven allegations 

against physicians retained on the 

physicians’ confidential files with CPSS 

could subsequently be disclosed to other 

jurisdictions as part of the provision of 

MAC has been concerned about the 

development of patient care policies and/ 

or policies respecting the roles of physicians 

within RHAs. MAC’s concerns lie in two 

areas: the extent to which such policies are 

subject to appropriate review and revision 

by physicians prior to their adoption; 

and the extent to which RHAs may be 

developing policies de novo on matters 

that might better be addressed in a more 

standardized manner across the province. 

MAC asked that its concerns be forwarded 

to the Board and to the RMA Presidents for 

their consideration and direction. 


A member brought forward to MAC a 

concern regarding the on-call expectations 

for urban family physicians, and suggested 

that the SMA might consider developing 

policy guidelines for family physicians. MAC 

learned that there is considerable variation in 

the manner in which urban family physicians 

manage out of hours responsibility for their 

patients. The SMA may wish to address this 

as part of negotiations for remuneration of 

“full service” family physicians. 

MAC met with Dr K. Shaw to discuss the 

appropriate mechanisms to investigate and 

resolve complaints about cleanliness and 

other physical issues in physicians’ private 

clinics. There is a jurisdictional gap: the CPSS 

has the authority to monitor and correct 

physicians’ behaviour but not their facilities. 

The CPSS assumed that the offices of the 

Medical Officers of Health would have that 

jurisdiction; unfortunately, there is no clear 

authority for Public Health to inspect facilities 

or to monitor infection control processes. 

Although some private facilities are or may be 

covered under the regulations respecting the 

operation of non-hospital surgical facilities, 

these regulations are not sufficiently broad to 

apply to all physicians’ clinics. MAC agreed 

that the SMA should assist the CPSS in this 

matter, both by disseminating information 

to the profession and by collaborating with 

the CPSS on the development of appropriate 

bylaws to give the CPSS regulatory authority 

in this area of professional practice. 

MAC provided its opinion of its future role 

and function to assist the Board in its review 

of committee structures and functions. The 

committee believes it has several roles: it is 

advisory to the Board in legal and ethical 

matters affecting the interactions between the 

profession, the public, and bureaucratic and 

regulatory bodies; it is also a valuable resource 

to members and provides support upon request 

for their individual interactions with regulatory 

or bureaucratic authorities. MAC has a role both 

in the development of policy and in its exercise; 

however, the operational functions of member 

assistance can most often be performed by 

experienced senior SMA staff. 

MAC is grateful to Ms. Brenda Senger, Dr. 

Martin Vogel, and the SMA secretariat for 

their ongoing support in its work. 

Members of the Committee 

Dr J. N. Doig (resigned February 2010) 

Dr A. F. Doig 

Dr J. Leszczynski 

Dr J. Yelland 

Dr R. McKay 

Dr S. Oleksinski 

Dr J. Pfeifer 


Report from the Primary Care Working Group 

Dr Rizqi Ibrahim 

The Primary Care Working Group met 

on January 25, 2010. The meeting was 

chaired by Dr Larry Sandomirsky during 

Dr Rizqi Ibrahim’s absence from the 

country. The Model Contract for Primary 

Care has been agreed upon between the 

SMA, the Ministry and RHA CEOs. There 

are a few sections in the Memorandum 

of Understanding governing contract 

bargaining that still require some tweaking. 

This MOU will go to the Leadership Counsel 

once it has been completed. 

do a clinical assessment of every case but 

would be aware of the referral and the 

physician’s name would be attached. 

Donna Magnusson (Executive Director of 

Primary Care Branch) stated that there is no 

intention, at the policy level in the Ministry, 

for nurse practitioners to be practising on 

their own without professional affiliation 

to family physicians. The Committee stated 

that the referral process needed to be 

sorted out by the professional associations. 

Pharmacist Prescriptive Authority 

The Committee had previously provided 

input and advice to the Board on this matter 

and was updated on the current status. 

Details are contained in the Board Report. 

RN (NP) Referral to Specialists 

The SMA is currently waiting for a 

formal forum to discuss the matter. The 

Committee members expressed varied 

opinions and discussed the matter at 

some length. There was consensus that 

any referrals to Specialists from RNs (NPs) 

should occur in a collaborative practice 

environment as family physicians are 

trained to treat many cases that would 

not be “common medical conditions” and 

therefore would not require a specialist 

referral. It was accepted that the family 

physician would not necessarily need to 

New Model of Primary Care 

The Committee members were asked to 

forward their thoughts on the College of 

Family Practitioners’ primary care model. 

This model uses the “Medical Home” 

concept and focuses on collaborative 

practice that is flexible enough to 

accommodate the varying conditions of 

rural practices. The patient is the leader of 

their own health care and each patient has 

one physician, but that physician would 

be able to utilize the resources within their 

own clinical team for complete patient care. 

Resources such as the expertise of other 

providers, information technology, finance, 

and other supports are available to the 

physician. It was suggested that, as work 

proceeds with developing a new model, the 

focus be on the model itself and that the 

mode of payment be developed afterwards. 



Dr Rizqi Ibrahim, Committee Chair 

Dr Delores Logan 

Dr Janet Tootoosis 

Dr Larry Sandomirsky 

Dr Phillip Fourie 

Dr Mark Jutras 

Dr Dennis Bishop 

Dr Tessa Laubscher 

Ms Donna Magnusson 


Report from the Saskatchewan Physican Support 

Program Committee 

Dr Peter Butt 

The Saskatchewan Physician Support 

Program (SPSP) has met twice since the last 

Representative Assembly meeting. Support 

is available to physicians throughout the 

spectrum of their careers; from medical 

school and residency, through active practice 

and into retirement. Their struggles span a 

variety of issues, including mental health, 

substance abuse/addiction, physical health, 

marital and family concerns, stress/burn-out, 

financial distress, and disruptive behavior. 

Although presently assistance is available to 

spouses and family members of physicians, 

the Board of the SMA has identified 

“Promoting Physician and Family Wellness” 

as a priority with particular emphasis 

on education and support for spouses. 

Educational presentations re: physician health 

and wellness are also available upon request. 

Membership in the Committee 

reflects the expanded role of the SPSP 

mandate. Members are from a variety 

of backgrounds and expertise, the 

common denominator being a dedication 

to the provision of non-judgmental and 

confidential assistance and support. 

In 2009, the SPSP was contacted by 78 

physicians, physicians in training, and 

family members. These contacts included 

requests for education, professional 

consultation, referrals to community 

resources, and/or direct services from the 

SPSP. Increasingly, we are receiving calls 

from individuals requesting assistance in 

accessing community resources to address 

self-identified issues (primarily individual and 

marital counselling). Support to the spouses/ 

partners and family members of physicians 

have also increased as they access the 

program for their needs. We are delighted 

to act as referral agents, enabling callers to 

access the support they require in a proactive 

manner. Referral sources are also contacting 

the SPSP for advice and support in dealing 

with physician health/behavioral issues. 

Of these 78 contacts, 18 new files were 

opened for on-going support and monitoring 

by the SPSP. Twenty-six per cent of contacts 

were from medical students or residents and 

nine and half per cent were from physician 

spouses/partners or family members. A total 

of 55 files were active in 2009. 

Primary issue upon admission: 

• Mental Health/Psychiatry – 33% 

(primarily anxiety and depression) 

• Marital/Family Relationships – 11% 

(primarily marital) 

• Addictive Disorders – 25% 

• Physical Health – 5% 


• Occupational Issues – 24% (this area 

includes disruptive behavior, workplace 

relationships, complaints, professional 

boundaries, abuse) 

• Other – 2% (financial, criminal) 

We continue to participate in the Canadian 

Physician Health Network which is the 

national forum for physician health 

programs across Canada. Members of 

the committee have also been involved 

in developing and implementing a 

Physician Wellness Initiative and curriculum 

development regarding Stigma and Mental 

Health in the College of Medicine. 


Dr Kevin Dautremont 

Dr Mansfield Mela 

Dr Donna Malcolm 

Dr Senthil Damodharan 

Dr Anita Chakravarti 

Dr Martha Riesberry (PAIRS) 

Mr Alistair Smith (SMS) 

We would like to ensure that every doctor 

in the province has a primary physician 

overseeing their health needs. To assist 

in achieving this goal, we are asking for 

family doctors who are willing to treat their 

physician colleagues to self identify to Ms 

Brenda Senger at the SMA. This will allow 

us to provide information upon inquiry. 

I wish to welcome Martha Riesberry (PAIRS) 

and Alistair Smith (SMS) to the committee. 

Brenda Senger remains the initial contact 

person and the case manager. 


Report from the Legislative Committee 

Dr Ulla Nielsen 

Since the Fall Representative Assembly the 

Legislative Committee has provided advice 

to the Board in three primary areas. 

Firstly, advice was provided regarding the 

Ministry of Health’s proposed amendments 

to The Drug Schedules Regulations, 1997 

in order to accommodate Pharmacists’ 

enhanced prescriptive authority. 

Subsequently, input was provided regarding 

proposed amendments to the Bylaws of 

the College of Physicians and Surgeons 

in response to requirements under the 

Agreement on Internal Trade. Specifically, 

this related to the elimination of a signed 

three year contractual commitment as a 

condition of Provisional Licence. 

Thirdly, advice was provided to the 

SMA Committee on Uninsured Services 

concerning information requested by 

Saskatoon Health Region Wellness Services. 

We continue to respond as circumstances 

dictate. Our thanks go out to Dr Martin 

Vogel, Mr Reynold Robertson, and the staff 

of the SMA for their continued support. 


Report from the Canadian Medical Association 


Summary of CMA Board of Directors Meeting 

February 2010 

than raising taxes in order to ensure the 

sustainability of the system. 

Honorary Treasurer’s Report 

The Treasurer reported that CMA had a 

surplus of almost $700,000 for 2009 and that 

this money will be invested in the Reserve 

Fund. It was noted that a projected deficit for 

the year had been erased due to cost restraint 

measures implemented by staff. 

Strategic Planning 

The Board of Directors heard a report from 

the Strategic Plan Steering Committee, 

confirmed the criteria for the strategic 

review and engaged in an exercise to 

define a framework for the programs and 

services offered by the CMA. The Board 

also reaffirmed the current mission and 

vision of the CMA. 

Health Care Transformation (HCT) 

The Board was given an overview of results 

from a recent survey done for the CMA 

dealing with public attitudes towards the 

deficit, health care spending and transfer 

payments for health. Findings showed 

while Canadians see the urgency of the 

federal government tackling the deficit 

in next week’s budget, they do not want 

it to come at the expense of health care. 

Respondents favoured individuals paying 

a portion towards health costs rather 

An update from the Board Working 

Group on Health Care Transformation 

was presented. Recent activities have 

focused on CMA Blueprint for Health Care 

Transformation document and specifically 

development of a draft Patient Quality 

Charter. The charter is intended to outline 

both rights and responsibilities of patients. 

Work on development of a patient charter 

in Alberta and the use of a patient charter 

in the UK National Health Service since 

1991 was described. 

The Board approved parts of the CMA 

Blueprint for Health Care Transformation 

and the draft Patient Quality Charter for 

consultation purposes. A meeting with 

senior PTMA officials is scheduled for early 

March to discuss how the CMA vision for 

HCT will be implemented. Plans to consult 

on the Patient Quality Charter with the 

general public, disease/patient groups and 

key stakeholders were outlined. 

The Board was provided with details on how 

the upcoming release of the federal budget 

will be used to further the HCT agenda. 

General Council Planning 

The Speaker for General Council outlined 

plans for this year’s annual meeting to be 


held in Niagara Falls in August. The Board 

of Directors approved an approach to the 

management of the education/information 

and strategic session topics that will be 

aligned to key issues in the Health Care 

Transformation blueprint. The Board also 

approved an expansion of the Members’ 

Hour session and revisions to the annual 

meeting agenda to maximize delegate 

involvement. Consideration is also being 

given to having an educational session 

dealing with CMAJ. The deadline for 

proposed resolutions to be discussed at GC 

will be July 26 although Board-sponsored 

strategic session motions will be finalized 

at the May Board meeting. Use of the 

consent agenda to deal with resolutions not 

requiring debate will be expanded this year. 

Québec Tripartite Framework 

Representatives of the Quebec Medical 

Association (QMA) joined the Board of 

Directors for a discussion of results of the 

2009 Quebec tripartite agreement between 

the CMA, QMA, and MDPS. A detailed 

overview of the history, achievements and 

future objectives of the QMA was provided. 

Collaborative ventures with the CMA 

and MDPS were highlighted as was the 

growing role of the QMA as an advocacy 

body. The Board of Directors will discuss 

the appropriate go-forward approach to 

collaborative efforts at its meeting in May. 

Principles for the Protection of Patients’ 

Personal Health Information 

The Board of Directors approved 

consultation with stakeholders on draft 

principles for the protection of patients’ 

personal health information that have 

been developed by the CMA Committee 

on Ethics. The principles being developed 

will replace the existing CMA Privacy 

Code. Following the consultation process 

a set of principles will be presented at the 

Board meeting in May. 

Mental Health 

The Board of Directors approved a 

strategic plan for how the association will 

engage in the mental health agenda in 

Canada for the next three years, working 

closely with the Mental Health Commission 

of Canada. Fourteen resolutions dealing 

with mental health were passed at GC 

and the Board Working Group on Mental 

Health identified on which resolutions 

the CMA should take the lead and on 

which the Association will support others. 

Activities will focus on four pillars: 

• Comprehensive reform of the mental 

health care system 

• Reducing stigma and discrimination 

• Support best practices for physicians 

• Mental health strategy for physicians. 

The Board was told the mental health 

strategy for physicians will guide the work 

of the CMA Centre for Physician Health and 

Wellness on issues relating to physicians. 


The strategy that was approved by the 

Board outlines a comprehensive approach 

towards improving and protecting the 

mental health of physicians, residents and 

medical students in Canada. The vision is 

optimal mental health for all physicians 

through four main strategies: 

• Increased awareness, knowledge and skills 

regarding physician mental health issues 

• Improved access to a range of mental 

health services and programs 

• Create learning and work environments 

that support mental health of physicians 

• Monitor, evaluate and research physician 

mental health needs, services and policies. 

CMA Policy on Blood Borne Pathogens 

in the Health Care Workplace 

The Board approved the Policy on Blood 

Borne Pathogens in the Health Care 

Workplace, to replace CMA policies on HIV 

Infection in the Workplace (Update 2000) 

and Prevention of Hepatitis B in the Health 

Care Context (Update 2001). 

Optimal Prescribing 

The Board approved the circulation for 

consultation of a draft document entitled 

A Prescription for Optimal Prescribing: 

A CMA Discussion Paper. The document 

deals with what physicians can do, 

working with others, to ensure that 

Canadians are prescribed the drugs that 

will give them the most benefit. 

CMA Policy on Patient Safety 

An updated CMA Patient Safety framework 

was approved by the Board. The framework 

updates a document published in 2001 and 

positions the CMA in a better position for 

advocacy and leadership on patient safety, 

in light of a general external leadership 

vacuum in this area. 


Report from the 

Division of Continuing Professional Learning 

Penelope M. Davis, Assistant Dean 

The Division of Continuing Professional 

Learning has just gone through an intensive 

accreditation process. Assessors from the 

Association of Federal Medical Colleges 

spent two days reviewing our offices 

in Regina and Saskatoon and speaking 

with CPL providers, users and partners in 

programming including the SMA. As part 

of this process CPL has developed five-year 

strategic and business plans, and Dr Davis 

has made a presentation to the Board of 

the SMA based on these plans. 

A new database is in place and will make 

registration at conferences and the receipt 

of study credits more efficient. We hope to 

be able to tie it to a self assessment section 

which will enable physicians to assess their 

own educational needs, and be informed 

of proposed programs in the areas which 

they identify. As part of this new database 

CPL program advertising will be carried 

out on-line with considerable savings and 

better focused coverage of physicians in the 

province. We also hope to place conference 

evaluations on-line using “Survey 

Monkey”©. This option would allow 

physicians to complete their evaluation 

forms on line after a conference and receive 

their attendance and credit certificate online 

to be printed at home. 

A growing issue related to funding is the 

increased wish on the part of physicians 

to have education brought closer to 

their geographical location rather than 

to attend large central conferences. This 

unfortunately is accompanied by a belief 

that there should be no charge for such 

regional, videoconferenced or web-based 

programming. Since CPL supports all 

its other programming by the general 

revenue from major conferences this 

places the division in a difficult situation 

in that industry funding for DMS or 

telehealth meetings tends nowadays to 

be related to the care areas corresponding 

to each company’s pharmaceuticals and 

these may well not be the areas of need 

identified by the education consumers 

or an environmental scan. CPL is willing 

to provide more distributed learning 

opportunities, but there will be a cost, 

either to individual attendees or to agencies 

which are willing to provide financial 

support. 

The Division is preparing a survey of all 

urban physicians based upon the canMEDS 

competencies and the Four Pillars of Family 

Medicine as part of our goal of meeting 

the educational needs of all physicians 

in Saskatchewan. The final report will be 

made available to all stakeholders who have 


supported this initiative, including the SMA. 

The Division continues to provide 

orientation programs to International 

Medical Graduates entering the province, 

examination preparation courses for 

physicians challenging the Canadian 

Licensing exam, and preceptorships to assist 

incoming physicians to integrate their skills 

into the Canadian Health Care system. 

There appears to be a possibility of a 

Saskatchewan Based physician assessment 

for International Medical Graduates, with 

which CPL would be involved. A series 

of faculty education programs has been 

commenced for physicians who would act 

as preceptors in such a program. 

As an extension of this I would like to 

ask all active physicians to consider the 

implications of permitting unofficial 

observerships by non-licensed physicians 

in their offices or clinical setting. CPL went 

through a long legal consultative process 

with CPSS and Regional Health Authorities 

to develop a contract which indicated 

the limits of participation in observerships 

and outlined the responsibilities of the 

preceptor offering the experience. All CPL 

sanctioned observerships must be initiated 

by review of qualifications, statement of 

learning objectives and most importantly 

a contract signed by the observer, the 

preceptor and Dr. P. Davis from CPL. If 

inappropriate contact between the observer 

and any patient occurs, or is alleged to have 

occurred, the preceptor or the health region 

can be liable for any outcomes. Even with a 

signed contract there would be no lack of 

responsibility if the preceptor permits the 

observer to step outside the observer role, 

but the contract allows the preceptor to 

know the limits within which the observer 

must remain. 

With the departments of Continuing 

Nursing Education and Continuing Physical 

Therapy Education the Division of CPL has 

been able to secure a grant, against stiff 

competition, from the Interprofessional 

Health Collaborative of Saskatchewan 

for $10,000 to develop a conference on 

Interprofessional Management of Diabetes 

and a conference template for future 

interprofessional education. 

CPL staff extend their thanks to all the 

physicians is Saskatchewan who have 

helped CPL with program planning and 

presentation over the past year, their time 

and effort are valued highly. 


Range of Programming Offered 

CPL Programs Offered in 2009 

Conferences 

• Major Conferences 

• Regional Conferences (DMS) 

• Videoconference Series 

• Grand Rounds 

Workshops 

• ACORN 

• ACLS 

• NRP 

• STABLE 

• Fetal Health Surveillance 

• Patient Assessment 

• Communication Skills 

International Medical Graduate 

Support Programs 

• Orientation 

• Online CAPE assistance 

• Preceptorships 

• Observerships 

• Exam Preparation 

• Non-Licensed IMG Support 

Interprofessional Learning with: 

• Physiotherapy 

• Nursing 

• Pharmacy and Nutrition 

Regina Conferences 

Pasqua Infectious Diseases, January 

IMG Orientation, May 

Drug Therapy, March 

Tropical Med, August 

MCCQE 1 Prep Course, September 

ECG Update, November 

Saskatoon Conferences 

POGO, February 

History Taking, March 

MCC2 Prep Course, April 

History Taking and Communication, April 

Skills Workshop, May 

Headache Management (interprofessional), June 

IMG Orientation, September 

SEMAC (Emergency Care), October 

Practical Management of Common Medical 

Problems, November 

Videoconference Series 

January 

• Hematological Oncology Emergencies 

• Office Management of Epistaxis and 

Other ENT Procedures 

February 

• Disruptive Behaviour Disorders 

Web-based Learning 

• Podcasts 

• Conference highlights 

• Proposed accredited programming 

• Research 

March 

• Management of Breast Cancer 

• Prevention and Management of Diabetes 

Foot Complications 


April 

• Management of Lung Cancer 

• Drugs in Pregnancy 

May 

• Post PCI Care 

• Guidelines for Management of Chronic 

Kidney Disease 

June 

• Working with Major Depression 

September 

• Cardiac CT 

October 

• Early Psychosis Intervention 

• H1N1 

November 

• Bipolar Disorder 

• Neonatal Sepsis 

December 

• Emergency Management of Stroke 

Regional Conferences/DMS Meetings 

January 

• Rational Use of Opioids in the 

Management of Chronic Non Malignant Pain 

• Arrhythmias and the EP Lab 

March 

• Approach to Proteinuria and Hematuria 

• Working with Depression 

• Frequently Asked Kidney Questions 

April 

• AD(H)D in Children 

May 

• Realizing the Paradigm Shift in CV Risk 

• Stratification: New Evidence and a New 

Patient Approach 

June 

• Optimizing Cardiovascular Protective 

Measures for Patients with High CV risk (at 

three separate sites) 

September 

• Current Issues in the Management of 

ADHD and Associated Disruptive Behaviours 

October 

• Emergency Psychiatric Medicine 

November 

• Optimizing Cardiovascular Protective 

Measures for Patients with High CV risk (at 

one more site) 

• Prevention of Venous Thromboembolism 

in Higher Risk Patients 

February 

• Update on Ankylosing Spondylitis 



Joint Medical Professional Review Committee 

Dr Joan Stevenson 

The JMPRC is a committee composed 

of your peers with two representatives 

appointed by each of the three bodies – 

SMA, CPSS, and the Ministry of Health. 

Information is presented to the committee 

by the Director of Medical Compensation for 

the committee’s consideration in the form 

of a statistical package with no identifying 

information regarding the individual 

physician. It is this group of peers that, on 

review of the information provided, could 

either regard the statistics as being quite 

acceptable or request more information 

in the form of actual patient records and 

an explanatory letter from the physician. 

If there are still issues that require further 

explanation, then an interview is requested. 

A great deal of time and effort is required 

by both the physician and the committee 

members. Every effort is made to ensure an 

open and honest dialogue between both 

parties, with the hope that the interaction is 

professional, fair and educational. 

involved in the review process. Our aim is 

to ensure billed services are delivered and 

appropriately recorded, as set out in the fee 

schedule. We are all responsible for the fees 

submitted to SaskHealth and should be very 

familiar with the requirements for the use 

of each code. 

Finally, the committee would like to pass 

along their gratitude to Dr Jim Coucill for 

his many years of participation on the 

committee. He provided guidance on many 

issues and was a professional and ethical 

resource for all of us. The Ministry of Health 

has now appointed Dr Allan Miller as a 

member. Other committee members are 

Dr Annette Viljoen (GP Meadow Lake), 

Dr Werner Oberholzer (GP Radville), Dr 

Carol Klym (GP Saskatoon), and Dr Vino 

Padayachee (GP Estevan). Observer for the 

SMA is Stan Oleksinski and for the CPSS is 

Dr Lowell Loewen. 

We are a privileged group of some 1600 

physicians who bill the Health Ministry 

relatively unscrutinized. Our committee 

would review less than 25 physician profiles 

a year and interview even less. Both general 

practitioners and specialists have been 



Practice Enhancement Program Committee 

Joanne Peat 

PEP Committee Retreat 

The Committee met for a Retreat in January 

to work on improving the efficiency of the 

Practice Enhancement Program. One area 

of discussion was how to bring the benefits 

of PEP to groups of specialists who have 

not previously worked with PEP to create 

assessment tools and have never been able 

to receive the benefit of a PEP assessment. It 

was agreed that assessments should ideally 

be done by peers and that we should be able 

to achieve total or at least substantial self 

sufficiency in Saskatchewan. If PEP is unable 

to fulfill its responsibilities to the profession it 

may be necessary to import both assessment 

tools and assessors from outside the province. 

Other issues discussed include Committee 

structure, program operations, the use of 

existing databases in the development of 

assessment tools, and awareness of electronic 

medical record systems in conducting 

assessments. The results of the PEP Retreat 

have since been presented to both the 

Council of the CPSS and the SMA Board. 

formats and provide feedback on the 

‘Ultimate PEP Final Report.’ In addition to 

the current narrative format, consideration 

will be given to the advantages of a 

computer-assisted report. 

Attendees will also hear presentations on 

the following: 

• History and Inception of PEP 

• Alternate and Comparable Assessment 

Programs 

• PEP and the CPSS Mandate to Ensure 

Continued Competence 

• Vision for the Future of PEP 

Feedback from Physicians Assessed 

In a recent post-assessment survey of 55 

physicians who had completed the PEP 

process, 30 changed aspects of patient 

care, 35 changed aspects of practice 

management, and 18 changed how they 

communicate with patients. 

There continues to be satisfaction by those 

assessed with their participation. 

PEP Assessor’s Conference 

The 10th PEP Assessor’s Conference is 

scheduled for May 7-8, in Prince Albert 

SK. The program will focus on the final 

reporting process by PEP to doctors who 

have been assessed. Attendees will be 

asked to review Final Reports in various 

PEP Assessment Results 

Most physicians (742/855 assessed = 87%) 

achieve Category One status initially. PEP 

puts great effort into enhancement. Of 102 

potential reassessments 14 physicians did 

not remain in practice. Seventy improved 

their practices enough to earn Category 


One while 16 remained Category Two. 

Of those 12 achieved Category One 

after further reassessment. Thus 82 of 

88 physicians with initial Category Two 

assessment results choosing to remain in 

practice made significant improvements 

guided by PEP and achieved Category One. 

That is good for them and their patients. 

PEP Assessment Categories 

Category 1: Consistent good care, no 

concerns regarding Patient care or records. 

Category 2: Acceptable, but significant 

need for improvement in areas listed. 

Category 3: Immediate Cause for Concern - 

Serious risk of harm to a patient. 

Follow-up Action per Category 

Category 1: Full accreditation, no review for 

5 years. 

Category 2: Necessitates planned follow-up. 

Category 3: Referred to the College of 

Physicians and Surgeons. 

Legibility: Illegibility precludes assessment 

(reaching a conclusion about care). A review will 

be carried out after a specified period of time, 

which might include chart-stimulated recall. 

PEP Assessment Statistics 

1996 - 2009 Category 1 Category 2 Category 3 TOTAL 

Age Group A (64) 65 19 1 85 

Gender Male 528 87 4 619 

Female 214 22 0 236 

Urban Regina 153 26 4 183 

Saskatoon 240 25 0 265 

Rural All Others 349 58 0 407 

Family Practice 624 101 4 729 

Specialty 118 8 0 126 

Assessments to Date 742 109 4 855 

Reassessments Conducted to Date 102 

Assessments not yet categorized 3 

Total: 960 


Breakdown of Specialties (1996 - 2009) 

Cat 1 Cat 2 

ACMI (Radiology) 17 

Dermatology 7 

General Surgery 4 

Nephrology 11 

Obstetrics/Gynecology 12 2 

Ophthalmology 20 

Pedatrics 7 2 

Psychiatry 40 4 

Specialities 118 8 (6.70%) 

Family Physicians 624 101 (16.18%) 

PRACTICE ENHANCEMENT PROGRAM 

Comparison of Family Physician and Specialist assessments 

120 

100 

80 

60 

40 

Fam Phys 

Specialty 

Total 

20 

0 

1997 2000 2003 2006 2009 

We sincerely thank our assessors for 

their continuing contributions to the 

improvement of the quality of medical 

practice in Saskatchewan. Thank you to 

the Saskatchewan Medical Association, the 

College of Physicians and Surgeons, and 

the Ministry of Health for continued advice 

and financial support. 

PEP Committee 

Dr George Carson, Co-Chair 

Dr Marilyn Caughlin 

Dr Brian Laursen, Co-Chair 

Dr Penny Davis 

Ms Joanne Peat, Coordinator 

Dr Yellepeddy Nataraj 

Dr Ayaz Ramji 


Practice Enhancement Program 

Post Assessment Questionnaire (Q3) 

Summary Report 

Total: 223 Responses out of 850+ Assessments Conducted (March 2010) 

Thank you for participating in the Practice Enhancement Program (PEP). In 

order to offer the best possible assessments to Saskatchewan physicians, your 

observations about your assessment and comments about the program would 

be useful and appreciated. 

A. Quality of Care Strongly Strongly No Not 

Agree Agree Neutral Disagree Comment Answered 

Do you agree with the comments (62) (134) (10) (6) (0) (5) (6) 

Do you agree that the areas (47) (126) (9) (6) (1) (29) (3) 

requiring attention have been 

properly identified? 

Specific suggestions for improvement (48) (128) (8) (1) (0) (31) (5) 

were made with respect to areas 

requiring attention. 

Do you agree with the (44) (120) (13) (5) (0) (31) (8) 

suggestions for improvement? 

B. Content of the Medical Strongly Strongly No Not 











Your Comments: 

C. Physical Facilities Strongly Strongly No Not 












D. Personnel Strongly Strongly No Not 











E. Requests, Lab Tests, Referrals, Etc. Strongly Strongly No Not 

Agree Agree Neutral Disagree Disagree Comment Answered 










F. Appropriate Use of Medications Strongly Strongly No Not 











G. Comments on Interview Strongly Strongly No Not 












H. The information received from the Patient Questonnaires was useful. 

Strongly Strongly No Not 

Agree Agree Neutral Disagree Opinion Answered 

(73) (120) (17) (2) (1) (2) (5) 

I. Enough information was forwarded to you prior to the assessment. 



(77) (130) (7) (2) (0) (1) (3) 

J. Resources are available to facilitate practice change? (e.g. ME, Tutorials) 


Agree Neutral Disagree Opinion Answered 

(60) (128) (10) (2) (0) (10) (9) 

K. The physician assessor's conduct was appropriate and professional. 



(147) (62) (5) (0) (0) (2) (3) 


KPMG LLP Telephone (306) 934-6200 

Chartered Accountants Fax (306) 934-6233 

600-128 4 th Avenue South Internet www.kpmg.ca 

Saskatoon Saskatchewan S7K 1M8 

Canada 

Financial Statements of the 

Saskatchewan Medical Association 

for the year ended December 31, 2009 


Chartered Accountants Fax (306) 934-6233 


ITORS' REPORT TO THE 

Saskatoon 

MEMBERS 

Saskatchewan S7K 1M8 

Canada 


ve audited the statement of financial Chartered position Accountants of Saskatchewan Medical Association Fax as at (306) 934-6233 


ber 31, 2009 and the statements of revenue and expenses, surplus and cash flows for the year 

Saskatoon Saskatchewan S7K 1M8 

nded. These financial statements are Canada the responsibility of the Association's management. Our 

sibility is to express an opinion on these financial statements based on our audit. 

nducted our audit in accordance with Canadian generally accepted auditing standards. Those 

rds require that we plan and perform an audit to obtain reasonable assurance whether the 

al statements are free AUDITORS' of material misstatement. REPORT An TO audit THE includes MEMBERS 

examining, on a test basis, 

ce supporting the amounts and disclosures in the financial statements. An audit also includes 

ing the accounting principles used and significant estimates made by management, as well as 

We have audited the statement of financial position of Saskatchewan Medical Association as at 

ting the overall financial statement presentation. 

December 31, 2009 and the statements of revenue and expenses, surplus and cash flows for the year 

AUDITORS' then ended. These REPORT financial statements TO THE are MEMBERS 

the responsibility of the Association's management. Our 

opinion, these financial statements present fairly, in all material respects, the financial position of 

responsibility is to express an opinion on these financial statements based on our audit. 

sociation as at December 31, 2009 and the results of its operations and its cash flows for the 

en ended in accordance We have with Canadian audited the generally statement accepted of financial accounting position principles. of Saskatchewan Medical Association as at 

December 

We conducted 

31, 2009 

our audit 

and the 

in accordance 

statements 

with 

of revenue 

Canadian 

and 

generally 

expenses, 

accepted 

surplus and 

auditing 

cash 

standards. 

flows for the 

Those 

year 

then 

standards 

ended. 

require 

These 

that 

financial 

we plan 

statements 

and perform 

are the 

an 

responsibility 

audit to obtain 

of the 

reasonable 

Association's 

assurance 

management. 

whether 

Our 

the 

responsibility 

financial statements 

is to express 

are free 

an 

of 

opinion 

material 

on these 

misstatement. 

financial statements 

An audit includes 

based on 

examining, 

our audit. 

on a test basis, 

evidence supporting the amounts and disclosures in the financial statements. An audit also includes 

We 

assessing 

conducted 

the accounting 

our audit in 

principles 

accordance 

used 

with 

and 

Canadian 

significant 

generally 

estimates 

accepted 

made by 

auditing 

management, 

standards. 

as well 

Those 

as 

red Accountants standards 

evaluating the 

require 

overall 

that 

financial 

we plan 

statement 

and perform 

presentation. 

an audit to obtain reasonable assurance whether the 

financial statements are free of material misstatement. An audit includes examining, on a test basis, 

evidence 

In our opinion, 

supporting 

these financial 

the amounts 

statements 

and disclosures 

present fairly, 

in the 

in 

financial 

all material 

statements. 

respects, the 

An 

financial 

audit also 

position 

includes 

of 

oon, Canada 

assessing 

the Association 

the accounting 

as at December 

principles 

31, 

used 

2009 

and 

and 

significant 

the results 

estimates 

of its operations 

made by 

and 

management, 

its cash flows 

as well 

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as 

ry 28, 2010 

evaluating 

year then ended 

the overall 

in accordance 

financial statement 

with Canadian 

presentation. 

generally accepted accounting principles. 

In our opinion, these financial statements present fairly, in all material respects, the financial position of 

the Association as at December 31, 2009 and the results of its operations and its cash flows for the 

year then ended in accordance with Canadian generally accepted accounting principles. 

Chartered Accountants 

Saskatoon, Canada 

February 28, 2010 

Chartered Accountants 

Saskatoon, Canada 

February 28, 2010 

KPMG LLP, is a Canadian limited liability partnership and a member firm of the KPMG 

network of independent member firms affiliated with KPMG International, a Swiss cooperative. 

KPMG Canada provides services to KPMG LLP. 

May 2010 | SMA Reports to the Representative Assembly 41 

KPMG LLP, is a Canadian limited liability partnership and a member firm of the KPMG

SASKATCHEWAN MEDICAL ASSOCIATION 

Statement of Financial Position 

December 31, 2009, with comparative figures for 2008 

Assets 

2009 2008 

Current assets: 

Cash and equivalents $ 18,666,004 $ 16,827,685 

Accounts receivable 293,576 72,831 

Prepaid expenses 57,850 85,662 

Due from administered entities 67,981 30,833 

19,085,411 17,017,011 

Investments (note 3) 9,883,286 7,603,967 

Equipment and leasehold improvements (note 4) 68,842 93,617 

Liabilities and Surplus 

$ 29,037,539 $ 24,714,595 

Current liabilities: 

Accounts payable $ 226,980 $ 310,718 

Undistributed retroactive payments (note 9(a)) 730,083 - 

Deferred revenue - membership fees 1,189,306 1,211,727 

Unutilized government grant (note 9(b)(ii)) 14,375,000 11,950,000 

16,521,369 13,472,445 

Surplus 12,516,170 11,242,150 

Commitments (note 11) 

$ 29,037,539 $ 24,714,595 

See accompanying notes to financial statements. 

On behalf of the Board: 

Director 

Director 

42 SMA Reports to the Representative Assembly | May 2010 

1


Statement of Revenue and Expenses 

Year ended December 31, 2009, with comparative figures for 2008 

Budget 2009 2008 

(unaudited) 

Revenue (schedule 2): 

Membership fees $ 2,978,039 $ 3,058,930 $ 2,921,170 

Administered programs (note 10) 531,065 566,971 485,400 

Investment income 658,125 417,404 971,851 

Health Quality Council - 200,000 200,000 

Insurance allowances 175,000 172,015 166,564 

C.M.A. grant 7,500 7,500 7,500 

Leadership development (note 8) - - 1,138,536 

Premium rebate allowance and 

sundry 500 2,480 36,183 

4,350,229 4,425,300 5,927,204 

Expenses: 

Administrative (schedule 3) 1,971,550 2,037,277 1,875,977 

C.M.A. dues 660,000 684,613 644,917 

Committee (schedule 4) 438,125 385,272 416,857 


Board 210,000 195,081 183,556 

Leadership development 100,000 124,254 86,711 

Office rent (net of recoveries) 146,000 120,314 136,895 

Practice Enhancement Program 75,000 75,000 75,000 

Regional Medical Associations 85,000 74,587 75,665 

Negotiations and related activities 100,000 69,781 101,641 

C.M.E. grant 65,000 65,000 62,000 

Investment management fees 70,100 55,546 59,695 

C.M.A. and divisional meetings 48,000 24,617 21,542 

Commissions - 14,810 23,862 

S.M.A. student bursaries 14,000 14,000 14,000 

Directors' and officers' liability 

insurance 11,000 10,570 10,570 

General practitioners physician 

profiles 5,000 5,250 - 

Consulting - 4,463 9,188 

3,998,775 4,160,435 3,998,076 

Excess of revenue over expenses before the 

undernoted 351,454 264,865 1,929,128 

Fair value adjustment on investments - 1,045,852 (1,532,992) 

Amortization 35,000 36,697 35,115 

Excess of revenue over expenses 

(schedule 1) $ 316,454 $ 1,274,020 $ 361,021 



2


Statement of Surplus 


Excess Purchase of Excess Purchase of 

Balance, (deficiency) equipment and Balance, (deficiency) equipment and Balance, 

January 1, of revenue leasehold December 31, of revenue leasehold December 31, 

2008 over expenses improvements 2008 over expenses improvements 2009 

Unrestricted: 

General $ 3,288,281 $ 454,191 $ (31,001) $ 3,711,471 693,264 (11,922) 4,392,813 

Physician Support Fund (note 4) 6,717,294 (1,164,883) - 5,552,411 712,183 - 6,264,594 

Communication Technology 

Fund (note 5) 129,456 - - 129,456 - - 129,456 

Insurance (note 6) 648,367 (31,708) - 616,659 32,208 - 648,867 

Leadership Development Fund 

(note 7) - 1,138,536 - 1,138,536 (126,938) - 1,011,598 

10,783,398 396,136 (31,001) 11,148,533 1,310,717 (11,922) 12,447,328 

Invested in equipment and 

leasehold improvements: 

General 97,731 (35,115) 31,001 93,617 (36,697) 11,922 68,842 

$ 10,881,129 $ 361,021 $ - $ 11,242,150 $ 1,274,020 $ - $ 12,516,170 


3 



Statement of Cash Flows 


Cash flows from (used in): 

2009 2008 

Operations: 

Excess of revenue over expenses $ 1,274,020 $ 361,021 

Items not involving cash: 

Amortization of equipment and leasehold 

improvements 36,697 35,115 

Gain on disposal of investments (13,633) (32,080) 

Reinvested investment income (264,402) (282,713) 

Market value adjustments on investments (1,045,852) 1,532,992 

Change in non-cash operating working capital: 

Accounts receivable (220,745) (18,748) 

Prepaid expenses 27,812 9,824 

Prepaid C.M.A. dues - 283,941 

Due from administered entities (37,148) 1,023 

Accounts payable (83,738) 143,869 

Undistributed retroactive payments 730,083 (5,094,543) 

Deferred revenue - membership fees (22,421) (22,342) 

Unutilized government grant 2,425,000 2,500,000 

2,805,673 (582,641) 

Investing: 

Purchase of equipment and leasehold improvements (11,922) (31,001) 

Purchase of investments (2,208,078) - 

Proceeds on disposal of investments 1,252,646 250,000 

(967,354) 218,999 

Increase (decrease) in cash and equivalents 1,838,319 (363,642) 

Cash and equivalents, beginning of year 16,827,685 17,191,327 

Cash and equivalents, end of year $ 18,666,004 $ 16,827,685 



4


Notes to Financial Statements 

Year ended December 31, 2009 

The Saskatchewan Medical Association (the "Association") is the professional association of 

Saskatchewan physicians. It represents the official voice of organized medicine in Saskatchewan and 

its work and activities represent the views and interests of Saskatchewan physicians. 

1. Significant accounting policies: 

(a) 

Use of estimates: 

The preparation of financial statements in conformity with Canadian generally accepted 

accounting principles requires management to make estimates and assumptions that affect 

the reported amounts of assets and liabilities and disclosure of contingent assets and 

liabilities at the date of the financial statements and the reported amount of revenue and 

expenses during the reporting period. Actual results could differ from these estimates. 

(b) 

Cash and equivalents: 

Cash and cash equivalents are recorded at fair value and consist of balances with financial 

institutions which have an initial term to maturity of three months or less. The Association's 

short-term investments in guaranteed investment certificates with an initial term to maturity of 

three months or less are considered to be cash equivalents and are recorded at fair value. 

(c) 

Recognition of revenue: 

Annual membership fees are for the period January 1 to December 31 of each year and are 

recognized as earned revenue on a pro-rata basis over the year. 

Insurance administration allowances are recognized as earned at the time that related 

insurance premiums become payable. 

Government grants received for the purpose of providing new program initiatives are 

recognized in revenue in the same period as related expenses are incurred. 

Other revenue items, except for interest on investments which is recognized over the term of 

maturity of the investment, are recognized as earned at the time such amounts are received. 

(d) 

Deferred revenue - membership fees: 

Deferred revenue - membership fees represents amounts received by the Association 

related to operations of the next fiscal year. 


5


Notes to Financial Statements (continued) 


1. Significant accounting policies (continued): 

(e) 

Investments: 

Investments are classified as held for trading and stated at fair value (note 3). 

Fixed income securities including bonds and equities are valued at year-end quoted market 

prices, where available. Where quoted market prices are not available, estimated fair values 

are calculated using comparable securities. Investment management fees are expensed as 

incurred. 

In determining fair values, adjustments have not been made for transaction costs as they are 

not considered significant. The unrealized gain or loss on investments, being the difference 

between original cost and fair value, is included in fair value adjustment on investments in the 

statement of revenue and expenses. 

(f) 

Equipment and leasehold improvements: 

Equipment and leasehold improvements are recorded at cost. Amortization is recorded over 

the estimated useful lives of the assets using the following method and annual rates: 

Asset Method Rate 

Furniture and equipment Straight-line 10% 

Computer equipment Straight-line 33 1/3% 

Leasehold improvements Straight-line Over lease term 

(g) 

Administered programs: 

The Association administers programs funded by the Province of Saskatchewan for 

physicians pursuant to agreements between the Minister of Health and the Association (note 

10). Funds received pursuant to these programs are maintained in bank accounts separate 

from the operating accounts of the Association and are not reflected in these financial 

statements. The activities of these programs are not reflected in the operations of the 

Association and are also not reflected in these financial statements. 


6




2. Recently issued accounting standards: 

Effective January 1, 2009 the Association adopted the Canadian Institute of Chartered 

Accountants ("CICA") amendments to section 1000 of the CICA Handbook. These 

amendments clarified the criteria for recognition of an asset or liability, removing the ability to 

recognize assets or liabilities solely on the basis of matching of revenue and expense items. 

Adoption of these recommendations had no effect on the financial statements for the year 

ended December 31, 2009. 

Effective January 1, 2009, the Association adopted the CICA amendments to the 4400 

Sections of the CICA Handbook. These amendments eliminate the requirement to show net 

assets invested in capital assets as a separate component of net assets, clarify the 

requirement for revenue and expenses to be presented on a gross basis when the not-forprofit 

organization is acting as principal and require a statement of cash flow. Adoption of 

these recommendations had no significant impact on the financial statements for the year 

ended December 31, 2009. 

Effective January 1, 2009, the Association adopted CICA Handbook Section 4470, 

Disclosure of Allocated Expenses by Not-for-Profit Organizations which establishes 

disclosure standards for entities that choose to classify their expenses by function and 

allocate expenses from one function to another. Adoption of these recommendations had no 

significant impact on the financial statements for the year ended December 31, 2009. 


7




3. Investments: 

2009 2008 

(Fair value) (Fair Value) 

General Account: 

Pooled funds: 

Canadian bonds (original cost - $1,615,601) $ 1,658,528 $ 1,589,592 

Canadian equity (original cost - $378,930) 489,206 298,073 

US and other foreign equity (original cost - $522,549) 406,368 307,732 

Total General Account (original cost - $2,517,080) $ 2,554,102 $ 2,195,397 

Physician Support Fund: 

Pooled funds: 

Canadian bonds (original cost - $1,665,861) $ 1,713,828 $ 1,810,957 

Canadian equity (original cost - $1,719,266) 2,345,252 1,610,992 

US and other foreign equity (original cost - $2,304,762) 1,755,675 1,536,962 

Total Physician Support Fund (original cost - $5,689,889) $ 5,814,755 $ 4,958,911 

Insurance Administration Account: 

Pooled funds: 

Canadian bonds (original cost - $330,906) $ 339,698 $ 325,579 

Canadian equity (original cost - $77,612) 100,199 61,051 

US and other foreign equity (original cost - $107,028) 83,232 63,029 

Total Insurance Administration Account (original cost - $515,546) $ 523,129 $ 449,659 

Leadership Development Fund: 

Pooled funds: 

Canadian bonds (original cost - $375,000) $ 363,741 - 

Canadian equity (original cost - $330,000) 337,501 - 

US and other foreign equity (original cost - $295,000) 290,058 - 

Total Leadership Development Fund (original cost-$1,000,000) $ 991,300 - 

Total Association (original cost - $9,722,515) $ 9,883,286 $ 7,603,967 


8




4. Equipment and leasehold improvements: 

2009 2008 

Accumulated Net book Net book 

Cost Amortization Value Value 


Furniture and equipment $ 164,057 $ 133,558 $ 30,499 $ 32,526 

Computer equipment 282,068 267,948 14,120 24,756 

Leasehold improvements 327,934 303,711 24,223 36,335 

774,059 705,217 68,842 93,617 


Computer equipment 10,099 10,099 - - 

Total Association $ 784,158 $ 715,316 $ 68,842 $ 93,617 

5. Physician Support Fund: 

The Canadian Medical Protective Association Fees Reimbursement Fund (the "C.M.P.A. Fund") 

was established in 1998 to reimburse eligible fee-for-service physicians the actual costs of 

Canadian Medical Protective Association (C.M.P.A.) liability insurance costs. 

On March 19, 2001 the Board of Directors of the Association and the Minister of Health for the 

Province of Saskatchewan signed a new agreement which was effective April 1, 2000. Pursuant 

to the new agreement, based on the calendar year beginning January 1, 2000, the Minister would 

only fund actual costs of C.M.P.A. dues reimbursed to eligible fee-for-service physicians (note 9). 

As a result, the surplus generated by the C.M.P.A. Fund prior to the new agreement, in the 

amount of $5,125,265 belongs to the Association. During 2003, the Board created the "Physician 

Support Fund" to manage revenues and expenditures associated with this surplus. Future 

expenditures from this fund are to be determined by the Board. 


9




6. Communication Technology Fund: 

The Communication Technology Fund ("CTF") was established in 1995 to develop programs to 

assist physicians in the use of information technology. The Minister of Health for the Province of 

Saskatchewan made a one time payment to the CTF of $500,000. 

During 2000, the CTF was discontinued and the remaining balance of funds of $235,691 was 

transferred to the Association to be used for information technology enhancements considered to 

be of benefit to Saskatchewan physicians. Future expenditures from CTF are to be determined 

by the information technology committee of the Association. There was no activity in this fund 

during the 2008 and 2009 fiscal years. As at December 31, 2009, $129,456 (2008 - $129,456) 

remains to be expended. 

7. Insurance Administration Account: 

The Association administers group insurance plans providing disability, life, accidental death and 

dismemberment, office overhead and medical office benefits insurance for its members. These 

plans are underwritten by three insurance companies and the Association collects premiums from 

members, remits these premiums to the insurance companies and receives an administrative 

allowance of 5.5% to 8.0% of premiums. The disability and life insurance plans are experience 

rated and the insurance companies underwriting these plans maintain specific reserve accounts 

which are not reflected in these financial statements. In years of favourable experience and, on 

the recommendation of the Association, the insurance companies rebate a portion of disability 

and life insurance premiums to plan members from their reserve accounts. 

During the year $127,000 (2008 - $127,000) of administration costs were recovered by the 

General Account from the Insurance Administration Account. 

8. Leadership Development Fund: 

The Leadership Development Fund ("LDF") was established in 2008 to encourage physicians to 

participate in leadership development training initiatives to facilitate their participation in 

management and leadership roles in the health care delivery system. Future expenditures from 

the LDF are to be determined by the Board. 


10




9. Agreement with Province of Saskatchewan: 

On October 20, 2006 the Board of Directors of the Association and the Minister of Health for the 

Province of Saskatchewan (the "Minister") signed an Agreement (the "Agreement") with respect to 

payments for insured services provided by physicians. The term of the Agreement is from April 1, 

2006 to March 31, 2009. In addition to payments for insured services to physicians during the 

term of the Agreement, the Agreement also provides for payments for past services, other 

programs and education and liability insurance costs. 

Negotiations with respect to a new Agreement are in progress and payments for past service, 

other programs and education and liability insurance costs, are expected to continue, in a similar 

manner as past years, until a new Agreement is reached. 

(a) 

Payments for past services: 

During 2009, the Minister paid $730,083 (2008 - $2,055,217) to the Association as payments 

for distribution to physicians in lieu of a retroactive amendment to the payment schedule. An 

analysis of the undistributed retroactive payments is as follows: 

2009 2008 

Undistributed retroactive payments, beginning of year $ - $ 5,094,543 

Retroactive payments received 730,083 2,055,217 

Retained by Association - (1,138,536) 

Distributed to physicians - (6,011,224) 

Undistributed retroactive payments, end of year $ 730,083 $ - 

During 2008, the Association determined that a portion of the funds in this account should be 

retained by the Association for purposes of establishing a Leadership Development Fund. 

The purpose of the Leadership Development Fund is to encourage and fund physicians to 

participate in leadership development training initiatives, including programs to facilitate 

management and leadership roles in the health care delivery system. The balance of the 

account was distributed to physicians in lieu of a retroactive amendment to the payment 

schedule. 

(b) 

Other programs and education: 

(i) The Agreement provides payments for the Rural and Regional Incentives Account, the 

Continuing Medical Education Fund, the C.M.P.A. Dues Reimbursement Fund, the 

Physician Retention Fund, the Specialist Recruitment and Retention Fund, the Parental 

Leave Program and the Electronic Medical Records Fund. Amounts received by the 

programs which are currently administered by the Association are described in note 10. 


11




9. Agreement with Province of Saskatchewan (continued): 

(ii) The Agreement provides for additional payments to be used for the purpose of providing 

new recruitment and retention initiatives. Funds can only be expended on the new 

initiatives upon agreement between the Minister and the Association and as programs 

are developed. An analysis of amounts received and expensed is as follows: 

2009 2008 

Unutilized government grants, beginning of year $ 11,950,000 $ 9,450,000 

Payments received 2,625,000 2,700,000 

Amounts expensed, Health Quality Council (200,000) (200,000) 

Unutilized government grants, end of year $ 14,375,000 $ 11,950,000 

(c) 

Liability insurance costs: 

In recognition of the impact of cost increases related to Canadian Medical Protective 

Association (C.M.P.A.) liability insurance costs, the Minister shall make available sufficient 

amounts to reimburse the actual costs of C.M.P.A. dues for eligible fee-for-service physicians 

for each year in the Agreement. In addition, the Minister shall make available amounts to 

reimburse the actual costs of C.M.P.A. dues for physicians on alternative payment 

arrangements for each year of the Agreement. All amounts are to be received by the 

C.M.P.A. Dues Reimbursement Fund, currently administered by the Association as described 

in note 10. 


12




10. Administered programs: 

The Association administers the Rural and Regional Incentives Account, Electronic Medical 

Records Fund, C.M.P.A Dues Reimbursement Fund, Physician Retention Fund, Specialist 

Recruitment and Retention Fund, Continuing Medical Education Fund, and the Parental Leave 

Program. The Association received amounts from these programs for recovery of the cost of 

administration as follows: 

2009 2008 

Electronic Medical Records Fund $ 201,506 $ 160,000 

Rural and Regional Incentives Account 140,000 122,000 

C.M.P.A Dues Reimbursement Fund 83,000 83,000 

Continuing Medical Education Fund 50,000 31,000 

Physician Retention Fund 41,400 40,000 

Specialist Recruitment and Retention Fund 40,300 39,000 

Parental Leave Program 10,765 10,400 

$ 566,971 $ 445,400 

11. Commitments: 

Estimated future minimum lease payments under operating leases for the rental of office space 

and equipment for the next three years are as follows: 

Office Space Vehicle Equipment Total 

2010 $ 68,303 $ 868 $ 10,681 $ 79,852 

2011 68,303 - 10,681 78,984 

2012 - - 5,341 5,341 

The office lease is effective for the period on January 1, 2007 to December 31, 2011. Minimum 

future lease payments for office space consist of base rental charges. Occupancy costs, parking 

fees and applicable taxes currently estimated at $64,000 per annum will be in addition to the base 

rental charges indicated above. 


13




12. Financial instruments and risk management: 

Cash and equivalents and investments are stated at fair value. The fair value of the Association's 

accounts receivable, due from administered entities, undistributed retroactive payments, and 

accounts payable approximate their carrying amounts due to the short-term period to maturity of 

the instruments. 

The Association is exposed to interest rate risk arising from fluctuation in interest rates on 

amounts invested in interest bearing accounts and investments. Cash, when received, is 

deposited into an interest bearing account with interest earned based on prime rates on the 

balance in the account. Cash equivalents consist of term deposits with a major Canadian 

financial institution which bear interest at 0.3% and mature in February and March of 2010. 

Amounts are invested in term deposits based on estimated financial requirements of the 

Association. 

The Association is exposed to market risk on its investments. Investments consist primarily of 

pooled funds managed by external investments advisors. These investments are subject to 

fluctuations in market value. The market value of investments is disclosed in note 3. 

The Association is also exposed to credit risk on its investments and accounts receivable. Credit 

risk related to investments is minimized by dealing with institutions that have strong credit ratings 

and by investing in a diversified pool of funds. Credit risk associated with accounts receivable is 

minimized as these receivables are from physicians who receive benefit from the Association. 

13. Pension plan: 

The employees of the Association participate in a multi-employer defined benefit pension plan 

administered by the Canadian Medical Association. Contributions by the Association on behalf of 

participating employees are expensed as incurred. 

During the year ended December 31, 2009, $137,099 (2008 - $120,723) was contributed to the 

plan. 

14. Comparative figures: 

Certain comparative figures have been reclassified to conform with the financial statement 

presentation adopted in the current year. 


14


Schedule of Revenue and Expenses 


Insurance 

General 

Administration 

2009 2008 2009 2008 

Revenue: (schedule 2) 

Membership fees $ 3,058,930 $ 2,921,170 $ - $ - $ 

Administered programs (note 8) 566,971 485,400 - - 

Investment income 225,920 609,738 22,314 35,577 

Health Quality Council 200,000 200,000 - - 

Insurance allowances - - 172,015 166,564 

C.M.A grant 7,500 7,500 - - 

Leadership development (note 7) - - - - 

Insurance Administration 

Account (note 6) 127,000 127,000 (127,000) (127,000) 

Premium rebate allowance and sundry 6,500 - (4,020) 36,183 

4,192,821 4,350,808 63,309 111,324 

Expenses: 

Administrative (schedule 3) 1,862,190 1,709,484 27,070 29,788 

C.M.A. dues 684,613 644,917 - - 

Committee (schedule 4) 330,562 368,709 - - 

Health Quality Council 200,000 200,000 - - 

Board 195,081 183,556 - - 

Leadership development - 86,711 - - 

Office rent 80,209 91,263 24,063 27,379 

Practice Enhancement Program 75,000 75,000 - - 

Regional Medical Associations 74,587 75,665 - - 

Negotiations and related activities 69,781 101,641 - - 

C.M.E. grant 65,000 62,000 - - 

Investment management fees 16,164 15,237 3,311 4,095 

C.M.A and divisional meetings 24,617 21,542 - - 

Commissions - - 14,810 23,862 

S.M.A. student bursaries 14,000 14,000 - - 

Directors' and officers' liability 

insurance 10,570 10,570 - - 

General Practitioners Physician Profiles 5,250 - - - 

Consulting - - 4,463 9,188 

3,707,624 3,660,295 73,717 94,312 

Excess of revenue over expenses 

before the undernoted 485,197 690,513 (10,408) 17,012 

Fair value adjustment on investments 208,067 (236,322) 42,616 (48,720) 

Excess of revenue over 

expenses before amortization 693,264 454,191 32,208 (31,708) 

Amortization 36,697 35,115 - - 

Excess of revenue over expenses $ 656,567 $ 419,076 $ 32,208 $ (31,708) $ 

15 


Schedule 1 

Physician 

Leadership 

Support Fund Development Fund Total Total 

2009 2008 2009 2008 2009 2008 

- $ - $ - $ - $ 3,058,930 $ 2,921,170 

- - - - 566,971 485,400 

163,154 326,536 6,016 - 417,404 971,851 

- - - - 200,000 200,000 

- - - - 172,015 166,564 

- - - - 7,500 7,500 

- - - 1,138,536 - 1,138,536 

- - - - - - 

- - - - 2,480 36,183 

163,154 326,536 6,016 1,138,536 4,425,300 5,927,204 

148,017 136,705 - - 2,037,277 1,875,977 

- - - - 684,613 644,917 

54,710 48,148 - - 385,272 416,857 

- - - - 200,000 200,000 

- - - - 195,081 183,556 

- - 124,254 - 124,254 86,711 

16,042 18,253 - - 120,314 136,895 

- - - - 75,000 75,000 

- - - - 74,587 75,665 

- - - - 69,781 101,641 

- - - - 65,000 62,000 

36,071 40,363 - - 55,546 59,695 

- - - - 24,617 21,542 

- - - - 14,810 23,862 

- - - - 14,000 14,000 

- - - - 10,570 10,570 

- - - - 5,250 - 

- - - - 4,463 9,188 

254,840 243,469 124,254 - 4,160,435 3,998,076 

(91,686) 83,067 (118,238) 1,138,536 264,865 1,929,128 

803,869 (1,247,950) (8,700) - 1,045,852 (1,532,992) 

712,183 (1,164,883) (126,938) 1,138,536 1,310,717 396,136 

- - - - 36,697 35,115 

712,183 $ (1,164,883) $ (126,938) 1,138,536 $ 1,274,020 $ 361,021 



Schedule of Revenue 

Schedule 2 


Budget Actual Actual 

2009 2009 2008 

(unaudited) 


Membership fees $ 2,978,039 $ 3,058,930 $ 2,921,170 

Administered programs 531,065 566,971 485,400 



Administration fees-Insurance Administration 

Account 127,000 127,000 127,000 

C.M.A. grant 7,500 7,500 7,500 

Sundry - 6,500 - 

3,993,604 4,192,821 4,350,808 


Insurance allowances 175,000 172,015 166,564 


Premium rebate allowance and sundry 500 (4,020) 36,183 

Administration expense - General Account (127,000) (127,000) (127,000) 

73,500 63,309 111,324 

Physical Support Fund: 


Leadership Development Fund: 

Leadership development - - 1,138,536 

Investment income - 6,016 - 

- 6,016 1,138,536 

Total Association $ 4,350,229 $ 4,425,300 $ 5,927,204 


16


Schedule of Administrative Expenses 

Schedule 3 



2009 2009 2008 

(unaudited) 


Salaries $ 1,145,550 $ 1,261,945 $ 1,110,705 

C.M.A. pension (note 13) 116,000 126,062 110,882 

Printing, postage and stationery 120,000 115,135 110,654 

Repairs, maintenance, service and technology 50,000 70,103 54,994 

Disability, life and dental insurance 73,500 66,411 61,514 

Automobile leasing and travel costs 47,000 43,620 44,361 

Canada pension plan 31,000 35,731 29,651 

Consulting services 91,350 33,931 89,655 

Accounting, audit and special services 35,000 31,241 32,181 

Secretariat expense and membership dues 18,500 21,436 18,002 

Legal and consulting fees 12,000 16,176 9,671 

Employment insurance 13,500 14,811 12,405 

President's and Vice President's expenses 8,500 8,500 8,500 

Sundry 6,000 1,743 1,928 

Recruitment - 6,212 1,974 

Telephone 7,000 4,546 5,740 

Workers' compensation 2,300 2,411 2,367 

Bank charges 1,100 2,176 1,432 

Training / staff education 10,000 - 2,868 

$ 1,788,300 $ 1,862,190 $ 1,709,484 


Printing, postage and stationery $ 18,000 $ 13,329 $ 15,588 


Telephone 4,200 3,582 3,298 

Bank charges, interest, exchange and sundry 350 1,113 502 

Waived life insurance premiums 2,700 885 3,646 

$ 33,250 $ 27,070 $ 29,788 


Salaries $ 112,350 $ 112,057 $ 105,632 

C.M.A. pension (note 13) 11,550 11,037 9,841 


Disability, life and dental insurance 7,200 6,673 6,928 

Printing, postage and stationery 5,200 4,187 4,643 

Canada pension plan 2,800 2,755 2,648 

Telephone 2,100 1,791 828 

Employment insurance 1,300 1,118 1,091 

Education material and sundry 500 - - 

$ 150,000 $ 148,017 $ 136,705 

Total association $ 1,971,550 $ 2,037,277 $ 1,875,977 


17


Schedule of Committee Expenses 

Schedule 4 



2009 2009 2008 

(unaudited) 


Representative assembly $ 190,000 $ 220,172 $ 232,528 

C.M.A. general council 55,000 36,084 61,005 

Economics and intersectional 

council 35,000 25,307 12,505 

Rural practice 20,000 18,502 18,710 

Ad hoc 4,000 7,216 2,177 

Tariff 13,000 4,854 8,347 

Primary care 25,000 3,853 15,744 

Representations to outside 

organizations 2,500 3,752 593 

Information technology 8,000 3,137 6,369 

Finance 3,000 3,001 2,683 

Membership services 2,000 2,144 577 

Electronic medical records 10,000 1,879 4,320 

Legislative 2,500 661 2,068 

Health and emergency services 6,000 - 1,083 

$ 376,000 $ 330,562 $ 368,709 


Saskatchewan physicians support 

program $ 40,000 $ 29,096 $ 30,961 

Professional review 10,000 15,082 6,675 

Member advisory 12,000 10,532 10,497 

Medical Benevolent Society 125 - 15 

$ 62,125 $ 54,710 $ 48,148 

Total Association $ 438,125 $ 385,272 $ 416,857 



Saskatchewan Medical Association 

402 - 321A - 21st Street East 

Saskatoon, Saskatchewan S7K 0C1 

Phone (306) 244-2196 

www.sma.sk.ca

Saskatchewan Medical Assocation Reports for the Representative ...

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