Digest (July/August, 2010, p. 25) - Alberta Medical Association

From The EditorChangingthoughtson changeDennis W. Jirsch,MD, PhDEditorSome 15 years agoI wrote a chapter onchange managementfor a text aimedat physicianadministrators.I wrote, “Changehas become the normin our personal andorganizational lives. The volume, themomentum and the very complexityof change all seem to increase. . . .Coping with change has become thenumber one priority for health careadministrators.” 1Well, how do the French put it? Plusça change, plus c'est la même chose. . . .The drivers for change at thetime were considered to be four:burgeoning technology, the qualityimprovement movement, the growingrealization that health and health careare vastly different, and the growingcost of health care.Technological change hasn’tslowed. Most hospital activity isdone on an outpatient or short-staybasis, and even out-of-hospital care isincreasingly focused and episodic.Recognition that health status hasmore to do with income, education,housing and other factors outsidethe health care system has occurrednominally, but little has been doneabout it.Quality improvement initiativeswere once “hot stuff” and were, at leastin part, the impetus for standardizedcare protocols. Recurring attentionto care pathways was meant to bethe vehicle for quality improvement,making things ever better.When was the last time youheard of quality improvementinitiatives that really related topatients' concerns or, heavenforbid, to the lives of thehealth care workforce?I hear little about care protocolsnow, and some of the imbedded onesthat are part of my clinical life haven’tchanged in years. They were meant tobe fluid, responsive things but havebeen relegated to the back burner.To my way of thinking it’s theso-called affordability crisis – thatmonotonic, overarching idée fixe– that is the continuing spur forhavoc-wreaking change. It hasusurped the rest of the agenda.When was the last time you heardof quality improvement initiatives thatreally related to patients' concernsor, heaven forbid, to the lives of thehealth care workforce?This fixation has found groundin successive political and politicallysubservient administrations whoswear they've heard the “Word FromAbove,” who know, just know, thatthis or that rejigging of the bodycorporate or resiting of services orprivatization initiative can save usfrom eternal health care damnation.I’d write a different article nowadaysand it would be more cautionaryand more cynical. I’d want to warnwould-be doc administrators that theirenvironment has much to do with costcontainment and actually little else.I’d warn would-be docadministrators that successive wavesof regime change portend lives thatare more tedious than ever and yetmore impermanent.Recall, for example, a few of thenames of non-doc administrators fromyesteryear. Google them and theirwhereabouts and you’ll see what I2Alberta Doctors’ Digest • July/August 2010

mean. In the non-stop game of musicalchairs that attends restructuring,they’re now (temporarily) in Timbuktuor Pickle Lake or Kapuskasing.In this Darwinian exercise for sure,a few of the alpha males and femaleshave made off with much bootyand are presumably leading cushy,indolent lives. But the ones who’vemade off with the swag, and theirmore numerous but less fortunatebedfellows, are gone, gone, gone inthe never-ending tumult.I’d exhort would-be docadministrators to mull over thistransience, to think on it long andhard. This ball hasn’t stopped yet. I’dcaution would-be doc administrators todevelop Plan B or what to do when thes * * * hits the fan and the next regimestands impatiently in the wings.An administrator I reported to yearsago was prescient in this regard, andwouldn’t hear of physicians doingfull-time admin work to the exclusionof clinical practice. It was a stroke ofbrilliance. When the job goes south,there’s comfort in being able to resumeclinical practice. Call it insurance.I’d suggest that today’s would-bedoc administrator should find outexactly what he or she can do. It’soften surprisingly little. Can onebuy a new fax machine, say, or anew computer without repetitivegenuflection to higher-ups?Turns out that many jobs withhighfalutin’ titles have such modestscopes of activity that they’re pretty wellimpotent. And much of the currentballyhoo about the need for “teamplayers” more realistically calls forfunctionaries, devoid of any initiative.The would-be doc administratorshould similarly find out who he orshe will report to. Given the harshlikelihood of continuing disruptionand movement, who will bubble-upI’d caution would-be docadministrators to develop Plan Bor what to do when the s * * *hits the fan and the next regimestands impatiently in the wings.when the next spasm runs throughthe corporation?It is almost axiomatic that thedoc administrator will report toa non-physician in our rebuiltcorporations. The spectrum ofpossibilities is large and willinclude the occasional wellgrounded,affable citizen.In the crucible of perpetual jobcompetition, the doc is likely to runup against truly unsavoury charactersclambering to get a foot or a toe up,no matter what. Best avoided.The doc administrator is probablyadvised to make new friends, andemulate a new peer group sincephysicians don’t often warm tocorporate satraps. Get used to it, I say.Start to use the jargon of “thesuits.” “Stakeholders,” for instance,aren’t Ku Klux Klan members. Ifyou’re planning something, “incent”it, “incentivize” it or “transition” to it,and take along your “learnings.”Use the word “accountability”incessantly. Backed into a corner?Blurt out “performance indicators.”No one knows much about these,even less about their utility, butmere mention will set ’em back ontheir haunches.And, dear and promising would-bedoc administrators, if you’re still braveof heart, I’d ask you one last time toreconsider. You’re unlikely to findbetter soul or litter mates than thebeleaguered folk who have workedwith you at the coal face.“Taking call” – often the reasonfor leaving clinical activity – isn’t asbad as it sometime seems, and all callshifts end eventually.But, if you make the jump, goodluck. Remember, you’ve been warned.To return to my text of 15 years ago,I’m now more suspicious, more wary.What, for instance, does the gooeyadmonition to “embrace change!”really mean? If I’m disconsolate at thenotion, it has more to do with the costof change – especially ill-considered,needless change – than the fact of it.We are all complicit here,enamored with the overwhelminglyunlikely quick fix and, when thatdoesn't work, with the soothing balmof a few more resource dollars. Andwe continue to confuse change withprogress and are inattentive to boththe mistakes and the small successesof our past.We haven't learned.Reference1. Jirsch, D.W. “Change and the medical administrator.”The CMA Guide to Medical Administration in CanadianHospitals. Ed. D.D. Gellman. Ottawa: Canadian MedicalAssociation, 1992. Chapter 4.We are all complicithere, enamored with theoverwhelmingly unlikelyquick fix and, when thatdoesn't work, with thesoothing balm of a fewmore resource dollars.Alberta Doctors’ Digest • July/August 2010 3

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TABLE OFCONTENTSPatients First ®Patients First ® is a registered trademarkof the Alberta Medical Association.The Alberta Doctors’ Digest is publishedsix times annually by the AlbertaMedical Association for its members.Editor:Dennis W. Jirsch, MD, PhDCo-Editor:Alexander H.G. Paterson, MB ChB,MD, FRCP, FACPEditor-in-Chief:Candy L. Holland, BSc, BEd, AD/PRPresident:Christopher J. (Chip) Doig,MD, MSc, FRCPCPresident-Elect:Patrick J. White, MB, BCh, MRCPsychImmediate Past President:Noel W. Grisdale, MD, CCFPAlberta Medical Association12230 106 Ave NWEdmonton AB T5N 3Z1T 780.482.2626 TF 1.800.272.9680F 780.482.5445amamail@albertadoctors.orgwww.albertadoctors.orgSeptember/October issue deadline: August 9The opinions expressed in the AlbertaDoctors’ Digest are those of the authors anddo not necessarily reflect the opinions orpositions of the Alberta Medical Associationor its Board of Directors. The associationreserves the right to edit all letters to the editor.The Alberta Medical Association assumesno responsibility or liability for damagesarising from any error or omission or fromthe use of any information or advicecontained in the Alberta Doctors’ Digest.Advertisements included in the AlbertaDoctors’ Digest are not necessarily endorsedby the Alberta Medical Association.© 2010 by the Alberta Medical AssociationDesign by Sarah Tiemstra at Backstreet CommunicationsDEPARTMENTS2 Editorial13 Mind Your Own Business14 Health Law Update18 Students' Voice21 PFSP PerspectivesFEATURES6 Medicare’s social contract with doctors,developing an Alberta Health ActThe Alberta Medical Association (AMA) presented its brief on July 9to Fred Horne (MLA, Edmonton-Rutherford), who has been consultingwith Albertans about a proposed Alberta Health Act.9 Dr. Slocombe acclaimed as AMA president-electDr. Linda Slocombe’s term as president-elect begins September 25 atadjournment of the Representative Forum/annual general meeting.10 The AMA and the profession in AlbertaAMA President Dr. Christopher J. (Chip) Doig addressed GrandRounds at the University of Alberta recently about physician manpower,Negotiations 2011 and academic alternate relationship plans.16 Premier Ed Stelmach on health care in AlbertaAt the Calgary Premier’s Dinner, in April, Premier Ed Stelmach spokeabout his commitment to publicly funded and administered health carein Alberta.17 Clarifying physicians' freedom to advocateThe professional responsibility of physicians for patient advocacy,including speaking in the media, is clarified by Alberta Health Services,the College of Physicians & Surgeons of Alberta and the AMA.Cover photo: Tommy Douglas, "Father of Canadian Medicare" ( courtesy of the Douglas-Coldwell Foundation), andFred Horne, MLA, Edmonton-Rutherford ( supplied).AMA Mission Statement23 Letters24 Web-footed MD26 In a Different Vein29 Classified AdvertisementsThe AMA stands as an advocate for its physician members, providing leadershipand support for their role in the provision of quality health care.Cert no. XXX-XXX-000Alberta Doctors’ Digest • July/August 2010 5

cover storyMedicare’ssocial contractwith doctors,developing anAlberta Health ActIn its July 9 brief on a proposedAlberta Health Act, the Alberta MedicalAssociation (AMA) emphasized thatAlberta must honor the social contractgovernments made with physicianswhen they introduced Medicare, andall Albertans must have timely and safeaccess to quality care based primarilyon need rather than ability to pay.The seven-page document (onlinewith the July 16 President's Letter atwww.albertadoctors.org/PresLet/Index)regarding a new legislative frameworkfor health care in Alberta was providedto Fred Horne (MLA, Edmonton-Rutherford), who is responsible forconsulting with Albertans about anew Alberta Health Act.Quality must include theopportunity to access carewithin a reasonable periodof time.It is a companion to the AMA’smuch more comprehensive brief tothe Minister’s Advisory Committeeon Health in October 2009.Other points raised are:• An “enabling” frameworkcould “vest overwhelmingauthority for decision-makingto government ministers anddepartments through regulationsand policies.”• Safety, quality, evidence-baseddecisions and sustainability –not lobbying – should determinewhether or not governmentpays for services not requiredby the Canada Health Act.• The Health Professions Act hasfragmented care, “which cancompromise safety and quality,can devalue cost-effectiveness andis contrary to the government’sgoal of sustainability.”• AMA should have formalrecognition in the AlbertaHealth Act.• AMA supports a patient’s charter.Excerpts from the AMA’s briefIntroductionAll Albertans must have timelyand safe access to quality care basedprimarily on need rather than abilityto pay. Albertans do receive highquality care, when they can access it.Quality must include the opportunityto access care within a reasonableperiod of time.The doctor-patient relationship –founded on compassion, trust andrespect – must remain a cornerstoneof the health system.This includes a patient’s historicright to choose her or his physician,and physicians acting as the agentsof their patients – within the broadestmeaning of the term “agency” –always in the best interests oftheir patients.Given physicians’ responsibilityto be advocates for patients, Alberta’shealth care legislative framework shouldrecognize organized medicine andprotect the unique role of physicianswithin the health care system.Medicare’s social contractLooking ahead, Alberta ishonor-bound to protect the socialcontract between the medicalprofession and the state.Anything less would be arepudiation of Tommy Douglas’agreement with physicians in the1962 Saskatoon Accord that was –and remains – the basis for Medicare,which includes safeguarding not onlythe patient-physician relationship butalso the integrity of this relationship.6Alberta Doctors’ Digest • July/August 2010

Any aberration from this socialcontract could unfairly disadvantageand disenfranchise physicians andpossibly destabilize Alberta’s healthcare system. It would also appear atodds with Alberta’s professed supportfor the Canada Health Act.'Prescriptive' vs. 'enabling'The current legislative framework(that includes the Canada Health Act)may be categorized as “prescriptive”because it identifies and prescribesthe unique roles of physician andhospital services.Perhaps the most prominentprescription is “core” services whereby“core” is defined by the provider, i.e.,physicians and hospitals, and not bythe service itself. (The Canada HealthAct defines “core” physician servicesas “medically required.”)An “enabling” framework couldvest overwhelming authority fordecision-making to governmentministers and departmentsthrough regulations and policies.A shift from a “prescriptive”legislative framework to an “enabling”regime would pose a serious threatto the underpinnings and tenetsof Medicare. Philosophical andoperational convulsions of thismagnitude and importance deservevigorous and full public debate.An “enabling” regime would bemuch more than a soupçon of processand procedures. Such a change mayappear to be benign when in realityTommy Douglas, "Father of Medicare."( courtesy of the Douglas-Coldwell Foundation.)it is a Trojan horse disguised as ahousekeeping detail.An “enabling” framework couldvest overwhelming authority fordecision-making to governmentministers and departments throughregulations and policies. Alberta,regrettably, does not have a sterlingreputation for transparency andopenness in such matters.The Alberta Medical Association,therefore, is alarmed that suchpractices could be legitimizedthrough legislation.'Reasonable compensation'The Canada Health Act in 1984reaffirmed governments’ socialcontract with the medical profession.Section 12.1(c), “Accessibility,”states: “In order to satisfy the criterionregarding accessibility, the health careinsurance plan of a province mustprovide for reasonable compensationfor all insured health services renderedby medical practitioners or dentists.”Section 12.2, “Reasonablecompensation,” acknowledges thevulnerability of physicians in havingFred Horne, MLA, Edmonton-Rutherford.( supplied.)nearly 100% of their compensationsubject to a single payer: government.Insured servicesThe Canada Health Act designates“insured health services” to be thoseprovided by physicians, dentists andhospitals under provincial legislation,and defines “physician services” as“any medically required servicesrendered by medical practitioners.”Alberta Doctors’ Digest • July/August 2010 7

Transparency on the processto determine core/non-coreand insured/uninsuredservices should be pursued.At a provincial level, Alberta Healthand Wellness (AHW) has imposedan artificial, limiting definition of“physician services” to mean onlyfee-for-service items in the Scheduleof Medical Benefits.Exempted are “medically required”services provided through alternaterelationship plans (ARPs), academicalternate relationship plans (AARPs)and ancillary programs that areproxies for compensation suchas Canadian Medical ProtectiveAssociation and continuing medicaleducation reimbursement, theRetention Benefit and the PhysicianOffice System Program (POSP).From the public’s perspective, thereare concerns (and confusion) about“private” health care.Transparency on the process todetermine core/non-core and insured/uninsured services should be pursued.Alberta currently funds servicesthat are outside the Canada Health Act(e.g., optometry, chiropractic, extendedliving and pharmaceuticals) andgovernment faces continual lobbyingfrom certain providers and theirpatients/clients for new or expandedpublic coverage.Two principles from the advisorycommittee – “Be committed toquality and safety” and “Enabledecision-making using thebest available evidence” – aremost germane, as is the AMA’srecommendation to the advisorycommittee to include a principleof “Sustainability” in legislation.The demand for “choice” toalternative therapies by a vocal andvociferous segment of the populationinserts a dimension of socialpolicy that may be contrary to theaforementioned principles.Scopes of practiceIt is not sufficient for a professionto justify its ability to perform acertain practice when applying foran expansion of scope.The onus should also be on theprofession to demonstrate that thischange in its practice will benefitthe provision of health care inAlberta within an integrated,collaborative structure with otherhealth care professions.The new health legislativeframework needs to address thisunfortunate development byreferencing the advisory committee’sproposed principles of “be committedto quality and safety” and “enableThe Alberta Medical Associationurges thoughtful considerationfor its original recommendationsthat Alberta redefine twoprinciples — comprehensivenessand accessibility — in theCanada Health Act, plus add twonew principles, sustainabilityand accountability.decision-making using the bestavailable evidence,” as well asseveral of the advisory committee’srecommendations.Physicians as partnersThe Alberta Medical Associationvalues its relationship with the AlbertaGovernment and with Alberta HealthServices (AHS).The AMA has enormous supportfrom the medical profession and anexcellent reputation among manyAlberta organizations, as well asearning kudos from the public forits patient-focused advocacy.Recognizing the AMA’s leadershiprole in legislation would enhancethe association’s ability to provideleadership as an identified partnerwith key roles and responsibilitiesalong with AHW, AHS, the HealthQuality Council of Canada anddesignated regulatory authorities(e.g., College of Physicians &Surgeons of Alberta).Alberta Health ActIn drafting the proposed act,the Alberta Medical Associationurges thoughtful consideration forits original recommendations thatAlberta redefine two principles –comprehensiveness and accessibility– in the Canada Health Act, plusadd two new principles, sustainabilityand accountability.Patient’s charterThe Alberta Medical Associationand the Canadian Medical Associationhave undertaken considerableresearch and consensus buildingwith patient-advocacy organizationsregarding the intent, goals, tone andcontent for a patient charter.Alberta has the opportunity tobecome the first province in Canadato embrace a patient’s health charter.The AMA is most interested inhelping this to happen.8Alberta Doctors’ Digest • July/August 2010

featureDr. Slocombeacclaimed president-electDr. Linda M. Slocombe, fromCalgary, has been acclaimed theAlberta Medical Association's (AMA's)president-elect for 2010-11.Her term begins September 25 atadjournment of the RepresentativeForum/annual general meetingin Edmonton, when the currentpresident-elect, Dr. Patrick J. White,becomes president. She will succeedDr. White as president in 2011-12.Dr. Slocombe practises familymedicine obstetrics in the GraceMaternal Child Clinic at the FoothillsMedical Centre, in Calgary. A memberof the Calgary Foothills Primary CareNetwork, she carries out obstetricsand after-hours clinic work.In addition to an active clinicalpractice, Dr. Slocombe devotes hertime to education. She received aclinical lecturer appointment with theDepartment of Family Medicine at theUniversity of Calgary earlier this year.An active AMA member,Dr. Slocombe has served as a:• member, Board of Directors(2005-present)• delegate, RepresentativeForum (2000-05)• member, Council of Presidents• past member, NominatingCommittee, ExecutiveCommittee and CentennialCelebration Steering Committee• AMA delegate, CanadianMedical AssociationGeneral CouncilDr. Linda M. Slocombe. ( supplied.)Dr. Slocombe has been presidentof the Calgary & Area Physicians'Association since 2008, and servedas president of the Primary CarePhysicians' Association in Calgaryfrom 2006 to 2008.The Nominating Committee selectedDr. Slocombe at its March 17 meeting.According to the AMA Constitutionand Bylaws, a call for nominationswas made in May. No president-electcandidates stepped forward.Are you looking to lease or purchase anew or pre-owned vehicle?All makes: Mercedes-Benz to Suzuki– No hassles.– No shopping dealership to dealership.– Factory incentive programs.– Top price paid for your trade.“Let my 37 years of Auto Experience and Fleet Connections work foryou. I will save you time and provide a no pressure quote on any vehicle.”David Baker has helped many physicians obtain theirvehicle of choice and is well known throughout the provinceas a new car dealer as well as a medical clinic administrator.Call: 1.888.311.3832 or 403.262.2222Email: mdbaker@shaw.caVisit: www.southdeerfootsuzuki.comMANY References availableAlberta Doctors’ Digest • July/August 2010 9

FeatureThe AMA and theprofession in Alberta –Today and tomorrowDr. Christopher J. (Chip) Doig.( Fred Katz Fine Art Photography.)Alberta Medical Association (AMA)President Dr. Christopher (Chip) J.Doig addressed Grand Roundsat the University of Alberta onApril 30. Excerpts of his speechare presented below.Negotiations 2011Let’s look at some of thenon-clinical changes that physiciansare dealing with in 2010 – and theyear’s not even half over!• Political uncertainty: There’sconsiderable media speculationabout Alberta’s politicallandscape and the next election.• Change in direction and cultureat Alberta Health and Wellness(AHW) with a new minister,Gene Zwozdesky, and a newdeputy minister.• New life for Alberta HealthServices (AHS) with eliminationof its $1.2-billion deficit andhaving predictable five-yearfunding. By the way, eliminatingAHS's deficit was somethingthe AMA had called for.• Development of province-widemedical staff bylaws. Specialrecognition and thanks go toDr. Carl W. Nohr in MedicineHat and Dr. A. Mark Joffe inEdmonton (AMA physicianreps on the AHS/AMAProvincial Medical StaffBylaws Working Group).• Government’s commitment tointroduce an Alberta HealthAct at the fall sitting of theLegislature, as the AMArecommended in its brief to theMinister’s Advisory Committeeon Health (see my October 26,2009 President’s Letter at www.albertadoctors.org/PresLet/Index).Furthermore, as we all know, moreand more attention is being given tomeasuring how well Canada is doingin health care compared with otherindustrialized countries and how wellAlberta is doing compared with theother provinces and territories.Several weeks ago the AMAinitiated Negotiations 2011 whenwe filed our “issues list” with AHSand AHW. This initiated the processfor negotiations within the masteragreement. However, the formalnegotiating table isn’t expected toconvene until the fall.As you would expect, the AMAoutlined a lengthy list of subjects andtopics reflecting the current landmarkeight-year master agreement, whichexpires in less than 12 months, onMarch 31, 2011.The AMA’s approach is much moreexpansive than a meat-and-potatoesmenu. Alberta physicians have alwaysput, and will always put, PatientsFirst ® . We need to be leaders whowill provide Value for Patients.This means we need to envisageideas, innovations and possibilitiesthat will advance the health careagenda for our patients.The AMA initiated Negotiations2011 when we filed our “issueslist” with AHS and AHW.This is not to discount the priorityof physician incomes and feeincreases.But, given the current economicclimate in Alberta and across the10Alberta Doctors’ Digest • July/August 2010

country, only focusing on a traditionalfee increase would not only besimplistic, it would also be contrary tothe best interests of both physiciansand our patients. The AMA would beshortchanging you!We need to recalibrate ouryardsticks as to what constitutessuccess beyond a percentage increaseto the fee schedule and we need todetermine the means for achievingsuch success.We believe that the AMA’s fourtouchstones — Access, Quality,Productivity and Sustainability— offer all three parties (AMA,AHS and AHW) excellentopportunities for interest-based negotiations.The AMA’s view is that negotiations,and especially Negotiations 2011,offer ample opportunity for creativityand ingenuity.The best chance for success comesfrom the development of effectiverelationships and an interest-basedphilosophy.We believe that the AMA’s fourtouchstones — Access, Quality,Productivity and Sustainability – offerall three parties (AMA, AHS andAHW) excellent opportunities forinterest-based negotiations.Even though our “issues list” islengthy, much work remains to fleshout the options.That’s why I posed five questionsin my April 21 President’s Letter(www.albertadoctors.org/PresLet/Index) and asked for your feedback.Physician resourcesAs for the public, the AMA’spolling reflects what the media isreporting – waiting times in the ER,shortages of doctors and lack of accessto family physicians. Everything elsepales by comparison.Recruitment and retention ofphysicians are always either front-andcentreor just below the radar screen.It all goes back to the early 1990swhen governments across Canadabought the argument from somehealth care economists that controllingthe number of doctors was the way tocontrol rising health care costs.No doctors to provide care, tosee patients and to run up costswould instantly mean lower costs forgovernments.So the deputy ministers of healthcommissioned the Barer-Stoddartreport and then the politicians, aspoliticians are wont to do, cherry-pickedthose recommendations that alignedwith their political predispositions andpeccadilloes.The next thing we knew,enrollments at medical schoolswere on the chopping block.And, oh yes. When the AMA andthe Canadian Medical Associationobjected to such irresponsibility andmyopia, guess what the politiciansaccused us of?They accused us of being “a specialinterest group.” I guess some politicalpotshots are eternal, renewable andrecyclable, not to mention, claptrapand unimaginative.It gives me no pleasure that themedical profession was right and thepoliticians were wrong. Instead, I wishthat there was much better access tophysicians for all Canadians.The 2007 Alberta GovernmentHealth Workforce Action Planestimated a shortage of 1,800physicians by 2016.The Alberta Government is tobe commended for being the firstprovince to reverse the medicalschool cuts and then to fundfuture expansion. The increase inundergraduate medical seats hasbeen about 115% over the past decade.As for post-graduate trainingpositions, they have increased byabout 75% over the past decade. Theprojection was for 1,335 post-gradpositions this year, and growing bynearly 60% to 1,815 positions in 2019.However, this year the faculties ofmedicine at both Calgary and Albertahave found themselves without thegovernment funding required to meetundergraduate enrollment targets.At the request of the faculties,the AMA has lobbied key ministers.As for the public, theAMA’s polling reflectswhat the media is reporting– waiting times in the ER,shortages of doctorsand lack of access tofamily physicians.Alberta Doctors’ Digest • July/August 2010 11

I have to say that I am notoptimistic. But, at least the keyministers have not dismissed usas being “a special interest group.”Also, at the request of medicalstudents, the AMA lobbied thegovernment not to approve tuitionincreases being sought by the twomedical schools. As you may know,the government has agreed withthe students.Because AHW will notcommit any ARP fundingbeyond March 31, 2011, when thecurrent trilateral agreementends, the result is to createeven more uncertaintyARPs & AARPsamong physicians.According to a recent AMA survey,alternate relationship plans (ARPs) –ARPs and academic ARPs (AARPs) –are high priorities for specialists.I discussed both ARPs and AARPsat some length in my President’s Letterof February 12 (www.albertadoctors.org/Preslet/Index).The AMA has a number ofprinciples that we believe mustbe reflected in an ARP and an AARP.A key AMA principle is thatphysician involvement in an ARPor AARP must be voluntary and theterms and conditions for doing somust be clearly understood.Other principles promoted bythe AMA include:1. Provisions for clinicalindependence.2. Fairness and equity onremuneration, includingincreases for clinical servicestied to generally negotiated feeincreases, as well as access toAMA benefit programs.3. Requirement for AMArepresentation.There are currently two majorinitiatives related to ARPs and AARPs.• One involves the Alberta Societyof Laboratory Physicians (ASLP).• The second, the faculties ofmedicine at the universitiesof Alberta and Calgary.Recently I spoke to the laboratoryphysicians. In addition to wanting anAARP, they also want to be repatriatedback under the trilateral agreement.Moving under the trilateralagreement will expedite the ASLP’sability to achieve a number ofother objectives.However, this will require theagreement of both AHS and AHW.As much as the AMA would like thisto occur, we cannot do it by ourselves.Once laboratory physicians areunder the trilateral agreement, theywill be eligible for other provisionssuch as automatically having theircompensation grid tied to feeincreases in the Schedule ofMedical Benefits (SOMB).If you’ll excuse the pun, this ismore than just an academic exercisefor laboratory physicians. They stillhave not seen the two most recentincreases that other physiciansreceived on April 1 of this year andApril 1, 2009.But the big elephant in theAARP room is the joint initiativefrom the universities of Alberta andCalgary faculties of medicine. Itcould potentially cover about 1,000physicians or 15% of the medicalprofession in Alberta.There is much work to bedone before this proposed AARPis ready for review and possibleimplementation.I am not prepared to predict whenit may be ready. Until it is, though,AHW is not prepared to approve anyother AARP proposals.AHW “will continue to provideconditional grant funding to existingacademic ARPs in the 2010-11fiscal year.”Furthermore, our understandingis that this funding for AARPs willcontinue into the 2011-12 fiscal year.Because AHW will not commit anyARP funding beyond March 31, 2011,when the current trilateral agreementends, the result is to create even moreuncertainty among physicians.However, we fully expect thegovernment will continue to payfor insured services billed throughthe SOMB.Certainly, there is no indicationwhatsoever that the governmentwill stop paying those fees on April 1next year.The AMA’s view is that thegovernment has the same obligationto pay for insured medical servicesprovided through ARP funding.12Alberta Doctors’ Digest • July/August 2010

Mind Your Own BusinessWhy would my clinicdevelop a team agreement?PMP StaffGroups ofpeople workingtogether do notalways recognizethey are a team and need a commonset of goals to support their clinic’ssuccess.A written agreement sets clearexpectations of all team members andsupports ongoing collegiality. Teamagreements assist in avoiding andresolving conflicts between members.With a team agreement,ground rules are established.This agreement is a simple set ofagreed-upon behaviors that all membersof the team develop jointly and to whichthey hold each other accountable.An agreement encompasses:Communication: Being honest,acknowledging each other by name,being polite and ensuring that weunderstand and are understood.Respect: Being non-judgmental andtimely in responses. Going directly tothe right person rather than involvingothers and valuing and appreciatingeach team member for what he or sheknows and does.Accountability and responsibility:Taking responsibility for your ownactions and being responsible for yourown work.Altruism: Focusing on the big clinicpicture and ensuring your actions donot negatively impact the clinic.Ethics: Treating each otheras equals and not harming theoperations or reputation of the clinic.Honor and integrity: Doing whatyou say and saying what you do;always using your best intentions.Leadership: Every team memberhas the opportunity for being arole model and a mentor and forsupporting a safe environment foropen communication.How does a team agreement work?With a team agreement, groundrules are established. Every team needsto develop a mutually agreed-uponset of standards for team conductand behavior.Don’t settle. The ground rules needto be agreed upon by consensus (i.e.,all participants must mutually agreeto be able to live with each rule).Encourage discussion and openness.View conflict and differences ofopinion as healthy.Review the team agreementannually and when a new memberjoins the team.The benefits of a team agreementinclude the following.• Team members who agree todeal directly with each otheravoid dragging themselves intoconflicts or disagreements as theyare able to respectfully discusstheir concerns with each other.• Team members who respecteach other for their knowledgeand skills and who agree toshare knowledge and skills buildstronger, more experiencedteams able to provide greatersupport to the clinic.• Working in a clinic wherecommunication is clear, polite,respectful and timely provides apositive work environment thatfosters increased morale andemployee retention.• Having a team agreement andhaving it as a performancemeasure supports physicians ineffectively managing their staff.How can my clinic develop a teamagreement?Physicians interested in developinga team agreement may want to contactthe Alberta Medical AssociationPractice Management Program (PMP).PMP supports clinics in developinga team agreement, as part of a largerpractice review or as a stand-alone project.Alberta Medical Association PracticeManagement Program (PMP) staff Susan M.Black, Stephanie A. Crichton, Cindy C.Michetti and Sean T. Smith in Calgary,as well as Robert L. Brick, Lucy L. Grenke,Glenda M. Nash and C. Grant Sorochan inEdmonton, contribute articles to the Digest.PMP provides high-quality business consultingservices to Alberta physicians as they developand implement primary care networks. ContactPMP at pmp@albertadoctors.org, 780.733.3632or toll-free 1.800.272.9680.Alberta Doctors’ Digest • July/August 2010 13

Health Law UpdateShould ‘not fitting in’form basis for revocation/changeto privileges?Jonathan P. Rossall,QC, LLMPartner, McLennanRoss LLP, Barristersand SolicitorsPhysiciansreading this articleknow there willlikely be provincialmedical staff bylawsimplemented in earlyspring 2011.The bylaws will deal, in part, with anew process for appointments to themedical staff (practitioners who holdAlberta Health Services appointments)and privileges for members of that staff.Although a good deal of effort hasgone into updating the bylaws andtrying to think outside the proverbialbox, a recent decision from theOntario Court of Appeal reminds usthat, even in the new era of provincialThe exercise of discretionin the granting of privilegescannot be arbitrary and must beundertaken for the right reasons.regionalization, the exercise ofdiscretion in the granting of privilegescannot be arbitrary and must beundertaken for the right reasons.The case in question marks the endof a journey for Dr. R (a cardiologist)that began in 1989. It appears, between1985 and 1989, issues had arisen withrespect to the renewal of his privilegesat a large municipal hospital, whichrelated to alleged personality conflictsbetween the doctor and health carestaff/physicians.There were absolutely no concernson record with regard to Dr. R’scompetence or the care given topatients. Nevertheless, in 1989,the hospital’s Medical AdvisoryCommittee (MAC) recommendedthat his privileges with the hospital berevoked immediately, without notice.Subsequently, the hospital boardfollowed the recommendation andrevoked the privileges.Six years later, after an appealand a re-hearing, the Ontario HealthServices Appeal and Review Board(HSARB) set aside the hospitalboard’s decision.Dr. R then sued the hospital forloss of income during the period hisprivileges had been revoked. Thetrial judge hearing the case reliedto a great extent on the reasonsissued by HSARB, and found thatthe hospital board was acting in aquasi-judicial capacity when it revokedthe privileges.As such, the court found that theboard owed Dr. R a duty of goodfaith, had acted in bad faith, andfound the hospital liable for thetort of intentional interference witheconomic relations.The result? Judgment for thedoctor in the amount of $3,000,000plus interest.On appeal, the Ontario Court ofAppeal upheld the trial judge andenlarged on the reasoning, findingthat the hospital board had nogrounds for revoking the privileges.The hospital had acted in anarbitrary and unwarranted manner,given there were no issues regardinghis competence or the care he gavehis patients. The evidence, in the eyesof the court, pointed to an impropermotive for revocation – Dr. R simplydidn’t “fit in.”It should be noted the hospitalsought leave to appeal this decision tothe Supreme Court of Canada, with nodecision as of the date of this article.In an era where administratorsand physician leaders are increasingly14Alberta Doctors’ Digest • July/August 2010

highlighting issues around disruptive behavior and otherworkplace communication issues, it is gratifying to seethe courts (at least in Ontario) remind hospital boardsthat decisions relating to privileges are an exercise ofa quasi-judicial role, and the boards, MACs or otheradministrative bodies charged with the decision-makingowe the physician a duty of good faith.Decisions relating to privileges and appointmentscannot be exercised in an arbitrary or capricious manner,and reasons given for any decision must reflect properconsideration of relevant facts and issues.Alberta’s minister of Health and Wellness hasindicated that, in the course of time, much of the existinghealth-related legislation in Alberta (including the HospitalsAct) will be repealed and replaced with one overarchingpiece of legislation.It is not known at this point whether that legislationwill continue the role of a Hospital Privileges Appeal Board(or similar body).However, it would seem clear the courts in Alberta shouldcontinue to exercise their jurisdiction to judicially review thedecisions of quasi-judicial bodies such as hospital boards or,in Alberta’s case, Alberta Health Services (or designate).In light of this decision, it is clearly of some comfort toOntario physicians that simply “not fitting in” should not formthe basis for a review of privileges within Ontario hospitals.Hopefully the same attitude will prevail should the sameissues come before the Alberta courts in the future.In light of this decision, it is clearly of some comfortto Ontario physicians that simply “not fitting in”should not form the basis for a review of privilegeswithin Ontario hospitals. Hopefully the same attitudewill prevail should the same issues come beforethe Alberta courts in the future.Alberta Doctors’ Digest • July/August 2010 15

featurePremier Ed Stelmachon health carein AlbertaPremierEd Stelmach. ( supplied by the Government of Alberta.)An excerpt about health care inAlberta follows from Premier EdStelmach’s presentation at the CalgaryPremier’s Dinner, April 15.Notwithstanding all of thecontinued economic challenges ourprovince, our country and the restof the world face, there remains anenergy and a sense of optimism inour province. Certainly the economicrecovery is still early, but there aremany positive signs around us.Much has been said and continuesto be said about health care. However,I want to make sure that there isno doubt about my commitment topublicly funded and administeredhealth care. And I want to makemy point by sharing where mycommitment comes from.Years ago, and probably longerthan I care to think about, my parentswere faced with what was for them ahuge bill as a result of some healthchallenges I faced as a child. The billrepresented about 20-25% of theirannual income from the farm – andthey paid it off – and it was not easy.I remember listening to my parentstalk about how the family was goingto bear the cost of this health bill. Thatmoment gave me a deep appreciation,that is shared by Albertans, of the valueof a publicly funded health care system.Albertans consistently tell us it’stheir number one priority. Theyalso told us they want the systemto improve.They told us they want the systemto be there when they or loved onesneed it. They said they want thequality of care to reflect the size oftheir investment.We merged several health boardsinto one accountable agency –Alberta Health Services (AHS).Many of you have experiencedmergers and know it’s a big culturalchange for those wedded to aninstitutionalized structure.I think you’ll agree that, in orderto improve performance, you mustfirst start with management andorganizational structure and thenmove to other operational changes.I want to take a brief moment andthank Ken Hughes and the rest of hisboard members at AHS for taking onwhat has been a massive, and oftenthankless, job.In this budget we made acommitment to a publicly fundedand publicly administered system.We have provided a five-year fundingcommitment, a first in Canada.There is no question otherpriorities will receive less budgetdollars to afford the increases inhealth care. So, in return, Albertansexpect the system to perform better,to make the kind of productivity gainsthat the private sector has to make intough times.Will this be a smooth road, withoutcontroversy? No, and likely mistakeswill be made. There is a truism outthere in the world. If you don’t try,you don’t make mistakes and thisisn’t the time for half measures.It’s tricky improving healthcare because you can’t just stopproduction and retool like a factory.Improvements must be made whilethe system continues to operate, notan easy task.We know that once Albertans arein the system, their experiences reflectthe excellent care that health systemprofessionals provide.Our challenge is making sure thataccess is quicker and recent stepshave demonstrated that the systemcan respond. AHS instituted an initialsurgery blitz and additional aggressivesteps will be taken as needs be.There is no doubt aboutmy commitment to publiclyfunded and administeredhealth care.16Alberta Doctors’ Digest • July/August 2010

featureClarifying physicians’freedom to advocateThe professional responsibility of physicians for patient advocacy, including speaking in the media, isclarified in a letter from Alberta Health Services, the College of Physicians & Surgeons of Alberta and theAlberta Medical Association (AMA). See below (also on AMA's website atwww.albertadoctors.org/Advocacy/FreetoSpeak).Alberta Doctors’ Digest • July/August 2010 17

Students' VoiceHelping medstudents findbalanceAt AMSCAR 2010, AMA President Dr. Christopher J. (Chip) Doig (center) with Aisling E. Campbelland Colin A. Casault, AMA Committee on Student Affairs members and student reps to the AMARepresentative Forum. ( supplied.)Colin A. CasaultMEDICAL STUDENT,CLASS OF 2012,UNIVERSITY OF CALGARYAisling E. CampbellMEDICAL STUDENT,CLASS OF 2013,UNIVERSITY OF ALBERTAA weekend in the mountainsis a good prescription for fun andrelaxation, especially for about 250busy medical students from theuniversities of Alberta (U of A) andCalgary (U of C).The students met, January 15-17,in Banff for the sixth annual AlbertaMedical Students’ Conference andRetreat (AMSCAR).The conference, dedicated tomedical student well-being, beganwith a welcome reception to meetand network.“AMSCAR was a great way togive ourselves a weekend break tomingle with our future colleagues,”said Audrey E. Chen, first-yearU of C medical student.Saturday’s sessions were aboutseveral professional and personaltopics, including nutrition, financialplanning, yoga and photography.The Physician and Family SupportProgram’s “Mindfulness in Medicine”session was popular. It helpedstudents recognize the importanceof meditation as part of a balanced,non-reactive and low-stress life.“Sessions like ‘Mindfulness inMedicine’ equipped attendees withthe skills to become tomorrow’srenaissance physicians,” said Brett K.J.Kilb, first-year U of C medical student.Facilitators from the AlbertaCollege of Family Physicians and theAlberta Rural Physician Action Plan“Sessions like ‘Mindfulnessin Medicine’ equippedattendees with the skills tobecome tomorrow’srenaissance physicians.”provided instructive clinical guidancewhen students were given a chanceto practise clinical skills, such asputting in a central line, suturingand intubation.The Saturday-evening gala featureda number of speakers, including amoving keynote address by AlbertaMedical Association (AMA) PresidentDr. Christopher J. (Chip) Doig,reminding students of the hardships ofthe profession and the importance ofmaintaining a healthy work-life balance.In addition, Pamela Brett-MacLean,PhD, spoke about finding balance andDr. Ted J. Jablonski spoke about theflexibility of practising family medicine.On Sunday, students skied,snowboarded, lounged in the hotsprings and explored Banff’s vibranttown. They also attended sessionsabout massage and ballroom dancing.The AMA, along with othergenerous donors, provided studentswith the opportunity to attend theconference and apply skills to achievea healthy balance in their personaland professional lives.18Alberta Doctors’ Digest • July/August 2010

Thinking about an elective with the CPSA?My clerkship experienceShaqil PeermohamedELECTIVE STUDENT, CLASS OF 2011,UNIVERSITY OF CALGARYThe day most medical studentscannot wait for had finally arrived –day one of clerkship.Many of my student colleaguesdonned their white coats or scrubs,and headed to their designatedhospital wards or clinics.However, my clerkship journey wasa unique, two-week elective with theCollege of Physicians & Surgeons ofAlberta (CPSA), in Edmonton.I was motivated by a stronginterest in administrative medicineand a desire to learn more aboutthe concepts of self-regulation andprofessionalism.I was motivated by a stronginterest in administrativemedicine and a desire to learnmore about the conceptsof self-regulation andprofessionalism.Assuming the role of a medicalregulator, I quickly found myselfinvolved in a wide range of activities.On the first day of my elective,I provided insight regarding theassessment of adverse events thathad taken place in non-hospital sites.Throughout the two-week period,I met with each Secretariat memberto discuss this role in the CPSAand the programs and services thegroup oversees. After signing aconfidentiality agreement, I was giventhe opportunity to review and discussphysician complaint files, assessingwhether or not further investigationwas indicated.During my elective, I also learnedabout many programs that assistphysicians in improving their medicalpractices and addressing their healthissues. A wealth of literature exploresthe topic of addictions and physicians.Evidence illustrates they are no lesssusceptible to alcohol and drug abusethan the rest of the population. CPSAhas many programs in place, suchas the Physician Wellness Program,to address these issues and assistphysicians in overcoming illnesses.“Please call me toexperience the dedicated,knowledgeable, andcaring service that I provideto all my clients.”Ann DawrantRE/MAX Real Estate Centre(780) 438-7000• Consistently in top 5% of Edmonton realtors• Prestigious RE/MAX Platinum Club• 24 years as a successful residential realtorspecializing in west and southwest Edmonton• Born and raised in Buenos Aires and haslived in Edmonton since 1967• Bilingual in English and SpanishWebsitewww.anndawrant.comE-mailanndawrant@shaw.caMy interest in the subjectof physician wellness led to anopportunity to assist with a researchproject that explores addictions inphysicians in Alberta.Overall, I found my electiveexperience to be educationaland valuable. I was engaged andinvolved in a variety of activities,ranging from meetings and strategicplanning sessions to research projects.This experience has enhancedmy leadership and communicationskills, as well as my passion foradministrative medicine. I stronglyrecommend that students considerthis unique and beneficial electiveopportunity if they have an interest inlearning more about self-regulationand professionalism.Alberta Doctors’ Digest • July/August 2010 19

Health policy 101at U of C student symposiumKevin S. WaskoMEDICAL STUDENT,CLASS OF 2011,UNIVERSITY OFCALGARYColin A. CasaultMEDICAL STUDENT,CLASS OF 2012,UNIVERSITY OFCALGARYWhat isactivity-basedfunding (ABF)and how will it affect physicians? OnMay 19, University of Calgary (U of C)medical students sought to answerthose questions at the third annualMedical Students’ Association’sHealth Policy Symposium.Presenters included ChrisMazurkewich, Alberta Health Services(AHS) Chief Financial Officer;Dr. G.N. (Gerry) Kiefer, Calgarypediatric orthopedic surgeon, AlbertaMedical Association (AMA) PastPresident and Canadian MedicalAssociation board member;Dr. Christopher J. (Chip) Doig,AMA President; and Dr. Thomas N.Noseworthy, Director, Centrefor Health and Policy Studies,Faculty of Medicine, U of C.year’s topic because it’s timely andit would incite debate among thespeakers and audience alike.This health care financing modellinks money to service volume. AHShas announced that ABF will be usedto fund certain aspects of Alberta’shealth care system. While it hasbeen implemented elsewhere (e.g.,Australia and the UK), there is somedebate as to how effective it has been.Mr. Mazurkewich stated ABFwould start in Alberta’s long-termcare homes. The plan is to eventuallyexpand the model to other spheresof health care delivery. Incentives areJoin the hundreds of people who save thousandsof dollars by getting your new or used vehiclefrom the United States. All makes & modelswith transferable warranty certified to meetCanadian standards.Call 780.732.1177 today ore-mail: mynextcar@scoutspecialized.comefficiency and the potential for reducedwaiting times. But, as the speakerswarned, there are dangers of “creamskimming,” a potential method ofexploiting the system.“Cream skimming” occurs if patientswhose expected costs are lower than thereimbursement amount are sought overthose whose expected costs are higherthan the reimbursement amount.This bias might potentially reducethe accessibility of health care for aselect population, which goes directlyagainst one of the central tenets of theCanada Health Act.ABF should not be viewed as apanacea for hospital funding but itcould be beneficial in some aspects ofhealth care delivery.It will be interesting to see whathappens with the health care systemin Alberta as ABF moves forward andthe extent to which it is ultimatelyimplemented.Looking for a new car or SUV?Many issues that affect health careorganizations are not covered in themedical school curriculum, leaving usto seek out that information ourselves.At the annual symposium, powerplayers in health policy are broughtto the students, as well as physicianattendees. ABF was chosen as thiscoutpecialized, inc.20Alberta Doctors’ Digest • July/August 2010

PFSP PerspectivesPhysicians care for physicians:You are not aloneDianne B. Maier,MD, FRCPCPROGRAM/CLINICALDIRECTOR, PFSPLearning, understanding we arenot alone and building collegiality is awin-win-win situation. There is alwaysknowledge translation!What is knowledge translation?It's a buzzword in health care fora dynamic, iterative process thatincludes synthesis, dissemination,exchange and an ethically soundapplication to improve populationhealth, services and products, andto be considered to strengthen ourhealth care system. 1Simply put, this means puttingknowledge to action. 2 It appliesto physician health and how thePhysician and Family SupportProgram (PFSP) works for you.Just as medicine is aface-to-face business, PFSPbelieves the best learninghappens when physiciansget together and shareexperiences.Just as medicine is a face-to-facebusiness, PFSP believes the bestlearning happens when physiciansget together and share experiences(e.g., about fatigue, an adverse eventor complaint, experience as a patientor being a colleague’s physician).Physicians, at all career stages,and their immediate families benefitfrom the core business of PFSP bygetting confidential access to healthservices. We collect the best evidenceavailable in physician health,synthesize it and disseminate it.PFSP is concerned with the health ofthe whole person and with issues thataffect physicians and their families. Wefocus on issues specific to a physician’swork and health that have an impact onpractice, including safety, satisfactionand retention.A positive change in a physician'shealth translates to better care andpatient health. Our intention is todeliver physician health educationthat makes a difference.You can access our communicationsin a variety of ways, such as:π “PFSP Perspectives” in the AlbertaDoctors’ Digest (www.albertadoctors.org/PFSP/ADDarticles)π PFSP updates in e-MD Scope (www.albertadoctors.org/MDScope/Index)π PFSP web pages (www.albertadoctors.org/PFSP/Index)π PFSP-sponsored educationsessions in your community or ata provincial medical conferenceby your particular association orsociety of medicine.We invite you to contact PFSPwhen planning a continuingmedical education event. Youmay wish to tap into the followingPFSP-health promotion projectsand initiatives:• Fatigue management: Do it foryour patients. Do it for yourself.Initially focused on sleepand alertness for patient andorganization safety, this nowalso covers compassion fatigue.An Alberta physiciancontinued to be curious,observant and thoughtful aftera PFSP presentation aboutfatigue management. He thenincorporated what he learnedabout workplace nutrition froman Alberta Medical Association(AMA) annual general meeting(AGM). As a result, he effectivelypursued positive change at hisregional hospital.This knowledge translationresulted in the following positivechanges for physicians, theirhealth, patient care and, generally,a healthier medical workplace.Sleep rooms are nowdesignated for physicians to restor nap when working extendedhours in the hospital.Alberta Doctors’ Digest • July/August 2010 21

The physician’s lounge willbe refurbished for improvedrest and restoration, along withimproved opportunities forcollegiality. Physicians will alsobe able to get fresh food andbeverages from a refrigerator.• Career transitions: Smallchanges, big impact speaks tothe importance of a resilientmedical career, empoweringchange, and retirement “beyondthe financials.”• Adverse events is a particularlypowerful initiative. We discusswhat has been rarely discussedin our house of medicine – whatyou and your family can expectwhen there is an adverse event,a challenge to privileges, acomplaint or a medical legal suit.π Another PFSP communication andamazing knowledge translation?The study by Dr. Jane B. Lemaire,Jean E. Wallace, PhD, and theirUniversity of Calgary collaborators.PFSP presented the results of theWell Doc? Module 1, Physiciannutrition and cognition duringwork hours: What happens when weprovide doctors with nutrition? at theAMA's 2009 AGM, accompaniedby nutritious recipes designed forthe all-important physiciannutrition break at work.Delegates completed a PFSPsurvey, which was based upon thequalitative aspects of the studyquestions. Aggregate data reflectedthe study participants.Their knowledge is apparent.Physicians need to consumeappropriate, nutritious foodand beverages throughout theirwork days (and nights) to maintaintheir health and cognition. Patientcare counts on it. Yet, there are anumber of barriers, individualand systemic, to this being areality for many physicians.π Tools and/or products furtherincrease awareness for knowledgetranslation. You might recognizethese as themed surveys availableat the PFSP booth at manyconferences and the AMA'sRepresentative Forum.How else could PFSP serve you?Feedback regarding disruptivephysician behavior and calls to thePFSP toll-free line (1.877.SOS. 4MDS,24 hours-a-day, 7 days-a-week, 365days-a-year) reflect an increase inoccupational issues of all kinds.• With our team “connectingthe dots” of existing projects,PFSP will be addressing healthymedical workplaces.Upcoming discussions willcentre on the importanceof civility, communication,collegiality, collaboration andconflict resolution and that, in aworkplace, everyone plays a part.How about something less formal?Fun in presentation, PFSP-brandeditems are designed with a particularproject in mind, such as:• Frisbees to remind us about theimportance of play and leisure.• Sleep masks to remind us abouteffective fatigue management.• Beverage coasters and pamphletswith Canadian MedicalProtective Association (CMPA)and PFSP contact information,helpful if responding to anadverse event.• Dental floss as a tribute to ourcolleagues in recovery fromsubstance-use disorders whohave much to teach us all –be self-aware and practiseself-care daily because it's allabout our health.At the national level, physiciansmay take advantage of PFSP'sexperiences with valued physicianhealth partners in knowledgetranslation, as follows:• The Canadian Physician HealthNetwork, which includesrepresentatives from theCanadian Medical Association(CMA) Centre for PhysicianHealth and Well-being, allprovincial physician healthprograms, academic medicine,the CMPA, CanadianAssociation of Internes andResidents and the CanadianFederation of Medical Students• The CMA mental health strategyfor physicians (to be publishedthis year)PFSP also suggests you check twonew important “made-in-Canada”physician health resources:• The Royal College of Physiciansand Surgeons of CanadaCanMEDS Physician HealthGuide. 3 This has been specificallydesigned to support and assistmultiple stakeholders (fromeducator to trainee to practisingphysician) in understandingand developing competency inthe emerging field of physicianheath education.• ePhysicianHealth.com(http://ephysicianhealth.com).This is learning about physicianhealth via the Internet –at your convenience, fromyour computer.The circle of physician healthknowledge translation comes backto PFSP's core services.Each time a physician or familymember accesses confidential PFSPservices by calling 1.877.767.4637,has a conversation with the on-callassessment physician, receivessupport and referral to the mostappropriate health resource,knowledge is translated.There is utmost appreciation ofthe importance of confidentialityand privacy in seeking assistance.Physicians care for physicians andyou are not alone.22Alberta Doctors’ Digest • July/August 2010

PFSP also learns from iteration in the process. We enjoyreceiving feedback and especially like hearing how there hasbeen transformation, small or large, in a physician's life,influenced, in part, by PFSP knowledge translation. Perhapsyou have some ideas for your physician health program.In the end, the work of physician health is about assistingin making informed decisions and making a difference forour profession, families and patients.PFSP continues to support a healthy culture of medicine.Will you?Physician health in Alberta• More than 1,000 physicians at all career stages, andtheir families, received services from PFSP in 2009.• Physicians are prepared to fight the stigma whenfacing mental health issues as they seek care throughPFSP. They know the benefit of early intervention andeffective treatment for themselves and their families.And they will be better prepared to compassionatelyassist their patients facing these issues.References available upon request.LettersA physiotherapist’s views follow about the article "Obesityin Canada – What can physicians do differently to better helppatients manage their weight?" from the March/April 2010Alberta Doctors’ Digest. Excerpts of her letter follow.Physiotherapists' role in clinical management ofobese patientsPhysiotherapists have developed a range of pragmatictreatment strategies by combining academic knowledgeand training with the practical experience of regularlyproblem-solving with obese patients.Based on objective assessment findings, physiotherapistsprovide safe, appropriate and sustainable physical activityprograms that minimize the risk of over-use injuries. Obesepatients are often capable of commencing and maintainingstrength-training programs. Whether gym- or home-based,patients can quickly achieve positive results that reinforcetheir participation.Aside from the health benefits, the advantages ofengaging patients in community or Internet-based activitiesare the relative accessibility and affordability, combinedwith positive social interaction.Canadian obesity guidelines indicate the prevention ofweight gain and improvement in functional benchmarks (e.g.,being able to walk up 12 stairs without pain) are often moremeaningful to obese patients than specific weight-loss goals.Physiotherapists are skilled at developing these functionalgoals and encouraging progression of physical activity.Using clinical outcomes (i.e., strength, two-minute walkor arm-ergometry tests, timed up-and-go, or balance tests),physiotherapists also measure a program’s effectiveness andmotivate patients. Considering the distressingly low successrates of obesity-intervention programs, fostering improvedfunction in obese patients seems critical to managing thepotentially overwhelming, negative economic and healtheffects of the obesity epidemic.Sarah Kerslake, BPhtyPhysiotherapist, 10+ years experience treating andfostering functional goals with obese patients; researchcoordinator, Banff Sport Medicine; sessional lecturer,University of Alberta Department of Physical Therapy.The Alberta Medical Association welcomes commentsabout Digest articles and suggestions for future topics. Pleasecontact Editor-in-Chief Candy L. Holland at candy.holland@albertadoctors.org, visit www.albertadoctors.org and click on theDiscussions link (at the top of the site, near the Site Map andSearch links) or write her c/o Public Affairs, Alberta MedicalAssociation, 12230 106 Ave NW, Edmonton AB T5N 3Z1.The association reserves the right to edit all letters.Alberta Doctors’ Digest • July/August 2010 23

Web-footed MDApple’s new iPad –Tool or toy?J. Barrie McCombs,MD, FCFPMedical InformationService Coordinator,the Alberta RuralPhysician Action PlanTo satisfy myrecurring, relapsingtechno-lust, I visitedthe Apple Store tosee the new iPad.It is an impressivepiece of technology, but I didn’t buyone because I already own at least onedevice that does what I would expectof the iPad. But it might be perfect foryou, so let’s look at its major features.The iPad is 189.7 mm (7.47 inches)wide by 242.8 mm (9.56 inches)long and 13.4 mm (half-an-inch)thick. The display is mainly a brighttouch-sensitive screen that looks likea large version of Apple’s iPod touchor iPhone devices.Its chief advantages are portabilityand ease of use. The iPad’s usefulness israted somewhere between a smartphoneand a small laptop computer.Available modelsEach of the two models comes with16, 32 or 64 gigabytes of memory. Thefirst connects to the Internet usingonly wireless (Wi-Fi) technology. Thesecond can connect to both wirelessand the newer 3G cellular networksoffered by Telus, Rogers and Bell.To use a cellular network you mustalso purchase a subscriber identitymodule (SIM) card and a data serviceplan. Unfortunately, the networksdo not yet allow you to share a singledata plan between the iPad and anyother device.HardwareThe iPad uses the touch-sensitivescreen to display a full-sized keyboard,suitable for touch typing. A cable isprovided to connect to a USB 2.0 port ona desktop computer for synchronizingdata and charging the battery.Among other accessories, Applesells an external keyboard and aprotective case that can act as a viewingstand. Surprisingly, no earphones areprovided and there are no USB portsfor connecting external devices.Operating systemThe operating system is easy touse. It is only capable of running oneapplication at a time.Apple provides the free iTunesprogram for synchronizing files betweenthe iPad and a desktop computer. iTunesalso connects to an online Apple Store,where users can purchase applications,music and videos.Internet browserThe Safari browser applicationworks whenever a wireless or cellularInternet connection is available. Onecurrent limitation is that Safari cannotdisplay the Flash video format used onmany websites.Mail, contacts and calendarApplications are included formanaging email messages, contactsand an events calendar. It is unclearhow well these applications can besynchronized with similar desktopapplications, such as Microsoft Outlook.Music and videoThe iPod application plays music onthe iPad’s internal speakers. The videoapplication plays movies, TV shows andother videos.Both music and video files areavailable from the iTunes Store. Thesefeatures make it attractive as a source ofpersonal entertainment during long trips.BooksThe iBooks application providescompetition for the Kindle and otherbook-reading devices, and offers uniquebookmarking and search features. Bookscan be downloaded from the iTunes Store.PhotosThe iPhoto application allows theiPad to be used as a digital picture framefor storing and organizing photos. Anadaptor is available to connect directly toa digital camera.Cellular phoneThe iPad can function as a cellularphone or speakerphone when connectedto a 3G network. However, its large sizewill limit this usage.Software applicationsA wide variety of application programsare available, including those written forthe iPhone. These include Apple’s Pages(word processor), Numbers (spreadsheet)and Keynote (presentations), which aresimilar to Word, Excel and PowerPointfound in Microsoft Office.Medical applicationsMany mobile medical softwarevendors have adapted their programsto run on the iPhone. They will beeasier to read on the larger iPad display,making it a useful quick-reference tool.24Alberta Doctors’ Digest • July/August 2010

The bottom lineFor now, I’ll stick with a basic cellphone, an iPod touch for music and aPC desktop for serious computing. Imight change my mind if I find moreuseful iPad applications.For more information about theiPad, visit the following websites.Applewww.apple.com/casupport.apple.com/manualsThe first site provides detailedinformation about the iPad and itsfeatures. The second site provides thecomplete user manual.iPad in Canadawww.ipadincanada.caThis website offers useful andup-to-date information about the iPad,including a comparison of the dataplans available from the Telus, Rogersand Bell networks.Your comments and suggestionsare welcome.Please contact me:barrie.mccombs@rpap.ab.caT 403.289.4227FeatureResident working withunderserved patients awardedTD Insurance Meloche Monnex/AMA ScholarshipFamily medicine residentDr. Michael W. Aucoin is the 2010recipient of the TD Insurance MelocheMonnex/Alberta Medical Association(AMA) Scholarship, which also marksthe 20th year the scholarship hasbeen awarded.Dr. Aucoin was granted $5,000for further clinical training in an areawhere expertise is needed in Albertaand his new and valuable, enhancedskills will help meet the ever-changingmedical needs of patients in theprovince.After having completed his medicaldegree at Dalhousie University, in2008, and studying and researchingat the Calgary Refugee HealthProgram for two years, he is almostfinished his residency.Soon Dr. Aucoin will begin an R3year of residency in the Global HealthEnhanced Skills program, at theUniversity of Calgary Department ofFamily Medicine (advanced training forfamily physicians to become “competentpractitioners in resource-poor settingswithin Canada and abroad”).During the one-year program,Dr. Aucoin will complete clinicalrotations in HIV, tuberculosis,hepatitis and addictions, immersedin Aboriginal medicine, inner-citymedicine and refugee health.Dr. Aucoin will also receive ahygiene and tropical medicinediploma to help meet the needs ofAlberta's large refugee population.Afterwards he plans to practise inCalgary. Dr. Aucoin has been offereda clinical position at the CalgaryRefugee Health Program, where hewill provide medical care to newlyarrived refugees. He would also liketo continue working with Calgary'svulnerable inner-city patients.In the words of a supervisor whoenthusiastically endorsed Dr. Aucoin’snomination for this award, “Michaelhas had a long-standing focus ofworking in medical communitiesabroad where patients are vulnerableAMA Immediate Past President Dr. Noel W. Grisdale (left) and Lone St.Croix, Vice President, Affinity Market Group, TD Insurance MelocheMonnex (right) present Dr. Michael W. Aucoin with the TD InsuranceMeloche Monnex/AMA Scholarship. ( Dawn C. Wyver, AMA.)and poor. He will make a caring,compassionate and exceptionally trainedasset to Alberta’s physicians whoserve this population here at home.”Applications for the scholarship aredue in March. For more information,contact Pat Shinkewski, on behalf of theCommittee on Achievement Awards:pat.shinkewski@albertadoctors.org,780.482.0315 or 1.800.272.9680, ext. 315.For more information about thescholarship and other recipientswho have been recognized for theirtremendous work over the last20 years, visit the AMA website(www.albertadoctors.org/AwardsScholarships/MonnexAMA).Alberta Doctors’ Digest • July/August 2010 25

In A Different VeinDoing an evening course:The golfing doctorAlexander H.G.Paterson,MB ChB, MD,FRCP, FACPCo-editorMy friend, Ed,does a lot of eveningcourses, plus a goodfew morning andafternoon ones.When he announces he’s off toanother course, we are all impressedat his zeal for self-improvement.The golfing doctor is a superiorspecimen, possessing a heightenedawareness of the unfairness of lifeand the play of chance.He or she is painfully aware ofthe temptation to exaggerate or evendeceive, coupled with the inevitabilityof discovery because someone,somewhere is always watching.The golfing doctor understandsthat one must retain fortitude inall disappointments, for fortunewill change.And, most importantly, the golfingdoctor is aware of the necessity forharmony and cool in the face ofThe golfing doctor is aware ofthe necessity for harmony andcool in the face of adversity.adversity, together with that intrinsicparadox – the absurdity of it all – theattempt to control events with a thinstick, at a distance of four feet fromman’s otherwise miraculous hands.Sudden success or failure in golf,as English writer P.G. Wodehouseobserved, is like the sudden acquisitionor loss of wealth. It is apt to deteriorateand unsettle the character.The golfer well knows what lurksin the heart of man.To play a round of golf withsomeone is to observe the interplayof one’s own character foibles withthose of his opponent: the obsessivecompulsivewho focuses on the rulesand technicalities of the game; themasochist who self-flagellates overevery poor shot; the sly type whosurreptitiously shifts the ball to a betterlie; the self-absorbed who believesevery shot is a medal event and takestwo practice strokes to make it; thestoryteller, usually dressed in startlingtartan pants, telling ribald jokes withthe intent to disrupt one’s focus.The full panoply of human follyand arrogance, yet determination, isdisplayed on the golf course.The ancient game of golf ismade for doctors. Melding physicalskills with mental toughness and arequirement for spiritual harmony,it is better than yoga physically,tops meditation mentally and rivalsorganized religion spiritually.For self-discipline, physical rigorand a general oneness with the world,golf is unrivalled. I realize I have,by now, lost half my readers, but nomatter – the truth must come out.I was taken to see Henry Cotton(three-time winner of the British Open)at the age of three, and a putter wasput in my hands at the age of four – acommonly used pediatric developmentalmilestone for Scots children, notcommonly used in Canada.Into the lowest percentile groupI fell and my parents received visitsfrom social workers.The club was a wooden-shaft, sawnoff to half-length, and metal-headed.The grip was of wound black tape.I used this club as a driver, fairwaywood, wedge and putter for severalyears, playing on the children’s golfcourse by the Blacksmith’s Forge inGullane, East Lothian. Clydesdale horseswere shod as I hit off with my uni-club.Wooden tees were costly. Iffound, they would be pocketedsurreptitiously. If honesty prevailed,they would be handed in at the adults’pro shop to be returned to owner.There was a sandbox on each tee.One built up a little mound of sand,placed the ball on top and blasted away.I described this teeing-up processrecently to a friend. “How primitive,”he said. I had expected a responseof “How environmentally sound,”so changed the subject.Through my teenage years andinto my 20s I despised golf, a gamefor the elderly – anyone over 40 –and, in general, a waste of time when26Alberta Doctors’ Digest • July/August 2010

one could be in a pub or partying.These were more important activities,although with the recent revelationscoming from Mr. T. Woods, perhapsthis was too hasty a conclusion. I’mnow back in the game.For peace and beauty, the Red DeerGolf & Country Club is up there.It’s the site of the Alberta MedicalAssociation’s (AMA’s) annual North/South Doctors’ Golf Tournament,which Dr. Pat Rose coordinatedyears ago. Now Dr. Pat Heslip helpswith the event.Here you can meet some charactersfrom the medical world of yesteryear,as well as play on a tough course withthe Red Deer River rolling by. Aftera belly-stretching breakfast, you headout for the shotgun start full of hope,bacon and eggs.They have cardiac resuscitationequipment (donated by the AMA)readily available so you can continueyour round with only a shortinterruption when one of yourpartners has an MI.Watching golfers return to theclubhouse at noon for lunch has beenlikened (by gynecologist, raconteurand poet John Boyd) as “The Returnof the Zombies.”The worst doctors are those whoare puffed up with arrogance. A whiffof this deadly sin enters most of usfrom time to time.Golf is excellent therapy for thischaracter flaw. Try Royal Troon, achampionship links course on theWest Coast of Scotland, with the islandof Ailsa Craig in view on the Irish Sea.I last tee’d off at Troon in 2000.Caddies were hired at £20 per round,plus tip. My caddie was William Wallace.Surrounding the first tee at Troonwas a fair crowd of holidaymakersand, much more threatening, caddieswaiting to be hired. It was earlyafternoon and some had sunk a fewpints in the pub over the road andwere in a critical mood.Wallace tee’d up my ball and saidcomfortingly: “Pay no attention taethem, sir. You want a good shot upthe middle, not too far mind. Watchthe far bunker on the right.”The crowd fell silent. My practiceswing went well. In fact, wasn’t it acertain Lord Robertson who said: “Myfavorite shots in golf are the practiceswing and the conceded putt. All therest can never be mastered.”I topped the ball, scudding it off tothe left rough, a mere 60 yards up.There was a general tittering fromthe crowd and a voice from the backshouted, “Aw, take another shot, Tiger.”We strode off down the fairway,with the Irish Sea on our right andthe old clubhouse on our left, to thesound of the chuckling golf gods, thesea breeze cooling my face.For inner peace and harmonyI played Paradise Canyon, nearLethbridge, for the first time thisyear, and a lovely course it is, too.The back nine winds along by theOldman River. Bluebirds, swallowsand Spotted Towhees twitter,chirp and cackle at the shots. Theriver’s banks and coulees show theshuddering upheavals of Earth’sgeology like a layer cake.Golfing in the Rockies.Dr. Paterson’s friendshunt for the ball.( Dr. Alexander H.G.Paterson.)Gazing at the cliffs of sandstone,shale and coal from the Mesozoic Erasettles the mind wonderfully. Thatback-wrenching, fat seven-iron shotmeant for the green, but rolling only15 yards, is put in its proper place inthe great scheme of things.It really doesn’t matter. Millionsof years don’t matter, they pass away.All things must pass. This is betterthan meditation.Watch the Digestpost-summer for reportsabout the oldest golf eventin Alberta — the 83rd annualNorth/South Doctors’ GolfTournament, in Red Deer.On the way back to Calgary, feedingthe harmony further, I recommendthe 7-Eleven in Claresholm fordeep-fried chicken kebobs (“placedon a stick by Mother Nature”), thickpotato wedges (with Ranchman’sdressing) and Hawkins Cheezieswashed down with a Coke slurpee.Another medical deadly sin is totake oneself too seriously, and yet onemust do this from time to time to beeffective and professional.Alberta Doctors’ Digest • July/August 2010 27

This paradox brings Muirfield tomind. To play it with enjoyment youmust be relaxed, yet have your witsabout you. You must take the gameseriously but not be too serious aboutit. You must respect the tradition butrealize some of it is tongue-in-cheek.The game at Muirfield, a links courseby the Firth of Forth, is different. Theconvention, for the last 250 years, hasbeen to play the course well-oiled.You start with a beer, move onto the buffet featuring local fish andmeats, and then sit down in thedining room surveyed by oil paintingsof severe, frock-coated club captainsin tri-cornered hats, clutching woodenclubs resembling the modern hybridones. The meal is washed down witha bottle of wine.Standing on the first tee requirescompensation for the gentle sway andthe rosy tinge to the world. This is,however, the Old Game – a two-ballfoursome, played at a pace blisteringby North American standards.A visiting American to Muirfield once commented to his caddie after a poorshot into a deep bunker, “It’s a funny game, golf.” To which the horrified caddiereplied, “It’s not meant to be!”But golf is meant to be fun. So for a healthy life and self-improvementget-away from the clinic, do an evening or an afternoon course.PHYSICIAN(S) REQUIRED FT/PTAlso locums requiredDr. Paterson focuseson his putt, in July, inCanmore. ( supplied.)Indulge in new clubs. Try a demo club first. It always improves your game –until you buy it.But golf is meant to be fun.I took a practice swing and wasupbraided by my friend, Paul. “Don’tthink we’ve time for that. Just hit it.We’re not playing for medals. . . .”Two players hit off the tee whilethe other two walk briskly up thefairway to play the second shot,by which time the original playersare making for the green to putt.The effects of the lunch wear offquickly in the sea breeze and you’reback in the clubhouse within twoand a half hours, ready for morerefreshments.ALL-WELLPRIMARY CARE CENTRESMILLWOODSPhone:EDMONTONClinic Manager orDr. Paul Arnold(780) 970-2070(780) 953-6733- Signing bonus or guarantee -28Alberta Doctors’ Digest • July/August 2010

Classified AdvertisementsPhysician wantedCALGARY ABCelebrating more than 25 years ofexcellence in serving physicians,MCI The Doctor’s Office hasimmediate openings in group familypractice or walk-in shifts. Lighton-call requirements, flexible hoursand schedules, no investment, nofinancial risk, no leases to sign andno administrative or human resourcesburdens. MCI Medical Clinics providequality practice support in eight busylocations throughout the city.Contact: Margaret GilliesTF 1.866.624.8222, ext. 433practice@mcimed.comwww.mcithedoctorsoffice.comCALGARY ABNewly built, busy, computerizedoffice in southwest Calgary is lookingfor part-time physicians to fill walk-inshifts for late afternoon/early evening.No costs, no overhead.Contact: MonicaWestglen Medical Clinic108-30 Springborough Blvd SWCalgary AB T3H 0N9T 403.240.2258 (private)CALGARY ABMed+Stop Medical Clinics Ltd. hasimmediate openings for part-timephysicians in our four Calgarylocations. Our family practice medicalcentres offer pleasant workingconditions in well-equipped modernfacilities, high income, low overhead,no investment, no administrativeburdens and a quality of lifestyle notavailable in most medical practices.Contact: Marion BarrettMed+Stop Medical Clinics Ltd.290-5255 Richmond Rd SWCalgary AB T3E 7C4T 403.240.1752F 403.249.3120msmc@telusplanet.netCALGARY ABWe are seeking part- or full-timephysicians for our northwest Calgaryclinic for evening and weekend shifts.We are a busy, high-volume walk-inclinic and offer an attractive split. Thereare no on-call or administrative duties.You will be assisted by friendly staff andwill see appreciative patients. Excellentincome, pleasant environment.Contact: Dr. Richa LoveT 403.295.7666richalove@shaw.caCALGARY AND EDMONTON ABJoin our dynamic team. Part- andfull-time physicians required forWellpoint Health, a growing nationalhealth care provider. We are looking tofill positions at all of our walk-in andoccupational health clinics in Calgary,Midnapore, Foothills Industrial Parkand Calgary Airport. We are also lookingfor walk-in physicians in Edmontonfor the Kingsway Mall location.Above-average compensationincluding a minimum daily guaranteeof $1,000, 70/30 split and up to$5,000 signing bonus.Contact:T 403.880.2040sdada@wellpointhealth.ca orT 403.680.8885jlewis@wellpointhealth.cawww.wellpointhealth.caCOLD LAKE ABGeneral practitioners urgently neededwith and without special skills. Verymodern and lucrative clinic, usingWolf Medical Systems electronicmedical records, is looking for morephysicians. This clinic is in the ColdLake Health Centre and immediatepositions are available. No overheads,only monthly fixed-fee rent withoutincrease for duration of contract. No60/40 arrangements, allowing youto keep the money you earn throughyour hard work. Choose your ownhours/workload. Compulsory currentemergency room on-call rotationis one-in-seven, obstetric calls arecurrently one-in-three and anesthesiacalls are currently one-in-two.Candidates to have Canadian MedicalProtective Association membership(compulsory) and general practitionerwith obstetrics must be eligible topractise obstetrics in Zone 5. Generalpractitioner with anesthesia mustbe eligible to practise anesthesia inZone 5.Contact: Dr. Jakes DekkerCold Lake Medical ClinicT 780.639.3180F 780.639.3181jed@incentre.netDRAYTON VALLEY ABGeneral practitioner required forMalone Medical Clinic, which is fullycomputerized, modern and one blockfrom the Drayton Valley Hospital.Opportunities to work in the emergencydepartment and additional skillsincluding obstetrics and anesthesiawould be an asset, but not essential.Contact: Heather Barrett,Office ManagerT 780.542.3366F 780.542.6207malone@telus.netLETHBRIDGE ABCampbell Clinic, established in 1906, isseeking part- and full-time physicians;new graduates welcome. Currently,we have 17 family physicians, onepediatrician and one internist.Alberta Doctors’ Digest • July/August 2010 29

Multidisciplinary primary care teamsinclude a pharmacist, clinical educator,behaviorist and mental health/socialworker. Fully integrated electronicmedical records, on-site X-ray,laboratory service and pharmacy.Friendly support staff and professionalmanagement. Excellent start-upconditions and above-average incomewith a very competitive overhead.We welcome your enquiries.Contact: Chris Harty,Clinic ManagerT 403.381.2263charty@campbellclinic.caLETHBRIDGE ABBigelow Fowler Clinic (19 physicians)has immediate openings for partorfull-time physicians. On-call isone-to-two times per month. Fullyintegrated electronic medical recordlinks three clinic locations forfamily practice and walk-in clinics.X-ray, lab services and pharmacy onsite. Friendly, competent staff andprofessional management allow youto focus on quality of care. Excellentincome opportunity with verycompetitive overheads.Contact: Tim JanzenBigelow Fowler Clinic1605 9th Ave SLethbridge AB T1J 1W2T 403.327.3121F 403.320.5593tjanzen@bigelowfowler.comPhysician and/or locum wantedCALGARY AND EDMONTON ABIs your practice flexible enough tofit your lifestyle? Medicentres isa no-appointment family practicewith clinics throughout Calgary andEdmonton. We are searching forsuperior physicians with whom topartner on a part-time, full-time andlocum basis. No investment andno administrative responsibilities.Pursue the lifestyle you deserve.Contact: Lorna Duke,Manager, Physician ServicesMedicentres CanadaT 780.483.7115edmphys@medicentres.comShannon Klassen,Coordinator, Physician ServicesT 403.291.5599calphys@medicentres.comRED DEER ABRed Deer’s Associate Medical Group,established in 1946, is centralAlberta’s largest family medicineclinic. We are currently seeking partandfull-time physicians, as well aslocums, who are interested in seeingpatients in booked appointmentsas well as in a busy walk-inenvironment. The medical practicesare professionally managed with anexcellent, knowledgeable supportteam, very experienced colleague base,competitive overhead rates and fullyintegrated electronic medical records.The clinic is connected to the Red DeerPrimary Care Network and has anumber of health care professionalscollaboratively working with familyphysicians. We have a manageableobstetrics on-call schedule with alow-risk maternity group handling themajority of new obstetric patients. InMay the Associate Medical Group alsoopened a new state-of-the-art walk-inclinic in Red Deer’s highest-trafficretail location, which is expected togenerate large income potential withgenerous financial splits. Laboratoryand hospital nearby. Downtownlocation, pharmacy on site (downtownclinic) and close to walk-in location.Contact: Martin Penninga, ManagerT 403.346.2057F 403.347.2989martinpenninga@telus.netwww.associatemedicalgroup.comST. ALBERT ABPhysician and locum opportunitiesavailable within St. Albert. Incentivesfor full-time physicians and locumsavailable.Contact: Sheila Cousineau,Assistant ManagerSt. Albert and Sturgeon PCNT 780.418.6721sheila@saspcn.comwww.saspcn.comSpace availableEDMONTON ABBeautiful and professionally designed1,300 sq. ft. luxury medical officeavailable for lease in southwestEdmonton, in a contemporaryprofessional centre in prestigiousTerwillegar/Riverbend. Includestwo private offices and fourexamination rooms. Office featuresinclude built-in high-speednetworking, phone and securitysystem, mahogany doors, quartzreception desk and ceramic tile.Main floor is handicap accessible,ample free client/staff parking, easyaccess via transit and all major routes.Contact:780.445.6830 (pager)rheum@uniserve.comCoursesSEA COURSES CME CRUISESCompanion cruises FREE.ALASKA CME CRUISESeptember 12-19Focus: Cardiology, ENT, men’s healthShip: Celebrity MercuryGREEK ISLES CME CRUISEOctober 2-9Focus: Internal medicineShip: Splendour of the SeasCHINA AND YANGTZE RIVERCME TOUROctober 27-November 11Focus: Rheumatology and chronic painShanghai, Xian, Beijing andYangtze River30Alberta Doctors’ Digest • July/August 2010

CARIBBEAN CME CRUISENovember 26-December 6Focus: Sexual health medicineShip: Celebrity EquinoxSOUTH AMERICA CME CRUISEJanuary 16-30, 2011Focus: Respirology, cardiologyand psychiatryShip: Celebrity InfinityCARIBBEAN CME CRUISEFebruary 5-12, 2011Focus: Botox and fillers trainingShip: Oasis of the SeasFebruary 19-26, 2011Focus: Clinical medicine for hospitalistsShip: Liberty of the SeasMarch 12-19, 2011Focus: Diabetes managementShip: EurodamDUBAI AND UNITED ARABEMIRATES CME CRUISEMarch 21-28, 2011Focus: Aesthetic medicineShip: Brilliance of the SeasContact: Sea Courses CruisesTF 1.888.647.7327cruises@seacourses.comwww.seacourses.comPractice for saleEDMONTON ABRheumatology practice for sale inEdmonton. Impressive opportunityto take over a well-established,comprehensive, solo, adultrheumatology practice in prestigiousarea of Edmonton. Offers excellentincome, impressive and solid referralbase throughout the province.Terms negotiable.Contact:780.445.6830 (pager)rheum@uniserve.comServicesACCOUNTING ANDCONSULTING SERVICESEDMONTON ABAccounting, bookkeeping, personaland corporate tax returns andpayroll. Experienced in incorporatingprofessional and non-professionalcorporations. Specialize in managingaccounts for professionals. Pickup and drop off for Edmontonand vicinity; able to accommodateout-of-town clients via mail.Contact: N. Ali Amiri, MBA,Financial and ManagementConsultantSeek Value Inc.T 780.909.0900F 780.439.0909aamiri.mba1999@ivey.caDOCUDAVIT MEDICALSOLUTIONSRetiring, moving or closing yourfamily or general practice, physician’sestate? DOCUdavit Medical Solutionsprovides free storage for your paperor electronic patient records with nohidden costs. We also provide greatrates for closing specialists.Contact: Sid SoilDOCUdavit SolutionsTF 1.888.781.9083, ext. 105ssoil@docudavit.comIPAC AND OHS CONSULTING& AUDITINGCALGARY ABAre you ready for an InfectionPrevention and Control (IPAC) audit?Are you in compliance with theAlberta Occupational Health &Safety (OHS) legislation?We can assist you in ensuringcompliance to the IPAC standardsand OHS regulatory requirementsby conducting a gap analysisand recommending practices andprocedures to successfully pass an auditand ensure compliance to regulations.We will assess the hygiene standardsand equipment reprocessing practicesof your office, develop the healthand safety procedures, and providenecessary training for your staff.Contact us to set up a free consultation.Contact: AshifT 403.770.9578ashif@x-inc.bizRECORD STORAGE & RETRIEVALSERVICES INC.Closing practice? Canada’s numberone medical records storage/scanningcompany invites closing generalpractitioners to store their files forfree. Fully compliant. In businesssince 1997.TF 1.888.563.3732, ext. 221info@rsrs.comwww.recordsolutions.ca/medicalpracticeclosure.htmlDisplay orClassified AdsTo Place or renew, contact:Daphne C. AndrychukSecretary, Public AffairsAlberta Medical AssociationT 780.482.2626, ext. 275TF 1.800.272.9680, ext. 275F 780.482.5445daphne.andrychuk@albertadoctors.orgCanada Post Publications Mail Agreement No. 40070054Return Undeliverable Canadian Addresses toAlberta Medical Association, 12230 106 Ave NW, Edmonton AB T5N 3Z1Alberta Doctors’ Digest • July/August 2010 31

When you’re a doctor, people depend on you for a lot of different things, especiallyyour time. It’s a constant balancing act between staying up to date on pharmacologyand medical advances, and maintaining the administrative side of your practice. It’s timeto simplify. Let us take care of your billing so you can get back to doing what you do best,being a doctor. We just have one question that you probably haven’t heard in a while:What will you do with all your extra time? Let us know at stratbill.caWELCOMING BACK YOUR TIMEHere’s our solution. We will:• Remove the billing process from your daily routine• Maximize your revenue and reduce overhead• Free up your time• Give you the opportunity to get backto being a doctorBeing a doctor wasn’t always this complicated.Let Stratbill take on some of your responsibilitiesso you can get back to doing what you do best.Stratbill, letting doctors be doctors.