Constituency Activity - Table of Contents
OMA District Reports ...... 2 District 2 ...... 2 District 4 ...... 3 District 11 ...... 4 OMA Branch Society/Territorial Division Reports ...... 6 Greater Niagara Medical Society ...... 6 Niagara South Medical Society ...... 7 OMA Assembly Reports ...... 8 Surgical Assembly ...... 8 OMA Section Reports ...... 9 Ontario’s Anesthesiologists, A Section of the OMA ...... 9 Section on Cardiology ...... 11 Section of Eye Physicians and Surgeons of Ontario ...... 13 Section on General and Family Practice ...... 16 Section on General Internal Medicine ...... 19 Section on Hospital Medicine ...... 21 Section on Laboratory Medicine ...... 22 Section of Medical Students ...... 25 Section on Occupational and Environmental Medicine ...... 27 Section on Palliative Medicine ...... 28 Section on Sport and Exercise Medicine ...... 29 Section on Rheumatology ...... 31 OMA Forum Reports ...... 33 Academic Medicine Forum ...... 33 Rural Medicine Forum ...... 35 OMA Medical Interest Group (MIG) Reports ...... 37 Medical Interest Group (MIG) of Clinic Endoscopists ...... 37 Medical Interest Group (MIG) on Clinical Hypnosis ...... 38
April 2018 OMA Reports to Council 1
OMA District Reports
District 2
April 2018 Report to Council
“The OMA Districts work with local physicians, health care providers, and government to ensure physicians have a voice and are influencing local decisions in the best interests for their patients and communities.”
Your District 2 Executive and Delegates met several times in post-board teleconferences as well as in person at our Annual Meeting this fall in Ingersoll and at our Council Meetings in May and November. We helped to prioritize negotiations concerns for District 2 members and discussed issues impacting physician practice and well-being. We responded to member inquiries about negotiations, tax changes and other issues. Several of us met with our Members of Parliament (MPs) and Members of Provincial Parliament (MPPs), including Progressive Conservative (PC) Health Critic Jeff Yurek, who hails from our District.
An OMA Advocates session was well attended in our District this fall. Social events like the London Knights game offered a great way to network with our colleagues. A Physician Leadership Institute Workshop on Conflict Management and Negotiation was very well attended increasing the confidence of Physician Leaders in our area.
Dr. Sharad Rai organized a Patient Health Care Forum in London, which was successful in advocating for patients to bring forward their stories of difficulties navigating the health care system and wait times in our District.
Physicians in our District have historically had good working relationships with the Local Health Integration Network (LHIN) and the ‘Line in the Sand’ has made these relationships challenging. Moreover, our District 2 spans two LHINs (LHIN 2 and LHIN 3) and some of the physicians in our LHIN are in OMA District 4. This structural barrier makes it challenging to mobilize one group of physicians to deal with one LHIN and carry out one of the key functions of the District as quoted above. We may be more effective if our District boundaries matched LHIN boundaries (as they do in District 1 which overlaps with LHIN 1). LHIN boundaries were selected to reflect ‘local areas where people naturally seek health care’ whereas the OMA District boundaries are based on historical medical societies. This may be a change that could make the OMA more effective on a local level.
Thanks to Dr. Tatiana Jevremovic, our outgoing District 2 Board Director, and Dr. Silvia Orsini, who will continue on as District 2 Board Director in the second year of her term. Thanks as well to Mr. Frank Rubini who has been a great support to the physicians in District 2. I will be stepping down as District 2 Chair but hope to continue on as a Delegate.
Respectfully submitted,
Dr. Kellie Scott, MD CCFP FCFP Chair, OMA District 2
April 2018 OMA Reports to Council 2
District 4
April 2018 Report to Council
The current District 4 Executive (as of March 7) is as follows:
Dr. Walter D.J. Owsianik – Chair Dr. James Kovacs – Director Dr. Jeff Kolbasnik – Director Mr. Scott Witmer – OMA Regional Manager Ms. Jessica Wooder– Executive Director, Hamilton Academy of Medicine
District 4 continues to be a proactive and responsive district within a changing health care environment. This year, the Executive has focused on enhancing communication and working towards common goals within the district.
The District 4 Executive continues to meet monthly with Branch Society Presidents to discuss both local and provincial issues. These meetings encourage two-way communication between District 4 members and members of the OMA Board by providing Directors with the chance to hear feedback at a “grass roots” level. For example, the group worked together to review and establish top negotiations priorities within the district.
Members have remained engaged by attending face-to-face events across the district. The Hamilton Academy of Medicine hosted another successful District 4 Annual General Meeting (AGM) and OMA President’s Tour on November 24th, 2017. District members were grateful for the opportunity to participate in an open dialogue with then OMA President, Dr. Shawn Whatley, who discussed current opportunities and challenges facing our profession. The OMA has also worked with District 4 to host a number of Health Care Advocate sessions in preparation for the Provincial Election this June.
District 4 continues to support the Ontario Medical Student Bursary Fund (OMSBF) Golf Tournament as a "White Tee" sponsor. Members understand the financial strain on medical students, and are honored to support Ontario's future physician leaders.
District 4 OMA Council Delegates continue to meet for breakfast on the Sunday mornings of Council. This has been a long standing tradition, and has proven to be a great opportunity for leaders to interact and meet one another. More importantly, it allows delegates to collaborate and share ideas on projects across the district.
Your District 4 Executive has been, and will continue to be actively involved in representing your interests. We will continue to monitor challenges and opportunities facing the profession and in our communities. We are committed to responding in a proactive manor. Your support and input is appreciated. Feel free to contact us.
Respectfully submitted,
Dr. Walter D.J. Owsianik Chair, OMA District 4
April 2018 OMA Reports to Council 3
District 11
April 2018 Report to Council
The last two years have seen the District leverage and strengthen its zone-based representation model as this is critical to protect our members’ professional wellbeing.
The District’s Zones cluster or group our Chapters (Societies) along natural referral patterns into five distinct regions within the District. Their purpose is to create regional communities of practice that bolster the physician voice, influence and power within each of the Local Health Integration Networks (LHINs) and LHIN sub-regions. They also serve as our ‘on the ground’ presence addressing the myriad of challenges affecting our members at the regional level.
Meetings of the District Executive have now been expanded to include elected delegates from both the District’s Chapters (aka Societies) and Zones (regions). Additionally, District Delegate breakfast meetings at Council deliberately organize Delegates by zone to facilitate the development of strategy among these leaders for their shared membership.
New District Charter Bolsters District’s Governance Framework
Governance efforts in 2017-18 have focused on developing the District’s inaugural Rules and Regulations or Charter. Meant to augment what is already in the OMA Bylaws, the District’s Charter provides a snapshot of the District articulating the various governance levels therein (Chapter/Society; Zone: District), role and responsibilities of the District’s Officers; Standing Committees of the District and other key facets of the District’s operations.
The intent behind the Charter is to provide structure and promote synergy among the many elements that comprise the District. Unlike Section Rules and Regulations, changes to the District Charter do not require Board approval which makes it more nimble and responsive to changes in the governance and operating environments.
Enhancing Members’ Professional and Personal Wellbeing
The District’s “Doctors’ Lounge” series is a health and wellness initiative that promotes physician interaction and collegiality within a non-clinical setting. Organized by Dr. Harold Pupko, a District 11 elected leader, these creative evening sessions are free and attended by a diverse group of District 11 physicians drawn from different cultures and stages of practice ranging from medical students to mature clinicians and retirees as well as an equal number of male and female practitioners.
The Doctors’ Lounge series has taken a life of its own, garnering much praise and interest from those who appreciate the District’s efforts to create a different value proposition for Toronto’s doctors.
These efforts also include periodic Continuing Medical Education (CME) events co- sponsored by Toronto Public Health (TPH) and the District. In January 2018, the District and TPH sponsored a highly successful event dealing with Sexually Transmitted
April 2018 OMA Reports to Council 4
Infections (STIs), Hepatitis C and other communicable diseases. A sellout crowd packed Mt. Sinai auditorium to hear from some of Toronto’s best in this field.
Thank You to the District 11 Leadership Team
As I end my term as Interim Chair, I would like to extend my thanks to our District elected leaders including our 5 Directors, Drs. David Esser, Hemant Shah, Rachel Forman, Audrey Karlinsky and David Jacobs as well as District Past-Chair, Dr. Javed Alloo, District Secretary, Dr. Rajni Singhal and District Treasurer, Dr. Michael Verbora. The District is also ably supported by its Executive Director, Ms. Kathy Bugeja, and OMA Regional Manager, Mr. Manny Khattak.
Respectfully submitted,
Michael Finkelstein, MD, MHSc, FRCPC Interim Chair, OMA District 11
April 2018 OMA Reports to Council 5
OMA Branch Society/Territorial Division Reports
Greater Niagara Medical Society
April 2018 Report to Council
The Greater Niagara Medical Society (GNMS) has had a number of events and again contributed to charity this year:
1. April 18, 2017: Annual General Meeting 2. Spring 2017: GNMS Facebook Page started (see Dr. Dec to become a “friend”) 3. June 28, 2017: Annual Summer Party – Peller Estates (Niagara-On-The-Lake) i. Golf Tournament – (both good shots & bad shots!) ii. Dinner/Prizes/Entertainment 4. Sept. 20, 2017: GNMS Clinic Day (Greater Niagara General Hospital) i. Choosing Wisely – Recommendations for Long Term Care ii. Diabetes & the Kidney - 2017 iii. Approach to an Itch that just won’t go away 5. Fall 2017: submitted GNMS members’ petitions to both the House of Commons through Member of Parliament (MP) Rob Nicholson and the Ontario Provincial Legislature through Member of Provincial Parliament (MPP) Wayne Gates regarding the “Tax Fairness” issue and Minister Morneau’s corporations tax revision proposal. 6. Oct. 24, 2017: Fall Meeting: Guest – District 4 Director Dr. James Kovacs 7. Dec. 2, 2017: Annual Christmas Party – Embassy Suites by Hilton (Niagara Falls) i. Dinner/Prizes/Charitable Fundraising/Entertainment/Dancing in the Aisles! 8. Jan. 24, 2018: Donation to NIAGARAHEALTH FOUNDATION i. in co-operation with the Menechella Family
Respectfully submitted,
Dr. David Dec President, Greater Niagara Medical Society
April 2018 OMA Reports to Council 6
Niagara South Medical Society
April 2018 Report to Council
The Niagara South Medical Society (NSMS) has been active with many events for the 2017 calendar year. To start we had our Annual Clinic Day in March, followed by the spring NSMS meeting, which was well attended. The Doctors Day event was held in April in conjunction with the Niagara Health System Medical Staff Association and other local societies. Dr. Wayda of Port Colborne, who is an active member of our society, received the Niagara Region Family Physician of the year award at this event.
The summer social which included Lincoln County Academy of Medicine was at the Chateau des Charmes winery and was well attended. We held our second annual Family Picnic at Heartland Forest. There were many new faces and members of other societies in attendance.
The society held the Annual General Meeting (AGM) in October with a Continuing Medical Education (CME) event. Dr. David Goswami was presented with the Glenn Sawyer Service Award and Rick Horne was presented with the Community Service Award. At the meeting, a new Executive was elected.
Following this meeting, the new Executives met with the outgoing Executives to discuss plans for the next year, including membership involvement and CME event day for 2018.
The yearly Christmas party at Lookout Point included many new members, and retirees. A donation was made to two separate charities in memory of Dr. P. Ansari and Dr. Ellis. The NSMS also donated $500 to the Big Move Cancer Ride and $2,000 to the Ontario Medical Student Bursary Fund.
Respectfully submitted,
NSMS Executive
April 2018 OMA Reports to Council 7
OMA Assembly Reports
Surgical Assembly
April 2018 Report to Council
The OMA Surgical Assembly meets by teleconference after OMA Board meetings. We also met in person at Council meetings. The next face-to-face Surgical Assembly meeting will be at Spring Council 2018.
Many of the Surgical Assembly’s issues reflect those affecting all physicians. The absence of a negotiated agreement with the Ministry of Health and Long-Term Care (MOHLTC) and unilateral actions by the government continue to be the most concerning issues. There is also concern about recent incorporation changes and the effect on members.
Members are watching progress on an OMA sponsored retirement plan.
Surgical Assembly members continue to encounter on-going payment difficulties with the MOHLTC. Many payment claims are being delayed or denied. The Ministry is withholding data on this matter and it would be good to know how many codes are being rejected and how much doctors are owed. This item continues to be pursued.
The Surgical Assembly has been informed about new OMA governance changes that have reformed the functioning of the OMA Board and its committees.
Relativity is also an on-going issue. Assembly members have been encouraged to communicate with the Relativity Review Committee to express their concerns.
Our Assembly members have been particularly affected by difficulty in finding suitable practice locations with hospital privileges and operating room resources. There are numerous examples of underemployed specialists in Ontario.
I would like to thank the Surgical Assembly members and OMA staff for their support during my tenure. I have been privileged to lead this Assembly and wish our new leader the best as I transition from the Surgical Assembly Chair.
Respectfully submitted,
Dr. Stephen Kosar Director, OMA Surgical Assembly
April 2018 OMA Reports to Council 8
OMA Section Reports
Ontario’s Anesthesiologists, A Section of the OMA
April 2018 Report to Council
Ontario’s Anesthesiologists (OA) hosted another successful Ontario Anesthesia Meeting and conference weekend at the Westin Harbour Conference Centre in Toronto. Our impressive planning committee was led by Dr. Adriaan Van Rensburg and Dr. Ryan Smith as our academic chairs. Dr. Greg Bosey was our conference Chair and Dr. Peter Cino joined as additional planning support. The planning committee did a wonderful job creating a rich academic program, booking exceptional speakers and including diverse sponsors and break-out sessions for the weekend. Our OMA planning team, Jennifer Csamer and Nazlene Shivcharan, did an outstanding job of making sure the planning committee’s vision came to life, alongside the OA Admin and Communications Coordinator Emily Hill. We are very grateful to Dr. Shawn Whatley, President of the OMA, for providing our members with an update regarding ongoing negotiations. This year’s conference also had two excellent speakers, Dr. Brian Kavanagh and Dr. Bert Lauwers, who gave the key-note Beyond the Mask (BTM) presentations. We awarded our 2017 Distinguished Service Award to Dr. Christopher Ricci, an outstanding clinician from Hamilton who has worked hard to raise the quality of care for anesthesia providers. This year we introduced our first annual Family Practice (FP-) Anesthetists Luncheon and had a tremendous turnout. We also saw a remarkable turnout to our annual Physician Leadership Institute (PLI) Leadership Day on Conflict Management Negotiations, led by Janice Stein, and hosted a successful Saturday night social event in the trendy Distillery District. Planning for our 2018 meeting is well underway and will be held in Toronto again, at the Westin Harbour Castle.
Our BTM Initiative has had another successful year and saw remarkable traction with our 2017 projects. We were excited to announce the launch of our Choosing Wisely Implementation Guide last June, an impressive document to support conversations and actions to reduce unnecessary tests, treatments and procedures. Our working group also created three Resource Centres for our members over the last year, including a distinct Chief, FP-Anesthetist and General Membership group. These Resource Centres have dynamic tools for Ontario Anesthesiologists to engage in discussions and share information about a range of peri-operative and leadership activities. We have plans in 2018 to continue to promote the use of the Implementation Guide and to capture and celebrate success stories of our members.
The Section has also been working on a partnership with the Ontario Hospital Association to develop tailored, applied, accredited and relevant programs for Anesthesiologists and FP-Anesthetists. Our first one-day session last November, Strategic Leadership in a Reform Environment, was a huge success. We will be offering additional programs in 2018 and have a BTM group dedicated to leadership and capacity development. We will also continue to work closely with the Chiefs to support them in their leadership roles, build relationships with external stakeholders and to strengthen the perception of Anesthesiologists’ value among healthcare colleagues. The Executive is very proud of the dedicated work of our 20-member working group and are excited to see the launch of their respective projects in 2018.
April 2018 OMA Reports to Council 9
The Executive and our Section members were also actively involved during some of the more challenging moments in 2017, as Ontario Physicians continue to oppose the government’s flawed legislation. Our Section met frequently over the course of the year to discuss urgent events. Our Tariff Chair, Dr. Goldszmidt, has been doing incredible work at a variety of in-person meetings with the Negotiations Committee with regards to ministry proposals pertaining to anesthesiology. We were also very proud of our past- chair, Dr. Paul Tenenbein, for his devoted work on the OMA Negotiations Committee. We continue to support the current advocacy actions and hope to see fair and meaningful negotiations in 2018.
There were numerous changes in our Executive over the past year. Dr. Monica Olsen came on as our new Vice-Chair and Dr. Tarit Saha came on as our new Secretary. We strongly value their contributions to our considerable Section projects and operations. The Executive recently welcomed a new Member at Large, Dr. Chris Coutinho, who has been a highly engaged and effective member of our BTM working group. Our Executive also said goodbye to one of our Members at Large, Dr. Lukasz Bartosik, and we thank him for his expertise and contributions during his time with us.
We also thank all the wonderful Anesthesiologists and FP-Anesthetists who have worked on the variety of committees and projects with the Section. And we greatly value the regular messages of guidance and support from our members. We will continue to work to deliver meaningful projects that help elevate our role in the health care system and we hope to continue to contribute to OMA negotiations work in a thoughtful and engaging way.
Respectfully submitted,
Dr. Chris Harle Chair, Ontario’s Anesthesiologists, a Section of the OMA
April 2018 OMA Reports to Council 10
Section on Cardiology
April 2018 Report to Council
The Section on Cardiology (Section) welcomes the opportunity to submit this Report to Council on its activities in 2017 and priorities for 2018.
In 2017, the Section focused overwhelmingly on communicating the views and priorities of Ontario’s cardiologists to OMA senior leaders regarding the need for structural change within the OMA, and on the issues of negotiations priorities, binding arbitration, job action, and income relativity.
The Section is encouraged by the structural and governance changes that were made to the OMA’s Board of Directors and senior leadership last year, and the path the organization has set to becoming more transparent, responsive and accountable to grassroots members. It is crucial for this positive change to continue throughout 2018 and beyond. We remain concerned, however, by the OMA’s income relativity policy and the Comparison of Average Net Daily Income (CANDI) methodology, which does not properly account for the vast amount of work performed by our Section’s members outside of daytime work hours.
The Section appreciated the Negotiations Committee’s invitation in late fall 2017 to become directly involved in the Physician Services Agreement (PSA) negotiations/mediation process by responding to the Ministry of Health and Long-Term Care’s proposals affecting Cardiology. We look forward to continuing this involvement throughout the binding arbitration phase in 2018.
The Section appreciates the work of the Ontario Association of Cardiologists (OAC) throughout the year to represent the interests of cardiologists and achieve the following successes: • Worked with CorHealth Ontario to revise the Echocardiography Quality Improvement (EQI) program’s Facility Agreement to make it, and the entire EQI program’s accreditation process, fairer to echocardiography facility owners. Also, established the Echocardiography Quality Assessment Committee to address system- wide issues affecting the provision of high quality echocardiography services throughout the province. • Worked with OntarioMD to develop new electronic medical record (EMR) requirements that are fundamental to the clinical practices of cardiologists. A Draft EMR Cardiology Specification was developed to inform the digital health community of the functional needs of cardiologist. EMR Vendors can now leverage the specification in developing EMR solutions that lead to enhanced cardiac patient care and clinical practice efficiency. • Worked with OntarioMD to develop a timeframe for extending Health Report Manager (HRM) sending capabilities to community cardiology clinics, who were overlooked when HRM came into existence in 2014. • Worked with Health Quality Ontario to provide clinical experts to assist with health technology assessments in the areas of remote cardiac monitoring and transcatheter aortic valve implantation (TAVI), and in the development of the heart failure care in the community quality standard.
April 2018 OMA Reports to Council 11
The Section supports the OMA’s advocacy work that seeks changes to the federal government’s tax changes and believes that it should continue to pursue this throughout 2018.
Respectfully submitted,
James Swan, M.D. F.R.C.P.(C) F.A.C.C. Chair, Section on Cardiology
April 2018 OMA Reports to Council 12
Section of Eye Physicians and Surgeons of Ontario
April 2018 Report to Council
The Eye Physicians and Surgeons of Ontario (EPSO) are dedicated to preserving and restoring the vision of Ontario residents. We do this by: promoting patient safety collaborating with health organizations and agencies, technology leaders, hospitals, and our elected government, to maintain the highest standards of care helping our member ophthalmologists to contribute to the very best health care for their patients.
Promoting Patient Safety Through the use of social media, several campaigns were launched over 2017 promoting patient safety. As a result, EPSO’s online presence has grown and evolved. September – Press Release: back to school eye exams for children October – Campaign: Dangers of wearing cosmetic contacts November – Campaigns: #FallPreventionMonth & #DiabetesAwarenessMonth December – Campaign: #HealthyVision – wearing protective equipment – winter sports safety
Advocating for Patient Safety In September, a story broke in the media about a 24-year-old Ottawa woman that attempted to tattoo her eye purple with severe results. Doctors Cheskes (Chair) and McReelis (Past Chair) sent a letter to Minister Hoskins immediately requesting a ban on scleral tattoos. Minister Hoskins responded with a request for a meeting on October 31st and at that meeting EPSO pressed to have Bill 160 – a large omnibus bill – amended to include a ban. On November 16th, Doctors Cheskes and McReelis presented to the Standing Committee on General Government. On November 26th the amendment to Bill 160 passed the second reading which included the ban on tattoos and eye jewellery implants. The following day, EPSO launched a media campaign which was observed around the world. On December 12th the Amendment passed the third reading and received royal assent. “No person shall sell, offer for sale or provide a scleral tattoo or implant eye jewellery under the conjunctiva in Ontario unless a regulated health professional.” Ontario is the first province in Canada to have this legislation.
Advancing and Improving Ophthalmic Care Through collaboration with eye health partners, EPSO supports the creation of resources to help ophthalmologists provide essential care to Ontarians. EPSO members are also asked to weigh in on new procedures or treatments. In 2017 EPSO worked on the following projects: In February a cataract wait time video was developed and posted on social media – the video posts reached over 290K people, was watched over 316K times, and had 4,400 engagements British Columbia (BC) Model of using Avastin as a first line agent for retinal disorders – after review EPSO will not support the BC Model of Avastin for adoption in Ontario at this time Low Vision Report - Ongoing development of Low Vision Guidelines through Eye Health Council of Ontario (EHCO)
April 2018 OMA Reports to Council 13
Addressing Cataract Surgery Wait Times – this was one of the key asks on EPSO’s Lobb-Eye Day at Queen’s Park in September. EPSO raised concerns over the discrepancy in reporting cataract wait times. More recently – EPSO has developed a white paper “Ensuring Access and Excellence in Cataract Surgery” to address the growing demand and the lack of funding and resources to meet that demand. EPSO is requesting new Quality-Based Procedure (QBP) cataract surgery envelopes for 2018
Advocating for our Member Ophthalmologists Negotiations EPSO met many times with the OMA’s Negotiations Committee and were presented with a proposal from the Ministry of Health and Long-Term Care in October which included significant cuts in all areas of ophthalmology. In December EPSO prepared a formal written response to the Ministry which summarized Ontario’s impending vision care crisis. The Ministry responded with a rebuttal which EPSO prepared a written response to; however, this was not passed on to the government as the OMA triggered the binding arbitration process. EPSO will continue to work on behalf of its members to protect the profession. Relativity EPSO’s Dr. Kylen McReelis sits on the OMA’s Relativity Review Committee which has been tasked with updating the Comparison of Average Net Daily Income (CANDI) for 2017. EPSO was invited to present to the committee in October and meetings are ongoing to address methodology, intersectional issues, overhead and relativity ranking. Physician Billing Disclosure EPSO continues to work with the OMA to protect the privacy of physician billings. In July, the Divisional Court held that the names of the top 100 billers could be released to the Toronto Star. OMA Legal filed for leave to appeal this decision in September. On November 7th, leave was granted and the OMA will now proceed to argue against the disclosure at the Court of Appeal. The case is not expected to be heard before 2018. New Graduates Many of Ontario’s ophthalmologists are approaching an age in which many Ontarians would seriously preparing for retirement, if not retired already. There are approximately 13-16 new ophthalmology graduates per year that look for employment opportunities in Ontario but are unsuccessful in obtaining access at a public operating room. As a result, these new graduates are at risk of losing their surgical skills that they have trained more than nine years to attain. To address this concern, EPSO has developed a ‘White Cataract Paper’ - Ensuring Access and Excellence in Cataract Surgery - recommending that QBP allotments for cataract surgeries are increased by 5000 and an additional 1000 surgeries are allocated to the Kensington Eye Institute on the condition new graduates are hired to perform these surgeries. This whitepaper will be used to advocate for our members and Ontarians in 2018. Recognizing Excellence & Raising Awareness EPSO regularly shares updates on the good work its member ophthalmologists do in an effort to raise public awareness. These member focussed social media posts tend to get the highest amount of engagement and reach.
Three EPSO members were awarded for their contributions to ophthalmology. Media placements were secured to raise awareness for the work they do.
April 2018 OMA Reports to Council 14
Dr. John Fowler – Excellence in Educational Leadership Dr. Ike Ahmed – Innovator of the Year Dr. Bruce Jackson – Lifetime Achievement
Respectfully submitted,
Dr. Jordan Cheskes Chair, Section of Eye Physicians and Surgeons of Ontario
April 2018 OMA Reports to Council 15
Section on General and Family Practice
April 2018 Report to Council
Constituency Activity
The core mandate of the Section on General and Family Practice (SGFP) is to advance the professional and economic interests of its 14,000 members. It does this by promoting the value proposition of family doctors in our health care system, advancing the economic interests of our members, and influencing the development of policy and initiatives that affect family practice. Key activities pursued by the Section during the 2017-18 Association year reflect this advocacy focus and include the following:
Binding Arbitration Framework Agreement (BAF) Developing the 2018 Negotiations Platform of the Section Building the Consolidated Voice of Family Medicine in Ontario Addressing Income Disparity Maintaining the Line in the Sand Other Section Business
Binding Arbitration Framework Agreement (BAF)
In the Spring of 2017, the OMA was focused on attaining a BAF which, as the OMA membership had clearly indicated, was the prerequisite before any bilateral negotiations between the Ministry of Health and Long-Term Care (MOHLTC) and OMA could begin.
The SGFP Executive conducted extensive due diligence which included meetings with the OMA Negotiations team, including external legal counsel, to gain clarity on what the BAF would mean for its 14,000 members. In early June, the Section produced “Your Guide to Choosing Whether or Not to Support the BAF” to provide its members with the information they needed to make their own informed decisions during the upcoming membership referendum. Ultimately, the Section Executive endorsed the BAF because it felt the Agreement offered significantly stronger positioning and protections to negotiate stable and fair funding for the profession. On June 17, the BAF was ratified through a special OMA membership referendum.
Developing the 2018 Negotiations Platform of the Section
Concurrently during the springtime, the Section was developing its 2018 negotiations platform, recognizing that once a BAF is ratified, the timelines for advancing its position before the OMA Negotiations Committee were very short.
Development of the 2018 SGFP Negotiations Platform was informed by two special planning sessions conducted by the Section. The first session, held in February, included representatives from key stakeholder groups either representing (e.g., Ontario College of Family Physicians (OCFP), Association of Family Health Teams of Ontario (AFHTO)) or influencing the development of primary care in Ontario (e.g., Health Quality Ontario (HQO)). The goal was to identify areas of common interest and solutions to key issues facing the profession. The second planning session, held in April with only Section Executive members, refined this earlier work to develop unique positions, many
April 2018 OMA Reports to Council 16 of which have been embraced within the larger OMA Negotiations mandate. It remains to be seen what transpires as the negotiations process moves through the various stages of mediation and arbitration.
Building the Consolidated Voice of Family Medicine in Ontario
During the past 2 years, the Section has deliberately been strengthening its relationship with its family medicine partners: the OCFP and the AFHTO. Together, SGFP, OCFP and AFHTO represent the consolidated voice of family doctors in this province. This alliance builds off the strengths of the respective organizations and helps to safeguard against potential divide and conquer strategies that may be employed by the MOHLTC or its agencies.
In February, both OCFP and AFHTO were key participants in the Section’s Family Practice Summit. In July, the OMA Negotiations Committee invited both organizations to present their negotiations priorities which echoed those of the Section. There have been several opportunities since then for the three representative bodies to share information and co-develop a strategy which works to the benefit of our shared membership.
Addressing Income Disparity
Achieving income relativity across the clinical specialties (inter-sectional) and within family practice (intra-sectional) has been a long-standing goal of the Section.
In late fall, the Section was invited to present before the OMA Relativity Review Committee, which was struck as part of the OMA’s negotiations effort, to propose changes to the existing Comparison of Average Net Daily Income (CANDI) methodology.
The Section believes the current methodology is flawed and ignores the fact that family doctors, serving over 155,000 patients per day, provide the best value to our health care system. Family doctors take care of patients and families in their home, in our offices, in retirement homes, in long-term care facilities, in hospices, in emergency rooms and in hospitals. This value to the system should be recognized in addressing the current income disparity in Ontario.
One solution, adopted recently by the Alberta Medical Association’s General Assembly, commits to narrowing the significant gap between high and low income earning specialties in that province over the next 5 years. The Section concurs with this approach and has urged the OMA Negotiations Committee to advocate for this as well.
Maintaining the Line in the Sand
At their October 2016 meeting, members of the Section Executive passed the following historic motion:
“That the SGFP Executive recommends to ALL family physicians that they do not take part in any meeting with either the Ministry of Health or the LHINs dealing with Bill 41, or any aspects of “Patients First” until a Physician Services Agreement has been ratified by the OMA.”
April 2018 OMA Reports to Council 17
This motion, referred to as Line in the Sand (LiTS), was a direct response to government’s unilateral actions over the past several years including passage of Bill 41, (aka Patients First Act), which has ill-conceived implications for how family doctors will practice in this province, having been designed and fast-tracked through the legislature with no consultation with the profession and organized medicine.
Throughout 2017-18, the Section has considered its position carefully, and remains committed to a stand against unilateral government actions. The SGFP feels that a better primary care system can only be built when true respect and collaboration are evidenced in the relationship between local health agencies and Ontario’s family doctors.
Other Section Business
In August 2017, the Section Chair and Past-Chair participated in the Family Doctors of Canada Forum that was held in Quebec City. Bringing together peer and elected leaders from across Canada, the Forum provides an opportunity for participants to share information and strategy which, in turn, provides strength when addressing issues back home. Since that time, the Section has used the new contacts it made during the Forum to help develop strategy associated with the province’s opioids strategy as it relates to physician prescribing. These connections also informed the development of the Section’s position before the OMA Relativity Review Committee (described above).
In May 2017, the Section mini-Executive met with staff from the Ontario Auditor General’s Office who were conducting a value for money audit of lab services in the province. A key focus of the meeting was identification of what family doctors need to provide timely, accessible lab services to their patients. The meeting also offered an opportunity to showcase current innovative approaches used by family health organizations within their community to ensure timely and accessible reporting and tracking of test results.
All of these activities described above reflect the primary commitment of the Section: to identify, meet and represent the unique needs of Ontario’s Family Doctors.
Respectfully submitted,
Ross Male, MD, CCFP Chair, Section on General and Family Practice
April 2018 OMA Reports to Council 18
Section on General Internal Medicine
April 2018 Report to Council
Our Section still suffers a major economic impact from the loss of the G700 fee being billed with the electrocardiogram (ECG) technical fee (G310), the cut by 55% in the ECG professional fee (G313), and the loss of the E078 code - a 50% bonus on follow- up visits for some 30 "chronic diseases" such as diabetes mellitus, dementia, and congestive heart failure.
On May 10, 2017, a survey was sent to all members of the Section on General Internal Medicine regarding our priorities during current negotiations.
I received 46 replies; 41 agreed with restoration of the E078 code, which added a 50% premium for follow-up visits for patients with some 30 “chronic diseases” such as diabetes mellitus, congestive heart failure, and dementia.
There was a variety of other requests. These included restoration of most or all of the ECG interpretation fee, inpatient care (including better weekend premiums) and telephone and e-counseling of patients. Others were supervision of blood transfusions, counseling of families involved in organ donation, care of adults with multiple morbidities, treatment of patients with irritable bowel syndrome (IBS) and fibrositis, and family outpatient care conferences for patients with diabetes mellitus and congestive heart failure.
Most of us were very concerned about Finance Minister Bill Morneau’s proposed changes on taxes on professional corporations. I collaborated with an Ontario dentist, who provided me with information on fees paid on behalf of various low-income groups, and I stressed in newspaper articles that if Morneau’s proposals became law, many dentists would no longer subsidize these groups of patients. There would likely be an effect on physician manpower, as many mobile, younger physicians might leave Canada as a result. My opinion articles on this topic appeared in the Yukon and in every province, including French translations for Quebec.
Many provinces are running deficits and Ottawa predicts one of over $25 billion for 2017-2018. It makes no sense to argue over whether there should be a 3% or 6% annual increase in health transfer payments from the federal government; there is only one taxpayer.
There is a need to amend the Canada Health Act and certain pieces of provincial legislation so as to permit a limited amount of private care. If operating rooms (ORs) were expanded, and made available to Americans, this would provide new employment to MDs and nurses in Canada. The extra revenue would relieve the financial strain on our hospitals, and on provincial and territorial ministries of health. Wait time would likely shorten for all.
Physicians in Eastern Ontario for over three decades have been adversely affected by Quebec’s refusal to obey Section 11 of the Canada Health Act (CHA). This stipulates that physicians are to be paid at their own, host-province rate, not that of the patient. Quebec has refused to sign the Reciprocal Medical Billing Agreement. Ottawa still
April 2018 OMA Reports to Council 19 selectively enforces only the part of the CHA which prohibits extra-billing, and ignores the sections on portability as well as binding arbitration for MDs in fee disputes.
I have repeatedly suggested that Ottawa do an “end-run” around the intransigent Quebec government and pay MDs directly for treating out-of-province patients. It does so for federal prisoners, refugees (through the Interim Federal Health Program (IFHP)), and did so until a few years ago for members of the Royal Canadian Mounted Police (RCMP). I have specifically urged Conservative leader Andrew Scheer and his Health Critic Marilyn Gladu to introduce legislation setting up such a voluntary mechanism of payment, which most MDs across Canada would likely use.
Recent articles of mine on this subject have appeared in Le Devoir, Le Droit, the Sherbrooke Record, Ottawa Citizen, Toronto Sun, Ottawa Sun, Medical Post, ProfessionSante, and the Regina Leader-Post (in the home riding of Andrew Scheer).
The Section on General Internal Medicine holds dinner meetings open to all members and their spouses/partners once per year, with complimentary food and wine. These are usually times to coincide with the spring meeting of OMA Council. In 2015, Dr. Michael Kaufmann led an interactive discussion on "The Vulnerable Physician." The next year, Dr. Albert Schumacher - former president of the OMA and the Canadian Medical Association (CMA) - led a Health Care Advocate Training session.
On May 5, 2017, Dr. Harry Zeit spoke on "Caring for Self while Caring for Others - A Primer." The speaker for our April 27, 2018 annual dinner meeting will be Dr. Michael Paré, Chair of the OMA Section on Primary Care Mental Health. His title is “What is So Great (and So Horrible) about the Practice of Medicine?”
Members of our 2017 Section Executive were as follows: Chair – Charles Shaver Vice-Chair – Pearl Behl Secretary – Sewa Singhal
Respectfully submitted,
Charles S. Shaver, MD Chair, Section on General Internal Medicine
April 2018 OMA Reports to Council 20
Section on Hospital Medicine
April 2018 Report to Council
In 2017, the Section Executive’s efforts were directed mainly towards supporting the ongoing work in Ministry of Health and Long-Term Care (MOHLTC)-OMA negotiations and in developing a strategic plan to support Ontario’s hospital medicine physicians in the upcoming year.
The Section Executive presented both in writing and in person the Section’s major priorities to the Negotiations Committee and the Relativity Review Committee. The priorities include the development of an Alternate Funding Agreement for Ontario’s Hospitalists, fee for service adjustments to stabilize hospital medicine programs, and addressing inappropriate access bonus negation by General and Family Practice (GP/FP) hospitalist clinical activity.
The Negotiations and Relativity Review Committees were receptive to the Section’s presentations and agreed to consider the Section's priorities in its negotiations with the Ministry.
In our 2017 Scientific Session and Annual General Meeting (AGM) in May, the Section Executive presented a session on the Society of Hospital Medicine Assessment Guide for Hospitals and Hospitalists, “The Key Principles and Characteristics of an Effective Hospital Medicine Group” (HMG). Participants were encouraged to share how their own HMG meets or needs improvement with respect to the key principles and characteristics, and to consider how to implement a 1-3 month plan to improve their own HMG. Dr. Christine Soong, University of Toronto, presented on “Quality Improvement: What Every Hospitalist Needs to Know”, describing the pitfalls and key enablers of success in Quality Improvement initiatives and how hospital medicine physicians can demonstrate value through quality improvement efforts.
In our strategic planning meeting in September, the Section Executive identified areas that the Section could help in supporting the work of its members. Facilitating knowledge sharing between Ontario’s HMGs is expected to have a large potential in elevating the status and functioning of its partner groups. Innovations that HMGs have developed or participated in across the province could also be shared. The Section also identified the development of toolkits for contract negotiations with hospitals and patient handovers as possible opportunities to assist HMG leaders and enhance hospitalist practice. Direction in identifying deliverables for the Section will be validated in its 2018 AGM in April.
Respectfully submitted,
Stephen Chin MD CCFP FHM Chair, Section on Hospital Medicine
April 2018 OMA Reports to Council 21
Section on Laboratory Medicine
April 2018 Report to Council
During the 2017-18 Association year, the Lab Med Section was busy advocating for the needs of their members on a number of fronts:
Binding Arbitration Framework Agreement (BAF) Preparing for Negotiations Narrowing the Disparity Gap Before the OMA Relativity Review Committee Urging Cancer Care Ontario (CCO) and the College of Physicians and Surgeons of Ontario (CPSO) to “Walk the Talk” Vis-à-Vis the Quality Management Program for Pathology Other Section Activities
Binding Arbitration Framework (BAF) Agreement
Prior to the OMA membership referendum, the Section Executive conducted extensive due diligence (accessing relevant information through the OMA website; attending tele- townhall and roadshow presentations) to gain a better understanding of what the BAF Agreement means for laboratory physicians. The Section Executive also invited members of the OMA Negotiations team, including external legal counsel, to the Section’s 2017 Annual General Meeting (AGM) to hear them explain the nuances of the Agreement: how it might affect our ability to negotiate for an Alternate Payment Plan (APP) and how it might afford key protections we currently don’t have.
At that meeting, we were very encouraged to learn that the BAF provides an ongoing arbitration mechanism throughout the life of this and subsequent Physician Services Agreements that would enable the Section to bring forward issues – like unfunded quality assurance programs mandated upon our profession – to a Board of Arbitration for deliberation. While there is no guarantee this mechanism might resolve in our favour, this is an avenue to voice our concerns that we have not had before. For that reason, the Section Executive urged its members to ratify the BAF.
Preparing for Negotiations
As part of its effort to develop its 2017 negotiations platform, the Section Executive issued a member-wide survey testing key elements of the Section’s proposed negotiations strategy which centres on securing an APP-like funding mechanism to replace the current Laboratory Medicine Funding Framework Agreement (LMFFA). This mechanism would also incorporate modifiers to allow for workload considerations, new funding positions, etc. 90% of survey respondents support this approach.
These results were shared with attendees at the May 26 Lab Directors’ Summit who refined some of the ideas and encouraged the Section to keep pursuing its strategy.
On June 23, Section representatives presented their platform before the OMA Negotiations Committee. The Section is hopeful this will form part of the OMA’s mandate in its negotiations with the Ministry.
April 2018 OMA Reports to Council 22
Narrowing the Disparity Gap Before the OMA Relativity Review Committee
On October 20, 2017, the Section was invited to present its issues and concerns before the OMA Relativity Review Committee which is reviewing the current Comparison of Average Net Daily Income (CANDI) methodology. At that time Section presenters emphasized that from a relativity standpoint, lab physicians in Ontario are disadvantaged vis-à-vis other specialties and colleagues in other provinces due to a number of factors that include:
Flat salary structure affecting 90% of our members which doesn’t accommodate significantly increasing workload; No new funded lab MD positions since 2012; The negative impact of Ministry Unilateral Action discounts on our ability to recruit and retain lab MDs in our province; and Inability of CANDI methodology to capture the increasing amount of after hours work.
Section representatives were encouraged by the Committee’s offer to work with us to gather the evidence that supports our claims.
Urging CCO and the CPSO to “Walk the Talk” Vis-à-Vis the Quality Management Program (QMP) for Pathology
For the past several years, the Section has consistently reminded QMP principals that without the requisite system-wide resources (which include pathologist, other professional and administrative staff, data analysts, business analytics, IT systems, etc.), that cover all phases of the testing process (pre-analytical, analytical and post- analytical), the quality ambitions of the QMP cannot be suitably met. In fact, we are already starting to see evidence of the inability of sites to comply with QMP requirements as presented at the provincial quality committee that has been created to govern the QMP program.
As another tactic to advocate for our members’ needs, the Section recently urged both CCO and the CPSO to exercise their leverage during this negotiations cycle to help us secure the requisite resources in order to evolve the QMP from its current stalemate position. We were disappointed with CCO’s and the College’s joint response. They do not appear to be as invested in the program as we would have thought. They did offer some assurance, however, that local facilities and pathologists who are unable to comply with QMP requirements will not be penalized should they lack the necessary pathologist and other resources to achieve the program goals.
The Section is pursuing other ideas to help advocate for our members’ needs.
Other Section Activities
Other Section activities during 2017 also included the following:
May 26 2017 Lab Directors’ Summit organized and hosted by the Section that, in addition to discussing negotiations strategy featured the following: - QMP Update by Dr. Kathy Chorneyko, QMP Provincial Pathology Lead.
April 2018 OMA Reports to Council 23
- The Grand River Hospital Experience: What Can Be Accomplished When You Have the Right (IT) Tools by Dr. Demo Divaris, Section Vice-Chair. The Section 2017 AGM which was also held at the conclusion of the May 26 Summit. A conference call between Section Chair, Dr. Catherine Ross, and staff from the Ontario Auditor-General’s Office who were conducting their value for money audit of laboratory services in Ontario. Section input helped to clarify the testing cycle and quality processes already put in place by Ontario’s laboratory physicians.
Appreciation is extended to my colleagues on the Section Executive - Drs. Niki MacNeill (Past-Chair), Dimitrios Divaris (Vice-Chair), Neil Davis (Secretary-Treasurer), Brendan Mullen (Tariff Chair), and Dr. Suhas Joshi, (Member-at-Large) as well as members of the Section’s Council and Tariff Committees whose collective advice helps shape the direction of the Section. Special thanks are also extended to Kathy Bugeja, SPI Group who serves as the strategic consultant to both the Section and to Path2Quality.
Respectfully submitted,
Catherine Ross, MD, FRCPC Chair, Section on Laboratory Medicine
April 2018 OMA Reports to Council 24
Section of Medical Students
April 2018 Report to Council
The Section of Medical Students is excited to share our accomplishments in the 2017- 2018 year in representing and advocating for students at the provincial and national level.
The Unmatched Medical Graduate One of the most significant challenges faced by medical students is the process of matching to residency. Last year, there was an unprecedented high in the number of students in Ontario that went unmatched in the first and second iteration. The Executive of the Section of Medical Students has advocated for students at tables including the Health Workforce Planning Advisory Table within the Ministry of Health and Long Term Care (MOHLTC) to improve the process of physician services planning and residency spot allocation. We continue to have meetings with the Association of Faculties of Medicine of Canada (AFMC) and the Council of Ontario Faculties of Medicine (COFM) and recently endorsed a position paper from the Canadian Federation of Medical Students (CFMS) highlighting key recommendations to tackle this growing concern. We authored a Health Human Resources Guide in 2016 showing workforce trends for physicians in Ontario. Furthermore, from surveying the student population, our Lobby Day Ask this year will revolve around improving physician services planning and the unmatched Canadian medical graduate in April 2018.
Medical Student Mental Health The Section continues to prioritize advocacy and raising awareness around medical student mental health. We host an annual Wellness Retreat where we give students the opportunity to spend a weekend focusing on strategies to be resilient within the medical profession. This year’s Wellness Retreat was held March 23-25th with 110 medical students in attendance. For the first time this year, we funded 7 Ontario medical students, in conjunction with the OMA’s Physician Health Program, to attend the Canadian Conference on Physician Health in September 2017. At the Canadian Medical Association (CMA) General Council, we submitted an emerging issue on Physician and Medical Learner Suicide and advocated for our leading organizations to create tools to better support the medical community. We continue to advocate for Applied Suicide Intervention Skills Training (ASIST) to occur at each medical school after hosting our own workshop last year in February 2017, and for improved policies at each school to support student wellbeing. As an ongoing project, we will also be conducting a needs assessment of our Section to explore students’ perceptions on barriers to accessing services and receiving proper care.
Student Engagement We continue to have excellent student engagement through our communications and events. Each year, we host an Ontario Medical Students’ Weekend, Wellness Retreat, Lobby Day Weekend, and an Annual General Meeting. Together with the OMA we also produce an annual Leadership Summit. There are various videos on social media highlighting these events. For the CMA Presidential Election this year, we hosted all the candidates at our Council meeting and held a live stream for platform presentations as well as a Q&A from students all over Ontario. Afterward, we engaged students in the voting process and provided summaries of each candidate’s platform. Furthermore,
April 2018 OMA Reports to Council 25 together with the OMA we host an Ambassador Program which funds 6 students to attend OMA General Council in both the spring and fall to gain exposure to medical politics. We have revamped our website and created a bilingualism committee this year to engage our francophone students.
Tuition Freeze Advocacy At the most recent OMA Fall General Council, medical students passed a motion advocating for a freeze on medical student tuition. We have had members interviewed on this topic to start addressing the growing debt that medical students face in the era of rising tuition. We are continuing to address the issue by gathering information and performing an environmental scan of students’ financial challenges.
Overall, the Section on Medical Students has prioritized listening to our constituents’ concerns to most effectively represent their interests and have taken great strides forward on both our advocacy and engagement.
Respectfully submitted,
Andrew Dawson, Chair, Section of Medical Students
Vivian Ng, Co-Chair, Section of Medical Students
April 2018 OMA Reports to Council 26
Section on Occupational and Environmental Medicine
April 2018 Report to Council
Each year the Section on Occupational and Environmental Medicine organizes a “Day in Occupational Medicine”, to present practical information on evaluating, treating and preventing work-related diseases and injuries to primary care physicians, occupational health physicians and allied health professionals. This year’s conference will be held Saturday, April 14, 2018 at the Sheraton Toronto Airport Hotel (801 Dixon Rd). https://www.oma.org/sections/news-events/event-calendar/11th-day-in-occupational- medicine/
The Section is offering 3 student bursaries of up to $350 to support the awardee to attend a conference relevant to occupational and/or environmental medicine with winners to be announced mid-March. https://www.oma.org/wp-content/wp-private.php?filename=OccMedicineBursary.pdf
The Section participates in relevant Consultations in which expertise in Occupational Medicine adds benefit, including the following College of Physicians and Surgeons of Ontario (CPSO) consultations: Ensuring Competence, Scope of Practice, Disasters and Public Health Emergencies, Workplace Safety and Insurance Board (WSIB) Policy of Chronic Mental Stress, Bill 148: Better Jobs Act, Physicians’ Guide to Uninsured Services. We heard a request from the Canadian Mesothelioma Foundation regarding Section support for proposed asbestos ban.
Joint efforts with other organizations have included: Tax reforms joint letter to Mr. Morneau with Occupational Medicine Specialists of Canada (OMSOC), and Section support for revision of Occupational Medicine Core Competencies revisions. Recreational Cannabis remains a topic of significant interest in the Occupational Medicine community.
Areas in which there was no Section consultation but in which we would be interested in future engagement include Relativity Review and Fitness to Drive.
Respectfully submitted,
Dr. Joan Saary Chair, OMA Section on Occupational and Environmental Medicine
April 2018 OMA Reports to Council 27
Section on Palliative Medicine
April 2018 Report to Council
The past year has been a very busy time for the Section. We have been in contact with our Section for many short and long term processes that will impact Palliative Care in Ontario.
We have prepared submissions for the Negotiations Committee (NC) as well as our input on Negotiations with respect to Relativity related issues. We will continue to do our best to support the NC on the negotiations with the Ministry of Health and Long-Term Care (MOHLTC).
The delivery of Palliative Care and Palliative Medicine in the province of Ontario is now under review and major short and long term plans are being developed by the MOHLTC with very active input from the Ontario Palliative Care Network (OPCN). This has been very challenging for the Section as we wish to have the active involvement of the Section on Palliative Care but more importantly the OMA and all of the relevant Sections within the OMA, especially the Section on General and Family Practice (SGFP). There is minimal financial support from the MOHLTC and OPCN for this review, so the Section has agreed to supply some support to this initiative, but we have been mostly dependent upon volunteer donation of time and on other occasions, direct financial support of Section Members for submissions to OPCN, and indirectly to the MOHLTC. Models of care and physician remuneration are key issues in the delivery of palliative care in Ontario and we currently are making some progress, although guarded, in these crucial areas.
The OMA and Palliative Section continue to participate actively in an ad hoc working group to address the Ministry's decision to delist high potency opioids announced in August 2016. Changes are near completion for the Palliative Care Facilitated Access (PCFA) Program to allow high dose opioids to be covered while refining the criteria for members eligible to receive PCFA status. Nurse Practitioners have implemented their own PCFA criteria and now are eligible to utilize the PCFA as well.
Community Palliative On-Call (CPOC) Group Leads have been contacted by Ministry officials to insure that groups still meet eligibility criteria and reporting requirements. Members continue to support expansion of this program.
The Section will hold its Annual General Meeting on Sunday, April 23rd in Richmond Hill as part of the Hospice Palliative Care Ontario (HPCO) annual conference.
Respectfully submitted,
William Splinter, MD Chair, Section on Palliative Medicine
April 2018 OMA Reports to Council 28
Section on Sport and Exercise Medicine
April 2018 Report to Council
2017 was a busy year for the Section on Sport & Exercise Medicine. We completed a number of projects that our Executive have been working on for a couple of years. In addition we continued to plan and provide an excellent Continuing Medical Education (CME) event in our annual OMA Sport Med conference January 26-27, 2018 in Toronto.
Our Section now has a new look. We have approved a new logo, seen here at the top of the page. This logo represents the combination of a skilled and professional organization, with the fluidity of motion and activity that is key to the health of our patients and all Ontarians. As well, we have proceeded with a new look to our Section’s website with a new web developer. The new site fits in our new look with a more user- friendly platform, more information and more active links.
Also, we developed and distributed our first ever version of Commonly Used Billing Codes. This was a strong effort from our Executive to review the most commonly used codes, and to evaluate them in respect to capitation and focused practice rules. The final product looks excellent and has already become a valuable resource for our Section members. The plan is to re-evaluate every 2 years.
At our Annual General Meeting in January, we discussed proposed changes to our Section’s Rules & Regulations. Two changes were proposed, namely 1) formally changing the title to the Section on Sport & Exercise Medicine, and 2) changing the title of the Executive position from Program Chair to Vice Chair to be in keeping with other Sections within the OMA.
Our Section maintains a voice in various sports and safety advisory committees, including the Canadian Concussion Collaborative and the OMA Kids Run Club. Going forward, we look forward to our continued involvement with these projects and
April 2018 OMA Reports to Council 29 initiatives. As well, we are working on an in depth survey of our members to gain more valuable data and statistics for use in negotiations and relativity discussions.
If you require any further information or clarification on any of the projects or Section involvement, please feel free to contact myself or other members of our Section Executive.
Respectfully submitted,
Dr. Jack Ceaser Chair, Section on Sport and Exercise Medicine
April 2018 OMA Reports to Council 30
Section on Rheumatology
April 2018 Report to Council
The OMA Section on Rheumatology has approximately 180 primary members. Throughout another busy year in 2017, we remained actively engaged in OMA affairs. We faced another year without a negotiated contract with the Ontario government, and the passage of several pieces of legislation with potentially negative impacts on physicians and patients. Our Section supported the agreement on binding interest arbitration. We were pleased by the appointment of a new OMA Negotiations Committee and Negotiations Adviser, and the resumption of formal negotiations. We made formal presentations to the Negotiations Committee regarding our priorities, and to the Relativity Review Committee. As Section Chair, I have participated in monthly confidential teleconferences providing updates on the progress of negotiations.
We have been represented, either by myself, our Section Vice-chair, Dr. Nikhil Chopra, or our Section Secretary, Dr. Julie Kovacs, at all regular and special meetings of OMA Council, at all Medical Assembly meetings and teleconferences, and at all meetings and teleconferences related to OMA negotiations and OMA governance.
I continue to serve as an OMA representative on a Ministry of Health and Long-Term Care (MOHLTC) task force (Special Authorization Digital Information Exchange (SADIE) project) working on modernizing the Ontario Public Drug Program’s (OPDP) Exceptional Access Program (EAP) for specialty drug access. I have been joined this year on this committee by Ontario Rheumatology Association (ORA) representatives Dr. Jane Purvis and Dr. Chris McKibbon.
Our sister organization, the ORA, continues to advocate for better access to rheumatologic care and newer pharmacologic therapies. The board and executive of the ORA include the leadership of the OMA Section on Rheumatology, ensuring alignment between the goals of the ORA and our OMA Section. As well, members of our Section meet regularly with MOHLTC staff in the OPDP branch to deal with access to drugs under the Limited Use and EAPs. Significant progress has been made on reducing turnaround times. Work continues to improve access to drug therapies for uveitis, gout, osteoporosis and pediatric rheumatic diseases. Our participation was instrumental in developing a mechanism for Temporary Facilitated Access to rheumatology EAP drugs, such as biologics, during the transition to OHIP+ for Ontario patients aged 24 and under.
Members of the Section on Rheumatology participated in the OMA Single Election process. With the OMA term limits in force, 2017 was my last year as Section Chair and Delegate to Council. Our new Section Executive for 2018-19 was acclaimed. Dr. Kovacs will succeed me as Section Chair and Delegate to Council. Dr. Chopra remains Vice- chair, and we welcome back Dr. Jane Purvis to our Executive as Section Secretary. I will remain engaged as Past-Chair of the Section. Section members wishing to become more involved in the OMA are encouraged to contact me or any member of our Section Executive.
April 2018 OMA Reports to Council 31
Respectfully submitted,
Philip A. Baer, MDCM FRCPC FACR Chair, OMA Section on Rheumatology
April 2018 OMA Reports to Council 32
OMA Forum Reports
Academic Medicine Forum
April 2018 Report to Council
The objective of the Academic Medicine Forum (AMF) is to enhance the engagement of academic physicians belonging to the OMA. The AMF was created in May 2013 as part of the last OMA governance review and will be evaluated in 2018.
AMF Executive
The AMF Executive includes representatives from distributive models of teaching as well as those teaching in an Academic Health Sciences Centre (AHSC). The Executive includes representatives from each of the 6 medical schools. In 2017, the AMF Executive met twice in person and numerous times via teleconference.
AMF Members Meeting
The AMF Annual General Meeting (AGM) and members’ meeting was held in conjunction with the Spring 2017 OMA Council meeting. The AMF members meeting included a presentation by Dr. Chris Simpson and Danielle Claus titled: The Kingston Experience: A snapshot of SEAMO1 and a view from the front lines. The presentation focused on the pros and cons of a fully converted Alternative Funding Plan (AFP).
Current AMF Activities
• Collaboration with the Council of Ontario Faculties of Medicine (COFM) (representing the Ontario Deans of Medicine) and the AFP Chairs Group to provide a comprehensive submission to OMA and the Ministry of Health and Long-Term Care Negotiations Teams with respect to funding of Academic Physicians. • Collaboration with the Ontario Medical Student Association (OMSA) and the Professional Association of Residents of Ontario (PARO) with respect to the value that the AMF can offer medical students and residents. Changes to ensure medical students have improved matching to residency positions, advocating against cuts to residency positions and reducing the numbers of unmatched students is a very important issue concerning our student members of the OMA. Lack of job opportunities for graduating family physicians and specialists to work in Ontario is of huge concern to our resident physicians. • Recruitment of AMF Members in order to strengthen representation of Academic Physicians within the OMA. At the time of this report there are now over 3,250 AMF members. This has been the result of an ongoing recruitment drive to engage academic physicians in the OMA’s work. • Elections of the AMF Executive took place in late 2017 and the AMF Chair and mini-Executive will be elected in spring 2018.
1 Southeastern Ontario Academic Medical Organization
April 2018 OMA Reports to Council 33
• The AMF Terms of Reference have been amended to allow for student & resident Affiliate members. The AMF continues to build strong linkages with resident and medical student members. • There will be a continued strengthening and collaboration with representative academic groups such as the Ontario Deans of Medicine through COFM, Residents and Medical Students of Ontario through their respective Sections within the OMA and AFP groups through the AFP Chairs Committee. • Dr. Dan Reilly has been appointed as the AMF Executive member to sit on the OMA Rural Expert Panel.
Respectfully submitted,
Dr. Robert Swenson Chair, OMA Academic Medicine Forum
April 2018 OMA Reports to Council 34
Rural Medicine Forum
April 2018 Report to Council
The Rural Expert Panel, in its leadership function of the Rural Medicine Forum, continues its work toward ensuring the interests, talents and voices of rural physicians across the province are represented and appreciated by an ever-expanding number of colleagues, policy makers and organizations.
The OMA Negotiations Committee and Health Policy department were given input from the Rural Caucus and Rural Medicine Forum members. Members identified key priorities to be brought forward, not the least of which was the need for support of rural physicians in the acquisition and maintenance of broad skills and knowledge through Continuing Medical Education (CME) initiatives. Modernization of compensation and incentives for rural physician practice were also explicitly noted as being of high importance to members. The Rural Caucus examined and provided input on developing and/or monitoring quality measurement in rural communities. They spoke of the importance of rural physicians playing a leadership role along the entire spectrum of developing, promoting, implementing and monitoring quality and access metrics.
Representatives of the Rural Expert Panel met with the College of Physicians and Surgeons of Ontario (CPSO) to discuss the College’s proposed guideline relating to MD provision of Emergency Room (ER) services. We asked the CPSO to be mindful of the risk of unintended consequences for rural patients and physicians whenever they enact any policy or adopt a guideline. Urban-centric policies and guidelines, while well intentioned, do not always suit the realities and needs of rural care, in the ER or elsewhere.
In 2017, members of the Expert Panel were active in other realms: presenting at the Northern Ontario School of Medicine’s (NOSM) Northern Constellations, the Society of Rural Physicians of Canada (SRPC) Conference, and the Rural Ontario Medical Program’s (ROMP) annual resident gathering. The Panel was also represented at the Rural Ontario Municipal Association (ROMA) convention last year. Each of these meetings is an opportunity to raise the profile of rural medicine in Ontario, with learners, colleagues and the public.
For the upcoming year, we have set our sights on promoting rural generalism, within the OMA and without. The Panel had a meeting with SRPC President, Dr. M. Tromp; there was bilateral interest in exploring collaboration with this national organization to benefit rural physicians in Ontario and across the country. A non-exhaustive list of other Panel work planned to raise the profile of specialist and family medicine generalism includes:
1) encouraging members to visit the Rural Exchange on the web, promoting collegial conversation and serving to get a “finger on the pulse” of rural doctors 2) asking Rural members at Rural Caucus (April 27, 2018) how they feel the OMA can help restore the “luster” of Generalism and bringing these ideas to Health Policy at OMA to inform future policy 3) discussing the current Rural Expert Panel mandate at Caucus 2018 to ensure it reflects the contemporary wishes and needs of members
April 2018 OMA Reports to Council 35
4) attending conferences and retreats, including hosting a brown bag lunch at SRPC Rural & Remote (R&R) Medicine Course and Northern Constellations in April 2018, to create even more linkages between rural physicians
Respectfully submitted,
Lisa Habermehl, MD CCFP FCFP Chair, Rural Expert Panel
April 2018 OMA Reports to Council 36
OMA Medical Interest Group (MIG) Reports
Medical Interest Group (MIG) of Clinic Endoscopists
Report to Council 2018
There continue to be ongoing challenges to physicians practicing in out-of-hospital premises (OHPs). Approximately one third of colonoscopies performed in Ontario takes place in OHPs. This not only represents a significant proportion of provincial capacity but also is felt to be required capacity by the Ministry of Health and Long-Term Care. Despite this, clinics continue to struggle to remain viable without a funding model and due to this lack of funding operate under the cloud of an uncertain future.
We are unsure as to what the future impact of the new changes in legislation to merge OHPs into Community Health Facilities (CHF) will be and would hope that this could lead to a sustainable funding model at some point. In the interim, however, the threat of either general or relativity based fee reductions to endoscopy present a real and immediate risk to sustainability and could lead to the closure of many clinics which in turn could have significant effects on capacity and ultimately patient care.
Our group has been actively involved with our negotiations team to express these concerns and provide any required context as issues arise. We plan to continue to work with the OMA negotiations team, to advocate for our members’ concerns, and to advocate for the provision of high quality endoscopy in an out of hospital setting during negotiations and beyond.
Respectfully submitted,
Dr. Andrew Bellini Chair, MIG of Clinic Endoscopists
April 2018 OMA Reports to Council 37
Medical Interest Group (MIG) on Clinical Hypnosis
April 2018 Report to Council
Executive Members: Dr. Mussarrat Qaadri, Chair Dr. Shafiq Qaadri, Vice Chair Dr. M. Dales, Secretary
Dear Council Members,
The Executive of the Clinical Hypnosis Medical Interest Group (MIG) were active meeting and communicating with members about our mandate and events.
There were two Executive meetings this calendar year, on March 29, 2017, and May 4, 2017 and the well-attended Annual General Meeting (AGM) on May 4, 2017, with Dr. Panjawani of Toronto making a clinical presentation, which was well received and informative. He also agreed to join the Clinical Hypnosis MIG.
Our Chair, Dr. Mussarrat Qaadri, in addition to our Executive meetings, attended the Annual OMA Spring Council (May 5-7, 2017) and several other clinical group meetings where she publicized our Clinical Hypnosis MIG and requested members to join. Dr. Mussarrat Qaadri also attended the Advanced Clinical Hypnosis Meeting of the Canadian Society of Clinical Hypnosis of Ontario on September 15, 2017 and informed more members about the OMA Clinical Hypnosis MIG and requested physicians to join the MIG. Four physicians agreed to join including the President of the Canadian Society of Clinical Hypnosis. Dr. Qaadri also represented the MIG as MIG Chair on OMA teleconferences on December 3, 2017 and January 14, 2018.
Dr. Michael Dales kept records of the meeting he attended, and communicated with members on the MIG’s behalf, urging their active participation as in his previous report to you. He also helped with the Executive nominations for the coming year.
His article, submitted sometime ago to the Ontario Medical Review (OMR) titled "Hypnosis and the Hope" has as yet to be published by the journal. We would like to emphasize and inform all OMA members that clinical hypnosis is a great therapeutic tool and would like them to join and participate in the MIG.
Respectfully submitted,
Dr. Michael Dales Secretary, MIG on Clinical Hypnosis
Dr. Mussarrat Qaadri Chair, MIG on Clinical Hypnosis
April 2018 OMA Reports to Council 38
Disclaimer
The Ontario Medical Association (OMA) administers the distribution of Reports to Council for its various Constituency Groups (“Constituency Reports”). The statements, views, opinions, and positions contained in the Constituency Reports are solely those of the Constituency Group who authored the Constituency Report. Such statement, views, opinion, and positions expressed in this communication may not reflect the views, policies, and opinions of the OMA. The OMA does not warrant the accuracy, timeliness, or completeness of the information contained in Constituency Reports, nor does it accept any responsibility for its contents.
April 2018 OMA Reports to Council 39