November Messenger 2018

Melissa Campbell CPSA, Messenger


Five reasons your permit renewal could be delayed, ultimately ruining everything

…a humorous, but often true story of our colleagues who forget to renew

Save yourself some frustration and late fees in 2019 by completing your Annual Renewal early. Take some time today to check it off your seasonal to-do list. In the meantime, here are just a few of the reasons you could be thrown off the honourable path to Annual Renewal.

  1. You’ve delayed your Annual Renewal, then on Dec. 31, you remember to quickly submit your Renewal Information Form (RIF) and make payments. You try to finish your forms and submit payment in time but it’s only T minus 5 minutes to midnight! You’re stressing about late fees, the CPSA offices are closed, there’s no one around to give you a helping hand and New Year’s Eve is officially ruined.
  2. You remembered to complete your own Annual Renewal. BUT, you’re also the designated shareholder of a Professional Corporation (PC) and didn’t submit a separate form or pay for your PC renewal. The other shareholders are mad at you and stop inviting you to their bi-weekly speed-knitting contest.
  3. Our reminder emails went to your junk mail. Ouch, that hurts… we thought we were friends? How else can we remind you to renew and keep you up to date with the many changes in our profession? Ahem… here’s a not-so-subtle reminder to make sure info@cpsa.ab.ca is on your allowed senders list.
  4. You changed your contact information, but forgot to tell the people who email you (probably the most). Also ouch! For us to give you the latest information and remind you to renew, we need your current email address. Update it in the Physician Portal, or send us a note at memberinquiries@cpsa.ab.ca
  5. You thought you entered our draw to win back your 2019 Renewal fee by signing up for Pre-Authorized Payment (PAP) (by 4:15 p.m. tomorrow!), but you didn’t. This reason is just shameless self-promotion of our contest. But signing up for PAP saves you a step every year and this year, you could win back your renewal fee if you sign up by Nov. 9!

In all seriousness, Annual Renewal for members and PCs is a big deal. It’s important to complete yours before the new year, not only to save yourself frustration and late fees, but also so we can update your public profile to help patients know where to find you, what kind of medical services you offer and whether or not you’re taking new patients. Plus, if you allow your permit to be cancelled, you might have to re-apply for registration before you can continue to see patients and bill Alberta Health for services.

Take some time at the end of your day today, log in to the portal and complete your renewal.

Questions? Email memberinquiries@cpsa.ab.ca.


Five new questions in your 2019 RIF

For the second year in a row, you will see an “Education Outreach” section in your Renewal Information Form (RIF), designed solely for your own learning and quality improvement purposes.

For the 2019 RIF, we selected five new multiple choice questions (MCQs) based on their importance, timeliness and relevance to physician practice in Alberta. Topics include:

  • Cannabis for Medical Purposes
  • Referral Consultation
  • Continuity of Care
  • Patient Record Retention
  • Role of the College’s Continuing Competence department

Education is our priority

Your responses are strictly confidential and we will only use them in aggregate form, to direct future educational and quality improvement initiatives for physicians. Whether your answer choice is correct or incorrect, it will not be used it in any evaluative way. A link after each question can also lead you to more information on each topic.

We hope this section is informative and motivates you to continue learning and providing quality patient care.

Questions? Email CC.inquiries@cpsa.ab.ca.


Physician feedback improves MD Snapshot-Practice Checkup report

Your new 2018 report is coming mid-November

Based on feedback from nearly 1,200 physicians via focus groups, conversations and surveys, we made significant changes to the MD Snapshot-Practice Checkup report to make it more meaningful and useful for you.

What we heard…

Changes we made based on your feedback…

Refine the language, clarify concepts and terminology, and make the report shorter.

We made the report more succinct, clear and shorter in length. Here’s how: we rewrote the report and included a glossary of key terms, we removed tables and we made the text more straightforward and concise.

Make the report more specific to my practice.

We included Opportunities for self-reflection that are applicable to all active physicians.

Provide more information on potential risk and protective factors to my performance.

We added three new factors in the 2018 report: prescribing, country of medical school training and discipline (FM/GP vs. other specialties).

We added improved support materials in the 2018 report. We did this after conducting an extensive, updated literature review, analyzing all available evidence relating to the report’s factors. We also triangulated this evidence with the College’s own registration, complaints and prescribing databases, as well as evidence from years of research at the Collège des médecins du Québec.

How can I obtain Continuing Medical Education (CME) credits for reviewing the report?

We rephrased and highlighted how to obtain CME credits in the 2018 report.

I want to access the report online.

We are testing both hard copy mailed reports and online reports sent via the College’s physician portal. We recognize some physicians may prefer one medium to the other.

After you receive your 2018 report, we look forward to your continued feedback. This will help us make further changes as necessary.

About your annual MD Snapshot-Practice Checkup
MD Snapshot-Practice Checkup
is a quality improvement initiative, designed to support you in medical practice. Each year, you will receive a customized and confidential report, based on your responses to the annual Renewal Information Form (RIF). You can use your report to self-reflect on possible practice changes, develop a personalized learning plan, mitigate potential risk factors and leverage potential support factors. Any learning activities you take based on the report are eligible for CME credits, through MainPro+ and MOC programs.

Questions? Contact the Continuing Competence department at 780-969-4935 or CC.Inquiries@cpsa.ab.ca


New rules for MAID reporting now in effect

AHS Care Coordination Service will receive all reports

On Nov. 1, 2018, the Government of Canada’s new Monitoring of Medical Assistance in Dying (MAID) Regulations came into effect. The regulations apply only to MAID requests received on or after this date. Requests in progress before Nov. 1 are not subject to the new rules.

Physicians and Nurse Practitioners must now file reports at each step in the MAID process, including when they receive a request for MAID. Pharmacists who dispense any substance for MAID are also required to report basic information.

To streamline reporting:

  • all practitioners will report through the AHS Care Coordination Service
  • forms already in use are being updated to incorporate the federal requirements

The AHS Care Coordination Service will manage data collection on behalf of the MAID Regulatory Review Committee, for reporting to Alberta’s Minister of Health and Health Canada as applicable. As well as making the process easier for practitioners, this will provide a safeguard against non-compliance with the regulations, enacted under the Criminal Code of Canada.

Practitioners who provide MAID are also required to submit specific information to the Office of the Chief Medical Examiner within 24 hours of the patient’s death.

To access the forms, go to the AHS website and click on the Forms tab. A summary detailing what to report and when is also posted there. A secure RightFax has been set up to submit completed forms to the AHS Care Coordination Service.

For more information on the MAID process in Alberta, log in to the CPSA Physician Portal and look under Additional Resources.

Questions about MAID reporting? Email maidreporting@ahs.ca.


Two Alberta physicians sanctioned by College Hearing Tribunals

Court upholds finding of unprofessional conduct for Cochrane physician

General practitioner Dr. Habeeb Ali from Cochrane was found guilty of unprofessional conduct and sanctioned by a College Hearing Tribunal.

The Hearing Tribunal originally made a decision in this case in 2014, with sanctions handed down in 2015. Dr. Ali subsequently appealed the decision to both College Council in 2016, and the Alberta Court of Appeal in December 2017. Both appeals were unsuccessful and the decision was upheld.

Background

In 2009, Dr. Ali entered into a five-year Continuing Care Agreement with the College in response to a matter involving a sexual boundary violation. He was not compliant with all of the terms of this agreement, by failing to pay required fees in a timely manner and by not making himself available for meetings with the College when requested.

Additionally, Dr. Ali did not meet his obligations as a bankrupt person by failing to submit income and tax documentation to his bankruptcy trustee. This constitutes a breach of the Bankruptcy and Insolvency Act, which is considered unprofessional conduct under the Health Professions Act.

Order of the Hearing Tribunal

The Hearing Tribunal ordered that Dr. Ali receive a reprimand and be responsible for paying $39,000 towards the initial investigation and hearing (approximately two-thirds of the total cost), $26,750.28 for the cost of the appeal to College Council and $4,490.76 for the cost of the appeal to the Alberta courts (totaling $70,241.04).

Commentary

In making this decision, the Hearing Tribunal recognized that Dr. Ali’s behaviour did not compromise patient care. However, physicians are expected to maintain a certain level of professionalism, which includes meeting their responsibilities in matters of financial hardships and agreements with the College.

Failing to cooperate with the College regarding a Continuing Care Agreement and not paying College fees within an appropriate timeframe demonstrates a lack of priority to the College, which is not acceptable. The Hearing Tribunal felt the sanctions they ordered served as a reminder of the importance of professional responsibility for a physician.

 

Edmonton physician guilty of unprofessional content

In a joint submission by Dr. Daniel McKennitt and the College’s Complaints Director, Dr. McKennitt admitted to six counts of unprofessional conduct before a College Hearing Tribunal.

Background

Dr. McKennitt, a family physician from Edmonton, acknowledged that between 2015 and 2016, he:

  • violated the terms of his Continuing Care Agreement with the College by prescribing himself a controlled substance, prescribing while not permitted to see patients outside of his training program and prescribing to someone with whom he was in a personal relationship;
  • deceived the College during the course of a complaints investigation by providing false information;
  • used another physician’s prescription pad without authorization and then deceived the Edmonton Police Service during their investigation of a forged prescription; and
  • engaged in an inappropriate relationship with a patient.

Order of the Hearing Tribunal

Following Dr. McKennitt’s admission of unprofessional conduct, his counsel and legal counsel for the College’s Complaints Director submitted a joint recommendation for the following sanctions:

  1. A 24-month suspension of his practice permit, with credit for the time Dr. McKennitt has already spent out of practice (his permit was suspended in July 2016).
  2. Once reinstated, Dr. McKennitt’s practice permit will have the following conditions:
    • No prescribing of any drugs monitored by the Triplicate Prescription Program.
    • Practice only in a group setting approved by the College.
    • The other physicians and nurses in the group practice must be informed of this Hearing Tribunal decision.
    • All patients must be seen with a chaperone present (or a parent or guardian, in the case of a minor).
    • Participation in and full cooperation with the College’s Physician Health Monitoring Program until discharge from the program is approved by the College.
  3. Dr. McKennitt is responsible for the costs of the investigation and hearing ($25,131.24), to be paid over a period of 36 months.

Commentary

These sanctions are comparable with those handed down in similar complaints and address both the need for deterrence against such behaviour and the desire for rehabilitation whenever possible. In making their decision, the Hearing Tribunal considered the seriousness of the charges as well as Dr. McKennitt’s admission of his conduct and subsequent cooperation with the disciplinary process.

Dr. McKennitt has expressed remorse for his actions and while he has no immediate plans to return to practice, he has completed a boundary course from Western University in Ontario and a program through the regulatory body in British Columbia. If Dr. McKennitt does return to practice, the conditions on his permit put the College in a position to protect the public by closely monitoring his practice, proactively addressing any potential issues and intervening if needed.


Transgender Health Training Conference Coming to Edmonton in 2019

By Dr. Michael Marshall

Since February, I’ve served as the inaugural program lead for the newly-established Gender Program, in the Department of Psychiatry at the University of Alberta.

Launched in partnership with the University of Alberta and Alberta Health Services, it is a new program, aimed at serving the needs of Alberta’s gender diverse and trans-identified population.

While other health professionals will treat transgender individuals for day-to-day health care, currently I am one of just two psychiatrists in greater Edmonton (and one of only a few in all of Alberta) who specializes in serving the needs of transgender individuals. As such, there is a need to build more system capacity to address the health needs of the transgender population and to increase the knowledge base amongst care providers.

To this end, I’m excited to announce that the Gender Program and the World Professional Association for Transgender Health (WPATH) will soon host WPATH’s first-ever conference in Alberta, focused on providing training for clinicians interested in providing competent and informed care to transgender individuals.

The conference, scheduled for Feb. 1-3, 2019, will take place at Bernard Snell Hall, in the Clinical Sciences Building adjacent to University of Alberta Hospital.

Guest speakers include world leaders in transgender health care, with surgeons, therapists, psychiatrists and other clinicians.

WPATH, a non-profit, interdisciplinary, professional and educational organization devoted to transgender health, has developed a core curriculum for training clinicians in competent, compassionate and culturally-sensitive transgender care.

Known as the Global Education Initiative (GEI), the curriculum is built around a series of courses, which will be integrated within the conference agenda. These include:

  • Foundations in Transgender Health: A two-day training course that addresses what all clinicians should know about gender development, healthcare and related issues.
  • Advanced Medical Treatment: A full-day training session focused on advanced hormonal treatment and complications, co-occurring conditions, ongoing primary care and aging.
  • Advanced Mental Health: A full-day session that dives into advanced psychotherapy topics, mental health morbidity and how to navigate issues like countertransference, re-identification and trauma.
  • Workshops: Specialized, four-to-eight-hour interactive and case-based sessions that focus on specific areas of interest for those who have completed the Foundations in Transgender Health course.

In addition, the WPATH Certification Program is an optional benefit offered to association members.

By bringing the WPATH GEI program to Alberta, we hope to provide more high-quality, transgender-focused training to clinicians so there will be more of us on the ground in Alberta, reducing wait times and increasing access to care.

We won’t overcome these challenges overnight. But we have begun the journey toward making Alberta a more welcoming and supportive home for transgender people. Please consider joining us. 

Registration opens soon at www.wpath.org/gei.


Congratulations are in order!

Two Alberta physicians are recognized

First, congratulations to Dr. Michael Allan of Edmonton, who has been honoured by the College of Family Physicians of Canada (CFPC) with a Reg L. Perkin Award as one of 2018’s Family Physicians of the Year. Each year, 10 physicians (one from each province) are nominated by their colleagues and CFPC’s Chapters for their leadership, commitment to family medicine and contributions to patient care. Find out more about Dr. Allan’s award and other CFPC awards here.

We also extend our congratulations to Dr. Sayeh Zielke, a cardiologist from Lethbridge, who has been recognized by Lethbridge Member of Parliament Rachael Harder with a Community Builders Award, for the positive impact she’s had on her community.


The future of medical cannabis

By Lorian Hardcastle, JD, LLM, SJD, Assistant Professor, Faculty of Law and Cumming School of Medicine, University of Calgary

Canadians seeking to consume cannabis for medical purposes must obtain a medical document from a health professional. They may then purchase cannabis from a licensed producer, register with Health Canada to produce their own supply, or designate someone to produce it for them. According to Health Canada, in June 2018 alone Canadians purchased 6,227 kilograms of cannabis, producers made 135,062 shipments and health professionals provided 3,836 medical documents. In light of the legalization of recreational cannabis, policy-makers and professional bodies are now asking whether we need two sets of cannabis regulations.

Are regulations on medical cannabis necessary?

The Canadian Medical Association (CMA) recommended phasing out the medical cannabis regulations, noting a “lack of clinical research, guidance and regulatory oversight for cannabis as a potential medical intervention.” They argue that many physicians are uncomfortable “prescribing a substance that hasn’t undergone the same regulatory review processes required for all other prescription medicines,” which generate information for prescribers on clinical indications, dosages, and medication interactions. There is support for the CMA’s argument about the limited evidence respecting medical cannabis—for example, a recent guideline published in Canadian Family Physician recommended limiting medical cannabis, apart from a small subset of conditions.

Protecting patients by providing appropriate care

In response to the CMA, one could argue that a lack of high-quality evidence demands additional research and a more significant role for health professionals (rather than limiting their involvement) to ensure that patients are properly informed. In this regard, the CPSA advises that physician responsibilities include, “providing objective, evidence-based information to patients seeking medical cannabis to support informed decision-making.” If patients self-prescribe cannabis for medical conditions and purchase it from recreational retail outlets, they will not receive potentially important information about its efficacy for their conditions, alternative treatments or medication interactions.

Medical cannabis users and advocacy groups argue in favour of retaining a separate regulatory scheme. Some fear that producers will focus on more economically viable recreational products over existing medical products that users depend upon. Others argue that patients may feel stigmatized and avoid talking to health professionals if cannabis is perceived as a recreational rather than medical product.  Although an increasing number of insurers cover medical cannabis for certain conditions, progress could halt with the abolition of the medical cannabis regulations.

Creating a single recreational cannabis regime also raises human rights concerns. Provincial laws protect those who use cannabis for medical purposes from discrimination in the context of employment, housing and other areas. If existing regulations are abolished and doctors no longer provide medical documents, these users may have difficulty establishing their claims for accommodation.

Health Canada plans to review the ongoing need for separate medical and recreational regulations within five years. In the meantime, policymakers have taken steps to improve the evidentiary basis for medical cannabis, including earmarking funds for cannabis research and creating a special category of licence to facilitate cannabis research. These steps, along with ongoing consultation with the relevant stakeholders, will enable Health Canada to make a more informed decision about whether to keep the medical regulations.