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Notes for an address by Dr. Peter Barrett, Past-President, Canadian Medical Association : Public hearings on primary care reform : Presentation to the Standing Senate Committee on Social Affairs, Science and Technology

https://policybase.cma.ca/en/permalink/policy2011
Last Reviewed
2020-02-29
Date
2002-05-22
Topics
Health systems, system funding and performance
Health human resources
  1 document  
Policy Type
Parliamentary submission
Last Reviewed
2020-02-29
Date
2002-05-22
Topics
Health systems, system funding and performance
Health human resources
Text
On behalf of the 53,000 physician members of the CMA, we appreciate the opportunity to offer our thoughts on the issue of primary care reform and the recommendations made recently in your April 2002 report. I am very pleased to be presenting today with my CMA colleague, Dr. Susan Hutchison, Chair of our GP Forum along with Dr. Elliot Halparin and Dr. Kenneth Sky from the Ontario Medical Association. Before I begin presenting the CMA’s recommendations, I believe it’s important to make a few points clear in regard to primary care: * First, is that Canada has one of the best primary care systems in the world. (Just ask Canadians, we have. Our 2001 Report Card showed that 60% of Canadians believe that we have one of the best health care systems in the world and gave high marks for both quality of service and system access). * Second, is that primary care reform is not the panacea for all that ails Medicare. * And finally, primary care and specialty care are inextricably linked. I like to expand a bit on the last point because I think it’s an important consideration. There is a tendency to separate medical care into two areas; primary care and specialty care. However, we need to recognize that medical and health care encompasses a broad spectrum of services ranging from primary prevention to highly specialized quaternary care. Primary care and specialty care are so critically interdependent that we need to adapt an integrated approach to patient care. Now, in respect to the CMA’s recommendations on implementing changes for the delivery of primary care, we believe that government must respect the following four policy premises: 1. All Canadians should have access to a family physician. 2. To ensure comprehensive and integrated care, family physicians should remain as the central provider and coordinator of timely access to publicly-funded medical services. 3. There is no single model that will meet the primary care needs of all communities in all regions of the country. 4. Scopes of practice should be determined in a manner that serves the interests of patients and the public safely, efficiently, and competently. Access to Family Physicians A successful renewal of primary health care delivery cannot be accomplished without addressing the shortage of family physicians and general practitioners. The effects of an aging practitioners population, changes in lifestyle and productivity, along with the declining popularity of this field as the career choice of medical school graduates are all having an impact on the supply of family physician. Physician as Central Coordinator While multistakeholder teams offer the potential for providing a broader array of services to meet patients’ health care needs, it is also clear that for most Canadians, having a family doctor as the central provider for all primary medical care services is a core value. As the College of Family Physicians of Canada (CFPC) indicated in its submission to the Royal Commission on the Future of Health Care in Canada, research shows that over 90% of Canadians seek advice from a family physician as their first resource in the health care system. The CFPC also noted that a recent Ontario College of Family Physicians Decima public opinion survey found that 94% agree that it is important to have a family physician who provides the majority of care and co-ordinates the care delivered by others. i A family physician as the central coordinator of medical services ensures efficient and effective use of system resources as it allows for only one entry point into the health care system. This facilitates a continuity of care, as the family physician generally has developed an ongoing relationship with his or her patients and as a result is able to direct the patient through the system such that the patient receives the appropriate care from the appropriate provider. No Single Model for Reform In recent years, several government task force and commission reports, including the report of this Committee, have called for primary care reform. Common themes that have emerged include; 24/7 coverage; alternatives to fee-for-service payment of physicians; nurse practitioners and health promotion and disease prevention. Governments across the country have launched pilot projects of various models of primary care delivery. It is critical that these projects are evaluated before they are adopted on a grander scale. Moreover, we must take into account the range of geographical settings across the country, from isolated rural communities to the highly urbanized communities with advanced medical science centres. Scopes of Practice There is a prevailing myth that physicians are a barrier to change when in fact the progressive changes in the health care system have been more often than not physician lead. Canadian physicians are willing to work in teams and the CMA has developed a “Scopes of Practice” policy that clearly supports a collaborative and cooperative approach. A policy that has been supported in principle by the Canadian Nurses Association and the Canadian Pharmacists Association. Because of the growing complexity of care, the exponential growth of knowledge, and an increased emphasis on health promotion and disease prevention, primary care delivery will increasingly rely on multi-stakeholder teams. This is a positive development. However, expanding the primary care team to include nurses, pharmacists, dieticians, and others, while desirable, will cost the system more, not less. Therefore, we need to change our way of thinking about primary care reform. We need to think of it as an investment. We need to think of it not in terms of cost savings but as a cost-effective way to meet the emerging unmet needs of Canadians. Conclusion To conclude, there is no question that primary care delivery needs to evolve to ensure it continues to meet the needs of Canadians. But we see this as making a good system better, not fundamental reform. Thank you. i College of Family Physicians of Canada. Shaping The Future of Health Care: Submission to the Commission on the Future of Health Care in Canada. Ottawa: CFPC; Oct 25, 2001.
Documents
Less detail

Principles concerning physician information

https://policybase.cma.ca/en/permalink/policy208
Last Reviewed
2019-03-03
Date
2002-06-02
Topics
Health information and e-health
Ethics and medical professionalism
  1 document  
Policy Type
Policy document
Last Reviewed
2019-03-03
Date
2002-06-02
Topics
Health information and e-health
Ethics and medical professionalism
Text
Principles concerning physician information (CMA policy – approved June 2002) In an environment in which the capacity to capture, link and transmit information is growing and the need for fuller accountability is being created, the demand for physician information, and the number of people and organizations seeking to collect it, is increasing. Physician information, that is, information that includes personal health information about and information that relates or may relate to the professional activity of an identifiable physician or group of physicians, is valuable for a variety of purposes. The legitimacy and importance of these purposes varies a great deal, and therefore the rationale and rules related to the collection, use, access and disclosure of physician information also varies. The Canadian Medical Association (CMA) developed this policy to provide guiding principles to those who collect, use, have access to or disclose physician information. Such people are termed “custodians,” and they should be held publicly accountable. These principles complement and act in concert with the CMA Health Information Privacy Code (1), which holds patient health information sacrosanct. Physicians have legitimate interests in what information about them is collected, on what authority, by whom and for what purposes it is collected, and what safeguards and controls are in place. These interests include privacy and the right to exercise some control over the information; protection from the possibility that information will cause unwarranted harm, either at the individual or the group level; and assurance that interpretation of the information is accurate and unbiased. These legitimate interests extend to information about physicians that has been rendered in non-identifiable or aggregate format (e.g., to protect against the possibility of individual physicians being identified or of physician groups being unjustly stigmatized). Information in these formats, however, may be less sensitive than information from which an individual physician can be readily identified and, therefore, may warrant less protection. The purposes for the use of physician information may be more or less compelling. One compelling use is related to the fact that physicians, as members of a self-regulating profession, are professionally accountable to their patients, their profession and society. Physicians support this professional accountability purpose through the legislated mandate of their regulatory colleges. Physicians also recognize the importance of peer review in the context of professional development and maintenance of competence. The CMA supports the collection, use, access and disclosure of physician information subject to the conditions outlined below. Purpose(s): The purpose(s) for the collection of physician information, and any other purpose(s) for which physician information may be subsequently used, accessed or disclosed, should be precisely specified at or before the collection. There should be a reasonable expectation that the information will achieve the stated purpose(s). The policy does not prevent the use of information for purposes that were not intended and not reasonably anticipated if principles 3 and 4 of this policy are met. Consent: As a rule, information should be collected directly from the physician. Subject to principle 4, consent should be sought from the physician for the collection, use, access or disclosure of physician information. The physician should be informed about all intended and anticipated uses, accesses or disclosures of the information. Conditions for collection, use, access and disclosure: The information should: be limited to the minimum necessary to carry out the stated purpose(s), be in the least intrusive format required for the stated purpose(s), and its collection, use, access and disclosure should not infringe on the physician’s duty of confidentiality with respect to that information. Use of information without consent: There may be justification for the collection, use, access or disclosure of physician information without the physician’s consent if, in addition to the conditions in principle 3 being met, the custodian publicly demonstrates with respect to the purpose(s), generically construed, that: the stated purpose(s) could not be met or would be seriously compromised if consent were required, the stated purpose(s) is(are) of sufficient importance that the public interest outweighs to a substantial degree the physician’s right to privacy and right of consent in a free and democratic society, and that the collection, use, access or disclosure of physician information with respect to the stated purpose(s) always ensures justice and fairness to the physician by being consistent with principle 6 of this policy. Physician’s access to his or her own information: Physicians have a right to view and ensure, in a timely manner, the accuracy of the information collected about them. This principle does not apply if there is reason to believe that the disclosure to the physician will cause substantial adverse effect to others. The onus is on the custodian to justify a denial of access. 6. Information quality and interpretation: Custodians must take reasonable steps to ensure that the information they collect, use, gain access to or disclose is accurate, complete and correct. Custodians must use valid and reliable collection methods and, as appropriate, involve physicians to interpret the information; these physicians must have practice characteristics and credentials similar to those of the physician whose information is being interpreted. 7. Security: Physical and human safeguards must exist to ensure the integrity and reliability of physician information and to protect against unauthorized collection, use, access or disclosure of physician information. 8. Retention and destruction: Physician information should be retained only for the length of time necessary to fulfill the specified purpose(s), after which time it should be destroyed. 9. Inquiries and complaints: Custodians must have in place a process whereby inquiries and complaints can be received, processed and adjudicated in a fair and timely way. The complaint process, including how to initiate a complaint, must be made known to physicians. 10. Openness and transparency: Custodians must have transparent and explicit record-keeping or database management policies, practices and systems that are open to public scrutiny, including the purpose(s) for the collection, use, access and disclosure of physician information. The existence of any physician information record-keeping systems or database systems must be made known and available upon request to physicians. 11. Accountability: Custodians of physician information must ensure that they have proper authority and mandate to collect, use, gain access to or disclose physician information. Custodians must have policies and procedures in place that give effect to the principles in this document. Custodians must have a designated person who is responsible for monitoring practices and ensuring compliance with the policies and procedures. (1) Canadian Medical Association. Health Information Privacy Code. CMAJ 1998;159(8):997-1016.
Documents
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Scopes of practice

https://policybase.cma.ca/en/permalink/policy1237
Last Reviewed
2019-03-03
Date
2002-01-22
Topics
Health human resources
  1 document  
Policy Type
Policy document
Last Reviewed
2019-03-03
Date
2002-01-22
Topics
Health human resources
Text
SCOPES OF PRACTICE Purpose This policy outlines the principles and criteria that are important for physicians to consider when they are involved in the determination of the scopes of practice of physicians and other health care providers, whether regulated or unregulated, in all settings. The primary purposes of scopes of practice determinations are to meet the health care needs and to serve the interests of patients and the public safely, efficiently, and competently. Background There are many factors impacting the scopes of practice of health providers: broadening definition of health, emerging use of alternative therapies, increasing patient consumerism, advances in technology and in treatment and diagnostic modalities, information technology, legislation, changing demographics, increasing health care costs, and the shortage of physicians, nurses and other providers. Scopes of practice must reflect these changes in societal needs (including the need of the public for access to services), societal expectations, and preferences of patients and the public for certain types of health care providers to fulfill particular roles and functions, while at the same time reflecting economic realities. These factors and related issues (e.g., access, availability and cost) are influencing governments and other stakeholders to consider new roles and expanded scopes of practice for health care providers. There is a need to define principles and criteria for understanding and articulating scopes of practice that ensure public safety and appropriate utilization of provider skills. Principles for determining scopes of practice Focus: Scopes of practice statements should promote safe, ethical, high-quality care that responds to the needs of patients and the public in a timely manner, is affordable and is provided by competent health care providers. Flexibility: A flexible approach is required that enables providers to practise to the extent of their education, training, skills, knowledge, experience, competence and judgment while being responsive to the needs of patients and the public. Collaboration and cooperation: In order to support interdisciplinary approaches to patient care and good health outcomes, physicians engage in collaborative and cooperative practice with other health care providers who are qualified and appropriately trained and who use, wherever possible, an evidence-based approach. Good communication is essential to collaboration and cooperation. Coordination: A qualified health care provider should coordinate individual patient care. Patient choice: Scopes of practice should take into account patients' choice of health care provider. Criteria for determining scopes of practice Accountability: Scopes of practice should reflect the degree of accountability, responsibility and authority that the health care provider assumes for the outcome of his or her practice. Education: Scopes of practice should reflect the breadth, depth and relevance of the training and education of the health care provider. This includes consideration of the extent of the accredited or approved educational program(s), certification of the provider and maintenance of competency. Competencies and practice standards: Scopes of practice should reflect the degree of knowledge, values, attitudes and skills (i.e., clinical expertise and judgment, critical thinking, analysis, problem solving, decision making, leadership) of the provider group. Quality assurance and improvement: Scopes of practice should reflect measures of quality assurance and improvement that have been implemented for the protection of patients and the public. Risk assessment: Scopes of practice should take into consideration risk to patients. Evidence-based practices: Scopes of practice should reflect the degree to which the provider group practices are based on valid scientific evidence where available. Setting and culture: Scopes of practice should be sensitive to the place, context and culture in which the practice occurs. Legal liability and insurance: Scopes of practice should reflect case law and the legal liability assumed by the health care provider including mutual professional malpractice protection or liability insurance coverage. Regulation: Scopes of practice should reflect the legislative and regulatory authority, where applicable, of the health care provider. Conclusion Principles and criteria to ensure safe, competent and ethical patient care should guide the development of scopes of practice of health care providers. To this end, the CMA has developed these principles and criteria to assist physicians and medical organizations when they are involved in the determination of scopes of practice. The CMA welcomes opportunities to dialogue with others on how scopes of practice can be improved for the benefit of patients and society in general.
Documents
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Physical activity

https://policybase.cma.ca/en/permalink/policy1881
Last Reviewed
2019-03-03
Date
2004-12-04
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
BD05-03-55
The Canadian Medical Association urges federal/provincial/territorial governments to explore tax incentives as a possible component of a broad comprehensive strategy to increase physical activity.
Policy Type
Policy resolution
Last Reviewed
2019-03-03
Date
2004-12-04
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
BD05-03-55
The Canadian Medical Association urges federal/provincial/territorial governments to explore tax incentives as a possible component of a broad comprehensive strategy to increase physical activity.
Text
The Canadian Medical Association urges federal/provincial/territorial governments to explore tax incentives as a possible component of a broad comprehensive strategy to increase physical activity.
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Canada Health Access Fund

https://policybase.cma.ca/en/permalink/policy1490
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Health systems, system funding and performance
Resolution
GC04-10
The Canadian Medical Association calls on the federal and provincial/territorial governments to establish a Canada Health Access Fund to assure that individual Canadians can obtain portable and timely access to care at the time and to the extent of their needs.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Health systems, system funding and performance
Resolution
GC04-10
The Canadian Medical Association calls on the federal and provincial/territorial governments to establish a Canada Health Access Fund to assure that individual Canadians can obtain portable and timely access to care at the time and to the extent of their needs.
Text
The Canadian Medical Association calls on the federal and provincial/territorial governments to establish a Canada Health Access Fund to assure that individual Canadians can obtain portable and timely access to care at the time and to the extent of their needs.
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Wait time protocols and benchmarks

https://policybase.cma.ca/en/permalink/policy1491
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-11
The Canadian Medical Association will ensure that practising physicians are involved in the development of wait time protocols and benchmarks that are based on the available evidence, that are administratively straightforward and that are satisfactory to the needs of patients and physicians.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-11
The Canadian Medical Association will ensure that practising physicians are involved in the development of wait time protocols and benchmarks that are based on the available evidence, that are administratively straightforward and that are satisfactory to the needs of patients and physicians.
Text
The Canadian Medical Association will ensure that practising physicians are involved in the development of wait time protocols and benchmarks that are based on the available evidence, that are administratively straightforward and that are satisfactory to the needs of patients and physicians.
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Increasing the number of family physicians

https://policybase.cma.ca/en/permalink/policy1494
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-21
The Canadian Medical Association calls on federal, provincial and territorial governments to work together to expand the number of comprehensive family physicians across Canada through the combined approach of training, recruitment and retention initiatives that are incentive based and developed with the input of actively practicing physicians.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-21
The Canadian Medical Association calls on federal, provincial and territorial governments to work together to expand the number of comprehensive family physicians across Canada through the combined approach of training, recruitment and retention initiatives that are incentive based and developed with the input of actively practicing physicians.
Text
The Canadian Medical Association calls on federal, provincial and territorial governments to work together to expand the number of comprehensive family physicians across Canada through the combined approach of training, recruitment and retention initiatives that are incentive based and developed with the input of actively practicing physicians.
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Interest-free postponement of student loan debt during residency

https://policybase.cma.ca/en/permalink/policy1497
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Resolution
GC04-24
The Canadian Medical Association, in conjunction with the Canadian Federation of Medical Students, the Canadian Association of Internes and Residents, the Fédération des étudiants en médecine du Québec and the Fédération des médecins résidents du Québec, advocates the federal government to modify relevant federal law in order to postpone federal student loan debt repayment while maintaining interest-free loan status until the completion of the residency period.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Resolution
GC04-24
The Canadian Medical Association, in conjunction with the Canadian Federation of Medical Students, the Canadian Association of Internes and Residents, the Fédération des étudiants en médecine du Québec and the Fédération des médecins résidents du Québec, advocates the federal government to modify relevant federal law in order to postpone federal student loan debt repayment while maintaining interest-free loan status until the completion of the residency period.
Text
The Canadian Medical Association, in conjunction with the Canadian Federation of Medical Students, the Canadian Association of Internes and Residents, the Fédération des étudiants en médecine du Québec and the Fédération des médecins résidents du Québec, advocates the federal government to modify relevant federal law in order to postpone federal student loan debt repayment while maintaining interest-free loan status until the completion of the residency period.
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Family physicians and hospital affiliation

https://policybase.cma.ca/en/permalink/policy1502
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-36
The Canadian Medical Association calls on the federal, provincial and territorial governments to work together with the Association and its divisions and affiliates to develop initiatives that are incentive based to encourage family physicians to retain hospital affiliation and provide hospital care in supporting the provision of the full continuum of primary care to patients.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-36
The Canadian Medical Association calls on the federal, provincial and territorial governments to work together with the Association and its divisions and affiliates to develop initiatives that are incentive based to encourage family physicians to retain hospital affiliation and provide hospital care in supporting the provision of the full continuum of primary care to patients.
Text
The Canadian Medical Association calls on the federal, provincial and territorial governments to work together with the Association and its divisions and affiliates to develop initiatives that are incentive based to encourage family physicians to retain hospital affiliation and provide hospital care in supporting the provision of the full continuum of primary care to patients.
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Compensation for remote consultation

https://policybase.cma.ca/en/permalink/policy1505
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Health information and e-health
Physician practice/ compensation/ forms
Resolution
GC04-41
The Canadian Medical Association recommends that provincial and territorial authorities recognize that any type of remote consultation such as telemedicine and teleconsultation is a medical act to be duly compensated.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Health information and e-health
Physician practice/ compensation/ forms
Resolution
GC04-41
The Canadian Medical Association recommends that provincial and territorial authorities recognize that any type of remote consultation such as telemedicine and teleconsultation is a medical act to be duly compensated.
Text
The Canadian Medical Association recommends that provincial and territorial authorities recognize that any type of remote consultation such as telemedicine and teleconsultation is a medical act to be duly compensated.
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Physician health and well-being

https://policybase.cma.ca/en/permalink/policy1512
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Physician practice/ compensation/ forms
Resolution
GC04-48
The Canadian Medical Association supports the educational needs of physician leaders with respect to physician health and well-being through the creation of professional development opportunities and programs.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Physician practice/ compensation/ forms
Resolution
GC04-48
The Canadian Medical Association supports the educational needs of physician leaders with respect to physician health and well-being through the creation of professional development opportunities and programs.
Text
The Canadian Medical Association supports the educational needs of physician leaders with respect to physician health and well-being through the creation of professional development opportunities and programs.
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Role of physicians in private delivery of publicly funded medical services

https://policybase.cma.ca/en/permalink/policy1516
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-83
The Canadian Medical Association calls upon federal, provincial and territorial governments to respect the role and the independence of physicians in their private delivery of publicly funded medical services.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-83
The Canadian Medical Association calls upon federal, provincial and territorial governments to respect the role and the independence of physicians in their private delivery of publicly funded medical services.
Text
The Canadian Medical Association calls upon federal, provincial and territorial governments to respect the role and the independence of physicians in their private delivery of publicly funded medical services.
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Compensation ceilings for GP's and access to front-line services

https://policybase.cma.ca/en/permalink/policy1524
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-51
The Canadian Medical Association recommends that compensation ceilings for general practitioners where they exist be removed in order to improve access to front-line services.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC04-51
The Canadian Medical Association recommends that compensation ceilings for general practitioners where they exist be removed in order to improve access to front-line services.
Text
The Canadian Medical Association recommends that compensation ceilings for general practitioners where they exist be removed in order to improve access to front-line services.
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Promotion of physical activity among physicians

https://policybase.cma.ca/en/permalink/policy1525
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Population health/ health equity/ public health
Resolution
GC04-52
The Canadian Medical Association, in keeping with its vision of a healthy population and national advocacy mission, shall vigorously promote physical activity among physicians for the sake of their own wellness, which in turn enhances their ability to care for others and sets an important example in encouraging patients to be physically active.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Population health/ health equity/ public health
Resolution
GC04-52
The Canadian Medical Association, in keeping with its vision of a healthy population and national advocacy mission, shall vigorously promote physical activity among physicians for the sake of their own wellness, which in turn enhances their ability to care for others and sets an important example in encouraging patients to be physically active.
Text
The Canadian Medical Association, in keeping with its vision of a healthy population and national advocacy mission, shall vigorously promote physical activity among physicians for the sake of their own wellness, which in turn enhances their ability to care for others and sets an important example in encouraging patients to be physically active.
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Initiatives to reduce wait times

https://policybase.cma.ca/en/permalink/policy1530
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Resolution
GC04-15
The Canadian Medical Association, consistent with A Prescription for Sustainability, advocates to reduce wait times through the following initiatives: a) development of pan-Canadian wait time benchmarks based on available evidence; b) a network of regional registries and referral programs for specialized care; c) streamlined referral for investigation and specialty consultations; and d) Canadian Health Access Fund designed to support inter-jurisdictional portability of care.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Ethics and medical professionalism
Health human resources
Health systems, system funding and performance
Resolution
GC04-15
The Canadian Medical Association, consistent with A Prescription for Sustainability, advocates to reduce wait times through the following initiatives: a) development of pan-Canadian wait time benchmarks based on available evidence; b) a network of regional registries and referral programs for specialized care; c) streamlined referral for investigation and specialty consultations; and d) Canadian Health Access Fund designed to support inter-jurisdictional portability of care.
Text
The Canadian Medical Association, consistent with A Prescription for Sustainability, advocates to reduce wait times through the following initiatives: a) development of pan-Canadian wait time benchmarks based on available evidence; b) a network of regional registries and referral programs for specialized care; c) streamlined referral for investigation and specialty consultations; and d) Canadian Health Access Fund designed to support inter-jurisdictional portability of care.
Less detail

Professional advisory committee to the Conference of Health Ministers

https://policybase.cma.ca/en/permalink/policy1533
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Health systems, system funding and performance
Resolution
GC04-26
The Canadian Medical Association calls on governments to implement a professional advisory committee to the Conference of Health Ministers comprised of physicians and other front line providers representing national health organizations.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2004-08-18
Topics
Health human resources
Health systems, system funding and performance
Resolution
GC04-26
The Canadian Medical Association calls on governments to implement a professional advisory committee to the Conference of Health Ministers comprised of physicians and other front line providers representing national health organizations.
Text
The Canadian Medical Association calls on governments to implement a professional advisory committee to the Conference of Health Ministers comprised of physicians and other front line providers representing national health organizations.
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Letter to the Honourable Pierre Pettigrew on mandatory retirement

https://policybase.cma.ca/en/permalink/policy11701
Last Reviewed
2017-03-04
Date
2004-03-24
Topics
Health human resources
  1 document  
Policy Type
Parliamentary submission
Last Reviewed
2017-03-04
Date
2004-03-24
Topics
Health human resources
Text
Dear Minister: On behalf of the Canadian Medical Association, I am writing to highlight the concerns of our members regarding the issue of mandatory retirement for physicians practicing medicine in Canada. The sustained interest in this subject follows as a result of a resolution adopted by the CMA General Council on August 20, 2003. This resolution reads "that CMA, its divisions and affiliates advocate for the enactment of regulations and/or legislation that will prevent mandatory retirement of physicians based on age." Your predecessor, the Honourable Anne McLellan, requested further information from the CMA with regard to the aforementioned legislation, for the purposes of further discussion with provincial counterparts. Currently, rules governing mandatory retirement of physicians are complex and vary across jurisdictions. Nationally, the Canadian Human Rights Act governs mandatory retirement only insofar as physicians are considered employees of a federally regulated sector. The Act states that mandatory retirement is not discriminatory when a person has "reached the normal age of retirement for employees performing similar types of work." Provincially/territorially, human rights legislation varies from jurisdiction to jurisdiction. In general, employers are not allowed to discriminate on the basis of age, although some provinces and territories only protect employees to the age of 65. Most physicians however, operate as self-employed business persons, billing provincial Medicare plans on a fee-for-service basis, according to tariffs agreed upon by provincial medical associations. This means that human rights legislation does not protect most physicians. Therefore, while physicians are still free to practice medicine after they reach the age of 65 (i.e. contract to provide medical care to patients, and bill the provincial insurer for insured services), renewal of their admitting privileges depends on the policies or regulations of individual hospitals. In light of the evidence supporting an existing shortage of physicians, federal and provincial/territorial decision makers should be acutely aware of the detrimental effect mandatory retirement has with regard to health human resource planning initiatives. Currently, 10.7% of practising Canadian physicians are over the age of 65. Many of these physicians practice quite actively. In 2003, a CMA survey indicated that physicians over 65 reported working on average 46 hours per week, excluding on-call responsibilities. To remove this experienced cohort of practitioners from the practice setting would be to further exacerbate the growing medical professional shortage. It is shortsighted to uphold restrictions on the practice of medicine by physicians, solely on the basis of age. Continuing professional development for practicing physicians throughout their medical careers is mandated by both the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada as a requirement of maintenance of certification. In a system which self-regulates based on competency, barriers to practice that are age-based are both unnecessary and discriminatory. The CMA respectfully requests you to follow the lead of your predecessor and raise the issue of mandatory retirement with your provincial/territorial counterparts. There should be no disparity nation wide; age-based barriers to practicing medicine should not be tolerated for physician employees or independent contractors alike. In some cases, federal, provincial and territorial human rights legislation may need to be amended. Equally as important, these concerns must be factored into discussions around health human resource planning. Thank you for your time and interest in this very important matter. We look forward with anticipation to your response. For your information, a more detailed account of mandatory retirement follows in the addendum to this letter. Should you have any further questions, I would be pleased to discuss this issue in further detail with you and your staff. Sincerely, Dr. Sunil Patel President, Canadian Medical Association cc: Presidents, Provincial / Territorial Medical Associations BACKGROUNDER: MANDATORY RETIREMENT Preface: Since its introduction in 1884 by German Chancellor Otto von Bismarck, the age of 65 has become firmly entrenched as "retirement age". Mandatory retirement can be considered a form of discrimination or bias, insofar as scientific data does not support the principle of retirement on the basis of attainment of a specific chronological age. While human rights legislation governs the mandatory age of retirement for employees (including some physicians) with variations from province to province, the extent to which provincial human rights legislation applies to the mandatory retirement of physicians varies, depending on whether the physician is an employee of the hospital or an independent contractor. Legislative and regulatory framework: Human Rights Legislation vis-à-vis Mandatory Retirement Federal and provincial/territorial human rights legislation govern mandatory retirement for physician employees, depending on whether their employers are under federal or provincial jurisdiction. As most health institutions are under provincial jurisdiction, the vast majority of physician employees are protected by provincial human rights legislation. Each province and territory has enacted human rights legislation that governs in their respective areas of jurisdiction. The legislation tends to be analogous from one province to the next, but there are differences worth noting. Mandatory retirement constitutes a discriminatory measure for employers under the jurisdiction of seven provinces and territories. Four provinces do not consider mandatory retirement to be discrimination if the employee is 65 years or older. In two provinces, if mandatory retirement is provided for in a retirement or pension plan, it does not amount to discrimination. Jurisdiction Provisions governing mandatory retirement age Canada Mandatory retirement is not a discriminatory practice when a person has reached the normal retirement age for employees performing the same type of work. Consequently, in that case, the Act allows for mandatory retirement. Alberta Mandatory retirement constitutes a discriminatory measure for employers under the jurisdiction of this province. British Columbia Older employees are protected until the age of 65 against discrimination based on age. Consequently, employees aged 65 or over cannot file a complaint if they are obliged to retire for that reason. Manitoba Mandatory retirement constitutes a discriminatory measure for employers under the jurisdiction of this province. New Brunswick Termination of employment provided for in a retirement or pension plan does not constitute a discriminatory measure. In the absence of such a plan, however, employees who are obliged to retire may file a complaint for discrimination based on age, under the legislation on human rights. Newfoundland and Labrador Termination of employment provided for in a retirement or pension plan does not constitute a discriminatory measure. In the absence of such a plan, however, employees who are obliged to retire may file a complaint for discrimination based on age. They may use this recourse until the age of 65. Jurisdiction Provisions governing mandatory retirement age Northwest Territories Mandatory retirement constitutes a discriminatory measure for employers under the jurisdiction of this territory. Nova Scotia Mandatory retirement at age 65 does not constitute a discriminatory measure if it is standard in the workplace in question. However, the Human Rights Commission of this province investigates when an employee aged 65 or over is not treated in the same manner as others of the same age where retirement is concerned. Nunavut Mandatory retirement constitutes a discriminatory measure for employers under the jurisdiction of this territory. Ontario Older employees are protected against age-based discrimination up to the age of 65. Consequently, employees aged 65 or over cannot file a complaint if they are obliged to retire for this reason. Prince Edward Island Mandatory retirement constitutes a discriminatory measure for employers under the jurisdiction of this province. Quebec Mandatory retirement constitutes a form of discrimination according to the Charter of Human Rights and Freedoms and, more explicitly, is forbidden by the Act Respecting Labour Standards. Saskatchewan Older employees are protected against age-based discrimination up to the age of 65. Consequently, employees aged 65 or over cannot file a complaint if they are obliged to retire for this reason. Yukon Mandatory retirement constitutes a discriminatory measure for employers under the jurisdiction of this territory. Employment Status of Practicing Physicians Most physicians operate as independent contractors, billing provincial Medicare plans on a fee-for-service basis. Human rights legislation therefore does not protect the majority of physicians because the application of the legislation is limited to certain specific relationships, such as the traditional employment relationship. In other words, since physicians are more likely to be engaged by their patients to provide care than by the hospitals in which they provide it, the relationship between physicians and hospitals is more similar to a service contract than to a traditional employment contract. As a result, physicians who are independent contractors are free to practice medicine after they reach the age of 65. Depending on the hospital specific regulatory framework however, physicians may or may not be allowed to maintain their admitting privileges. Colleges of Physicians and Surgeons Regulatory bodies that license physicians do not place any restrictions on physician practice based solely on age. The Colleges of Physicians and Surgeons are not involved in administering hospital admitting privileges. None of the provincial or territorial colleges restrict licenses to practice medicine on the basis of a physician's age. Physicians who are employed in a traditional employment or master/servant relationship are covered by applicable human rights legislation, depending on whether their employers are federally or provincially/ territorially regulated. This means that some physicians can be forced into retirement at the age of 65, while others cannot. Policy Considerations: The Changing Physician Workforce Mandatory age-based retirement for health care workers has been a contested policy for almost 25 years. The issue assumes significant value for the CMA membership. Most physicians, operating as independent contractors, are not protected by human rights legislation in terms of retirement. Hospital admitting privileges are administered by the individual institutions, and renewal of such privileges may be subject to hospital policies on mandatory retirement. As more and more physicians choose to work in a traditional employment situation, the lack of human rights protection for physicians in private practice will be thrown in sharp relief. Health Human Resources Labour shortages challenge arguments for mandatory retirement. The health sector in particular has been hit hard by human resource shortages, which are predicted to increase as the baby-boom generation begins to retire in 2012. According to a study released by the Institute for Research on Public Policy (IRPP), challenges associated with the aging workforce in Canada will require greater flexibility, by way of removing barriers to labour force participation among individuals nearing retirement.1 Physician Health and Wellbeing For many people, employment provides a fundamental sense of dignity and self-worth. Practicing medicine promotes independence, security, self-esteem and a sense of participation in the community. Involuntary termination of employment can cause psychological and emotional distress. Physician malaise is a burgeoning concern and its address has become a strategic priority for the Canadian Medical Association. Protection of physicians, be they employees or independent contractors, from mandatory retirement is a strategy which would see one dimension of physician anxiety diminished and would therefore be supported by the CMA. Mandatory retirement can have a particularly serious financial impact on physicians. Employer pension plans are often not available in employment relationships which feature part-time or provisional employees. In order to secure or maintain their standard of living upon retirement, physicians must save extensively via RRSPs or private pension plans. Those physicians with family members to support, such as young adults in post secondary education, children with disabilities, or older family members fear that they will not be able to do so if forced to leave the practice of medicine. Liability Issues While the threat of malpractice may present as one logical argument in support of a mandatory retirement age, the statistics do not support such a claim. The Canadian Medical Protective Association (CMPA) maintains that there is no significant correlation between physicians' physical age and the corresponding number of lawsuits. Dr. Norman Brown of the CMPA notes that of the over 500 new lawsuits a year, there is not a significant number involving elderly physicians. Conclusion: The public interest is best served by ensuring that all competent physicians, regardless of age, are able to practice medicine. Artificial barriers to practice based on age are simply discriminatory and counter productive in an era of health human resource shortages. 1 Merette, Marcel. (2003) "The Bright Side: A Positive View on the Economics of Aging." Institute for Research on Public Policy. Nov 18/03.
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Physician mental health and wellness

https://policybase.cma.ca/en/permalink/policy37
Last Reviewed
2016-05-20
Date
2002-08-21
Topics
Health human resources
Resolution
GC02-50
That Canadian Medical Association promote awareness of physician mental health and wellness issues and reduction of the stigma associated with the need to seek personal assistance for these issues
  1 document  
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2002-08-21
Topics
Health human resources
Resolution
GC02-50
That Canadian Medical Association promote awareness of physician mental health and wellness issues and reduction of the stigma associated with the need to seek personal assistance for these issues
Text
That Canadian Medical Association promote awareness of physician mental health and wellness issues and reduction of the stigma associated with the need to seek personal assistance for these issues
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Aboriginal physicians

https://policybase.cma.ca/en/permalink/policy53
Last Reviewed
2016-05-20
Date
2002-08-21
Topics
Health human resources
Resolution
GC02-66
That Canadian Medical Association work with others to develop a health human resource strategy aimed at improving: Recruitment, training, retention of Aboriginal physicians and other health care workers; Integrated, holistic primary care service delivery relevant to the needs of the Aboriginal community and under community control.
  1 document  
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2002-08-21
Topics
Health human resources
Resolution
GC02-66
That Canadian Medical Association work with others to develop a health human resource strategy aimed at improving: Recruitment, training, retention of Aboriginal physicians and other health care workers; Integrated, holistic primary care service delivery relevant to the needs of the Aboriginal community and under community control.
Text
That Canadian Medical Association work with others to develop a health human resource strategy aimed at improving: Recruitment, training, retention of Aboriginal physicians and other health care workers; Integrated, holistic primary care service delivery relevant to the needs of the Aboriginal community and under community control.
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Last Reviewed
2016-05-20
Date
2002-08-21
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC02-67
That Canadian Medical Association support the concept that liability for individual practitioner actions in any collaborative care model must be clearly delineated and appropriately insured.
  1 document  
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2002-08-21
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC02-67
That Canadian Medical Association support the concept that liability for individual practitioner actions in any collaborative care model must be clearly delineated and appropriately insured.
Text
That Canadian Medical Association support the concept that liability for individual practitioner actions in any collaborative care model must be clearly delineated and appropriately insured.
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