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CMA PolicyBase

Policies that advocate for the medical profession and Canadians


24 records – page 1 of 2.

Canada Health Infoway

https://policybase.cma.ca/en/permalink/policy8924
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Health systems, system funding and performance
Health human resources
Health information and e-health
Resolution
GC07-110
The Canadian Medical Association and its provincial/territorial medical associations and affiliates call on Canada Health Infoway to support physicians in developing electronic medical records and linkages to electronic health records by making funding directly available to physicians.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Health systems, system funding and performance
Health human resources
Health information and e-health
Resolution
GC07-110
The Canadian Medical Association and its provincial/territorial medical associations and affiliates call on Canada Health Infoway to support physicians in developing electronic medical records and linkages to electronic health records by making funding directly available to physicians.
Text
The Canadian Medical Association and its provincial/territorial medical associations and affiliates call on Canada Health Infoway to support physicians in developing electronic medical records and linkages to electronic health records by making funding directly available to physicians.
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Clinical care to incorporate evidence-based technological advances

https://policybase.cma.ca/en/permalink/policy399
Last Reviewed
2014-03-01
Date
2000-08-16
Topics
Health systems, system funding and performance
Health information and e-health
Resolution
GC00-196
That federal, provincial and territorial governments respond to the health care needs of Canadians by ensuring the provision of clinical care that continually incorporates evidence-based technological advances in information, prevention, and diagnostic and therapeutic services.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2000-08-16
Topics
Health systems, system funding and performance
Health information and e-health
Resolution
GC00-196
That federal, provincial and territorial governments respond to the health care needs of Canadians by ensuring the provision of clinical care that continually incorporates evidence-based technological advances in information, prevention, and diagnostic and therapeutic services.
Text
That federal, provincial and territorial governments respond to the health care needs of Canadians by ensuring the provision of clinical care that continually incorporates evidence-based technological advances in information, prevention, and diagnostic and therapeutic services.
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Collaborative care model

https://policybase.cma.ca/en/permalink/policy8881
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC07-39
The Canadian Medical Association will advocate for the development of a collaborative care model that protects and promotes excellence in medical education.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC07-39
The Canadian Medical Association will advocate for the development of a collaborative care model that protects and promotes excellence in medical education.
Text
The Canadian Medical Association will advocate for the development of a collaborative care model that protects and promotes excellence in medical education.
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Completion of government forms

https://policybase.cma.ca/en/permalink/policy8868
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Physician practice/ compensation/ forms
Health systems, system funding and performance
Resolution
GC07-56
The Canadian Medical Association will work with the federal government to: a. acquire physician input into the design and content of forms completed by physicians for the federal government and its agencies; b. review the responsibilities and extent to which the federal government and/or patients bear the costs of all physician assessments and services required for completion of government forms; and c. establish an appropriate fee structure for payment of all physician services required for completion of all federally mandated forms.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Physician practice/ compensation/ forms
Health systems, system funding and performance
Resolution
GC07-56
The Canadian Medical Association will work with the federal government to: a. acquire physician input into the design and content of forms completed by physicians for the federal government and its agencies; b. review the responsibilities and extent to which the federal government and/or patients bear the costs of all physician assessments and services required for completion of government forms; and c. establish an appropriate fee structure for payment of all physician services required for completion of all federally mandated forms.
Text
The Canadian Medical Association will work with the federal government to: a. acquire physician input into the design and content of forms completed by physicians for the federal government and its agencies; b. review the responsibilities and extent to which the federal government and/or patients bear the costs of all physician assessments and services required for completion of government forms; and c. establish an appropriate fee structure for payment of all physician services required for completion of all federally mandated forms.
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Confidentiality of medical records

https://policybase.cma.ca/en/permalink/policy598
Last Reviewed
2017-03-04
Date
1979-06-20
Topics
Health information and e-health
Ethics and medical professionalism
Resolution
GC79-2
The Canadian Medical Association deplores any action taken by any level of government which threatens confidentiality of medical records.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
1979-06-20
Topics
Health information and e-health
Ethics and medical professionalism
Resolution
GC79-2
The Canadian Medical Association deplores any action taken by any level of government which threatens confidentiality of medical records.
Text
The Canadian Medical Association deplores any action taken by any level of government which threatens confidentiality of medical records.
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The environment and tax incentives

https://policybase.cma.ca/en/permalink/policy8888
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Population health/ health equity/ public health
Physician practice/ compensation/ forms
Resolution
GC07-71
The Canadian Medical Association calls on the federal government to provide funding and/or tax incentives to assist the health care sector and health care professionals to adopt more environmentally sensitive practices.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Population health/ health equity/ public health
Physician practice/ compensation/ forms
Resolution
GC07-71
The Canadian Medical Association calls on the federal government to provide funding and/or tax incentives to assist the health care sector and health care professionals to adopt more environmentally sensitive practices.
Text
The Canadian Medical Association calls on the federal government to provide funding and/or tax incentives to assist the health care sector and health care professionals to adopt more environmentally sensitive practices.
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Government funding for health information technology

https://policybase.cma.ca/en/permalink/policy402
Last Reviewed
2014-03-01
Date
2000-08-16
Topics
Health information and e-health
Resolution
GC00-200
That the federal, provincial and territorial governments fund the health information technology required to enhance the delivery of quality care and sustain the health care system.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2000-08-16
Topics
Health information and e-health
Resolution
GC00-200
That the federal, provincial and territorial governments fund the health information technology required to enhance the delivery of quality care and sustain the health care system.
Text
That the federal, provincial and territorial governments fund the health information technology required to enhance the delivery of quality care and sustain the health care system.
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Medical Council of Canada

https://policybase.cma.ca/en/permalink/policy510
Last Reviewed
2014-03-01
Date
1989-08-23
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC89-71
That the Canadian Medical Association reaffirm its endorsement of the Medical Council of Canada as a national examination corporation.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
1989-08-23
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC89-71
That the Canadian Medical Association reaffirm its endorsement of the Medical Council of Canada as a national examination corporation.
Text
That the Canadian Medical Association reaffirm its endorsement of the Medical Council of Canada as a national examination corporation.
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National Physician Human Resource Strategy

https://policybase.cma.ca/en/permalink/policy8879
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC07-37
The Canadian Medical Association recommends the creation of a National Physician Human Resource Strategy that takes into account the changing practice styles of all physicians as well as the increased demand for medical care including factors such as an aging population.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC07-37
The Canadian Medical Association recommends the creation of a National Physician Human Resource Strategy that takes into account the changing practice styles of all physicians as well as the increased demand for medical care including factors such as an aging population.
Text
The Canadian Medical Association recommends the creation of a National Physician Human Resource Strategy that takes into account the changing practice styles of all physicians as well as the increased demand for medical care including factors such as an aging population.
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Patient-focused funding for hospital services

https://policybase.cma.ca/en/permalink/policy8867
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Physician practice/ compensation/ forms
Health systems, system funding and performance
Resolution
GC07-55
The Canadian Medical Association will work with the provincial/territorial medical associations to co-host a workshop on the financial and patient care implications of patient-focused funding for hospital services and pay-for-performance for physician services.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Physician practice/ compensation/ forms
Health systems, system funding and performance
Resolution
GC07-55
The Canadian Medical Association will work with the provincial/territorial medical associations to co-host a workshop on the financial and patient care implications of patient-focused funding for hospital services and pay-for-performance for physician services.
Text
The Canadian Medical Association will work with the provincial/territorial medical associations to co-host a workshop on the financial and patient care implications of patient-focused funding for hospital services and pay-for-performance for physician services.
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Patient-focused Funding (PFF)

https://policybase.cma.ca/en/permalink/policy9000
Last Reviewed
2014-03-01
Date
2007-05-29
Topics
Physician practice/ compensation/ forms
Health human resources
Health systems, system funding and performance
Resolution
BD07-06-217
The Canadian Medical Association will consider the concept of patient-focused funding, in which funding is allocated as closely as possible to the point of care between patients and physicians and covers the whole patient care pathway and follows the patient to point of service.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2007-05-29
Topics
Physician practice/ compensation/ forms
Health human resources
Health systems, system funding and performance
Resolution
BD07-06-217
The Canadian Medical Association will consider the concept of patient-focused funding, in which funding is allocated as closely as possible to the point of care between patients and physicians and covers the whole patient care pathway and follows the patient to point of service.
Text
The Canadian Medical Association will consider the concept of patient-focused funding, in which funding is allocated as closely as possible to the point of care between patients and physicians and covers the whole patient care pathway and follows the patient to point of service.
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Physician retention

https://policybase.cma.ca/en/permalink/policy8926
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Ethics and medical professionalism
Health human resources
Physician practice/ compensation/ forms
Resolution
GC07-112
The Canadian Medical Association will examine ways to increase flexibility in a physician's workplace to create a healthy work-life balance and to communicate the importance that such balance plays in physician retention.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Ethics and medical professionalism
Health human resources
Physician practice/ compensation/ forms
Resolution
GC07-112
The Canadian Medical Association will examine ways to increase flexibility in a physician's workplace to create a healthy work-life balance and to communicate the importance that such balance plays in physician retention.
Text
The Canadian Medical Association will examine ways to increase flexibility in a physician's workplace to create a healthy work-life balance and to communicate the importance that such balance plays in physician retention.
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Presentation to the House of Commons Standing Committee on Finance -December 7, 2007

https://policybase.cma.ca/en/permalink/policy9057
Last Reviewed
2020-02-29
Date
2007-12-07
Topics
Health systems, system funding and performance
Health human resources
Physician practice/ compensation/ forms
  1 document  
Policy Type
Parliamentary submission
Last Reviewed
2020-02-29
Date
2007-12-07
Topics
Health systems, system funding and performance
Health human resources
Physician practice/ compensation/ forms
Text
It is a pleasure to address the Standing Committee on Finance today as part of your pre-budget consultations. In keeping with the theme set by the Committee, our presentation - Tax Incentives for Better Living - focuses on changing the tax system to better support the health and well being of all Canadians. Today I will share with you three recommendations improving the health of Canadians and productivity of the Canadian economy: First, tax incentives for pre-paid long-term care insurance; Second, tax incentives to retain and recruit more doctors and nurses; Third, tax incentives to enhance health system productivity and quality improvements. 1. Long Term Care insurance Canada's population is ageing fast. Yet, long-term care has received little policy attention in Canada. Unlike other countries like the UK and Germany who have systems in place, Canada is not prepared to address these looming challenges. The first of the baby-boomers will turn 65 in 2011. By 2031, seniors will comprise one quarter of the population - double the current proportion of 13%. The second challenge is the lack of health service labour force that will be able to care for this ageing population. Long-term care cannot and should not be financed on the same pay-as-you-go basis as medical/hospital insurance. Therefore the CMA urges the Committee to consider either tax-pre-paid or tax-deferred options for funding long-term care. These options are examined in full in the package we have supplied you with today. 2. Improving access to quality care Canada's physician shortage is a critical issue. Here in Quebec, 1 in 4 people do not have access to a family physician. Overall 3.5 people in Canada do not have a family Physician. Despite this dire shortage, the Canada Student Loans program creates barriers to the training of more physicians. Medical students routinely begin their postgraduate training with debts of over $120,000. Although still in training, they must begin paying back their medical school loans as they complete their graduate training. This policy affects both the kind of specialty that physicians-in-training choose, and ultimately where they decide to practice. We urge this Committee to recommend the extension of interest-free status on Canada Student Loans for all eligible health professional students pursuing postgraduate training. 3. Health System IT: increasing productivity and quality of care The last issue I will address is health system automation. Investment in information technology will lead to better, safer and cheaper patient care. In spite of the recent $400 million transfer to Canada Health Infoway, Canada still ranks at the bottom of the G8 countries in access to health information technologies. We spend just one-third of the OECD average on IT in our hospitals. This is a significant factor with respect to our poor record in avoidable adverse health effects. An Electronic Health Record (EHR) could provide annual, system-wide savings of $6.1 billion - every year - and reduce wait times and thereby absenteeism. But, the EHR potential can only be realized if physician's offices across Canada are fully automated. The federal government could invest directly in physician office automation by introducing dedicated tax credits or by accelerating the capital cost allowance related to health information technologies for patients. Before I conclude, the CMA again urges the Committee to address a long-standing tax issue that costs physicians and the health care system over $65 million a year. When you add hospitals - that cost more than doubles to over $145 million-or the equivalent of 60 MRI machines a year. The application of the GST on physicians is a consumption tax on a producer of vital services and affects the ability of physicians to provide care to their patients. And now with the emphasis on further sales tax harmonization, the problem will be compounded. Nearly 20 years ago when the GST was put into place, physician office expenses were relatively low for example: tongue depressors, bandages and small things. There was practically no use computers or information technology. How many of you used computers 20 years ago? Now Canadian physicians' could be and should be using 21st century equipment that is expensive but powerful. This powerful diagnostic equipment can save lives and save the system millions of dollars in the long run. It provides a clear return on investment. Yet, physicians still have to pay the GST (and the PST) on diagnostic equipment that costs a minimum of $500,000 that's an extra $30,000 that physicians must pay. The result of this misalignment of tax policy and health policy is that most Radiologists' diagnostic imaging equipment is over 30-years old. Canadians deserve better. It's time for the federal government to stop taxing health care. We urge the Committee to recommend the "zero-rating" publicly funded health services or to provide one-hundred percent tax rebates to physicians and hospitals. Conclusion In conclusion, we trust the Committee recognizes the benefits of aligning tax policy with health policy in order to create the right incentives for citizens to realize their potential. By supporting: 1. Tax Incentives for Long-Term Care 2. Tax Incentives to Bolster Health Human Resources and, 3. Tax Incentives to Support Health System Automation. This committee can respond to immediate access to health care pressures that Canadians are facing. Delaying a response to these pressures will have an impact on the competiveness of our economy now, and with compounding effects in the future. I appreciate the opportunity of entering into a dialogue with members of the Committee and look forward to your questions. Thank you.
Documents
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Professional development as part of CMA e-strategy

https://policybase.cma.ca/en/permalink/policy468
Last Reviewed
2014-03-01
Date
2000-08-16
Topics
Health human resources
Health information and e-health
Resolution
GC00-12
That General Council endorse Canadian Medical Association's offering of professional development to physicians as part of the Canadian Medical Association's e-strategy.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2000-08-16
Topics
Health human resources
Health information and e-health
Resolution
GC00-12
That General Council endorse Canadian Medical Association's offering of professional development to physicians as part of the Canadian Medical Association's e-strategy.
Text
That General Council endorse Canadian Medical Association's offering of professional development to physicians as part of the Canadian Medical Association's e-strategy.
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Putting Patients First: Patient-Centred Collaborative Care - A Discussion Paper

https://policybase.cma.ca/en/permalink/policy8863
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Physician practice/ compensation/ forms
Population health/ health equity/ public health
Resolution
GC07-34
The Canadian Medical Association endorses the strategic policy directions outlined in the CMA document Putting Patients First: Patient-Centred Collaborative Care - A Discussion Paper as necessary elements of any collaborative care team.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Physician practice/ compensation/ forms
Population health/ health equity/ public health
Resolution
GC07-34
The Canadian Medical Association endorses the strategic policy directions outlined in the CMA document Putting Patients First: Patient-Centred Collaborative Care - A Discussion Paper as necessary elements of any collaborative care team.
Text
The Canadian Medical Association endorses the strategic policy directions outlined in the CMA document Putting Patients First: Patient-Centred Collaborative Care - A Discussion Paper as necessary elements of any collaborative care team.
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The role of family physicians

https://policybase.cma.ca/en/permalink/policy8937
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC07-86
The Canadian Medical Association urges provincial and territorial governments to develop strategies promoting the role of family physicians in Canada.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC07-86
The Canadian Medical Association urges provincial and territorial governments to develop strategies promoting the role of family physicians in Canada.
Text
The Canadian Medical Association urges provincial and territorial governments to develop strategies promoting the role of family physicians in Canada.
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Rural and remote practice issues

https://policybase.cma.ca/en/permalink/policy211
Last Reviewed
2020-02-29
Date
2000-05-09
Topics
Physician practice/ compensation/ forms
  1 document  
Policy Type
Policy document
Last Reviewed
2020-02-29
Date
2000-05-09
Replaces
Promoting medicine as a career for rural high school students (Resolution BD88-03-78)
Topics
Physician practice/ compensation/ forms
Text
CMA Policy : Rural and Remote Practice Issues The Canadian Medical Association (CMA) believes that all Canadians should have reasonable access to uniform, high quality medical care. The CMA is concerned, however, that the health care infrastructure and level of professional support in rural and remote areas are insufficient to provide quality care and retain and recruit physicians relative to community needs. The CMA has developed this policy to outline specific issues and recommendations that may help retain and recruit physicians to rural and remote areas of Canada and thereby improve the health status of rural and remote populations. The following 3 key issue areas are addressed in this policy: training, compensation and work/lifestyle support. Commitment and action by all stakeholders, including governments, medical schools, professional associations and others, are urgently required. Preamble Canadian physicians and other health care professionals are greatly frustrated by the impact that health care budget cuts and reorganization have had, and continue to have, on the timely provision of quality care to patients and general working conditions. For many physicians who practise in rural and remote communities, the impact is exacerbated by the breadth of their practice, as well as long working hours, geographic isolation, and lack of professional backup and access to specialist services. This policy has been prepared to help governments, policy-makers, communities and others involved in the retention and recruitment of physicians understand the various professional and personal factors that must be addressed to retain and recruit physicians to rural and remote areas of Canada. This policy applies to both general practitioners/family physicians as well as specialists. The CMA believes that this policy must be considered in the context of other relevant CMA policies, including but not limited to Physician Health and Wellbeing, Physician Compensation, Physician Resource Planning, Principles for a Re-entry System in Canadian Postgraduate Medical Education and Charter for Physicians. In addition, any strategies that are developed should not be coercive and must include community and physician input; they must also be comprehensive, flexible and varied to meet and respond to local needs and interests. Definitions Rural and remote There are no standard, broadly accepted terms or definitions for "rural" and "remote" since they cannot be sufficiently defined to reflect the unique and dynamic nature of the various regions and communities that could presumably be labelled as such. The terms "rural" or "remote" medicine may be applied to many things: the physicians themselves, the population they serve, the geography of the community or access to medical services. For each of these factors, there are a number of ways to define and measure rurality. For example, a 1999 CMA survey of rural physicians showed that the most frequently mentioned characteristics of a rural community were (1) high level of on-call responsibilities, (2) long distance to a secondary referral centre, (3) lack of specialist services and (4) insufficient family physicians. As another example, Statistics Canada defines rural and small town residents for some analyses as those living in communities outside Census Metropolitan Areas (population of at least 100 000) or Census Agglomerations (population between 10 000 and 99 999), and where less than 50% of the workforce commute to a larger urban centre. Medical school For the purposes of this policy, a medical school is understood to encompass the entire continuum of medical education, i.e., undergraduate, postgraduate, continuing medical education and maintenance of competence. Training Some Canadian studies have shown that medical trainees who were raised in rural communities have a greater tendency to return to these or similar communities to practise medicine. Some studies also show that individuals who do clerkships in rural or remote communities, or have some exposure to the rural practice environment during residency training, have a greater tendency to consider practising in rural or remote communities upon graduation. The CMA applauds those medical schools that promote careers in medicine to individuals from rural and remote areas and provide medical students and residents with exposure to rural practice during their training. Regular collaboration and communication among training directors for rural and remote programs, as well as rural medical educators and leaders from other health disciplines, are strongly encouraged so that rural training issues and possible linkages may be discussed. The benefits of rural training extend not only to those physicians who ultimately end up in rural practice; those who remain in urban areas also benefit by having an enhanced understanding of the challenges of rural and remote practice. As outlined in the CMA’s 1992 Report of the Advisory Panel on the Provision of Medical Services in Underserviced Regions, the CMA believes that partnerships among medical schools, the practising profession and communities need to be formalized, particularly since medical schools have a crucial role in helping to recruit and retain physicians for rural and remote communities. The medical school’s role in such a partnership takes the form of a social contract. This contract begins with the admission of students who demonstrate a prior interest in working in rural or remote communities and may come from these communities. It also includes the exposure of students to rural practice during their undergraduate and postgraduate training. It is followed by the provision of specialized training for the conditions in which they will work and ongoing educational support during their rural and remote practice. For these reasons, the CMA strongly encourages academic health science centres (AHSCs), provincial governments, professional associations and rural communities to work together to formally define the geographic regions for which each AHSC is responsible. The AHSCs are also encouraged to include within their mission a social contract to contribute to meeting the health needs of their rural or remote populations. Practising physicians are committed to lifelong learning. In order to preserve a high standard of quality care to their patients, they must be knowledgeable about new clinical and technological advances in medicine; they must also continually develop advanced or additional clinical skills in, for example, obstetrics, general surgery and anaesthesia, to better serve the patients in their communities, especially when specialist services are not readily available. There are many practical and financial barriers that physicians in rural and remote communities face in obtaining and maintaining additional skills training, including housing, practice and other costs (e.g., locum tenens replacement expenses) while they are away from work. The CMA strongly encourages governments to develop and maintain mechanisms, such as compensation or additional tax relief, to reduce the barriers associated with obtaining advanced or additional skills training. In light of these issues, the CMA recommends that 1. Universities, governments and others encourage and fund research into criteria that predispose students to select and succeed in rural practice. 2. All medical students, as early as possible at the undergraduate level, be exposed to appropriately funded and accredited rural practice environments. 3. Medical schools develop training programs that encourage and promote the selection of rural practice as a career. 4. Universities work with professional associations, governments and rural communities to determine the barriers that prevent rural students from entering the profession, and take appropriate action to eliminate or reduce these barriers. 5. A Web site based compendium of rural experiences and electives for medical students be developed, maintained and adequately funded. 6. Advanced skills acquisition and maintenance opportunities be provided to physicians practising in or going to rural and remote areas. 7. CMA divisions and provincial/territorial governments ensure that physicians who work in rural and remote areas receive full remuneration while obtaining advanced skills, including support for the locum tenens who will replace them. 8. Any individual formally enrolled in a Royal College of Physicians of Surgeons of Canada or College of Family Physicians of Canada program be covered by the collective agreement of their housestaff organization. 9. Providers, funders and accreditors of continuing medical education for rural physicians ensure that the continuing medical education is developed in close collaboration with rural physicians and is accessible, needs-based and reflective of rural physicians’ scope of practice. 10. Physicians who practise in rural or remote areas be given reasonable opportunities to re-enter training in a postgraduate program without any return-in-service obligations. 11. In order to promote mutual understanding, universities encourage teaching faculty to work in rural practices and that rural physicians be invited to teach in academic health science centres. 12. Medical schools develop training programs for both students and residents that encourage and promote the provision of skills appropriate to rural practice needs. 13. Medical schools support rural faculty development and provide full faculty status to these individuals. Compensation The CMA believes that compensation for physicians who practise in rural and remote areas must be flexible and reflect the full spectrum of professional and personal factors that are often inherent to practising and living in such a setting. These professional factors may include long working hours and the need for additional competencies to meet community needs, such as advanced obstetrics, anaesthesia and general surgery, as well as psychotherapy and chemotherapy. They may also include a high level of on-call responsibilities as well as a lack or total absence of backup from specialists, nurses and other complementary services that are usually available in an urban environment. Other challenges are professional isolation, limited opportunities for education or training, and high practice start-up costs. Also, if for a number of reasons a physician wishes to relocate to an urban setting, he or she may face billing restrictions as well as challenges in finding a replacement physician. Compensation for these factors is necessary to help retain physicians and recruit new ones. In addition, compensation should guarantee protected time off, paid continuing medical education or additional skills training, and locum tenens coverage. Any pool of locum tenens for rural and remote practice should be adequately funded and cross-jurisdictional licensure issues should be minimized. Living in a rural or remote community can be very satisfying for many physicians and their families; however, they must usually forgo — often for an extended period of time— a number of urban advantages and amenities. These include educational, cultural, recreational and social opportunities for their spouse or partner, their children and themselves. They may also face altered family dynamics due to a decrease or significant loss of family income if there are limited or no suitable employment opportunities for their spouse or partner. The CMA believes that all physicians should have a choice of payment options and service delivery models to reflect their needs as well as those of their patients. Physicians must receive fair and equitable remuneration and have a practice environment that allows for a reasonable quality of life. Although the CMA does not advocate one payment system for urban physicians and another for rural physicians, it believes that enhanced total compensation should be provided to physicians who work and live in rural and remote communities. In recognition of these issues, the CMA recommends that 14. Additional compensation to physicians working in rural and remote areas reflect the following areas: degree of isolation, level of responsibility, frequency of on-call, breadth of practice and additional skills. 15. In recognition of the differences among communities, payment modalities retain flexibility and reflect community needs and physician choice. 16. Financial incentives focus on retaining physicians currently practising in rural or remote areas and include a retention bonus based on duration of service. 17. Factors affecting the social and professional isolation of physicians and their families be considered in the development of compensation packages and working conditions. 18. Eligibility criteria for including physicians in a pool of locum tenens for rural or remote practice be developed in consultation with rural physicians. 19. Provincial/territorial licensing bodies establish portability of licensure for locum tenens and ensure that any fees or processes associated with licensure do not serve as barriers to interprovincial mobility. 20. Rural locum tenens programs be funded by provincial/territorial governments and include adequate compensation for accommodation, transportation and remuneration. As previously noted, some studies show that exposure to rural and remote areas during training influences students’ decision to practise in those communities upon graduation. The CMA is concerned, however, that travel and accommodation costs relating to these experiences place an undue financial burden on students. In addition, most physicians in rural and remote areas are already burdened with significant patient loads and find that they have limited time and resources to act as preceptors. The CMA believes that, to ensure the ongoing viability of student rural experiences, physician preceptors should be compensated for their participation and should not incur any additional expenses, such as student or resident accommodation costs. The CMA recommends that 21. Costs for accommodation and travel for student and resident rural training experiences in Canada not be borne by the trainees or the preceptors. 22. Training programs assume responsibility for adequately remunerating preceptors in rural or remote areas. Work and lifestyle support issues To retain and recruit physicians in rural and remote communities, there are issues beyond fair and adequate compensation that must be considered. It is crucial that the aforementioned working conditions, professional issues and array of personal and family-related issues be addressed. The ultimate goal should be to promote physician retention and implement measures that reduce the possibility of physician burnout. Like most people, physicians want to balance their professional and personal responsibilities to allow for a reasonable quality of life. Physicians in rural and remote areas practise in high stress environments that can negatively affect their health and well-being; as a consequence, the standard of care to their patients can suffer. The stress is intensified by excessive work hours, limited professional backup or support (including locum tenens), limited access to specialists, inadequate diagnostic and treatment resources, and limited or no opportunity for vacation or personal leave. At particular risk for burnout is the physician who practises in isolation. For these reasons many physicians, when considering practice opportunities, tend to seek working conditions that will not generate an excessive toll on their non-working lives. This reinforces the need for rural and remote practice environments that facilitate a balance between physicians’ professional and personal lives. In light of these issues, the CMA recommends that 23. Regardless of community size, there should always be at least 2 physicians available to serve the needs of the community. 24. Ideally, the on-call requirement for weekends never exceed 1 in 5 in any Canadian practice. (This is consistent with current CMA policy.) 25. Provincial/territorial governments have professional support and other mechanisms readily available to physicians who practise in rural and remote areas, such as sabbaticals and locum tenens. 26. Governments recognize the service of rural and remote physicians by ensuring that mechanisms exist to allow future access to practise in an urban area of their choice. The CMA believes that rural and remote physician retention and recruitment initiatives must address matters relating to professional isolation as well as social isolation for physicians and their families. This sense of isolation can increase when there are cultural, religious or other differences. For unattached physicians, zero tolerance and unreasonable restrictions with regard to relationships with potential patients can be disincentives to practise in rural or remote communities. Although the CMA believes that such policies and restrictions should be reviewed, the CMA encourages physicians to refer to the CMA policy on The Patient-Physician Relationship and the Sexual Abuse of Patients and the Code of Ethics of the Canadian Medical Association. Also, the CMA recommends that physicians abide by any provincial/territorial policies or legislation that may currently be in place. The medical services infrastructure in rural and remote areas is usually very different from that in urban settings. In addition to a lack of specialist services, physicians in these areas may often have to cope with a number of other factors such as limited or no appropriate diagnostic equipment or limited hospital beds. Physicians and their patients expect and deserve quality care. The diversity and needs of the populations, as well as the needs of the physicians who practise in rural and remote areas, must also be recognized and reflected in the infrastructure (e.g., demographic and geographical considerations). The CMA recommends that 27. A basic medical services infrastructure for rural and remote areas be defined, such as hospital beds, paramedical staff, diagnostic equipment, transportation, ready access to secondary and tertiary services, as well as information technology tools and support. 28. Provincial/territorial governments recognize that physicians who work in rural and remote areas need an environment that appropriately supports them in providing service to the local population.
Documents
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Salaried physicians

https://policybase.cma.ca/en/permalink/policy605
Last Reviewed
2014-03-01
Date
1989-08-21
Topics
Physician practice/ compensation/ forms
Resolution
GC89-06
That the Canadian Medical Association actively investigate ways and means of improving federal provisions as they relate to salaried physicians.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
1989-08-21
Topics
Physician practice/ compensation/ forms
Resolution
GC89-06
That the Canadian Medical Association actively investigate ways and means of improving federal provisions as they relate to salaried physicians.
Text
That the Canadian Medical Association actively investigate ways and means of improving federal provisions as they relate to salaried physicians.
Less detail

Self-regulation of physicians

https://policybase.cma.ca/en/permalink/policy9054
Last Reviewed
2014-03-01
Date
2007-09-26
Topics
Physician practice/ compensation/ forms
Health systems, system funding and performance
Resolution
BD08-02-24
The Canadian Medical Association Board of Directors expresses its strong support for self-regulation of physicians and opposes any legislation that undermines this principle.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2007-09-26
Topics
Physician practice/ compensation/ forms
Health systems, system funding and performance
Resolution
BD08-02-24
The Canadian Medical Association Board of Directors expresses its strong support for self-regulation of physicians and opposes any legislation that undermines this principle.
Text
The Canadian Medical Association Board of Directors expresses its strong support for self-regulation of physicians and opposes any legislation that undermines this principle.
Less detail

Service-based funding for hospital services

https://policybase.cma.ca/en/permalink/policy8871
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC07-59
The Canadian Medical Association will work with the federal government to commission a strategic peer-reviewed research competition to assess the international experience with service-based funding for hospital services through the use of case-mix groups or diagnosis-related groups.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2007-08-22
Topics
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC07-59
The Canadian Medical Association will work with the federal government to commission a strategic peer-reviewed research competition to assess the international experience with service-based funding for hospital services through the use of case-mix groups or diagnosis-related groups.
Text
The Canadian Medical Association will work with the federal government to commission a strategic peer-reviewed research competition to assess the international experience with service-based funding for hospital services through the use of case-mix groups or diagnosis-related groups.
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