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293 records – page 1 of 15.

Aboriginal peoples and mental illness

https://policybase.cma.ca/en/permalink/policy9210

Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC08-21
The Canadian Medical Association urges Canadian medical schools to include in their curricula material related to the deleterious effect of negative stereotyping of Aboriginal peoples suffering from mental illnesses and substance use disorders.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Population health/ health equity/ public health
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC08-21
The Canadian Medical Association urges Canadian medical schools to include in their curricula material related to the deleterious effect of negative stereotyping of Aboriginal peoples suffering from mental illnesses and substance use disorders.
Text
The Canadian Medical Association urges Canadian medical schools to include in their curricula material related to the deleterious effect of negative stereotyping of Aboriginal peoples suffering from mental illnesses and substance use disorders.
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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.

Documents

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Academic writing and editing among practicing physicians and physicians-in-training

https://policybase.cma.ca/en/permalink/policy11627

Date
2015-08-26
Topics
Physician practice/ compensation/ forms
Ethics and medical professionalism
Health systems, system funding and performance
Resolution
GC15-47
The Canadian Medical Association will promote the development of resources to foster academic writing and editing among practicing physicians and physicians-in-training.
Policy Type
Policy resolution
Date
2015-08-26
Topics
Physician practice/ compensation/ forms
Ethics and medical professionalism
Health systems, system funding and performance
Resolution
GC15-47
The Canadian Medical Association will promote the development of resources to foster academic writing and editing among practicing physicians and physicians-in-training.
Text
The Canadian Medical Association will promote the development of resources to foster academic writing and editing among practicing physicians and physicians-in-training.
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Accessibility: the solution lies in cooperation

https://policybase.cma.ca/en/permalink/policy11518

Date
2015-03-25
Topics
Health human resources
  1 document  
Policy Type
Parliamentary submission
Date
2015-03-25
Topics
Health human resources
Text
ACCESSIBILITY: THE SOLUTION LIES IN COOPERATION Joint Brief of The Quebec Medical Association and the Canadian Medical Association BILL no. 20: An Act to enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation March 25, 2015 Preamble We would like to thank the members of the Committee on Health and Social Services for giving the Quebec Medical Association (QMA) and the Canadian Medical Association (CMA) the opportunity to express their preliminary views on Bill 20. We use the word "preliminary" deliberately because the bill in its current form sets out broad principles but is lacking in specifics. We would have liked to see more transparency on the government's part early in the process, whereas the regulatory guidelines were only made public on March 19. This shows a lack of respect or courtesy, or is a deliberate expression of the government's determination to ignore the opinion of the professionals concerned, that is to say, physicians. We have chosen not to critique the bill clause by clause, so we will not go that route for the regulatory guidelines either. We will instead limit ourselves to a few general comments. For example, how was it determined that an HIV-positive patient is "worth" two vulnerable patients, or that a patient receiving end-of-life care at home is worth 25? Why not 22, 26, or 30? Only ministry insiders know for sure, since neither of our organizations was consulted. And how many civil servants will it take to measure and monitor this new form of "mathematical" medical practice? The QMA is the only Quebec association whose members include general practitioners, specialists, residents and medical students. It calls on its vast network of members to consider the issues the medical profession faces, propose solutions and innovate in order to rethink the role doctors play in society and continually improve medical practice. The CMA is the largest national association of Canadian physicians and advocates on their behalf at the national level. The association's mission is to help physicians care for patients. The CMA is a leader in engaging and serving physicians and the national voice for the highest standards for health and health care. This brief is a historic first for both organizations. This is the first time that the CMA has submitted a brief in Quebec's National Assembly as well as the first time that the QMA and CMA have submitted a joint brief. This joint initiative says a lot about how concerned the country's physicians are about Bill 20. This attack on the professional autonomy of physicians is unprecedented in the history of Canadian organized medicine. Undoubtedly, the issues speak to the entire medical profession because of the consequences the bill could have on the profession itself. Our input is intended to be realistic, constructive and reflective of our member's opinions and legitimate concerns. Our two organizations-which, we note, are not negotiating bodies-have a profound understanding of the health community in Quebec, Canada and internationally. In keeping with the tradition of our two organizations, we are constantly seeking ways to improve the health care system in order to bring about patient-centred care. That said, we are also well aware of the budget constraints Quebec is currently facing. Our comments will mainly address the following points: o Access to family physicians and specialists; o The "productivity" of Quebec physicians; o Examples elsewhere in Canada; o Success factors. Physician access Obviously, access to health care and services in Quebec is a problem, particularly with regard to family physicians. Statistics Canada reported that, in 2013, an average 15.5% of Canadians did not have a regular medical doctor1. Quebec, with 25.1% of residents lacking a family physician, was well above the national average. All four of the Atlantic Provinces as well as Ontario provided better access than Quebec while Manitoba and British Columbia reported rates that were about the same as the national average. Despite considerable investment in recent years, plainly many Quebecers still do not have access to a family physician and other specialists. We do not believe the status quo is an option. Something must be done. Unlike as provided in Bill 20, however, we do not believe that imposing patient quotas on physicians is the solution. Quotas could have the adverse effect of leading physicians to choose quantity of care over quality, which could result in incomplete examinations, increased use of diagnostic tests and, ultimately, overdiagnosis. This is the sort of practice that the QMA and CMA have been trying to eliminate for 18 months with their "Choosing Wisely Canada"2 awareness campaign, which advocates for better medicine and fewer tests and procedures of no added value. Overdiagnosis has significant impacts on cost, quality, effectiveness, efficacy and patient access to health care and, as a result, on the efficiency of the entire health care network. In short, doing more is not always better. The campaign has been embraced both by physicians and patients, but Bill 20 risks not only undermining considerable effort but also sending the public a contradictory message. The "productivity" of Quebec physicians The services provided by Quebec physicians have been the subject of much debate in recent months. The government's claim that Quebec physicians are less "productive" than their colleagues in other provinces is based on a false premise. The reality is that billing methods are different and cannot be meaningfully compared. The national data shows that 8.5% of Canadian physicians are salaried, while 41.9% are paid a fee per service and 41.4% are paid lump sums or through capitation, or a combination of the two. Longitudinal analysis of the 2014 National Physician Survey-a partnership between the College of Family Physicians of Canada, the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada-offers a way to relativize the "productivity" of Quebec physicians compared to that of their colleagues in other provinces. For more than a decade, the survey has been a point of reference for researchers, governments and stakeholders interested in analyzing and improving health care in Canada. The Canadian database for this study clearly shows that the gap between the hours devoted per week to direct patient services by Quebec and other Canadian physicians is shrinking. Even though physicians in the rest of Canada still report working more than their Quebec colleagues, the difference decreased 44% between 2010 and 2014 to 1.37 hours per week. For family physicians, the gap decreased 23% to 2.41 hours in 2014. Plainly, we are far from the alarming situation that has been decried in recent weeks. Furthermore, the results show that, on average, Quebec physicians perform more than 20% more research-related activities per week than their Canadian counterparts, confirming a trend over the past 10 years. On-call work for health care establishments should also be considered in the productivity debate as family physicians who perform such work spend on average more than eight hours per week on related tasks compared to approximately six hours in the rest of Canada. Counting specialists, the figure rises to more than 11 hours per week, compared to a bit less than eight hours per week by family physicians and specialists in the rest of the country. In 2014 Quebec family physicians reported having to spend 23% more time each week on administrative tasks than their Canadian colleagues (2.8 hours versus 2.27 hours). This trend has become more pronounced over the past 10 years. In short, Quebec physicians work almost as much as their colleagues in the rest of Canada. Yet they appear to be less efficient. Why? Because of the shortcomings in the way our system is organized, physicians are busy doing administrative work, seeking out clinical information that should be at their fingertips, and performing tasks that could be left to other health care professionals. These figures, which show that the number of hours worked by physicians in direct patient care declined an average of 10% in the other provinces between 2004 and 2014, raise a question. How is it that, despite this decrease in hours worked, there is better accessibility to health care services? Because in collaboration with physicians, Alberta, Ontario and British Columbia have each successfully introduced measures in recent years to improve their services, particularly on the front line. Quebec would do well to examine those initiatives. Elsewhere in Canada A GP for Me A GP for Me is an initiative in British Columbia jointly funded by the provincial government and Doctors of BC to:
Enable patients who want a family doctor to find one;
Increase the capacity of the primary health care;
Confirm and strengthen the continuous doctor-patient relationship; including better support for the needs of vulnerable patients. The mission of Doctors of BC3 is to make a meaningful difference in improving the health care for British Columbians by working to achieve quality patient care through engagement, collaboration and physician leadership. Its goal is to promote a social, economic and political climate in which members can provide the citizens of BC with the highest standard of health care, while achieving maximum professional satisfaction and fair economic reward. Ontario Ontario chose to tackle the access problem by obtaining the support and cooperation of faculties of medicine, health organizations and the College of Physicians and Surgeons of Ontario. Two hundred family health teams (the equivalent of Quebec's family medicine groups) were created. The groups promote access to care by bringing different health care providers together under the same roof. Ontario also has more specialized nurse practitioners than Quebec does. The result of all these efforts is that two million more Ontarians can now call on a family physician. The inspiring example of Taber, Alberta The Taber Integrated Primary Healthcare Project4 is an initiative launched in the early 2000s in the town of Taber, in rural Alberta. The goal of the project was to improve health care services delivery through integration of the services provided by a physician group and the Chinook Health Region. In light of the project's success, it was expanded to the entire region five years later. According to Dr. Robert Wedel, one of the people behind the project, four factors explain the initiative's success: a community assessment and shared planning; evidence-based, interdisciplinary care; an integrated electronic information system; and investment in processes and structures that support change. Community evaluation and shared planning: First, successful integration of primary health care depends on gaining an understanding of individual, family and community health care needs. Health services providers and users must also have a shared vision of optimal health care delivery. Evidence-based, interdisciplinary care: Second, the introduction of interdisciplinary teams (physicians, nurses, managers and other health professionals) facilitated the transition from a facility-based service delivery approach to a community-based wellness approach. Electronic information system: Third, the introduction of an integrated information system aided interdisciplinary care and access to patient information in various points of service. Alternative payment plan: Finally, processes and structures were put in place to support change over the long term. An alternative payment plan was implemented to clarify physician remuneration, define service and productivity expectations and protect organizational autonomy. The plan was also designed to enable physicians to delegate tasks to other professionals on the team in order to spend additional time with patients with more complex needs. The physicians now receive a fixed salary for specific services (in-clinic ambulatory services, emergencies, minor operations, prenatal care, and so on). However, some services continue to be billed on a fee-for-service basis (births, major operations and anaesthesia). Salaries are reduced when a registered patient receives care outside the physician group. Furthermore, organizational change strategies were put in place to address resistance to the changes. Modifications were made so that a common, integrated care site could eventually be established. All these changes had significant, positive consequences in Taber but also throughout the Chinook region. This approach enables better monitoring of chronic diseases and more prevention and education services for patients. Also noted was better accessibility to care, even for vulnerable and generally underserved patients. In the early 2000s, patients had to wait about 30 days before the first available appointment, but the wait has been completely eliminated since 2006. Physician services increased about 10% and those by other professionals, 50%. Patients visit their physicians less often (2.1 visits per year rather than 5.6 visits in other regions), and a marked decline in emergency room visits and laboratory tests has been observed. Quebec could capitalize on the Taber initiative by adapting it to the situation in Quebec and encouraging physicians to participate fully like the committed partners they are of patients and the health system. Success Factors Improvements from the Taber project and other initiatives in Alberta, Ontario and British Columbia-all of which provide greater health care access than Quebec-share three common features that are available to Quebec as well: o Electronic health records (EHRs) Quebec lags behind other provinces in adopting EHRs. A mere 25% of Quebec physicians order diagnostic and laboratory tests electronically. The 2014 National Physician Survey ranks Quebec almost last in health care system computerization. The Quebec Health Record Project promised for 2011 at a cost of $543 million has been, according the health minister himself, an abject failure. Recently he said that the Quebec government planned to deliver the project in 2021 at a cost of $1.6 billion before adding that he was not sure there would be money to pay for it. Physicians have nothing to do with this delay or the squandering of public funds. They're ready and waiting to make use of computerized records to improve health care access and communicate better with patients. The confusion and delays in switching to EHRs in Quebec are a big part of the reason for Quebec's poor results on the survey. Some of the problems might indeed be caused by the older generation's reluctance to embrace information technology, but that's not the whole story. We need to have a system that is absolutely reliable and accessible. Primary care organizations in Ontario are using electronic medical records to identify and support patient needs. All Ontario's primary care organizations mentioned using EHRs in descriptions they submitted on their quality improvement plans5-an example of how technology can be used to monitor patient needs and support improved delivery of care. Approximately 38% described using EHRs to identify specific diseases. We cannot overlook the fact that EHRs have been the cornerstone of the productivity improvements elsewhere in Canada. o Interdisciplinary work organization Quebec also lags behind in providing environments conducive to greater interdisciplinary work and enlisting contributions from other health professionals (nurse practitioners [NPs], nurses, managers and other health professionals). Certain Canadian provinces are far ahead in this area. Team care allows the various professionals to do their regular tasks and delegate when the situation calls for it. The solutions that have put most Canadian provinces on the road to solving the problem of frontline health care access have generally come through collaboration between the government and the medical profession. With effective information systems and the implementation of interdisciplinary approaches, in a spirit of cooperation and collaboration, such health care systems manage to provide the kind of accessible, high quality care patients and taxpayers are entitled to expect when they need it. The bottom line is that interdisciplinary work allows physicians to do what they do best: diagnose and treat. o Remuneration practices for population-based responsibility Quebec seems to be the Canadian province where physician remuneration is closest to a fee-for-service model. Quebec Health Insurance Plan data from 2013 shows that close to 80% of Quebec physicians' total compensation is fee-for-service.6 Elsewhere in the country, mixed remuneration methods appear to make it easier to foster population-based responsibility, i.e., not just covering a territory, but also incorporating the determinants of population health and well-being, among which are access to high quality services and the full participation of all stakeholders. In its 2011 support strategy for the practice of population-based responsibility7, MSSS spelled out the government's approach. However, that strategy was developed around local service networks managed through CSSSs, which were recently done away with by Bill 10, An Act to modify the organization and governance of the health and social services network, in particular by abolishing the regional agencies. The authors of the strategy define population-based responsibility collectively, as follows: * Using health and social services data to develop a shared picture of the reality on the ground; * Deciding, in consultation with the public, partners in the health and social services network and other sectors, on a basket of integrated, quality services to meet the needs of the local population; * Strengthening actions on health determinants in order to improve the health and well-being of the entire local population; and * Tracking performance and seeking ongoing improvements, in the interests of greater accountability Implementing population-based responsibility clearly requires a collective approach. Nothing in Bill 20 appears to indicate that the government might arrive at such an approach. No discussion of population-based responsibility would be complete without considering the Kaiser Permanente model. Kaiser Permanente is a nonprofit organization whose mission is to provide high quality, affordable health care services and improve the health of its members and the communities it serves. Approximately 9.9 million people receive health care from Kaiser Permanente, which has 17,000 physicians and 174,000 employees (including 48,000 nurses) working in 38 hospitals and medical centres and more than 600 clinics. The organization lists five keys to its model's success:8 1. Accountability for population 2. Transparency 3. Use of electronic health records and the Internet 4. Team care 5. Moving care out of doctor's office There are no provisions in Bill 20 for developing any of the above. Clearly, the fee-for-service model does not encourage population-based responsibility. We have seen in the Taber example a broad basket of services covered in the clinic's overall budget, with other things remaining fee-for-service (births, major operations, anaesthesia etc.). The way physicians are currently compensated stands in the way of any strategy whereby physician groups would receive fixed budgets to care for a given population. This is where Bill 20 goes off track-by individualizing patient targets instead of grouping them. Under group approaches, a physician who fails to meet commitments and does not see the required number of patients risks repercussions from colleagues and not the government, because the physician is responsible for contributing to the group's objectives. A physician in that same clinic who sees only complex cases will necessarily see fewer patients, but colleagues will be freed up to deal with more. We sincerely believe that physicians are in favour of a population-based responsibility approach. Yet the inescapable conclusion is that Bill 20, with its fee-per-service and individualized appointment targets, is taking us in a different direction entirely. We are convinced that physicians are overwhelmingly in favour of mixed compensation methods. The health and welfare commissioner launched a series of studies to assess the impact of remuneration on health system effectiveness and efficiency. As soon as RAMQ data becomes available, researchers will be able to complete their work and show how adjusting remuneration methods would contribute to improving health care access. Conclusion It is no coincidence that we have not attempted a clause-by-clause critique of Bill 20. The government's entire approach needs to be changed. It is high time the government understood that physicians are part of the solution to health service access problems, and that a coercive approach is counterproductive and demoralizing. History is full of examples in which working together in a climate of mutual respect led to impressive results. Both the QMA and CMA fully support the idea and purpose of the bill-to improve access to health care-but we believe Bill 20 is not the answer. We think changes worked out in partnership get the best results. All real improvements to the health care system have always been achieved in an atmosphere of dialogue and collaboration. To sum up, the QMA and CMA recommend first and foremost that the government work with the medical profession to improve access to health care, as well as the following measures: * Speed up the process of switching to electronic health records-an indispensable tool in 2015. * Reorganize tasks to accord a greater role to other health professionals (NPs, nurses, administrators and others) by forming care teams that can pool their knowledge and skills to better serve patients. * Reconsider Quebec's near-exclusive reliance on fee-for-service and consider bringing in a form of mixed remuneration that leads towards a population-based responsibility model. Elsewhere in Canada, this approach has contributed significantly to improvements in health care access, particularly on the front line. 1 http://www.statcan.gc.ca/pub/82-625-x/2014001/article/14013-eng.htm 2 http://www.choosingwiselycanada.org/ 3 https://www.doctorsofbc.ca/sites/default/files/strategicplan-doctorsofbc-web.pdf 4 Wedel R, Kalischuk RG, Patterson E, et al. Turning Vision into Reality: Successful Integration of Primary Healthcare in Taber, Canada. Healthcare Policy 2007; 3(1): 81-95. 5 http://www.hqontario.ca/portals/0/Documents/qi/qip-analysis-pc-en.pdf 6 Régie de l'assurance maladie du Québec. Évolution du coût des services médicaux et du nombre de médecins selon le mode de rémunération. Services médicaux, Québec, 2009-2013. 7 http://publications.msss.gouv.qc.ca/acrobat/f/documentation/2011/11-228-04W.pdf 8 Molly Porter. An Overview of Kaiser Permanente: Integration, Innovation, and Information Systems in Health Care. Presentation for the Canadian Medical Association, Kaiser Permanente International, March 2, 2015.

Documents

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Access to a family physician

https://policybase.cma.ca/en/permalink/policy9534

Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Population health/ health equity/ public health
Resolution
GC09-29
The Canadian Medical Association will work with provincial/territorial medical associations (PTMAs) to urge governments to collaborate with PTMAs in the implementation of a program that will identify and manage "orphan" patients who do not have access to a family physician.
Policy Type
Policy resolution
Last Reviewed
2016-05-20
Date
2009-08-19
Topics
Health human resources
Health systems, system funding and performance
Physician practice/ compensation/ forms
Population health/ health equity/ public health
Resolution
GC09-29
The Canadian Medical Association will work with provincial/territorial medical associations (PTMAs) to urge governments to collaborate with PTMAs in the implementation of a program that will identify and manage "orphan" patients who do not have access to a family physician.
Text
The Canadian Medical Association will work with provincial/territorial medical associations (PTMAs) to urge governments to collaborate with PTMAs in the implementation of a program that will identify and manage "orphan" patients who do not have access to a family physician.
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Access to family physicians

https://policybase.cma.ca/en/permalink/policy9231

Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Health human resources
Health systems, system funding and performance
Resolution
GC08-51
The Canadian Medical Association, while recognizing the need for better management of chronic illnesses and vulnerable populations, considers that such an emphasis should not be detrimental to the efforts aimed at guaranteeing access to family physicians.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Health human resources
Health systems, system funding and performance
Resolution
GC08-51
The Canadian Medical Association, while recognizing the need for better management of chronic illnesses and vulnerable populations, considers that such an emphasis should not be detrimental to the efforts aimed at guaranteeing access to family physicians.
Text
The Canadian Medical Association, while recognizing the need for better management of chronic illnesses and vulnerable populations, considers that such an emphasis should not be detrimental to the efforts aimed at guaranteeing access to family physicians.
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Access to medical education for Aboriginal students

https://policybase.cma.ca/en/permalink/policy529

Last Reviewed
2017-03-04
Date
1996-08-21
Topics
Health human resources
Resolution
GC96-10
That the Canadian Medical Association and its Divisions work with Canadian medical schools to facilitate access to medical education for Canadian aboriginal students.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
1996-08-21
Topics
Health human resources
Resolution
GC96-10
That the Canadian Medical Association and its Divisions work with Canadian medical schools to facilitate access to medical education for Canadian aboriginal students.
Text
That the Canadian Medical Association and its Divisions work with Canadian medical schools to facilitate access to medical education for Canadian aboriginal students.
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Access to the comprehensive spectrum of medically necessary care

https://policybase.cma.ca/en/permalink/policy8508

Last Reviewed
2020-02-29
Date
2006-08-23
Topics
Health human resources
Health systems, system funding and performance
Resolution
GC06-34
The Canadian Medical Association and its divisions and affiliates call on the Federal/Provincial/Territorial Conference of Health Ministers to ensure that all Canadians have timely access to the comprehensive spectrum of medically necessary care by developing, through an open and consultative process, a policy framework that includes: a) a national human resources plan; b) national wait time benchmarks; c) a patient wait time guarantee supported by a publicly funded safety valve; and d) a regulatory regime to best support the public-private interface.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2006-08-23
Topics
Health human resources
Health systems, system funding and performance
Resolution
GC06-34
The Canadian Medical Association and its divisions and affiliates call on the Federal/Provincial/Territorial Conference of Health Ministers to ensure that all Canadians have timely access to the comprehensive spectrum of medically necessary care by developing, through an open and consultative process, a policy framework that includes: a) a national human resources plan; b) national wait time benchmarks; c) a patient wait time guarantee supported by a publicly funded safety valve; and d) a regulatory regime to best support the public-private interface.
Text
The Canadian Medical Association and its divisions and affiliates call on the Federal/Provincial/Territorial Conference of Health Ministers to ensure that all Canadians have timely access to the comprehensive spectrum of medically necessary care by developing, through an open and consultative process, a policy framework that includes: a) a national human resources plan; b) national wait time benchmarks; c) a patient wait time guarantee supported by a publicly funded safety valve; and d) a regulatory regime to best support the public-private interface.
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Last Reviewed
2017-03-04
Date
1974-06-26
Topics
Health human resources
Resolution
GC74-53
Whereas the profession has in the past demonstrated an interest in accreditation of certain institutions involved in the delivery of medical services, and whereas the profession is currently demonstrating an interest in the matter of encouraging the establishment of minimum standards of professional practice in the office setting, and whereas the acknowledged purposes of such standards of accreditation are to facilitate peer review and continuing professional education, and whereas the profession has demonstrated its willingness to participate in such voluntary self assessment procedures, Be it resolved that the Canadian Medical Association accept the principle of practice accreditation and continue to search for acceptable methods of practice assessment and accreditation and encourage each of its divisions to establish or enjoin committees to examine the matter of office practice accreditation, with a view to establishing procedural guidelines and standards for their various regions.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
1974-06-26
Topics
Health human resources
Resolution
GC74-53
Whereas the profession has in the past demonstrated an interest in accreditation of certain institutions involved in the delivery of medical services, and whereas the profession is currently demonstrating an interest in the matter of encouraging the establishment of minimum standards of professional practice in the office setting, and whereas the acknowledged purposes of such standards of accreditation are to facilitate peer review and continuing professional education, and whereas the profession has demonstrated its willingness to participate in such voluntary self assessment procedures, Be it resolved that the Canadian Medical Association accept the principle of practice accreditation and continue to search for acceptable methods of practice assessment and accreditation and encourage each of its divisions to establish or enjoin committees to examine the matter of office practice accreditation, with a view to establishing procedural guidelines and standards for their various regions.
Text
Whereas the profession has in the past demonstrated an interest in accreditation of certain institutions involved in the delivery of medical services, and whereas the profession is currently demonstrating an interest in the matter of encouraging the establishment of minimum standards of professional practice in the office setting, and whereas the acknowledged purposes of such standards of accreditation are to facilitate peer review and continuing professional education, and whereas the profession has demonstrated its willingness to participate in such voluntary self assessment procedures, Be it resolved that the Canadian Medical Association accept the principle of practice accreditation and continue to search for acceptable methods of practice assessment and accreditation and encourage each of its divisions to establish or enjoin committees to examine the matter of office practice accreditation, with a view to establishing procedural guidelines and standards for their various regions.
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Accreditation Standards for Continuing Medical Education

https://policybase.cma.ca/en/permalink/policy9379

Last Reviewed
2020-02-29
Date
2008-10-04
Topics
Ethics and medical professionalism
Physician practice/ compensation/ forms
Resolution
BD09-03-32
The CMA commends the rigorous accreditation standards for continuing medical education adopted by the Committee on Accreditation of Continuing Medical Education and supports constant vigilance to ensure that the content of accredited CME events is consistent with the best available scientific information and ethically sound practice.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-10-04
Topics
Ethics and medical professionalism
Physician practice/ compensation/ forms
Resolution
BD09-03-32
The CMA commends the rigorous accreditation standards for continuing medical education adopted by the Committee on Accreditation of Continuing Medical Education and supports constant vigilance to ensure that the content of accredited CME events is consistent with the best available scientific information and ethically sound practice.
Text
The CMA commends the rigorous accreditation standards for continuing medical education adopted by the Committee on Accreditation of Continuing Medical Education and supports constant vigilance to ensure that the content of accredited CME events is consistent with the best available scientific information and ethically sound practice.
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Addressing professional issues of Canadian physicians and medical practice

https://policybase.cma.ca/en/permalink/policy465

Last Reviewed
2020-02-29
Date
1999-08-25
Topics
Physician practice/ compensation/ forms
Resolution
GC99-60
That the Canadian Medical Association be the national focus for enhancing organized medicine's effectiveness in addressing the variety of professional issues facing Canadian physicians and medical practice.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
1999-08-25
Topics
Physician practice/ compensation/ forms
Resolution
GC99-60
That the Canadian Medical Association be the national focus for enhancing organized medicine's effectiveness in addressing the variety of professional issues facing Canadian physicians and medical practice.
Text
That the Canadian Medical Association be the national focus for enhancing organized medicine's effectiveness in addressing the variety of professional issues facing Canadian physicians and medical practice.
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Admissions criteria

https://policybase.cma.ca/en/permalink/policy9279

Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Health human resources
Ethics and medical professionalism
Resolution
GC08-105
The Canadian Medical Association urges Canadian medical schools to revise admissions criteria to require a minimum of two years of post-secondary education.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2008-08-20
Topics
Health human resources
Ethics and medical professionalism
Resolution
GC08-105
The Canadian Medical Association urges Canadian medical schools to revise admissions criteria to require a minimum of two years of post-secondary education.
Text
The Canadian Medical Association urges Canadian medical schools to revise admissions criteria to require a minimum of two years of post-secondary education.
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Ambulance services

https://policybase.cma.ca/en/permalink/policy786

Last Reviewed
2017-03-04
Date
1975-06-25
Topics
Health human resources
Health systems, system funding and performance
Resolution
GC75-21
The Canadian Medical Association, recognizing the vital role of ambulance services in providing mobile life support for the acutely ill and injured, recommends that i) ambulance services be considered, where practicable, a direct extension of a hospital emergency department and integrated with the emergency services, ii) ambulance services incorporate standards of personnel education, vehicular design and life support equipment commensurate with those of the overall emergency care system.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
1975-06-25
Topics
Health human resources
Health systems, system funding and performance
Resolution
GC75-21
The Canadian Medical Association, recognizing the vital role of ambulance services in providing mobile life support for the acutely ill and injured, recommends that i) ambulance services be considered, where practicable, a direct extension of a hospital emergency department and integrated with the emergency services, ii) ambulance services incorporate standards of personnel education, vehicular design and life support equipment commensurate with those of the overall emergency care system.
Text
The Canadian Medical Association, recognizing the vital role of ambulance services in providing mobile life support for the acutely ill and injured, recommends that i) ambulance services be considered, where practicable, a direct extension of a hospital emergency department and integrated with the emergency services, ii) ambulance services incorporate standards of personnel education, vehicular design and life support equipment commensurate with those of the overall emergency care system.
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Application of evidence-based medicine

https://policybase.cma.ca/en/permalink/policy9893

Last Reviewed
2017-03-04
Date
2010-08-25
Topics
Health human resources
Ethics and medical professionalism
Health systems, system funding and performance
Resolution
GC10-70
The Canadian Medical Association calls on the Association of Faculties of Medicine of Canada, faculties of medicine, College of Family Physicians of Canada and Royal College of Physicians and Surgeons of Canada to greatly expand efforts to familiarize medical students and residents with the application of evidence-based medicine, including systematic reviews, clinical practice guidelines, care pathways and related techniques to improve quality, safety and efficiency in medicine.
Policy Type
Policy resolution
Last Reviewed
2017-03-04
Date
2010-08-25
Topics
Health human resources
Ethics and medical professionalism
Health systems, system funding and performance
Resolution
GC10-70
The Canadian Medical Association calls on the Association of Faculties of Medicine of Canada, faculties of medicine, College of Family Physicians of Canada and Royal College of Physicians and Surgeons of Canada to greatly expand efforts to familiarize medical students and residents with the application of evidence-based medicine, including systematic reviews, clinical practice guidelines, care pathways and related techniques to improve quality, safety and efficiency in medicine.
Text
The Canadian Medical Association calls on the Association of Faculties of Medicine of Canada, faculties of medicine, College of Family Physicians of Canada and Royal College of Physicians and Surgeons of Canada to greatly expand efforts to familiarize medical students and residents with the application of evidence-based medicine, including systematic reviews, clinical practice guidelines, care pathways and related techniques to improve quality, safety and efficiency in medicine.
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Appropriateness in health care

https://policybase.cma.ca/en/permalink/policy11897

Date
2016-08-24
Topics
Health human resources
Resolution
GC16-26
The Canadian Medical Association calls for emphasis on considerations of appropriateness in health care as part of the medical school curriculum.
Policy Type
Policy resolution
Date
2016-08-24
Topics
Health human resources
Resolution
GC16-26
The Canadian Medical Association calls for emphasis on considerations of appropriateness in health care as part of the medical school curriculum.
Text
The Canadian Medical Association calls for emphasis on considerations of appropriateness in health care as part of the medical school curriculum.
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Arm’s- length, anonymous pre-accreditation survey

https://policybase.cma.ca/en/permalink/policy11647

Date
2015-08-26
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC15-67
The Canadian Medical Association affirms its support for the continued use of the arm’s- length, anonymous pre-accreditation survey as an integral component of the national system of accreditation for postgraduate medical education.
Policy Type
Policy resolution
Date
2015-08-26
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC15-67
The Canadian Medical Association affirms its support for the continued use of the arm’s- length, anonymous pre-accreditation survey as an integral component of the national system of accreditation for postgraduate medical education.
Text
The Canadian Medical Association affirms its support for the continued use of the arm’s- length, anonymous pre-accreditation survey as an integral component of the national system of accreditation for postgraduate medical education.
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Around-the-clock services for frail and elderly Canadians living in the community.

https://policybase.cma.ca/en/permalink/policy11600

Date
2015-08-26
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC15-20
The Canadian Medical Association supports improved training, resource allocation and incentives to help primary care physicians develop robust, around-the-clock services for frail and elderly Canadians living in the community.
Policy Type
Policy resolution
Date
2015-08-26
Topics
Health human resources
Physician practice/ compensation/ forms
Resolution
GC15-20
The Canadian Medical Association supports improved training, resource allocation and incentives to help primary care physicians develop robust, around-the-clock services for frail and elderly Canadians living in the community.
Text
The Canadian Medical Association supports improved training, resource allocation and incentives to help primary care physicians develop robust, around-the-clock services for frail and elderly Canadians living in the community.
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Assisting graduates of residency programs to find jobs

https://policybase.cma.ca/en/permalink/policy10848

Last Reviewed
2020-02-29
Date
2013-08-21
Topics
Health human resources
Resolution
GC13-22
The Canadian Medical Association will work with stakeholders to help new graduates of Canadian residency programs seek job opportunities across Canada.
Policy Type
Policy resolution
Last Reviewed
2020-02-29
Date
2013-08-21
Topics
Health human resources
Resolution
GC13-22
The Canadian Medical Association will work with stakeholders to help new graduates of Canadian residency programs seek job opportunities across Canada.
Text
The Canadian Medical Association will work with stakeholders to help new graduates of Canadian residency programs seek job opportunities across Canada.
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Auditing Physician Billings

https://policybase.cma.ca/en/permalink/policy1878

Last Reviewed
2019-03-03
Date
2004-12-04
Topics
Physician practice/ compensation/ forms
  1 document  
Policy Type
Policy document
Last Reviewed
2019-03-03
Date
2004-12-04
Topics
Physician practice/ compensation/ forms
Text
Auditing Physician Billings Purpose: The CMA has developed a set of guiding principles to assist in the formation and modification of provincial/territorial billing audit processes. These principles will ensure that billing audit systems are fair, transparent, effective and timely, and that they uphold their original objectives of ensuring the accountability of public expenditures and educating physicians on appropriate billing practices. Background: As payments to physicians are made through public monies, the integrity of the payment system is validated through physician billing audits and reviews. Audits and reviews are usually prompted by: billings that appear to be outside of the “norm,” patient complaints, physician complaints or a “focus” on a particular service/area of practice/group of physicians. Each province/territory is responsible for and has in place particular processes and procedures to review physician billings. Billing audits can be stressful events that, regardless of the audit outcome, have had adverse effects on a physician’s health and practice. Although changes over the years in billing audit practices have occurred, they have not addressed all of the physicians’ concerns. Inadequacies in the existing procedures, such as the lack of a clear decision-making process, established review timelines and options for recourse still remain. In response to this situation, many provinces/territories are reviewing and modifying their existing billing audit process. The CMA and Canada’s physicians believe in an open, accountable and transparent health care financing system. It is for this reason that the CMA has developed this set of principles related to the key components of the audit process to ensure it is fair, efficient, effective and serves the purpose it was originally intended – to ensure the accountability of public funds and to educate physicians on proper billing practices. Principles: Education on proper billing practices: The audit and review process must be undertaken as an educational exercise. In a fee based system, billing code use and interpretation are complex and can often lead to unintentional errors. If or when inconsistencies occur, the physician must be alerted and provided with the opportunity to explain his/her billing behaviour. To assist in moving the audit and review process from under a cloud of perceived punishment to that of educational enlightenment, the repayment of any funds shall not commence until the audit and review process is complete and all appeal options have been exercised. As part of this overall educational framework, it is recommended that all newly licensed physicians be offered an educational program on proper billing interpretations, procedures and practices, and of the audit process itself. Fair, Transparent and Timely Process: In order for the audit and review process to be perceived as fair, it must operate at arms length from governments and the Colleges. As a profession, physicians have been granted the privilege of self-regulation by society. Given that medicine is a highly complex art and science, physicians are the only group truly qualified to set and maintain standards and to uphold accountability in matters of professional behaviour. The billing audit and review process must observe the principles of “Natural Justice” in that the: audit findings must be both impartial and be seen to be impartial and physicians affected by the findings must be offered a fair hearing by being given notice in writing of the findings; the opportunity to respond to the findings; all of the information to prepare a response; sufficient time to prepare a response; and an oral hearing if there is a dispute on factual matters or if requested by the physician. Physicians should be informed that legal counsel and assistance can be retained at any stage of the audit and review process. Physicians should consult with their respective provincial/territorial division or the Canadian Medical Protective Association (CMPA) to see whether such assistance is available, or with lawyers who specialize in this field. Specific time limits should be adhered to in the auditing and reviewing of a physician’s billings practice, particularly related to when the review period should commence and to the duration of the review period. For example, billings should not be reviewable more than 24 months after the service is rendered and the review period should not be greater than 12 months. These limitation periods recognize that physicians will not be able to recall, with certainty, the vast amount of information contained in a patient’s medical record over the past 10 years – the average length of time in which medical records must be held. It also ensures that audits and reviews are conducted in a timely fashion minimizing undue stress and hardship on the physician and, in light of the health human resources shortage, enabling them to re-focus their attention and energy on taking care of their patients. Informed Decision-Makers: Audits and reviews to determine whether there has been any incorrect or inaccurate billing should be undertaken solely by a physician’s peers, and where possible, consisting of physicians from the same specialty and subspecialty and with similar practice type, geography and demography. This peer review group shall consider age-gender distribution and the morbidity of the patients as well as other pertinent matters in arriving at its findings and conclusions. Outcomes: Any conclusions and/or findings from an audit and review must be prepared in a written report and forwarded, in a timely manner, to the physician and the paying agency. If either party is not satisfied with the findings, they have the option of launching an appeal. The preferred route would be to pursue and use Alternative Dispute Resolution processes since they tend to encourage a more co-operative climate resulting in fair and appropriate settlements, while avoiding the excessive financial, psychological and procedural costs that can be associated with formal court proceedings. Conclusion: These guiding principles are the product of an international, provincial and territorial scan of billing audit practices. They have undergone extensive consultation with the provincial/territorial medical associations and national medical organizations. They should be used to form the foundation of and to guide any reviews or modifications to existing provincial/territorial audit and review processes. CMA Policy, Medical Professionalism, 2002. Student Behaviour Guide_Natural.Justice.htm, Dec. 2002

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Avoiding negative consequences to health care delivery from federal taxation policy

https://policybase.cma.ca/en/permalink/policy11957

Date
2016-08-31
Topics
Health human resources
Physician practice/ compensation/ forms
  1 document  
Policy Type
Response to consultation
Date
2016-08-31
Topics
Health human resources
Physician practice/ compensation/ forms
Text
The Canadian Medical Association (CMA) provides this submission in response to Finance Canada’s consultation on Legislative Proposals Relating to Income Tax, Sales Tax and Excise Duties (Draft Tax Legislative Proposals). The CMA is the national voice of Canadian physicians. On behalf of its more than 83,000 members and the Canadian public, the CMA’s mission is helping physicians care for patients. In fulfillment of this mission, the CMA’s role is focused on national, pan-Canadian health advocacy and policy priorities. As detailed in this brief, the CMA is gravely concerned that by capturing group medical structures in the application of Clause 13 of the Draft Tax Legislative Proposals, the federal government will inadvertently negatively affect medical research, medical training and education as well as access to care. To ensure that the unintended consequences of this federal tax policy change do not occur, the CMA is strongly recommending that the federal government exempt group medical and health care delivery from the proposed changes to s.125 of the Income Tax Act regarding multiplication of access to the small business deduction in Clause 13 of the Draft Tax Legislative Proposals. Relevance of the Canadian Controlled Private Corporation Framework to Medical Practice Canada’s physicians are highly skilled professionals, providing an important public service and making a significant contribution to our country’s knowledge economy. Due to the design of Canada’s health care system, a large majority of physicians – more than 90% – are self-employed professionals and effectively small business owners. As self-employed small business owners, physicians typically do not have access to pensions or health benefits, although they are responsible for these benefits for their employees. Access to the Canadian-Controlled Private Corporation (CCPC) framework and the Small Business Deduction (SBD) are integral to managing a medical practice in Canada. It is imperative to recognize that physicians cannot pass on any increased costs, such as changes to CCPC framework and access to the SBD, onto patients, as other businesses would do with clients. In light of the unique business perspectives of medical practice, the CMA strongly welcomed the federal recognition in the 2016 budget of the value that health care professionals deliver to communities across Canada as small business operators. Contrary to this recognition, the 2016 budget also introduced a proposal to alter eligibility to the small business deduction that will impact physicians incorporated in group medical structures. What’s at risk: Contribution of group medical structures to health care delivery The CMA estimates that approximately 10,000 to 15,000 physicians will be affected by this federal taxation proposal. If implemented, this federal taxation measure will negatively affect group medical structures in communities across Canada. By capturing group medical structures, this proposal also introduces an inequity amongst incorporated physicians, and incentivizes solo practice, which counters provincial and territorial health delivery priorities. Group medical structures are prevalent within academic health science centres and amongst certain specialties, notably oncology, anaesthesiology, radiology, and cardiology. Specialist care has become increasingly sub-specialized. For many specialties, it is now standard practice for this care to be provided by teams composed of numerous specialists, sub-specialists and allied health care providers. Team-based care is essential for educating and training medical students and residents in teaching hospitals, and for conducting medical research. Put simply, group medical structures have not been formed for taxation or commercial purposes. Rather, group medical structures were formed to deliver provincial and territorial health priorities, primarily in the academic health setting, such as teaching, medical research as well as optimizing the delivery of patient care. Over many years, and even decades, provincial and territorial governments have been supporting and encouraging the delivery of care through team-based models. To be clear, group medical structures were formed to meet health sector priorities; they were not formed for business purposes. It is equally important to recognize that group medical structures differ in purpose and function from similar corporate or partnership structures seen in other professions. Unlike most other professionals, physicians do not form these structures for the purpose of enhancing their ability to earn profit. It is critical for Finance Canada to acknowledge that altering eligibility to the small business deduction will have more significant taxation implication than simply the 4.5% difference in the small business versus general rate at the federal level. It would be disingenuous for Finance Canada to attempt to argue that removing full access to the small business deduction for incorporated physicians in group medical structures will be a minor taxation increase. As taxation policy experts, Finance Canada is aware that this change will impact provincial/territorial taxation, as demonstrated below in Table 1. Table 1: Taxation impacts by province/territory, if the federal taxation proposal is implemented In Nova Scotia, for example, approximately 60% of specialist physicians practice in group medical structures. If the federal government applies this taxation proposal to group medical structures, these physicians will face an immediate 17.5% increase in taxation. In doing so, the federal government will establish a strong incentive for these physicians to move away from team-based practice to solo practice. If this comes to pass, the federal government may be responsible for triggering a reorganization of medical practice in Nova Scotia. Excerpts from physician communiques The CMA has received as well as been copied on a significant volume of correspondence from across our membership conveying deep concern with the federal taxation proposal. To provide an illustration of the risks of this proposal to health care, below are excerpts from some of these communiques:
“Our Partnership was formed in the 1970s…The mission of the Partnership is to achieve excellence in patient care, education and research activities….there would be a serious adverse effect on retention and recruitment if members do not have access to the full small business deduction…The changes will likely result in pressure to dissolve the partnership and revert to the era of departments services by independent contractors with competing individual financial interests.” Submitted to the CMA April 15, 2016 from a member of the Anesthesia Associates of the Ottawa Hospital General Campus
“The University of Ottawa Heart Institute is an academic health care institution dedicated to patient care, research and medical education…To support what we call our “academic mission,” cardiologists at the institute have formed an academic partnership…If these [taxation] changes go forward they will crippled the ability of groups such as ours to continue to function and will have a dramatic negative impact on medical education, innovative health care research, and the provision of high-quality patient care to our sickest patients.” Submitted to the CMA April 19, 2016 from a member of the Associates in Cardiology
“We are a general partnership consisting of 93 partners all of whom are academic anesthesiologists with appointments to the Faculty of the University of Toronto and with clinical appointments at the University Health Network, Sinai Health System or Women’s College Hospital…In contrast to traditional business partnerships, we glean no business advantage whatsoever from being in a partnership…the proposed legislation in Budget 2016 seems unfair in that it will add another financial hardship to our partners – in our view, this is a regressive tax on research, teaching and innovation.” Submitted to the CMA April 14, 2016 from members of the UHN-MSH Anesthesia Associates Recommendation The CMA recommends that the federal government exempt group medical and health care delivery from the proposed changes to s.125 of the Income Tax Act regarding multiplication of access to the small business deduction, as proposed in Clause 13 of the Draft Tax Legislative Proposals. Below is a proposed legislative amendment to ensure group medical structures are exempted from Clause 13 of the Draft Tax Legislative Proposals: Section 125 of the Act is amended by adding the following after proposed subsection 125(9): 125(10) Interpretation of designated member – [group medical partnership] – For purposes of this section, in determining whether a Canadian-controlled private corporation controlled directly or indirectly in any manner whatever by one or more physicians or a person that does not deal at arm's length with a physician is a designated member of a particular partnership in a taxation year, the term "particular partnership" shall not include any partnership that is a group medical partnership. 125(11) Interpretation of specified corporate income – [group medical corporation] – For purposes of this section, in determining the specified corporate income for a taxation year of a corporation controlled directly or indirectly in any manner whatever by one or more physicians or a person that does not deal at arm's length with a physician, the term "private corporation" shall not include a group medical corporation. Subsection 125(7) of the Act is amended by adding the following in alphabetical order: "group medical partnership" means a partnership that: (a) is controlled, directly or indirectly in any manner whatever, by one or more physicians or a person that does not deal at arm's length with a physician; and (b) earns all or substantially all of its income for the year from an active business of providing services or property to, or in relation to, a medical practice; "group medical corporation" means a corporation that: (a) is controlled, directly or indirectly in any manner whatever, by one or more physicians or a person that does not deal at arm's length with a physician; and (b) earns all or substantially all of its income for the year from an active business of providing services or property to, or in relation to, a medical practice. "medical practice" means any practice and authorized acts of a physician as defined in provincial or territorial legislation or regulations and any activities in relation to, or incidental to, such practice and authorized acts; "physician" means a health care practitioner duly licensed with a provincial or territorial medical regulatory authority and actively engaged in practice;

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293 records – page 1 of 15.