Earlier today, we announced a partnership with the Manitoba Chambers of Commerce to develop solutions to physician shortages in rural and Northern Manitoba.
A Stakeholder Summit will be held in September, bringing together physicians with a variety of health, business, and community leaders. They will review current challenges, examine physician recruitment and retention best practices from Manitoba and other Canadian jurisdictions, participate in facilitated discussions, and build consensus about the actions and strategies needed to attract and retain more doctors in rural and Northern Manitoba. A formal report will be developed based on the Summit consensus and submitted to government and health care system representatives.
In announcing the partnership, our President Dr. Candace Bradshaw explained that “patients are feeling the impact from the physician shortage every day. Manitobans are affected by ER closures, difficulty finding a family doctor, and long waits to get a diagnostic test or surgery. These are longer-term issues affected by a shortage of doctors, and they have been exacerbated by the pandemic over the last two years.”
From the Manitoba Chambers’ perspective, President and CEO Chuck Davidson emphasized why they are focusing on the physician shortage crisis now. “Our members told us in a recent survey that health care system recovery and investment is their top concern, because accessible, reliable, and efficient care enables Manitobans to flourish wherever they reside while ensuring the region is attractive to potential new residents and investment. There is a demonstrated direct correlation between a community’s level of physician care, and that community’s economic potential and long-term sustainability. Manitoba’s ability to recruit and retain more doctors will be an important contributor to our future economy.”
Responding to our joint plan, Health Minister Audrey Gordon welcomed the initiative, saying she “looks forward to the recommendations from Doctors Manitoba and the Manitoba Chambers of Commerce. These two groups have an intimate understanding of the needs of their members and what would attract physicians to these positions that are traditionally difficult to fill. Our government is open to exploring all options to improve the well-being and economic health of our rural and northern communities.”
Many jurisdictions throughout Canada are struggling with a shortage of physicians, but the challenge in Manitoba is particularly concerning:
Manitoba has the lowest number of family physicians per capita in Canada, and the third lowest for specialist physicians according to the most recent data from the Canadian Institute for Health Information.
40% of physicians are planning to retire, reduce their clinical hours, or move to another province over the next three years, according to a survey earlier this year by Doctors Manitoba.
Nearly half of physicians are showing signs of burnout, which research has shown to be a leading cause for physician retention challenges.
Of course, physician shortages are only part of the cause of the current crisis in rural and Northern health care. Doctors Manitoba continues to monitor and raise concerns about shortages in nurses, technologists and other health care workers, as well as other potential issues like medical transportation, administrative burden, health system support and the still undisclosed plan for rural hospital restructuring.
The Summit initiative builds on our RuralCare.ca public awareness campaign. Over the summer, we’ve used social and news media to raise awareness about the issues in rural and Northern health care. Widespread part- and full-time ER closures have hit an all-time high, and physicians have been concerned about patients accessing the care they need.
Are you interested in participating? If you are interested in participating in the Summit, please email Maclean at mboyd@doctorsmanitoba.ca. Please include your location of practice and full name in your email. Space is limited and we want to ensure we have a strong and regionally representative group of physicians and medical learners in attendance.
The Summit will be held on Wednesday, September 21 in Portage la Prairie. It will start at 10:00 am, and should wrap up by 3:00 or 4:00 pm.
Major CMPA Fee Credit for 2023
Earlier this week, CMPA announced a substantial credit on 2023 liability insurance fees. In Manitoba, after the one-time credit in 2023, your net fees will drop by an average of 90%! This is good news for physicians following two years of pandemic uncertainty.
The reason for this substantial credit is better-than-anticipated returns on investments, which CMPA is passing back to physicians as a one-time fee credit. This means the average physician CMPA fee of $3,563 will receive a one-time $3,219 fee credit, leaving just $345 to pay. The 2023 fees are now available on CMPA’s website under Fees and Payment. CMPA will post 2023 invoices online in the fall.
While this is certainly good news, we recommend physicians plan for this as a one-time reduction, and anticipate CMPA fees could return to previous levels the following year. In fact, when we look ahead to 2024, CMPA may not be able to offer a similar credit on its fees for a couple of reasons. First, the economic outlook is mixed which could result in lower investment returns. Second, it is possible claims against physicians could increase this year as patients catch up on care missed during the pandemic. In 2021, the amount paid out on claims actually increased from the year before. As well, we know CPSM has reported an increase in the number of complaints it is receiving which could increase the use of CMPA services.
CMPA manages claims cautiously, always ensuring it has sufficient funds to pay out all future claims.
For 2023, however, this is a positive development. For most physicians in Manitoba, we expect your net CMPA fees to be well below $1,300, the amount physicians must pay before qualifying for the PLIF/CMPA rebate we have negotiated with the provincial government (see eligibility criteria here). For this year, eligible physicians should receive your CMPA Rebate application shortly to claim your rebate for 2022 fees.
The provincial government announced a plan to increase Manitoba’s minimum wage to $15 per hour by October 2023. The phased-in approach will see the minimum wage increase to $13.50 per hour this October, then to $14.15 next April, followed by the increase to “around” $15 in October next year.
The Premier described this as a “fair and balanced approach” that seeks to help address inflation for low-income earners while phasing in the change to support small businesses.
Labour groups have long called for a $15 per hour minimum wage, but that was before the pandemic and current inflationary pressures. They say $15 is no longer sufficient, and instead pushed for the minimum wage to be increased to $16.15 per hour, which they describe as a minimum living wage. Business groups had advocated for an increase to $13 to $14 per hour.
Manitoba’s current minimum wage is $11.95 per hour. After the increase to $13.50, Manitoba’s minimum wage will still be the second lowest in Canada.
Doctors Manitoba is interested in how the minimum wage increase will impact your patients and your practice. We have heard from many physicians concerned about how a low minimum wage and inflation are impacting low-income patients and their well-being. We’re also aware this increase could affect physician practices on top of several other added costs over the past two years, such as PPE and other inflationary pressures. The Manitoba government says it will be consulting the business community on potential supports. Please send your thoughts to practiceadvice@doctorsmanitoba.ca.
COVID Surveillance Updates
Public Health posts weekly COVID-19 Surveillance Reports on Thursdays. This week’s report covers the week ending August 17 and shows“increased activity” . Highlights include:
Severe outcomes from COVID-19 increased compared to the previous week. There were 72 hospital admissions, up from 57 the week before. This includes 19ICU admissions, up from 12 the previous week. This is the highest number of weekly ICU admissions since May. Weekly hospital admissions last peaked at 264 the week ending April 16.
There were 2 deaths recorded, down from 6 the previous week. There have now been 2,093 deaths related to COVID-19.
There were 455 lab-confirmed cases reported in Manitoba over the week, up from from 347 the previous week. This is the highest number since May. The test positivity rate was 23.8%, up from 20.8%.
The updated wastewater surveillance dashboard for Winnipeg and Brandon continues to show lower levels of COVID-19 circulating for the most recent week, ending August 11. These levels are lower than peaks in July or earlier in August.
COVID Booster Updates
Today, Health Canada approved offering a booster dose of the Pfizer vaccine to children between five to 11 years old. Based on advice from the National Advisory Council on Immunization, children with underlying health conditions should be offered a booster no earlier than six months after their second dose, and all children in this age group can also receive the first booster dose. We anticipate Manitoba Public Health will issue guidance on this very soon directly to physicians.
Meanwhile, as we approach fall we are still awaiting a decision from Health Canada on a bivalent COVID-19 vaccine for use as early as September, though there there have been some developments about fall booster programs.
While we await the decision from Health Canada on a bivalent COVID-19 vaccine for use as early as September, there have been some developments about fall booster programs.
The first approval for a bivalent booster vaccine for adults occured a few days ago in the UK. Made by Moderna and found to meet the UK regulator’s standards of safety, quality and effectiveness, this updated version of the vaccine targets two variants of COVID-19 and triggers a strong immune response against both Omicron (BA.1) and the original 2020 strain.
Meanwhile in the U.S., the FDA is not satisfied with a booster that targets the original Omicron subvariant, instead directing vaccine developers to develop vaccines that target dominant subvariants BA.4 and BA.5. With pressure from the White House to have this booster available in September, the FDA has changed its approach to a new “streamlined” strategy that will see the boosters tested on mice, but not necessarily humans.
Here in Canada, provinces have adopted an uneven approach in using existing boosters based on the original 2020 strain through the summer, in anticipation of a new updated booster being available in early fall. In Manitoba, the second booster shot (4th dose) is available to Manitobans who are age 50+, or age 30+ for First Nations, Inuit and Métis people. Adults 18+ are only eligible if they live in a personal care home, elderly persons housing setting or if they are immuno-compromised.
This week, however, the Quebec government has introduced its own plan to offer a third booster shot, or 5th dose, to all adults by the end of August. Quebec is starting with those age 75+ or those who work in health care now and those 60+ will be able to book on Monday. Quebec plans to open up fifth dose appointments to all Québécois age 18+ on August 29. Quebec Health Minister Cristian Dube says they have the capacity to offer 300,000 doses of the vaccine each week. Public health will not be recommending any mandatory measures ahead of the start of schools reopening.
This has raised some concerns, as a booster shot now might mean those at risk would have to wait for a better bivalent booster if it becomes available early fall.
The National Advisory Committee on Immunization’s most recent advice about fall boosters from early summer suggests waiting for a possible bivalent booster, but advises provinces to plan for a booster shot campaign, prioritizing access based on risk.
Monkeypox Case Confirmed in Manitoba
Manitoba Public Health advised today of the first confirmed Monkeypox case in Manitoba.
Dr. Jazz Atwal, deputy chief provincial public health officer, reassured the public that it appears this case was infected outside of Manitoba, and that they “believe this is an isolated case.” Public health undertaking contact tracing, and will follow up should close contacts be identified.
Vaccine appointments continue to be available to eligible groups considered most at risk, with walk-in appointments now planned in downtown Winnipeg.
You are invited to share your views about testing and treatment for Helicobacter Pylori (H. Pylori) before the end of August.
A study led by Manitoba physicians Dr. Charles Bernstein, Dr. Seth Shaffer and Dr. Alexander Singer is exploring physicians’ current approaches to testing and treatment of H. pylori. The investigators are part of a larger team exploring the developing of metagenomics to determine H. pylori antibiotic resistance profiles.
No personal or identifying information will be collected and all information will be collated; no responses will be attributed to any one individual.
If you would like to complete the survey and/or have more information, please click here. The survey should take about 10 minutes to complete.
Health System News
It’s been a busy week for news in the health system. See below for the latest. The most relevant updates to clinical practice we’ve found include:
Nursing shortages have been a big talker this week, with the reliance on private nursing agencies and issues in rural and Northern areas dominating the headlines:
The Royal College is looking for nominations for the Dr. Thomas Dignan Indigenous Health Award. Nominate a physician, resident, medical learner, Elder and/or Knowledge Keeper whose contributions are making an impact in #Indigenous health. Dr. Dignan of Thunder Bay, Ontario, a Mohawk from Six Nations of the Grand River Territory, was a tireless advocate for eradicating disparities in health outcomes and inequities in the quality of health care facing Indigenous People. Deadline is Sept 30. Get the details here!
ICYMI
Here are a few important and popular recent updates, in case you missed them.
Free, On-Demand (self-led) Modules (for all physicians)
*Click on links below to register. You do not need to be a CMA member, you just need to have a complimentary cma.ca account. Click here to create an account and contact pli@cma.ca to set up your CMAID*
Additional practice management resources (e.g. checklists, interview questions, staffing, evaluating practice opportunities, etc.) are also available online (scroll to the bottom).
Cognitive Behavioural Therapy with mindfulness (CBTm) for Physicians & Medical Learners
Cognitive Behavioural Therapy with Mindfulness (CBTm) for Physicians and Medical Learners is a set of courses designed to offer education and skills training in evidence-based self-management strategies to support the mental wellbeing of physicians and medical learners, delivered in a supportive peer environment.
