In today’s message you will find:

Surgical Task Force Update on Hip, Knee Replacements

Yesterday the Diagnostic and Surgical Recovery Task Force announced three new out-of-province partnerships to help address wait lists for hip and knee replacements. This will create an opportunity for patients who are eligible for these procedures and willing to receive care out of province, to identify themselves and learn more about the process. The province has signed agreements that will help connect more patients with orthopedic surgeries, like hip or knee replacements, at three out-of-province clinics.

At the end of this month, a pilot project with Big Thunder Orthopedic Associates in northwestern Ontario will launch with six patients. It is expected the program will expand to provide care for as many as 20 to 30 people per month, or around 300 procedures per year, at locations in Dryden, Fort Frances and Kenora as the program is fully implemented. 

Manitoba is also building on its agreement with Sanford Health in North Dakota, which has provided spinal surgeries to 28 eligible patients in recent months. In September, up to 10 patients per month are expected to travel to the clinic for hip or knee surgeries, the minister noted, adding that 125 procedures may be completed this year, with capacity growing to 250 procedures in 2023 – 24

A third agreement has also been signed with the Cleveland Clinic, in Cleveland, Ohio, for hip surgeries. This project is expected to launch later in September, with 100 people expected to receive this care and another 200 in the following year. 

The task force’s surgical and diagnostic dashboard, which will provide monthly updates on median wait times, the number of people on wait-lists and completed procedures is expected to launch online in September. 

Patients can self-identify if they meet the criteria by completing this eform or by emailing patientnav@​gov.​mb.​ca. If a patient meets the criteria, their surgeon may refer them to one of the out-of-province programs. You can read the criteria for eligibility and other information here.

At the press briefing head of surgery, Dr. Ed Buchel stressed the significant effort and personal time given by anesthesiologists across the province in preventing over 300 surgeries being cancelled this coming fall. 

CMA Physician Health Survey Reflects DRMB Findings

The CMA released its 2021 National Physician Health Survey results today. The mental health of physicians and medical learners has continued to deteriorate in recent years, with the COVID-19 pandemic exacerbating existing cracks in the health care system. Ahead of the more recent staffing shortages and compounded pressures being felt in the health care system, 48 per cent of Canadian physicians and medical learners screened positive for depression and 53% are reporting higher levels of burnout. The survey found that six in ten respondents believe their mental health is worse now than before the pandemic. The survey also found that:

  • physicians and medical learners report feeling burdened by increased administrative loads, resulting from an average of 10 hours of administrative tasks each week
  • 51% of physicians report lacking work-life integration
  • 8/10 physicians are experiencing bullying and harassment in the workplace 
  • 79% of physicians and medical learners lack professional fulfillment
  • nearly half of respondents are considering reducing their clinical work in the next two years
  • 14% of respondents have thought of suicide in the last 12 months
  • nearly half (47%) reported low levels of social well-being (up from 31% in 2017)
  • there are several at-risk subgroups who may be experiencing more negative wellness outcomes, including residents, younger physicians, women, those with six to 10 years in practice, parents and/​or caregivers, those living with disabilities and those working in small towns/​rural or isolated/​remote areas 

The survey results are consistent with the concerning data Doctors Manitoba has collected from our members. We found that 41% of physicians are considering retiring, leaving Manitoba, or reducing their clinical hours over the next three years. That’s two in five. Physician wellness is one of our key priorities and this report validates the work we are doing to improve the health and well being of our members. We know workplace and system interventions are essential to reducing and preventing burnout so we are working to put physicians’ voices front and centre with health system leaders to develop solutions. We’re also investing in additional resources to ensure physicians can get the support they need now to address burnout, depression, and other psychological distress. You can read our President, Dr. Candace Bradshaw’s June 28 letter concerning physician health and wellness here.

Federal Health Minister Visits Manitoba

Jean-Yves Duclos, Federal Health Minister joined Minister Audrey Gordon to announce funding supporting long-term care in Manitoba. 

The federal government will be putting forward $37 million to help the long-term care system in the province. Minister Duclos said the funding will be use for financial support for staff retention, ensuring adequate supply of personal protective equipment for staff and visitors, renovation and upgrades of ventilation systems within facilities and strengthening infection and control measures, as well as training.” The money is coming from a newly signed agreement called the Safe Long-Term Care Fund, which has a total investment of $1 billion.

Doctors Manitoba Board President Dr. Candace Bradshaw joined other physicians and health care professionals as they met Minister Duclos for a round table discussion to explore the challenges and opportunities physicians face in delivering high-quality family health services and how the federal government can play a role in supporting physicians in the delivery of family health services.

COVID Update

COVID Surveillance Updates

Public Health posts weekly COVID-19 Surveillance Reports on Thursdays. This week’s report covers the week ending August 24 and shows​an increase in cases but a decrease in severe outcomes . Highlights include:

  • Severe outcomes from COVID-19 increased compared to the previous week. There were 60 hospital admissions, down from 72 the week before. This includes 8 ICU admissions, down from 19 the previous week. Weekly hospital admissions last peaked at 264 in the week ending April 16.
  • There were 9 deaths recorded, up from 2 the previous week. There have now been 2,105 deaths related to COVID-19.
  • There were 473 lab-confirmed cases reported in Manitoba over the week, up from from 455 the previous week and the highest number since May. The test positivity rate was 23.9%, up only slightly from 23.8 %.

The updated wastewater surveillance dashboard for Brandon shows lower levels than other peaks, but with an increase in viral load this week. Winnipeg continues to show lower levels of COVID-19 circulating for the most recent week, ending August 18. The levels in Winnipeg are lower than the peaks in July or earlier in August.

COVID Booster Update

Yesterday Manitoba Health approved first boosters of Pfizer/​Comirnaty® (10 mcg) COVID-19 vaccine ≥ 6 months after completion of a primary vaccine series for children 5 – 11 years of age. If you recommend a child receive a booster sooner than 6 months based on that child’s specific circumstances (e.g. to optimize immune response based on when a next dose of immunosuppressing medication is due), this will require a prescription if administered outside a physician’s office. Vaccination is specifically recommended for children with an underlying medical condition that places them at high risk of severe illness due to COVID-19. If an individual has had a recent COVID-19 infection, in addition to the eligibility criteria above, public health recommends (but does not require) the following intervals between infection and getting the vaccine:

  • two months if the person has not completed a primary series
  • three months if the person has completed a primary series.

Note: At the very least, people need to wait until they have fully recovered and completed their isolation period before getting their next eligible dose. NACI also advises that children aged 5-11 years may receive non-COVID-19 vaccines before, on the same day, or after receiving COVID-19 vaccines

You can read NACI’s recommendations here. Read the letter from Manitoba Health here.

Read last week’s update on boosters.

Taking Action on Rural Health Crisis — Reminder

In partnership with the Manitoba Chambers of Commerce a Stakeholder Summit will be held September 21 from 10am to 4pm in Portage la Prairie, bringing together physicians with a variety of health, business, and community leaders to 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.

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 Rural​Care​.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.

Want to participate?

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.

Health System Updates

Provincial Guidance for AGMPs

Guidance for Aerosol Generating Medical Procedures (AGMPs) has been updated to require all health care workers in procedure rooms to wear eye protection (regardless of the category of the patient receiving an AGMP), and an N95 respirator when patients/​residents/​clients are designated red or orange zone. In circumstances involving Green Zone patients and no clinical concern of infection, staff may perform a Point of Care Risk Assessment (PCRA) in order to choose a medical mask or an N95 for protection. You can view Provincial Guidance on the Transmission of COVID-19 here. Learn strategies to reduce risk from AGMPs, review accommodation, PPE and cohorting guidance, and view a list of procedures considered to be AGMPs here.

Med School Application Cycle Opens

The 2022/2023 Max Rady College of Medicine’s Doctor of Medicine application cycle is officially open! Learn about the program and how to apply here.

Providing abortions to American patients: Medico-legal risks and CMPA support

Physicians and medical learners in the US have adopted an AMA policy, stating access to reproductive health services, including abortion and contraception, is a human right. In accordance with the new policy, the AMA will seek expanded legal protections for patients and physicians against government systems of control and punishment that criminalize reproductive health services. The new policy also calls for AMA to seek legal protections for patients who cross state lines to receive reproductive health services, as well as legal protections for physicians and others who support or provide reproductive health services or referrals to patients who cross state lines.

The CMPA has provided advice to physicians respecting abortion services sought by U.S. residents, in light of the recent decision of the Supreme Court of the United States and legislative changes in many states (including North Dakota). There is considerable uncertainty about Canadian physicians’ liability under various state laws.

The CMPA is hosting a webcast on the issue on Tuesday, September 6, 2022 from noon to 1:00 p.m. CST. It will feature a virtual panel discussion, with Q&A session, and simultaneous interpretation.This webcast will be recorded and posted on the CMPA website. You can find out more information and resources and register for the webinar (CMPA member number and password required) here. Registration for the live webcast closes on September 12022

Seasonal influenza 2022/23: registration reminder

There is a remodeled ordering and delivering process for the 2022/23 influenza season that will guarantee earlier access to influenza vaccine, increase order frequency throughout the season, and reduce wastage. ALL health care providers need to register by filling out this form. The earlier you register, the sooner your location will be placed in one of the two distribution groups. Registration is still required even for those who have administered the influenza vaccines in the previous years or have already registered to receive COVID-19 vaccines. Providers/​facilities cannot request vaccine until they have registered. You can read more about the new enhanced ordering model here and read a FAQ page here. Read Manitoba Health’s letter to health care providers here.

Upcoming Events

Upcoming events are always listed on our events calendar.

Physician Wellness: Reflections on the challenges and opportunities — September 12, 2022 at 6pm

From Practice to Policy-Keeping What Worked: Lessons Learned from COVID-19 pediatric immunizations— Day-long Mini Conference — September 13

The Eighth Wave — Challenges and predictions for an uncertain future — September 19, 2022 at 12pm

Rural Health Care Summit — September 21 from 10am-4pm in Portage la Prairie

Reflections on Leadership During COVID-19: A discussion with Dr. Joss Reimer - September 21 5:30pm to 7:30pm

New to Practice Webinar — Two options — September 13 and September 21 — both at 6pm