In this week’s message you will find:
- In the National Spotlight
- Changes to Virtual Medicine Standard of Practice
- Changes to Shared Health Return to Work Guidance for Health Care Workers
- COVID Updates
- Financial Planning for physicians
- Health in the News
- Upcoming Events
In the National Spotlight
Doctors Manitoba is once again getting national attention. Our focus on the physician shortage in Manitoba, and our recommendations to recruit and retain more physicians, was the focus of a segment on Rosemary Barton Live, a national CBC program. Dr. Candace Bradshaw joined the show on Sunday to discuss the challenges and opportunities in Manitoba.
These recommendations are being made to alleviate the physician shortage and are just part of the solutions that will help physicians give Manitobans the care they need.
Developments in Alberta and BC
We continuously monitor developments and news from other PTMAs across the country and recently informed you about the newly ratified Master Agreement for Alberta physicians.
Earlier this week BC announced both a new compensation model for Family Physicians and a tentative Physicians Master Agreement.
The payment model, set to begin February 1, provides a family physician with the option to move to a blended payment model that includes a basic hourly rate, plus an encounter fee, and an annual fee for each patient in their panel. This model will be available to Family Physicians who provide longitudinal comprehensive care to their patients.
The tentative three-year Physician Master Agreement, will aim to achieve key priorities that improve health care, including discussion of gender equity, Indigenous reconciliation and workplace safety. It would also address many access issues.
Details of both the new model and the Physicians Master Agreement continue to emerge. We are watching developments closely and analyzing their impacts in the Manitoba context.
In addition to monitoring physician remuneration in other provinces, which is important to ensuring physicians here are remunerated fairly and competitively, we also monitor other public sector negotiations and have had two special committees look at innovative family practice and virtual care as part of our upcoming negotiations with government for a new master agreement in 2023.
Changes to CPSM’s Virtual Medicine Standard of Practice
The CPSM’s Standard of Practice for Virtual Medicine and the accompanying Contextual Information and Resources and FAQs were reviewed and updated at the end of September. The CPSM says these changes reflect virtual medicine lessons learned through the pandemic, and address some uncertainty expressed by physicians. The changes to the Standard of Practice are limited. Physicians are required to use their clinical judgment to determine if a virtual medicine visit is appropriate, and must also consider the patient’s best interest. The updates to the Contextual Information and Resources, which “are provided to support registrants in implementing this Standard”, give some added certainty to virtual medicine visits.
The most important changes are as follows:
- Examples of virtual medicine that would not meet the Standard would be physicians who do not personally offer timely in-person appointments within 24 – 48 hours, and restricting in-person visits inappropriately or without an objective rationale;
- Most psychiatry and mental health encounters can be safely provided through virtual medicine with the occasional in-person session;
- Video visits are preferable to telephone visits, unless the patient desires a telephone visit or cannot access video technology. Phone visits may be substituted only if acceptable to the patient, and generally when the physician is familiar with the patient and a video call is unlikely to yield additional information; and
- The CPSM reminds physicians to set aside time to recuperate and recharge, and not feel the need to be always available through technology.
The FAQs have been updated to reflect these changes and suggest greater flexibility in determining the balance of in-person and virtual medicine visits where appropriate. The Virtual Medicine Across Provincial and International Borders document offers greater clarity on when it is and is not appropriate to provide virtual medicine to patients located outside of Manitoba. If you have concerns about CPSM’s new guidance for virtual care, we invite you to contact us at COVID19@DoctorsManitoba.ca.
We remind you that: with any virtual medicine visit, if either you or your patient are temporarily out of the province, as a general rule you MAY NOT bill for the service. Further, liability may depend on many factors include specific location of the patient. Advice from CMPA should be sought.
Changes to Shared Health Return to Work Guidance for Health Care Workers
This week, Shared Health offered new guidance on return to work as follows:
“Motivated by widespread staffing challenges being experienced across the health system as well as the risk that staff illness may pose to the continued delivery of vital health services”, Shared Health has revised its return to work guidance. “The changes balance the need to minimize the risk of COVID-19 transmission in health settings with the need to maintain staffing for vital health services, particularly during the upcoming respiratory virus season”, and came into effect October 31.
Under the new guidance, health care workers with mild symptoms can return to work sooner or without a negative test result. Employees who develop new COVID-19 symptoms within four months of a confirmed case are no longer required to test for the virus. They can return if their symptoms are “mild and improving,” as long as any lingering effects don’t stop them from wearing personal protective equipment and no fever has been present for 24 hours without the use of medication.
Workers who develop symptoms without a confirmed case in the previous four months must perform a rapid antigen test, but they are no longer required to take a second test if the first result is negative and their symptoms do not worsen. They can return to work under the same conditions as those who have had infection in the last 4 months.
Health care workers who have a positive rapid test result may now return to work on the fifth day after the onset of symptoms or the positive test and will not require a negative test before returning to work.
Those who are asymptomatic following household exposure no longer have to test themselves before returning to work.
Current COVID-19 information for the public can be found here and information for Health Care Providers can be found here. The last update to return to work for health care workers was on April 1, 2022.
Doctors Manitoba is reviewing the guidance, seeking expert advice, and advocating for those who are ill to be able to rest and recover and not be pressured into returning to work before they are able to do so.
COVID Surveillance Update
Public Health posts weekly COVID-19 Surveillance Reports on Thursdays. This week’s report covers the week ending November 2 and shows increased activity compared to last week. Highlights include:
- Severe outcomes from COVID-19 are rising. There were 116 hospital admissions, up from 100 last week. This includes 7 ICU admissions, down from 16 last week. Weekly hospital admissions last peaked at 264 in the week ending April 16.
- There were 11 deaths recorded, up from 8 last week. There have now been 2,232 deaths related to COVID-19.
- There were 411 lab-confirmed cases reported in Manitoba over the last week, up from 362 last week.
- The test positivity rate was 28.7%, up from 24 % last week.
The updated wastewater surveillance dashboard for Winnipeg is showing decreased activity at all three sites monitored, and a significant decrease in Brandon.
As people move more activities indoors with fall and winter weather arriving, and with respiratory viruses circulating more broadly, experts are predicting COVID circulation to increase. This is leading to renewed calls for people to get their COVID booster shot and flu shot, to stay home when they are ill, and to consider masking when in poorly ventilated or crowded areas.
On September 9, 2022 the National Advisory Committee on Immunization (NACI) released updated guidance that reaffirmed the effectiveness and safety of receiving either mRNA COVID-19 vaccine during pregnancy and breastfeeding. Vaccination during pregnancy protects against severe disease, hospitalization, intensive care unit admission and death due to COVID-19. Current evidence indicates it is safe to receive an mRNA COVID-19 vaccine during any trimester. It does not increase the risk for miscarriage, stillbirth, low birth weight, preterm birth or neonatal intensive care admission. The rate of side effects after getting the vaccine are the same for both pregnant and non-pregnant people.
Manitoba Health recommends the following:
- Pregnant individuals should receive a fall COVID-19 vaccine booster dose at any stage of pregnancy.
- Individuals who are at high risk of severe illness from COVID-19 and are breastfeeding should receive a fall COVID-19 vaccine booster dose.
- The bivalent COVID-19 mRNA vaccine is the recommended product for fall booster doses.
- An interval of 6 months since the most recent COVID-19 vaccine dose or COVID-19 infection is recommended. However, the minimum interval is 3 months since their last dose and fully recovered from their last COVID-19 infection.
Financial planning for physicians — why you’re different
The following content is from MD Financial / Scotiabank
A financial plan is the roadmap that guides you to your life goals and lays out how you intend to use your money to reach those goals over time. Physicians and physician households face both unusual challenges and exceptional opportunities in their financial planning: learn how professional guidance can help.
Health in the News
Here are some recent news stories we have curated for physicians and medical learners.
DRMB in the News
- Doctor, nurse recruitment spending dropped in 2021 – 22: Documents — Brandon Sun (Print Edition) • Oct 28
- Premiers seek to pressure Ottawa for increased health-care funds — Winnipeg Free Press (Print Edition) • Oct 28
- Manitoba’s doctor shortage: medical professionals say the situation is ‘very critical’ — City News • Oct 30
- Plan tackles chronic doctor shortage — Winnipeg Free Press (Print Edition) • Oct 28
- The new report looking at recruiting doctors to rural Manitoba — CTV News • Oct 28
- How will our province address physician shortage in rural Manitoba? — SteinbachOnline.com • Oct 28
- ‘Top priority’; New plan to address doc shortage in northern region — Winnipeg Sun (Print Edition) • Oct 29
Health System News
- Throne speech must focus on health care — Winnipeg Free Press (Print Edition) • Nov 1
- Manitoba health-care workers no longer need negative COVID-19 test to return to work — CTV News • Nov 2
- CMA Eager to Collaborate for the Benefit of Health Care Workers - CMA • Nov 2
- Manitoba slated to spend less on health care in 2022: CIHI — The Winnipeg Sun • Nov 2
- Manitoba expands hours, adds staff at addictions treatment clinics — CBC Manitoba • Nov 2
- Critics call for changes to Manitoba’s ‘unacceptable’ English proficiency test requirement for nurses — CBC Manitoba • Nov 2
- Suicide crisis prompts Island Lake chiefs to call for equal access to health care — CBC Manitoba • Nov 2
- Community groups lobby for changes to help combat overdose deaths — The Winnipeg Sun • Nov 2
- ‘This has been needed for years’; Manitoba’s first formal overdose prevention site hits Winnipeg — Winnipeg Sun (Print Edition) • Nov 1
- Manitoba government says throne speech Nov. 15 will focus on health care and affordability — CBC Manitoba • Oct 28
- U.S.-bound Manitobans frustrated waiting for proof of vax booster — Winnipeg Free Press (Print Edition) • Oct 28
- Staff shortages driving need for agency nurses — Brandon Sun (Print Edition) • Oct 28
- Manitoba Government Investing $390,000 to Support Expansion of Rapid Access to Addictions Medicine Clinic Services — MB Gov • Nov 2
Here are some important and popular recent updates, in case you missed them:
- Last week our President Dr. Candace Bradshaw sent a message for all physicians and medical learners.
- We have been busy with reports and recommendations to deal with the physician shortage in Manitoba, especially in Rural and Northern communities.
- We’ve added new Cognitive Behavioural Therapy (with mindfulness) CBTm courses for the new year!
- We’ve got answers to physicians’ vaccine questions.
- Doctors Manitoba gained international attention at the International Conference on Physician Health in Florida
- Nominations are open for CMA’s President-Elect
- See our current advertising campaign and help spread the word!
- Nominations are Open for CMA Awards — Nominate a colleague today!
- There’s a new Major CMPA credit for 2023
Upcoming events are always listed on our events calendar.
Building the Foundations of Anti-Oppressive Healthcare—November 22 from 8:00am to 12:00pm CST
Learn the language and frameworks of anti-oppression and social justice. Explore how the Canadian healthcare system continues to participate in discrimination and oppression, and how health care professionals can engage in praxis – theory-informed action in the pursuit of social justice. Participants will be asked to critically reflect on their own assumptions and behaviours; to interrogate organizational practices and policies; and to identify ways to use their social power to disrupt, reshape, and reimagine our workplaces and institutions.
Jointly offered by CFD and Office of Inclusion and Diversity.
Raising Awareness — Avoiding Unauthorized Health Products Online — Five Session Options in November.
This webinar is intended to increase awareness of the prevalence of unauthorized and/or adulterated health products in the online market place. This webinar will also provide resources to health care professionals in order to guide patients to legitimate sources of compliant health products.