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In today’s message you will find:

Billing Advice

Starting October 1, there are new and enhanced fees and remuneration available to physicians thanks to the new Physician Services Agreement. This includes over 100 new tariffs across all blocs, which is the largest expansion of tariffs in decades, and perhaps ever. 

Over the last week we offered new resources to help you with implementing and adopting new and expanded remuneration options in your practice:

Based on questions coming in this week, we are offering some supplementary advice and guidance on a few new tariffs. Please keep your questions coming to practiceadvice@​doctorsmanitoba.​ca. We will be featuring new information in our weekly newsletters throughout October on new tariffs and how they can help you in your practice. 

Community-Based Practice Support

Every visit taking place in eligible community-based practices will now be eligible for a supplement of $3.50.

We’ve received several questions about what types of visits are eligible and in what facilities. 

The Physician’s Manual is clear that any visit (not procedure) tariff claimed in a physician office or home visit environment is eligible to also claim the Community-Based Practice Supplement ($3.50 per visit, tariff 8380). It is also clear that this tariff can not be claimed for visits in a hospital, PCH, or other publicly funded facility such as an RHA owned and operated clinic, or hospital outpatient clinic. Our billing guide offers more context about why this new tariff was created that helps to answer some of these questions. 

We’ve also received questions asking about how the $3.50 should be divided between clinic owners and associates. Like any tariff and overhead conversation, this is something that needs to be discussed and agreed to within individual clinics. Our billing guide offers some advice on this as well.

Learn more about why this new tariff was developed and how to claim it.

Hospital Premiums

All visits rendered for inpatient care will now be eligible for a 15% premium. A new tariff, 5515, has been created and must be claimed along with eligible hospital visit tariffs. You can read our billing guide here.

We’ve heard from some physicians asking to clarify the rules on this, including which visits are eligible. The Physician’s Manual clearly lists eligible visit tariffs that qualify for the 15% premium. If you have a visit tariff in hospital that is not on the list, but you think it should be, please let us know by emailing practiceadvice@​doctorsmanitoba.​ca, and we will look at pursuing this with Manitoba Health. 

We’ve also heard from some doctors about which facilities count as hospitals. We are seeking clarity on this now with Manitoba Health and will report back.

Extended Visits

Family physicians and pediatricians now have access to a new tariff for extended visits involving two or more patient complaints and lasting 20 minutes or longer. The new extended visit is available in-person or on video, and is approved as a provisional tariff for an 18-month period. Doctors Manitoba and Manitoba health will evaluate its value and effectiveness. Learn more about the new extended visit tariff here.

We’ve received questions from some physicians seeking clarity about what qualifies for an extended visit. The Physician’s Manual has clear criteria posted, noting that an extended visit can be claimed when assessing two or more distinct complaints or problems from the patient, and shall consist of:

  • A history of the presenting two or more complaints;
  • An examination of the parts or systems related to the presenting complaints;
  • A review of all pertinent investigations;
  • A complete written record and advice to the patient;
  • The visit shall be a minimum of twenty (20) minutes of physician time.

Some have asked if the extended visit is an extender for other visits. It is not. This is a new visit tariff, the first broad visit tariff added in three decades, and it stands alone as an alternate to an intermediate visit or complete exam.

We’ve also been asked if age premiums and/​or pelvic exams and pap tests, or extended hours premiums, can apply to an extended visit. The answer to this is yes. The extended visit tariff is treated like other common visit tariffs, and qualifies for these add-ons assuming the situation qualifies. 

Please remember the extended visit is a provisional tariff for an 18-month. It is new and will be evaluated jointly by Manitoba Health and Doctors Manitoba. We encourage physicians to be conscientious with the use of this new tariff and the supporting documentation, with an expectation that claims will be reviewed carefully as the province considers whether or not to make this tariff permanent. Please let us know how you are using this tariff in your practice and how it is making a difference for your patients by emailing us at practiceadvice@​doctorsmanitoba.​ca.

Manitoba’s New Government

On Tuesday, Manitobans elected a new government, led by the NDP’s Wab Kinew. He will soon become Canada’s first First Nations Premier. Health care emerged as the top issue in the election, and appears to be the top priority for the incoming government’s agenda. 

Doctors Manitoba worked months before the election to position health care as a top issue and consult physicians to inform recommendations for all political parties. Our Prescription for Health Care was released in August and shared with all political parties, and they each adopted different parts of our advice. The party that won the election, the NDP, specifically adopted some of our top recommendations, including:

  • Recruiting 400 more physicians to help bring Manitoba closer to the Canadian average for doctors per capita, including expanding training and recruitment incentives. 
  • Adding 250 providers to physician-led clinics to expand team-based care.
  • Building up hospital capacity. The NDP specifically promised 130 more inpatient beds and added surgical capacity, along with more PCH beds and home care.
  • Addressing burnout and improving retention, by ​“taking care of the health care workers that care for us.”
  • Improve the determinants of good health, starting with a focus on children. The NDP plan includes increasing the healthy child prenatal benefit and looking for other interventions to reduce infant and child mortality. 
  • Modernizing electronic health records and moving away from the reliance on paper and fax

Premier-designate Kinew has spoken since the election about fixing health care, and improving the culture within the health care system. This is important to addressing burnout and improving retention, which was also a key recommendation in our plan among many other commitments. 

We have carefully tracked the new government’s health pledges and we have already reached out to congratulate Premier-designate Wab Kinew and his team and offer physicians’ expertise and assistance on implementing their plans. 

One promise that raised some eyebrows in the medical community is the NDP plan to reopen 3 ERs in Winnipeg at Victoria, Seven Oaks and Concordia hospitals. We heard from several physicians concerned about what this would mean, as those three hospitals have been reconfigured, do not have ICUs or other in-house services or expertise required for busy urban ERs. We heard from other physicians who see potential in the plan, noting the current urgent care centres already offer services very similar to other ERs in the provinces, and with a growing population seeing these converted back to ERs would better serve the city. One consistent message we heard, and shared, with the NDP is that more ERs alone will not fix ER wait times. It appears this was considered, with a plan to open 130 more inpatient beds at HSC, Grace, St, Boniface, and Brandon hospitals, along with more PCH beds and expanded home care. What is encouraging, and was emphasized by Mr. Kinew at our Town Hall, is an openness to work with Doctors Manitoba and engage physicians on the planned changes and consider the advice of physicians in that process. 

The NDP also promised other health care changes, including building a new CancerCare building, reopening the Mature Women’s Centre at Victoria Hospital, expanding dialysis at Seven Oaks, and expanding cardiac care at St. Boniface Hospital. 

We anticipate the transition to the new government, and announcement of its cabinet, to happen in the next few weeks. This is typical in Canada when governments change.

If you have advice on how to help shape the implementation of the new government’s health care plan, please contact Keir Johnson at kjohnson@​doctorsmanitoba.​ca to help Doctors Manitoba with its ongoing advocacy on behalf of the profession.

Need Help Recruiting Family Physicians?

Doctors Manitoba and the Manitoba College of Family Physicians are working together to reach out to our members looking for help with recruiting more family physicians to your practice. 

Following our advocacy to address the physician shortage, Shared Health is offering free assistance with recruiting family physicians, including for physician-owned fee-for-service clinics. The province has a plan to recruit 150 more family physicians and with Shared Health has contracted Canadian Health Labs for assistance. This includes recruiting 50 family physicians for Winnipeg, 50 for rural, and 50 for northern Manitoba. 

Do you have current or upcoming vacancies in your clinic? If you would like help recruiting new physicians to your clinic, please complete this form to submit your request for assistance with recruitment. Please submit your request as soon as possible, and within two weeks. 

Nominations Open for CMA Awards

These annual awards celebrate individuals who are making significant contributions to health,health care and the medical profession. You can recognize an outstanding physician, medical learner or non-physician contributor across 10 awards. The deadline for nominations is Nov. 30, 2023. 

Recipients of the CMA Awards come from different career stages, specialties and backgrounds, and from rural and remote areas as well as big cities. They also reflect the diversity of the profession and the communities we serve.

With the exception of two awards — the Owen Adams Award of Honour and the John McCrae Memorial Award, which are open to non-CMA members — nominations can only be submitted by and for CMA members in good standing. Membership standing and renewals can be accessed here or by contacting the CMA Member Service Centre at memberservicecentre@​cma.​ca or 1−888−855−2555.

Please note that other than the Dr. Brian Brodie Organizational Leadership Development Award and the Dr. Ashok Muzumdar Memorial Award for Physicians with Disabilities, you can’t nominate yourself for an award.

Learn more about the awards and how to apply. If you have questions about the process, email awards@​cma.​ca.

Workshop: Your Life After Retirement

Retirement is an important life stage for physicians. Most information on retirement focuses on financial considerations and the practical aspects of closing a medical practice. Those discussions are certainly important but also limiting, as they miss an essential aspect of retirement — how to develop a meaningful and rewarding life after medicine.

Join us for an interactive, half-day workshop on November 21, from 8:30am to 12:30pm. Facilitated by Dr. Philippe Erhard and hosted at the Doctors Manitoba office at 20 Desjardins Drive, the workshop is designed specifically for physicians contemplating retirement or fully retired. It will help to manage this important life transition by answering the following questions:

  • Who am I now?
  • What will I do?
  • How will I keep intellectually and socially active?
  • How will I organize my days?

The process is practical and will address other important issues such as ageism, flexibility and renewed relationships. Participants will be able to:

  • Identify common obstacles to a successful retirement ‑Develop plans for a meaningful life with a renewed identity
  • Develop structures to avoid mental, physical and social stagnation
  • Organize their days in a leisurely fashion

Learn more and register now. Space is limited. 

Health System Updates

COVID-19 & Respiratory Updates

Health Canada has now approved Pfizer’s updated COVID-19 vaccine, so options are now approved from both Pfizer and Moderna that target XBB variants. The updated Moderna vaccine is currently being distributed to vaccine sites. More COVID-19 vaccines will continue to arrive over the coming weeks to ensure sufficient supply for all Manitobans who want to be immunized. Please see this recent memo from Public Health about the XBB vaccines and other important updated.

Manitoba Public Health is simplifying the requirements for physicians related to COVID-19 immunization, harmonizing the process with other vaccines. This means the additional administrative requirements previously in place for COVID-19 vaccines are no longer necessary. Physicians and clinics are: 

  • No longer required to complete a written COVID-19 consent form for each client 
  • No longer required to report their inventory and wastage 

Please note that other requirements remain, including reporting influenza and COVID-19 doses administered within two (2) business days. All health care providers who immunize in Manitoba are also expected to follow the Public Funded Immunization Program Standards and Informed Consent Guidelines and any other requirements set out in the Immunziation Program Manual for Immunization Providers in Manitoba.

New tariffs have been created for the XBB immunizations:

  • Moderna XBB.1.5 Vaccine (12+ years): Tariff 8161
  • Moderna XBB.1.5 — 0.1mg/ml (6 months — 11 years): Tariff 8162

Rapid tests and PCR testing are only recommended for people who are at high risk for serious outcomes as they need to know if they have COVID-19 to receive treatment options such as antivirals. Treatment must be started within days of symptoms appearing, so it is important to know if you are eligible and seek testing and as soon as possible. For more information about accessing treatment, speak with your health-care provider or call Health Links-Info Santé.

Rapid test kits continue to be available at no cost at many locations across the province. For more information about testing, including an online map of locations where rapid tests may be available, visit:
www​.gov​.mb​.ca/​c​o​v​i​d​1​9​/​t​e​s​t​i​n​g​.html.

COVID and flu surveillance will be published weekly by Public Health.

Access Improvement (AIM) Program

What is the relationship between primary care clinics and quality improvement? A recent study published in the Annals of Family Medicine, which analyzed data from more than 1,300 primary care practices across the United States, found that implementing quality improvement strategies in primary care can improve patient outcomes, reduce healthcare costs, and lower rates of hospitalizations, emergency department visits, and specialist referrals. 

The Access Improvement Model (AIM) program is designed to help primary care teams develop and improve their skills in quality improvement, change management, and team building to capitalize on opportunities for improvement within their clinic. We hope to engage with teams that are interested in exploring ways to make lasting improvements within their clinics, with a focus on patient access. If you would like to explore AIM in further detail, please visit the AIM website and be sure to contact the team at aim@​umanitoba.​ca.

COVID-19 Study Recruitment

The Trauma and Recovery Research Unit at McMaster University, led by Dr. Margaret McKinnon, is currently running a research study funded by the Public Health Agency of Canada and the Canadian Institutes for Health Research exploring how a trauma-informed policy for staff can better support the mental health of healthcare providers and improve organizational culture and the workplace environment. Here, we would love to hear from healthcare providers from all levels of the organization, including leadership at both middle and senior management, and frontline providers. 

Interested healthcare providers may choose to participate in both an interview and a survey, or a survey alone. This study has been approved by the Hamilton Research Ethics Board (#12667) and will provide an essential step towards the development of trauma-informed policies, resources, and tools for healthcare leaders that can be used to prevent and/​or mitigate the mental health impacts among Canadian HCPs who are suffering as a result of their service during COVID-19. 

→ Review the poster for more information.

→ Take part in the study.

Dr. Perry Gray’s Term Coming to an End

After more than three decades of service as a practicing physician working in direct patient care and in various leadership roles, Dr. Perry Gray has decided not to seek a renewed five-year term as chief medical officer, Shared Health and provincial lead of medical specialist services. His time in these roles will end when his contract expires on March 31, 2024. However, Dr. Gray will continue his clinical practice in the intermediate intensive care unit (IICU) at HSC Winnipeg

Read Shared Health’s full announcement.

Introducing Manitoba’s MD Physician Council member: Dr. Darcy Johnson 

While practising as a family physician in Winnipeg since 1983, Dr. Darcy Johnson, who serves as Manitoba CMPA councillor, has had a diverse career, fueled by his passion for physician advocacy. Recognizing the impact COVID-19 had on the medical system and physician wellness, he remains a strong advocate, working towards a more sustainable future for Canadian medicine. The MD Physician Council is a diverse group of physicians who collaborate with MD Financial Management to improve products and services for physicians at all career stages. Learn more about Dr. Johnson and the other Council members.

Physician of the Week

Dr. Ral Koko chose to practice medicine​“for the sheer love of humanity.” She loves truly getting to know her patients and when providing care, Dr. Koko feels most rewarded when she knows they feel seen, heard, acknowledged, and supported. She says she is proud​“of just allowing myself to be me.” She has a particular interest in Whole Health Medicine, where a round table approach plays a key role in the care of her patients. This is the cornerstone of her practice. Patients Greg and Corinne Backhouse appreciate Dr. Koko’s dedication to medicine, the time she takes with patients, and her compassionate and caring approach. 

→ Suggest a colleague as Physician of the Week here.

→ Read Physician of the Week feature stories.

Fantastic Physicians

Congratulations to Mikayla Barbosa, a Métis medical student, and to her mentor, Dr. Sheila Peters who met with the Minister of Health this past summer. Minister Gordon was briefed on the Truth and Reconciliation Commission’s Calls to Action Medical School Report Card initiative, where students are given the opportunity to provide annual feedback on the progress and/​or effort of their institution with regards to Calls to Action #23 and #24. As a full-time summer student at KIM Inc., Barbosa and five other Indigenous students are mentored by Dr. Sheila Peters. The position involves a personal capstone project as well as sharing circles and opportunities for one-on-one support and guidance from an experienced professional. Read more.

Leadership Development Opportunities

Leadership has a measurable impact on the wellness and satisfaction of teams. Specific leadership behaviours prevent burnout and increase satisfaction and well-being among team members (Dyrbye et al., Shanafelt, et al.) and all physicians play a leadership role within the system and/​or their practice setting. Doctors Manitoba is committed to providing and advocating for leadership training and mentorship to develop positive and effective leadership skills. Join us for one of the leadership development learning opportunities below.

Leadership Starts with Self-Awareness — Webinar — October 26 from 5.30pm‑6.30pm)

Self-awareness is one of the key components of Emotional Intelligence. Everyone has a story, and that story is fueled by our thoughts and emotions which in turn influence how we relate to ourselves, others and the world. Becoming self aware allows us to better manage ourselves, how we relate to others and show up in the world. 

At the end of this webinar, participants will be able to:

  • List the key components to identifying their personal story
  • Recognize how their story may impact themselves and others

→ Register Now for the​“Leadership Starts with Self-Awareness” webinar.

→ Learn more about other sessions in this series.

Dealing with Patient and Caregiver Bias: Recommendations for Physicians, Healthcare Providers & Medical Centres — October 24 from 6:30 – 8pm

A patient or caregiver’s refusal of care based on the physician’s race or ethnic background can raise thorny ethical, legal, and clinical issues — and can be painful and confusing for healthcare learners and providers. This session in our Leadership for Equity: Expanding Inclusive Medical Culture series will address the roles and responsibilities bystanders, learners, physicians, and healthcare leaders play when preparing for and confronting these situations.

Learning Objectives:

1. The ethical and legal considerations for healthcare leaders, learners, providers, and health centres when dealing with patients who discriminate against healthcare team members or request reassignment based on their healthcare team member’s race or ethnicity;
2. How to effectively balance patients’ and caregivers’ interests, healthcare learners’ or personnels’ employment rights, and healthcare centres’ duty to treat patients under these circumstances; and
3. The factors to consider when drafting or reviewing an organizational policy to address patient’s and caregiver’s biased behavior toward healthcare workers.

→ Register now.

→ Learn more about this session, Session 7: Uprooting Medical Violence: Building Leadership Through Equity, Solidarity and Collective Self- Determination, and watch recordings of previous sessions here.

Upcoming Events

Whether you’re looking to expand your knowledge, increase your awareness, or build leadership skills, we have many sessions planned!

Bug Day — Mark your calendars for the 2023 27th Annual Bug Day! — October 17 7:55am-4pm — Held Virtually.

Interested in the prevention and control of communicable diseases, and health issues in the community or healthcare setting? Bug Day is for you! Nationally and internationally recognized experts will present timely topics in infectious diseases and public health at Manitoba’s largest healthcare education event. Held every year during National Infection Prevention & Control Week, Bug Day is streamed online – it’s FREE, accredited, and you’re invited!

The program is accredited for physicians and can be used for continuing education purposes by other health care workers. There is no charge, but you must register to attend the live sessions. You can make a donation directly to the HSC Foundation Bug Day fund. Click here to visit the donation page. This donation page will automatically generate a confirmation email and a tax receipt. Register here.

Women in Medicine Retreat (Nov 3 – 5, Gimli) — This retreat, focusing on wellness and professional development, is open to practicing women physicians and residents. An initiative led by Dr. Astrid Guenther, the agenda includes Cultivating Self-Compassion to Heal from Shame (3.5 CME), yoga, mindfulness, networking, and is fully catered. For more information, contact astridsantin@​gmail.​com by October 13 (limited spots available).

Other Events

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