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COVID Surveillance Updates

The provincial government has shifted from daily COVID-19 updates to weekly surveillance updates through Public Health. These updates will be published on Thursdays and available on this Public Health website. The first update is expected tomorrow. Doctors Manitoba will monitor these reports and provide a summary to members in our regular newsletters. 

This change has triggered concerns for some being able to monitor risks with less frequent updates. Others have noted that the daily reports were not adding new information each day as the COVID situation has stabilized and is changing more gradually, and thus the trends over multiple days were the most valuable. Either way, Public Health has confirmed that more frequent reporting could resume if there’s a need. 

Meanwhile, both monitoring in Ontario and Quebec suggest a sixth wave could be emerging. Quebec’s interim public health director signaled earlier this week that another wave could be coming, and other experts have confirmed this. This is also the case in Ontario. Ontario infectious disease expert Dr. Isaac Bogoch said earlier this week that cases are increasing, so ​“we can call this a wave. We just don’t know the size of the wave.” 

An increase in cases had been predicted by the Ontario Science Table as restrictions ease and the more transmissible BA.2 sub-variant takes over. They projected that hospitalizations and ICU projections would increase over several weeks, but less so than in January and for a limited period of time. 

Important COVID Testing Changes

There are two significant changes coming related to COVID-19 testing, which will impact primary care physicians. Below, see an important update on the changes and the work we are undertaking with Shared Health in preparation. 

Effective April 1 (this Friday), Public Health will no longer contact patients who test positive for COVID-19. Effective April 15, all provincially-run test sites will close. This was outlined in a memo from Public Health sent this afternoon.

These appear to be major changes, though they are reflective of the trend towards COVID-19 being managed within the health care system like other health concerns. It also reflects the dramatic decrease for PCR testing — with only 200 or so public tests done per day — due to the introduction of rapid antigen tests and decreasing spread as the Omicron wave recedes. 

In a memo published today, Shared Health outlines the changes and the impact for family physicians, pediatricians and other primary care providers.
Starting this Friday, any physicians who order a PCR test for COVID-19 will be responsible for notifying the patient of a positive result. As Shared Health recommends:

  • Provide patients with the Public Health Factsheet at the time of swabbing as it includes instructions on what to do if the patient tests positive. 
  • Advise patients to check their own results through the Shared Health Online Portal or by calling Health Links-Info Santé.
  • Contact patients to advise them of positive results and direct them to the Factsheet with instructions about isolation, monitoring symptoms and treatment. 

As of April 15, all remaining provincial test sites will close; most have already closed. The only exception will be in Winnipeg, where independent test sites run by Dakota Medical Centre, the Minor Illness and Injury Clinic, and Ma Mawi Wi Chi Itata Centre will remain open for now. 

This is expected to have an impact on primary care physicians, particularly when testing is needed to inform community-based treatment decisions about COVID-19. Timely treatment, within 3 – 5 days of symptom onset, is important for COVID-19 for those patients at higher risk and eligible for treatment. Antibody and antiviral testing can be prescribed by physicians following a positive PCR test, or a positive rapid antigen test that is administered in a clinic office.

We know this raises several questions, which we are working through with Shared Health and Manitoba Health. This includes questions about clinical guidance, logistics and remuneration. We are working towards providing an update next week with answers and resources, to ensure physicians have at least one week notice before provincial test sites close. 

We have confirmed that rapid tests and PCH testing supplies will continue to be available to physicians at no charge. You can order rapid tests through Doctors Manitoba, and PCR specimen collection supplies through Cadham Lab.

We want to hear from you about these changes. While we work with Shared Health on further details, including clinical guidance and remuneration, please send us your questions and concerns. We’d also like to know if you’d like us to arrange a webinar about these changes. Let us know by emailing covid19@​doctorsmanitoba.​ca.

Backlog Update from Task Force

The provincial Diagnostic and Surgical Recovery Task Force and the Minister of Health provided a highly anticipated update today on their work to add capacity to address the massive backlog that has accumulated during the pandemic. 

The following new initiatives were announced:

  • Hip/​Knee Surgery: A fifth OR will be added at Concordia Hospital to add up to 1,000 more surgeries per year. Expected to be operational by the end of 2022, this will require an additional orthopedic surgeon along with other clinical staff. 
  • Spine assessment Clinic: Four additional physical therapists will be added to help speed up assessments for the 900+ patients waiting with back pain. About 90% of patients assessed at the HSC clinic do not require surgery, so this change will help them access other treatment options faster. This complements the short-term efforts to add surgical capacity by sending patients to North Dakota. Nine patients have now received spine surgery with more expected in the next few weeks. 
  • Cataract Surgery: Additional surgical capacity will be added at Misericordia as well as through a Request for Supply Arrangement (RFSA) competitive bid process. While the specific amount of increased capacity was not specified, it does appear that the intent is to increase the baseline capacity to catch up and keep up with the demand for cataract surgery. 
  • Diagnostic Imaging: A ​“mobile” CT scanner and two ​“mobile” MRIs will be stationed in Winnipeg. This should add up to 11,600 more CT scans per year and up to 7,200 more MRI scans.

In addition to these initiatives, the government announced that they are planning to dial back the surgery slow down that happens each summer, which typically sees surgical volumes run at a reported 40% capacity. Instead, many sites are planning for surgical volumes at 75% to 100% of normal, which the Health Minister said should equate to about an additional 200 – 250 surgical slates this summer. 

In the meantime, work continues on getting surgery back to normal capacity. There are currently 146 staff still redeployed as part of the pandemic response, but this is the lowest number since July 2021, and it is apparently improving each week. ​“We continue to build capacity on a day-to-day basis,” explained Dr. Ed Buchel, the Provincial Specialty Lead for Surgery. Hospitals are gradually returning to normal operations. As of last week, for example, bariatric surgery and endoscopy were back to 100% capacity. 

Task Force Chair, Dr. Peter MacDonald, explained that they have been meeting with different specialty groups and stakeholders to hear their concerns and ideas and develop proposals. Further initiatives are being planned, and should be announced soon. Health Minister Audrey Gordon acknowledged there are ​“thousands of Manitobans whose quality of life is profoundly affected” and described them as ​“waiting in limbo.” She recognized that ​“Manitobans are waiting for answers. They are waiting for relief from pain, for a return to their lives and doing the activities they love.” 

Dr. MacDonald emphasized that their ​“goal is to get wait times back to the 2019 levels, pre-COVID.” Last week, Doctors Manitoba updated our estimates of the backlog, reaching a new high of nearly 168,000 cases. After two long years, we acknowledged that while our estimates capture the missed procedures during the pandemic, some of these missed tests and surgeries may no longer be needed by the patients who would have, and should have, received them. We are undertaking a review of the work needed to clear the backlog, and we will be seeking your input in the days ahead.

Today, Task Force members acknowledged they don’t have an exact number for the backlog either due to limited data in many areas. They have selected a vendor to introduce centralized wait list information systems in the many diagnostic and surgical areas that don’t already have centralized wait lists. In the meantime, however, we will be meeting with Task Force analysts to review estimates and methodologies try to work collaboratively on estimating the backlog. 

Potential New Documentation Requirements

This week, two separate consultations have been launched and both have the implication of increasing the documentation burden on physicians.

As your professional association, we are looking at both consultation documents carefully and will send a further update next week on our analysis. In the meantime, we would welcome your initial reactions, both positive and negative. 

The first is a consultation launched by Manitoba Health on proposed new Regulations respecting physician billings. We are concerned these Regulations will increase charting and record requirements for physicians without improving the care of patients. We are also concerned the Regulations are intended to make it easier for Manitoba Health to deny physician billings, and for Manitoba Finance to pursue physician audits. We have made efforts to have Manitoba Health improve the Regulations, including engaging some of our members to educate Manitoba Health officials on the practical impact of these Regulations. You can review the draft Regulations and Manitoba Health’s explanation here.

Second, all members were notified today about a CPSM consultation on Standards for Episodic Care. The proposed Standards would impose new obligations on any physician working in ​“episodic care”, including walk-in clinics, sports medicine clinics, house calls, and other locations. Where the patient has a family physician, a summary of the visit and copies of any test results must be provided to the family physician. We have several concerns, including the additional administrative burden on some physicians, exactly who is and is not included, and the duties of the family physician receiving episodic care information. CPSM’s notice about the consultation, along with a link to the draft standard of practice, is available here.

Doctors Manitoba plans to submit submissions on behalf of members respecting both issues. We will provide a further analysis next week and invite your views. In the meantime, please feel free to send your thoughts to practiceadvice@​doctorsmanitoba.​ca. If you wish to make a submission directly to CPSM or the provincial government yourself, please send us a copy at the same address.

Ontario Physicians Get New Contract

Earlier this week, the Ontario Medical Association and the provincial government announced a new three-year master agreement.

The new OMA agreement includes modest 1% increases in year one and two, followed by an unknown increase in the third year, to be set following an analysis of the difference between actual and expected physician remuneration in 2023/24. It also includes targeted investments in a number of areas:

  • A framework to introduce permanent virtual care tariffs by September 2022;
  • Enabling more family physicians to join Family Health Organizations and participate in blended capitation compensation models; and
  • Addressing the gender pay gap for physicians through a joint OMA-government committee tasked with achieving gender pay equity. The agreement also increases parental leave benefits for physicians. 

The government and OMA also committed to working together to modernize the OHIP schedule of benefits, taking into consideration the time, intensity, complexity, risk and technical skills required for various medical services. 

Doctors Manitoba monitors developments like this across Canada as part of our role to ensure physicians in Manitoba receive competitive remuneration and other benefits and supports, so you can focus on delivering exceptional care to Manitobans. In our monitoring of trends in other provinces, we see three themes emerging. First, agreements are being renewed long after their expiry. The new OMA agreement expired a year ago and in Newfoundland and Labrador, they finally just ratified a new agreement earlier this year after being without a contract since 2017. Second, general increases are modest despite physicians in several provinces having had remuneration frozen for a period of time. Third, targeted increases are common to tackle priorities for both sides. Specific targeted areas varying from province-to-province, though primary care is a common focus in many jurisdictions.

Our Negotiations team has been meeting with working groups to determine physician priorities as we prepare to negotiate the next Master Agreement. The current Master Agreement in Manitoba expires in a year, on March 31, 2023. 

2022 Award Winners Celebrated

Last week, we unveiled the eight extraordinary physicians receiving our Doctors Manitoba Awards this year. You can read our full update on this here and meet our eight award winners! 

Since then, tens of thousands of Manitobans have engaged with this news on social media, with many offering messages of congratulations and sharing in the celebration. MKO Grand Chief Garrison Settee presented Medal of Excellence recipient Dr. Barry Lavallee with a Pendleton blanket on Friday afternoon in recognition of his award. CBC featured all of the award winners in a story last week. 

On CTV Morning today, Dr. Joss Reimer talked about receiving our Humanitarian Award for her work on the COVID-19 vaccine campaign. You can watch the segment here.

Join us in celebrating these eight extraordinary physicians. Save the evening of Thursday, May 19 in your calendar for our Awards Gala Celebration at RBC Convention Centre. You will be able to order your tickets soon. 

Webinar on Physician Insurance Options

As physicians, you know that without your input, many patients might be missing proactive ways to improve their health outcomes. The insurance team at Doctors Manitoba, and the team at MD Financial, want to ensure you have all the information you need to make an informed decision about your insurance needs. Insurance helps to manage risks in our personal and professional lives, protecting us and those we care for against life’s unexpected events, such as disability or premature death. It’s also a unique asset class that enables the ability to protect, grow, and distribute wealth in unique ways. However, the total range of available insurance strategies is often complex or unclear. As such, investors may not be taking full advantage of everything that insurance can offer. In this presentation, MD Financial and Doctors Manitoba will be highlighting the key areas of ambiguity around insurance, how to overcome common insurance misconceptions, and the most strategic and cost-effective tactics to implement to ensure you’re protecting not only you and your family, but also your wealth. 

Join us:

Physicians Supporting Physicians

On May 11, in partnership with Well Doc Alberta, Doctors Manitoba will be hosting a collaborative webinar on the topic of physician-to-physician peer support. Session participants will learn how to summarize types of supports for physicians, identify critical elements of a formal physician-to-physician peer support program, and reflect on how formal peer support teams can be useful within physician groups. Learn more here.

Fantastic Physicians

Congratulations to Dr. Ming-Ka Chan who received the Resident Doctors of Canada Mikhael Award for Medical Education (staff category). Dr. Chan, is a recognized leader in medical education globally and has received numerous accolades for her work in medical education. She is the Co-Director, Office of Leadership Education, Rady Faculty of Health Sciences, a founding member and current Chair of Sanokondu and was recently appointed as the inaugural Pediatrics Lead, Equity, Diversity, Inclusivity and Social Justice at the University of Manitoba. Congratulation Dr. Chan, and thank you for your work mentoring and advocating for equity, diversity and inclusivity!

Congratulations to Dr. Ken Kasper, who was recently recognized as one of Scheif’s Healthcare Heroes. Dr. Kasper an integral part of the Manitoba’s Virtual COVID Outpatient Program (VCOP). This remote monitoring program, that supports stable patients with connection to healthcare providers while they recover at home, has helped 515 Manitobans to date, freeing up around 4,000 hospital bed days at a time when our hospitals were beyond capacity . Congratulations and THANK YOU, Dr. Kasper.

ICYMI — Recent Updates

Here’s some of the most popular and most important recent updates, in case you missed them:

  • We shared some recent updates from the Legislature.
  • The Surgery and Diagnostic Backlog was updated last week and includes a new feature with stories about Manitobans affected by the backlog.
  • See our recent President’s Letter about how the 1% increase in physician remuneration for 2022/23 is being allocated.
  • Our Retention Benefit is being extended to members during maternal/​parental leave, and this will be applied retroactively. Learn more.
  • Don’t forget to claim your COVID vaccine expenses. Tomorrow is the last day for eligible patient outreach work and scheduled clinics. You will be able to submit claims for at least a few more weeks. Learn more here.

Upcoming Events

Bookmark our Events Calendar to be sure you don’t miss any events or learning opportunities that interest you. Some notable upcoming events include:

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