March/April 2011

THE ALBERTA DOCTORS’

The AMA is making progress in achieving fee equity.

4

3.6

3.14
3.2
2.9

Members help
2.8

2.4

AMA identify priorities

2
Dec�02 Dec�03 Dec�04 Dec�05 Dec�06 Dec�07 Dec�08 Dec�09 Dec�10

Results from September 2010 tracker

Changes in the health care system during the past 12 months have
Changes in the health improved my the
care system during ability
past 12to meet
months the
have needs
improved myof mytopatients.
ability meet the needs of my patients.

3.6

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2
Dec 02 Dec 03 Dec 04 Dec
� 05 Dec
� 06 Dec
� 07 Dec�08 Dec �09 Dec 10

PCNs in Alberta Call for AMA Stephen Children and Innovative medical
are changing Achievement energy drinks: community aims to
Duckett
primary care Awards reflects on What you improve inner-city
delivery nominations ‘eventful months’ should know residents’ needs

Patients First® Volume 36, Number 2

 From The Editor
Our possibly
final challenge
Dennis W. Jirsch,
MD, PhD
Editor
The New Testament
describes the Four
Horsemen of the
Apocalypse – war,
conquest, famine
and pestilence – as
primary obstacles to
man’s survival.
The metaphor has
stood up very well, but any current
discussion would probably include
genetic susceptibility and individual
behavior as causes of disease, and
would go on to review the successes
and failures associated with our health
care technologies.
We’re acquainted with the notion
that our generally increased longevity
has much to do with clean water,
better food and sanitation, plus
vaccinations.
It’s time, though, to get serious
about the much larger, global
determinants of our future health –
our burgeoning population and our
economic systems. Indeed, our future
depends on it.
As a young boy and an ardent
reader, I remember reading Thomas
Malthus’ An Essay on the Principle
of Population,1 which is one of the
hundred greatest books of all time.
Malthus reckoned, in 1798, that
the power of population growth is
2 Alberta Doctors’ Digest • March/April 2011
vastly greater than the power of the
earth to provide subsistence, and
that population growth would
outstrip food supply.
He was prescient regarding
population growth. World population
at the height of the Roman Empire,
around the time of Christ, was likely
near 300 million.
At the time of Malthus’ writing it
was, perhaps, one billion but reached
two billion circa 1930. We’ve got some
seven billion souls on the planet now,
and continue to add 75 or 80 million
more each year.2
The famine forecast by Reverend
Malthus never happened, but
Malthus’ ideas won’t go away.
Most famous of the
neo-Malthusians has been Stanford
biologist Paul Ehrlich, who warned
in his 1968 bestseller The Population
Bomb3: “. . . the battle to feed all
of humanity is over. In the 1970s
the world will undergo famines –
hundreds of millions of people will
starve to death.”
It’s time, though, to get
serious about the much larger,
global determinants of our
future health.
Again the forecasted mass famines
never materialized. The so-called
Green Revolution in farming – better
fertilizers, better seeds and better
farming methods – has, so far, kept
remarkably apace with population.
We’re left, though, with two camps
– the Boomers who think global
famine is never going to happen, and
the Doomsters who reckon it’s just a
matter of time.
Boomers, also known as
cornucopians, maintain there are
no limits to growth. Economist
Julian Simon argues in The Ultimate
Resource 4 that human capital will
always be the most important thing,
that the more people on earth, the
greater the probability of new and
ingenious ideas.
Simon has been echoed by many,
including economist Lawrence
Summers, former Harvard University
president and, until recently, National
Economic Council director in the
Obama administration: “There are no
. . . limits to (the) carrying capacity of
the earth that are likely to bind at any
time in the foreseeable future.”5
The debate continues, but on the
population front there is some good
news. In recent years, fertility rates
have fallen below replacement levels
in most developing countries.
The world’s population, however,
is projected to keep expanding until
the mid-21st century because of real
population growth in developing
countries, as well as enhanced longevity.
 We’ll add several more billions to
our census before we reach a zenith of
some nine or 10 billion people. Until
then, look for another three million
each year in the US and perhaps a
tenth of that number in Canada.
Even with falling fertility rates,
the number of people on the planet
is more than remarkable and
receives only periodic discussion in
mainstream news. It is, indeed, the
elephant in the room when we talk of
the harsh realities ahead: undeniable
climate change, looming fresh
water deficits, and degradation of
food-producing systems and fisheries.
It is, perhaps, difficult to think
about overpopulation in Canada, and
too many people consider the topic in
terms of population density.
Density is generally irrelevant to
questions of overpopulation. The key
is the number of people in a given
area relative to the area's resources
and the sustaining capacity of the
environment.
Overpopulation in a truly global
world has succeeded beyond
measure, drawing down soil and
water resources and contributing
massively to the deterioration of
global environment systems.
We now collectively use about
16 terawatts of energy a year (1 TW =
1012 watts) or the energy content of
a billion tons of coal.
Those of us in the developed
world use massively more than those
elsewhere, by log orders of magnitude.
“If the five billion people in developing
nations matched the consumption
patterns of the billion or so in the
industrialized world, at least two
more earths would be needed to
support everyone.” 5,6
Our economic systems certainly
don’t help since we are addicted to
growth, and more of what we have
been doing is definitely not better.
Growth of 3% per year means our
economic enterprise will double in
size in 23 or 24 years.
Given our current modus operandi,
this means our problems with
degrading the planet will double in the
same period and will increase fourfold
in just 50 years.
So far, our collective response to
this has been ho-hum. I expect some
don’t believe it and others bet we’ll
muddle through.
Historian Jared Diamond, author
of Collapse: How Societies Choose to
Fail or Succeed,8 has documented the
rapid decline of many civilizations
that preceded us, such as the Mayans
in the Yucatan peninsula, and has
pointed out that a primary cause of
such collapse has been the destruction
of environmental resources.
Peak population and wealth equate
with peak-resource consumption
and waste and, in turn, with
equal-peak environmental impact or
unsustainability. Declines of earlier
societies often followed swiftly on
their peaks.
Some, indeed, think that new
hocus pocus or techno-solutions will
help us, but it seems unlikely. All of
our current environmental problems
are unanticipated consequences of our
existing technology.
Umpteen international conferences
have produced no significant change
in our accumulation of greenhouse
gases and no enforceable agreement
to reverse the trend.
Others cotton on to the idea
of a “fortress” mentality, perhaps
imagining enclaves of the privileged
banding together to keep out
outsiders. It’s difficult to imagine
this as durable, as previous empires
dependent on walls haven’t lasted.
There would be the obvious need
to forage and harvest resources
beyond the gates. Remember, too,
the ubiquitous nature of greenhouse
effects everywhere.
Pretty gloomy stuff, I’d say. We
can perhaps agree at very least that
our population numbers concern
us enough to promote universal sex
education and access to contraception,
and better opportunities for women.
The “stretch goal” though amounts
to a “third revolution” for all of us –
after Agriculture and Industrialization
– embracing technologies that
will minimize our impact on the
environment, recognizing the
fundamental health-supporting role
of the planet and its ecosystem, and
mobilizing every last one of us in
doing something about it.
As docs, our special role may
be to realize that our health
and that of our planet are
pretty well aligned.
Yes, we’re going to have to think in
terms of new technologies. But, likely
most difficult, we’re also going to
need new forms of social organization
and leadership that is savvy, resolute
and geared to the long haul.
As docs, our special role may be to
realize that our health and that of our
planet are pretty well aligned and to
trumpet this widely.
Most of us can recall what cartoon
character Pogo said on seeing the
desecration of his much loved
Okefenokee Swamp: “We have met
the enemy and he is us.” Tell it like
it is, Pogo.
References available upon request
Alberta Doctors’ Digest • March/April 2011 3
Patients First ®
TABLE OF
CONTENTS
Patients First ® is a registered trademark DEPARTMENTS
of the Alberta Medical Association.
2 Editorial 32 Insurance Insights
The Alberta Doctors’ Digest is published
six times annually by the Alberta 18 Health Law Update 34 Web-footed MD
Medical Association for its members.
20 Mind Your Own Business 36 In a Different Vein
Editor:
Dennis W. Jirsch, MD, PhD
25 Students' Voice 39 Classified Advertisements
Co-Editor: 30 PFSP Perspectives
Alexander H.G. Paterson, MB ChB,
MD, FRCP, FACP
Editor-in-Chief: FEATURES
Candy L. Holland, BSc, BEd, AD/PR

President:
6 Members help AMA identify priorities
Patrick J. (P.J.) White, MB, BCh, Members helped the Alberta Medical Association (AMA) identify
MRCPsych priorities (e.g., for Negotiations 2011) via the September 2010 tracker.
President-Elect:
Linda M. Slocombe, MDCM, CCFP 10 Stephen Duckett reflects on eventful months
Immediate Past President:  tephen Duckett shares his thoughts about his time as Alberta
S
Christopher J. (Chip) Doig, MD,
MSc, FRCPC
Health Services president and chief executive officer.

Alberta Medical Association

14 Children and energy drinks: What you should know
12230 106 Ave NW Energy drinks contain various chemical substances but two main
Edmonton AB  T5N 3Z1 ingredients concern public health experts and parents.
T 780.482.2626  TF 1.800.272.9680
F 780.482.5445 16 Innovative ways to improve inner-city
amamail@albertadoctors.org
www.albertadoctors.org
residents' health
Some of Edmonton’s health care providers, researchers and community
May/June issue deadline: April 8
members are trying to better meet inner-city residents’ health needs.

The opinions expressed in the Alberta
Doctors’ Digest are those of the authors and
do not necessarily reflect the opinions or
positions of the Alberta Medical Association
or its Board of Directors. The association
reserves the right to edit all letters to the editor.
22 PCNs are changing primary care delivery
in Alberta
Primary care networks (PCNs) are making positive changes in the
delivery of primary care. And the impact of each one is unique.

The Alberta Medical Association assumes

44 AMA invites Achievement Awards nominations
no responsibility or liability for damages Nominations are due Friday, April 29.
arising from any error or omission or from
the use of any information or advice
contained in the Alberta Doctors’ Digest.
Advertisements included in the Alberta
Doctors’ Digest are not necessarily endorsed
by the Alberta Medical Association.
© 2011 by the Alberta Medical Association
AMA Mission Statement
Design by Sarah Tiemstra at Backstreet Communications.
The AMA stands as an advocate for its physician members, providing leadership
and support for their role in the provision of quality health care.
Cert no. XXX-XXX-000

Alberta Doctors’ Digest • March/April 2011 5

 C o ve r F ea t u r e

Members help AMA identify priorities

Results from
September 2010 tracker
The AMA is making progress in achieving fee equity.
4

3.6
The Alberta Medical Association (AMA) uses several priorities and develop the AMA’s annual business plan,
3.14
methods
3.2 to identify issues that are important to its strategies and activities.
2.9
membership.
2.8 In addition, the association’s effectiveness in meeting
One way is through quarterly tracking surveys that are members’ expectations and needs may be evaluated.
administered
2.4
by Vancouver-based twisurveys. Anonymity
of respondents is assured. While reviewing an excerpt of the September 2010
survey below, consider that trends are analyzed against a
2
Collecting members’ views helps the Representative five-point Likert scale.
Dec�02 Dec�03 Dec�04 Dec�05 Dec�06 Dec�07 Dec�08 Dec�09 Dec�10
Forum, Board of Directors and senior staff identify

Changes in the health carein

Changes system during the
the health past
care 12 months
system havethe
during improved mymonths
past 12 ability to have
meet the needs
of my patients. improved my ability to meet the needs of my patients.
4

3.6

3.2

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2
Dec 02 Dec 03 Dec 04 Dec
� 05 Dec
� 06 Dec
� 07 Dec�08 Dec �09 Dec 10

Funding of the Alberta health care system is keeping pace with the
Funding of the Alberta health care system is keeping
provinces pace with growth.
economic the province's economic growth.
3.4

2.6
2.36 2.21
2.2

1.8

1.4
Dec 02 Dec 03 Dec 04 Dec
� 05 Dec
� 06 Dec
� 07 Dec�08 Dec �09 Dec 10

6 Alberta Doctors’ Allowing physicians

Digest • March/April 2011 to practise in both public and private health care
enhance the availability of physicians in the public sector.
 Primary care networks will help physicians to improve the delivery of
care to our patients.
4.8 Primary care networks will help physicians to improve the delivery of
Primary care networks will help physicians to care
improve
to the
ourdelivery of care to our patients.
patients.
4.4
4.8

4
4.4 3.74

3.6
4
3.25 3.74
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Dec 02 Dec 03 Dec 04 Dec
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2.8
Dec 02 Dec 03 Dec 04 Dec
� 05 Dec
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The development of computerized health networks is improving the

The development of computerized health networks
delivering is improving
of health care the delivery
to my of health care to my patients.
patients.
4.8
The development of computerized health networks is improving the
4.4
delivering of health care to my patients.
4.8
3.86 3.92
4
4.4
3.6 3.92
3.86
4
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3.6
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3.2 Dec 02 The
Decphysician's
03 traditional
Dec 04 Dec� 05 roleDec
as manager
� 06 Dec and gatekeeper
� 07 Dec�08 of�09
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patient's record must be maintained in the design of electronic health
The physician's traditional role as manager and gatekeeper of the
The physician's traditional and medicalofrecords.
2.8
patient'srole as manager
record must beand gatekeeper
maintained inthe patient's
the designrecord must be maintained
of electronic health in
the design of electronic
4.8 Dec 02 Dechealth
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Dec
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and medical records.
Dec�08 Dec �09 Dec 10
4.26
4.8
4.4
4.18
4.26
4
4.4
4.18
3.6
4

3.2
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3.2
Dec 02 Dec 03 Dec 04 Dec
� 05 Dec
� 06 Dec
� 07 Dec�08 Dec �09 Dec 10

2.8
Dec 02 Dec 03 Dec 04 Dec
� 05 Dec
� 06 Dec
� 07 Dec�08 Dec �09 Dec 10

Having physicians' offices computerized will enhance the value of the

Having physicians' offices computerized will enhance the value of the provincial electronic health record.
provincial electronic health record.
4.8
Having physicians' offices computerized will enhance the value of the
4.4 provincial electronic health record.
4.8 4.09
3.96
4
4.4
3.6 4.09
3.96
4
3.2

3.6
2.8

3.2 Dec 02 Dec 03 Dec 04 Dec

� 05 Dec
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2.8
Dec 02 Dec 03 Dec 04 Dec
� 05 Dec
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� 07 Dec�08 Dec �09
Alberta Doctors’ Digest • Dec 10 2011
March/April 7
 3.2

2.8
Dec 02 Dec 03 Dec 04 Dec
� 05 Dec
� 06 Dec
� 07 Dec�08 Dec �09 Dec 10

In the past 12 months, I have taken steps to improve the balance between my professional life and
In the past 12 months, I have taken steps to improve the balance
my personal life. between my professional life and my personal life.
4.8

4.4

3.6 3.49
3.34

3.2

2.8
Dec 02 Dec 03 AMA
The Dec 04
keeps Dec
me� informed
05 Dec
� about
06 Dec
� 07 Dec�
association 08 Dec �09
activities Dec 10
4.8
The AMA keeps me informed about association activities.
The AMA keeps me informed about association activities
4.4
4.8
4.07 4.06
4
4.4
4.07 4.06
3.6
4

3.2
3.6

2.8
3.2
Dec 02 Dec 03 Dec 04 Dec
� 05 Dec
� 06 Dec
� 07 Dec�08 Dec �09 Dec 10
2.8
Dec 02 Dec 03 Dec 04 Dec
� 05 Dec
� 06 Dec
� 07 Dec�08 Dec �09 Dec 10

The AMA keeps me informed about the major issues in the health
The AMA keeps me informed about the major issues in the
care health care system.
system
4.8 The AMA keeps me informed about the major issues in the health
care system
4.8
4.4
3.96 3.97
4.4
4
3.96 3.97
4
3.6

3.6
3.2

3.2
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Dec 02 Dec 03 Dec 04 Dec
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2.8
Dec 02 The
Dec AMA
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involved
� 05 when
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08 Alberta
Dec �09 Dec 10
The AMA should be involved
Health when physicians
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8 Alberta Doctors’ Digest • March/April 2011

Director, University Health Centre
Reporting directly to the Vice-Provost and Dean of Students,
the Director, University Health Centre is responsible for the overall
direction, operation, and management of the University Health
Centre (UHC). The UHC, comprised of the UHC medical clinic,
Psychiatry and Student Counselling Services, the Sexual Assault
Centre, UHC Pharmacy, and the Health and Wellness Outreach
team, is one of 14 University Student Services within the portfolio
of the Vice-Provost and Dean of Students. It is the primary health
service on campus accessible to approximately 37,000 students, as
well as staff and families of students at the University of Alberta.
The successful candidate will exercise professional judgment
through well-developed skills in strategic planning, problem-
solving, and critical thinking and is expected to act with autonomy
and discretion on matters within the Director’s scope of authority.
The Director serves as a health, wellness, and medical liaison to
the greater campus community, assisting in policy and procedure
development and with matters requiring medical guidance.
Additionally, the Director will maintain a part-time General
Practitioner medical practice within UHC.
Working in a dynamic, challenging and high-paced environment,
the ideal candidate will hold a current license in good standing to
practice medicine in the province of Alberta and must be competent
in the provision of services with the usual scope of practice of
a General Practitioner. The ideal candidate will also possess
knowledge of the University of Alberta, its structures, systems,
policies, and values. Responsibilities also include budgetary
decisions (operating and ancillary) of all units within the UHC,
marketing of services, and implementation of service measures.
This full-time continuing Administrative Professional Officer
position offers a comprehensive benefits package; remuneration will
be commensurate with qualifications and experience. Consideration
of applications will continue until the position is filled.
Applications are invited to submit a cover letter and resume to:
Cheryl Luchkow
Assistant Dean of Students
5-02 Students’ Union Building
University of Alberta
Edmonton, AB T6G 2J7
dean@uss.ualberta.ca
Applicants are thanked in advance for their interest; however,
only those selected for an interview will be contacted.

All qualified candidates are encouraged to apply; however, Canadians and permanent residents will be given priority. The University of Alberta hires on the basis of
merit. We are committed to the principle of equity in employment. We welcome diversity and encourage applications from all qualified women and men, including
persons with disabilities, members of visible minorities, and Aboriginal persons.

FINAL
Date 01.31.11

University of Alberta
File Name UOA-ACA R11-021
Size 1/2pg Horizonal
Fonts used Arial
Publication
The Alberta Doctors’ •Digest
Alberta Doctors’ Digest March/April 2011 9

Do not resize or alter ad in any way.

 F ea t u r e
Stephen Duckett:
‘Reflections on 20 or so
eventful months’
With Alberta Health Services (AHS)
senior leaders on December 6, 2010,
Stephen Duckett reflected on his time
as the former AHS president and chief
executive officer. He was appointed
to AHS in January 2009 and was
dismissed November 24, 2010.
Excerpts of his comments to AHS
leaders follow.
Joining Alberta Health Services
Although the Internet age means
people can find out a lot about who you
are, I wanted to make my values clear
so there’d be no risk that I’d be asked
to do things I wouldn’t want to do.
Given the government’s previous
history on Medicare,1 in my first
meetings with Ken Hughes as Board
Chair and Minister Liepert in that
interview week, I told them that I
would not do anything that would
undermine the Canada Health Act.
They both accepted that position
and honoured it.
I see myself as a ‘friend of
Medicare’ with a small f. The capital
F folk go much further and want to
end private delivery, putting almost all
physician practices out of business.2
Not a position I can support.
The media created a Stephen
Duckett I didn’t recognize, portraying
me as a one-dimensional budget cutter,
10 Alberta Doctors’ Digest • March/April 2011
a portrayal that still continues.3 Yet
my main work and achievements in
Queensland had been about access and
quality, the other two goals of AHS!
An early challenge I faced was
the issue of AHS legitimacy.
Paradise lost?
An early challenge I faced was
the issue of AHS legitimacy. When I
arrived there were still many (inside
and outside AHS) who lamented the
demise of the predecessor entities,
and they looked back on the good old
days when everything was perfect.
Everything AHS did was bad and
not up to the standard of the previous
region, board, Commission. But as
I’ve said in previous presentations,4
all was not rosy.
Alberta spends more per capita
(adjusted for age and sex) than other
Canadian provinces, and gets less.
Male and female Albertans have a
shorter health-adjusted life expectancy
than the Canadian average. Albertans
who get cancer don’t live as long as
people from Ontario. All this using
data from before AHS was formed.
Investment decisions have
over-emphasized acute provision at the
expense of seniors’ care. In contrast
to other provinces, Alberta reduced
per-capita spending on non-acute
facilities over the last decade.
Is it any wonder that our acute
facilities had to become de facto
seniors housing, contributing to the
systemic problems that have created
the problems in emergency care?
And emergency department
performance in both Edmonton and
Calgary has been getting steadily
worse over the last decade, achieving
the eight-hour standard for admitted
patients about 60% of the time in
the first few years of the decade
to around 25% now. Neither level
acceptable, of course.
And there was significant variation
in practice between different parts
of the province, different admission
rates, differences in length of stay.
Little was done to learn from these
differences, different definitions were
used across the province and there
was no effective benchmarking.
The effects are still with us: it takes
a day longer to treat a person with a
stroke in Edmonton than it does in
Calgary, same for hip replacements.
This consumes excess bed days and
effectively reduces access in Edmonton.
Achievements
You know only too well what it was
like when I started. No functioning
formal structure. No financial reporting
system. No strategic direction. We
addressed all that quickly.
I think the single greatest
achievement is how you are working
together for the benefit of Albertans.
There are hundreds of examples
of how you’re sharing ideas, one
learning from another.
My experience with the workplace
engagement group, people in all sorts
of roles, from all parts of the province
was very rewarding and I think we
can already see the turn-around in
engagement as a result of that work.
I think the work we’ve done on
emergency access is a good example
and one I was particularly proud to
be part of and would like to write up.
Introducing new ideas into Alberta to
improve flow: the medical assessment
units, for example.
Work on these started in 2009.
The workshop I convened, leading
to the driver diagram, leading to
a coherent set of medium- and
long-term initiatives involving zones
and hospitals and others.
A problem for 10 years is not going
to be fixed in 10 weeks or indeed one
year, despite all of our best efforts,
but I think we are seeing early signs
of improvement. So I plan to claim
some credit if we see a turn-around
by mid-next year!
In 2009-10 we had a big budget
challenge and all stepped up to the
mark, and continue to do so. Bringing
the budget under control involved
hard work. But work that was and
is essential if Medicare is to be
sustainable.
If the 10-12% growth rates
experienced in Alberta in the past
had continued, there would have
been increasing questioning of the
fundamentals of Medicare, to the
detriment of all of us. So lots was
done to address the challenge.
Take procurement: here we saved
hundreds of millions of dollars
by standardizing and using our
purchasing power. This was not just
a CPSM achievement, but involved
countless people from across AHS
contributing and adjusting their
practices for the common good.
Our incipient Enterprise Risk
management framework is already
attracting positive comments from
other provinces. Developing modern,
province-wide medical staff by-laws.
We’ve done a lot on moving toward
interprovincial equity in clinical and
non-clinical areas. Take cervical cancer
screening, for example. Different
regions had different policies and
priorities with respect to invitations
and reminders.
Capital Health didn’t put the
same value on this as the Calgary
Health Region, with the result that
screening rates are appreciably lower
in Edmonton (69.6%) compared
to Calgary (74.3%), an issue we are
now addressing.
Expanding security coverage in the
province on a cost-neutral basis in a
new service model is another example
of improved service equity.
Developing Canada’s first
electronic provincial drug formulary
that other provinces now want to buy.
This was only possible because we
were one provincial organization, of
a size to support the specialized staff
needed to do this.
Developing a coherent,
evidence-based approach to workforce
planning, which looks not only at
supply but affecting demand.
Replacing more than a dozen
different funding schema for long-term
care by an equitable, provincially
consistent, activity-based funding
approach is another major achievement.
There are currently huge
variations in what we pay for care
(after standardizing for the needs
of residents) and the incentive on
facilities until now has been to take
the least-dependent rather than the
most-dependent resident, contributing
in part, I think, to our problem of
long-stay Alternate Level of Care
patients in our acute hospitals.
Tighter and better contracting
for services is yet another example.
At least having contracts is a start,
in contrast to the Villa Caritas
contractual mess we inherited from
Capital Health or the handshake
deals of another region.
The best-service contracting
example is in ophthalmology in
Calgary. Here we commissioned an
academic paper to give advice about
what best practice in contracting might
look like. And the answer came back,
not at all like what you are doing.5
So we went to tender and got
a significant price reduction: we
proposed to spend the same money as
had been previously allocated but with
20% more patients treated. A win you
would think. But politics intervened.
The ophthalmologist entrepreneurs
who had misread the tea leaves and
tendered too high complained to
the Minister that somehow an open,
transparent bidding process was
unfair and successfully enlisted the
media in their cause.
Alberta Doctors’ Digest • March/April 2011 11
 And a new process was cobbled
together. But at least we kept the
lower price.
Let me tell you this. I have listed
this as a success. I think we made the
right decision then and faced with
the same facts I’d support the same
decision again.
If I have to weigh up the interests
of a handful of business people who
misjudged the tender process against
the interests of hundreds of patients
who would now get treated quicker,
I know what side I’d always come
down on.
My take-home lesson was that
I took on too much. I should
have proceeded one step at
a time. I also was not ready
for the most disgusting media
campaign I’ve seen in my career.
We have also set the scene for better
intra-provincial cooperation, signaling
the end of the medical arms race
between Edmonton and Calgary. We’ve
got new mechanisms for intra-provincial
learning: the Alberta Clinician
Council and the clinical networks.
Although these are still nascent
organizations, which need nurturing
and validating, we are already seeing
the good work that can come from
them (e.g., the work of the Bone
and Joint network in developing
protocols and introducing clinical
benchmarking).
I’d also like to list our attempted
reform of mental health services
12 Alberta Doctors’ Digest • March/April 2011
in Edmonton as an achievement,
although there are certainly lessons
here as well.
My take-home lesson was that I took
on too much. I should have proceeded
one step at a time. I also was not
ready for the most disgusting media
campaign I’ve seen in my career.
A media campaign where people
who were supposed to care for the
mentally ill attempted to scare the
populace about how dangerous it
would be for people with mental
illness to be treated in nearby acute
hospitals or in the community.
That kind of stigma harms patients
and harms mental health services by
keeping them stigmatized and isolated.
Perhaps our biggest achievement has
been the Five Year Funding agreement,
negotiated at the end of 2009.
October 2009 was a terrible time for
me. What we faced then was the reality
that we most likely couldn’t meet our
payroll later that financial year.6
During 2009 we had to tighten
our belts. We had to set priorities.
We said we would minimize layoffs
and protect access to services. And we
kept that promise. I’m proud of that.
And so good came out of it all.
The Government dramatically
changed our financial parameters,
and put us on a secure, long-term
financial footing. The first time any
provincial government has done
anything like that in Canada.
The Five Year Funding agreement
is fair, but requires significantly
tighter financial discipline than
exercised by the previous entities
with their average 10% increases in
spending per annum.
Long-term secure funding, with
reasonable but not excessive growth
rates within which services must
manage, is an essential for Medicare
to survive. Those of us who support
Medicare should be arguing for that
in all provinces and nationally.
The role of the Chief
Executive Officer
We’ve set ambitious goals in our
Five Year plan.
Some responses to the plan called
for people’s jobs to be on the line if the
goals were not met.7 That type of call
leads to two potential consequences:
first, next time you won’t be as
ambitious in your goal setting,
with Albertans being the poorer.
Secondly, severance arrangements
need to be revisited. At present, the
executive essentially has one-year
severance entitlements. If there is to
be a higher risk of dismissal, then
there have to be greater protections.
Cookie incident
And now some words about the
cookie incident. First, I want to
acknowledge upfront that I made
a mistake.
I should have stopped and said,
“No comment,” etc., and I
acknowledge that my continued
cookie remarks made it appear
that I might not have cared for the
situation many Albertans face in
emergency departments every day
and the good work that the men
and women of AHS do every day.
That is not my view and I regret
deeply that I came across that way.
Making Medicare sustainable
One of my goals at AHS was to
show Canada (and the world) a new
health system which was sustainable.
This is still one of my goals, but for
now, it will probably be by writing
about what needs to be done. But this
will build on what we were setting in
place here.
To give you a taste, what we need to
do is ensure that: the right person enables
the right care in the right setting, on time,
every time.
Yes, I know it de-emphasizes the
prevention agenda, but that needs to be
dealt with separately.
Right person: You know my
obsession with full scope of practice,
doctors doing what doctors should
do, RNs likewise, etc. To understand
the dimensions.
The government has committed
to funding universities and colleges
to graduate 2,000 RNs per annum, a
commitment not kept incidentally.
What we need is an additional
commitment to train 1,000 health
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care aides annually. Then we’d see
some workplace transformation.
Thank you and au revoir.
References
1. http://www.thecanadianencyclopedia.com/index.cfm?PgNm=TC
E&Params=M1ARTM0012159
2. To be precise, according to their website (http://www.
friendsofmedicare.org/default.asp?mode=webpage&id=52),
they are opposed to a parallel system of for-profit delivery,
with no mention of any exclusion for physician practices.
3. http://www.edmontonjournal.com/health/interim+Alberta+
health+board+boss+will+focus+better+service+engaging+
staff/3890943/story.html
4. Most notably to this forum, the Board, zone planning days for
the Calgary, Edmonton and North Zones and at a University
of Alberta conference (http://www.economics.ualberta.ca/
boom_and_bust_again.cfm).
5. http://policyschool.ucalgary.ca/files/publicpolicy/Dranove_
Capps_Dafny_ONLINE.pdf
6. http://www.anticorruption.ca/forum/phpBB2/viewtopic.
php?p=9007
7. http://www.edmontonjournal.com/health/Alberta+unveils+
health+plan/3906386/story.html
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Alberta Doctors’ Digest • March/April 2011 13
 F ea t u r e
Children and energy drinks:
What you should know
Peter Nieman,
MD
Calgary
pediatrician,
part-time
faculty member,
University of
Calgary
Energy drinks contain various
chemical substances but two main
ingredients – caffeine and sugar –
concern some public health experts
and parents.
These drinks are in a class of their
own, known as “functional beverages.”
They fall under the Natural Health
Product Directorate of Health Canada.
Since energy drinks were launched
in North America almost 12 years
ago, their popularity has continued
to climb, in part, due to aggressive
marketing. In fact, they are part of
the fastest-growing segment in the
beverage industry.
The problem occurs when huge
amounts of energy drink are
consumed in quick succession or
when it is combined with other
stimulants, such as ephedrine
or amphetamines.
14 Alberta Doctors’ Digest • March/April 2011
Prince Edward Island has tried
hard to lead the way in limiting energy
drinks for children and adolescents.
[E.g., the Medical Society of Prince
Edward Island voted to tackle the
issue, energy drinks are banned
in schools and parent groups want
to extend the ban to stores, and a
pharmacy chain stopped selling
energy drinks to people under 18.]
Health Canada continues to monitor
the reported side-effects of energy
drinks closely.
For more information, visit Health
Canada’s website (www.hc-sc.gc.ca;
search for “energy drinks”). It suggests
children aged 10 to 12 should not
have more than 85 milligrams (mg)
of caffeine daily.
The caffeine content in energy
drinks is not much higher or different
from other common sources of caffeine.
• Per serving (usually eight ounces
or 250 millilitres [mL]), most
energy drinks have caffeine
levels of 60 to 150 mg.
• Contrast that with caffeine levels
in 250 mL of: coffee – 104 to
193 mg; tea – 20 to 90 mg; iced
tea – nine to 50 mg; cocoa drink
– three to 32 mg; soft drinks –
35 to 45 mg; one ounce/28 g of
dark chocolate – five to 35 mg.
However, the problem occurs when
huge amounts of energy drink are
consumed in quick succession or when
it is combined with other stimulants,
such as ephedrine or amphetamines.
Children and teens with
heart-rhythm abnormalities, high
blood pressure and diabetes are
particularly susceptible to energy drink
side-effects. Common side-effects
are headaches, high blood pressure,
irregular heart rates and anxiety.
Also, pregnant teenagers and
mothers who nurse should avoid energy
drinks. The caffeine may also act as a
diuretic and cause extra urination. If
combined with alcohol, the diuretic
impact is amplified. Most makers of
energy drinks caution users against
combining their products with alcohol.
The B vitamins play an important
role in energy metabolism and
mental alertness.
But objective research has so far
failed to consistently show that these
energy drinks actually provide the
so-called “pick-me-up” effect if used
in only one serving.
That is where some doctors –
especially an expert such as Dr. Roland
Griffiths, a professor in psychiatry
and neurosciences at Johns Hopkins
Medical School, and a caffeine expert
– have serious concerns.
They point out that some
adolescents have experienced
side-effects when exposed to
excessive amounts of energy drinks.
However, despite close monitoring
and scientific studies – which remained
limited even after 10 years – there is
still not enough data for the Canadian
Paediatric Society or the American
 For more information
Academy of Pediatrics to deliver official
statements condemning or banning
the sale of energy drinks to minors.
Researchers at the Centre for
Science in the Public Interest are
very concerned about children using
energy drinks. They estimate that
consumption of soft drinks and energy
drinks with caffeine has doubled
among children in the last 25 years.
They are supportive of warning
labels on cans that clearly state how
much caffeine a product contains.
It is unclear whether labels
will actually change behavior or
consumption but, at least, it would
serve as a warning.
“It is time for health authorities around the world to be awakened and alerted to concerns
about energy drinks sold to children.”
> Macdonald N. Stanbrook M. Hébert P.C. “’Caffeinating’ children and youth.”
CMAJ, October 19, 2010; 182(15): 1597. (www.cmaj.ca/cgi/reprint/182/15/1597)
“Health Canada received a report of an 18-year-old man who drank 2 cans (355 mL each) of
Red Bull Energy Drink over a half hour, on an empty stomach, for fatigue and hunger after a
night of studying. About 1 hour later, while at school, he experienced 2 grand mal seizures.”
> “Case presentation: Red Bull Energy Drink: Suspected association with seizure.”
Canadian Adverse Reaction Newsletter. Health Canada, October 2010; 20(4):
Page 3. (www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/pdf/medeff/carn-bcei_
v20n4-eng.pdf)
Patient information: “Excessive drinking of energy drinks or mixing them with
alcohol can have serious health effects.”
> “Safe use of energy drinks.” It’s Your Health. Health Canada, August 2010. (www.hc-sc.
gc.ca/hl-vs/alt_formats/pdf/iyh-vsv/food-aliment/boissons-energ-drinks-eng.pdf)

Complicating the picture further

is evidence that some children with
attention-deficit hyperactivity disorder
actually benefit from stimulants,
including caffeine.
Consumption of soft drinks
and energy drinks with caffeine
has doubled among children
in the last 25 years.
It does not mean they should
drink more coffee or energy drinks,
but the possibility of energy drinks
compounding the effects of prescribed
stimulant medications warrants
further study.
Exposing a teen or older child to
caffeine-containing energy drinks late
at night may affect the quality of sleep.
Where does this leave parents as
they await advice from authorities
such as pediatric organizations or
regulatory authorities?
My suggestions follow, based
on best-published evidence in
peer-reviewed publications:
• See the products as one-can
servings, with plenty of caffeine,
not much different from a
strong cup of espresso coffee.
For that reason, limit intake
or, ideally, avoid energy drinks
altogether. (Few parents allow
their children to drink coffee.)
• Explain to a teen that the hype
behind these products does not
justify the higher cost.
• Do not combine energy drinks
with alcohol. A highly caffeinated
drunk is still a drunk. Both
beverages are diuretics and
may lead to dehydration.
• Expect side-effects such as
headaches, high blood pressure,
jitters or a racing heart with
consumption of these drinks
in excess or for the first time.
As is the case with many
coffee drinkers, tolerance
develops over time.
• Be aware that one 250-mL
serving delivers 90 to 110
calories; numerous servings can
potentially lead to weight gain.
• The effect of caffeine on sport
performance is mixed in adults.
Although some adult athletic
studies have shown longer
endurance in cyclists or more
power in sprinters, results for
the pediatric athletic group are
still quite fuzzy. Much more
robust research is required.
• When exercising in hot, humid
conditions for more than an hour,
children lose key electrolytes.
Under these circumstances,
taking five ounces/142 mL of a
sports drink, such as Gatorade
or Powerade, every 15 to 20
minutes may be wise. But
energy drinks consumed
under these circumstances
may be very unwise.
When in any doubt, read labels
– if there are any – or research
online, e.g., the International Food
Information Council (www.ific.org).
Dr. Nieman’s original article –
“Should kids consume energy drinks?” –
appeared in the Calgary Herald,
May 14, 2009.

Alberta Doctors’ Digest • March/April 2011 15

 F ea t u r e
Innovative ways to
improve inner-city
residents’ health
Kathryn A. Dong, MD
Co-Director, EICHREN
Trying to better meet the health
needs of inner-city residents is the
mission of some of Edmonton’s
health care providers, researchers,
community members and workers.
Edmonton Inner City Health
Research and Education Network
(EICHREN) is using innovative
approaches to community-based
research and education to try and
improve health care access by, and
health outcomes for, Edmonton’s
inner-city residents.
The network is working on the
projects to better understand the
needs of inner-city populations,
exchange information and share
knowledge between front-line
health-care providers and enact
positive culture change at local
health institutions.
16 Alberta Doctors’ Digest • March/April 2011
Why? Inner-city residents carry
a disproportionate morbidity and
mortality burden due to a combination
of factors, such as a lack of stable
housing and proper nutrition,
exposure to violence, mental health
and/or addictions issues.
EICHREN started in 2008 with
some initial funding from the Royal
Alexandra Hospital Foundation.
Currently, the network is working on
projects to better understand the needs
of inner-city populations, exchange
information and share knowledge
between front-line health care providers
and enact positive culture change at
local health institutions.
EICHREN projects include the
following:
• A survey, at the Royal Alexandra
Hospital, will help in understanding
the needs of patients who live
in unstable housing situations
and/or present to the emergency
department (ED) with acute or
chronic substance-use issues.
The Needs Assessment and
Satisfaction with Care Survey of
Unstably Housed and/or Substance
Using Adults Presenting to the
Emergency Department will help
characterize the demographics
of this high-needs group, as
well as identify key areas for
improvement in ED services.
The survey also explores whether
this group would be interested
in accessing additional health-
promotion services from the ED.
As this population may have
difficulty accessing traditional
sources of medical care, the ED
serves as a key entry point into
the health care system. Maximizing
the care and services provided
are important in improving
health outcomes.
• A study will get the best practices
for screening, brief intervention
and referral of patients with
addictions issues into the hands of
family and emergency physicians.
Towards Patient-Centered Addictions
Care in a Socioeconomically
Disadvantaged Urban Population
is funded by Alberta Innovates
Health Solutions and Alberta
Health Services.
• A multi-modal physician training
package is being developed and
piloted.
As the physician-patient
relationship is a two-way street, a
booklet will be created for patients
about how to access the health care
system and what to expect.
These two interventions are
being tested and evaluated in
a study setting to determine if
such interventions are effective
at improving patient engagement
into additional care and satisfaction
with care.
Physician attitudes towards addicted
patients are also being tracked.
• An inner-city health care elective
will improve the comfort level of
medical trainees in dealing with
this high-needs population.
• An inner-city Health Discussion
Group will get knowledge into
the hands of front-line care
providers. A quarterly discussion
group chooses key topics
related to inner-city health for
discussion and reflection.

Open to University of Alberta • Grants competition: The

emergency medicine, family
medicine, internal medicine
and psychiatry residents, the
elective pairs residents with
primary mentors who have
considerable experience
working with an inner-city
population.
A resident also spends
two-to-three days per week in a
community becoming familiar
with community resources and
meeting community members
on their own turf.
network is committed to
being responsive to the needs
of the community and to
being action-based. As such,
applications were accepted until
March 1 in the second annual
EICHREN grants competition.
A total of $25,000 will support
various research projects related
to improving health and patient
care at the Royal Alexandra
Hospital site.
For more information about
EICHREN or to be added to the
EICHREN Co-Director Dr. Kathryn A. Dong chats with Research Assistant
Scott Kirkland about data he is collecting. ( supplied.)
distribution list, email: Christine
Vandenberghe, Project Coordinator,
EICHREN, at cnv@ualberta.ca or
Dr. Kathryn A. Dong, Co-Director,
EICHREN, at kathryni@ualberta.ca.
You may also follow EICHREN
on Facebook and Twitter.

Alberta Doctors’ Digest • March/April 2011 17

 Health Law Update
Preserving a cause of action
under the Fatal Accidents Act
Jonathan P. Rossall,
QC, LLM
Partner, McLennan
Ross LLP, Barristers
and Solicitors
When is a Release
not a Release?
A recent Alberta
Court of Appeal
decision explored
the effectiveness
of a Release, which
purported to preserve a surviving
spouse’s cause of action against
a physician under Alberta’s Fatal
Accidents Act.
In this case, a physician was sued in
relation to the diagnosis and treatment
of colon cancer in a female patient.
The action was ultimately settled
and the patient signed a Release that
specifically excluded any claim the
husband may have on his behalf or on
behalf of his children under the act.
Five months after the settlement
the wife died of colon cancer and the
husband commenced a new action
under the Fatal Accidents Act, on his
behalf and on behalf of the children,
making the same allegations against
the physician.
The relevant section of the act that
gave rise to the action follows:
“2. When the death of a person
has been caused by a wrongful
act, neglect or default that
18 Alberta Doctors’ Digest • March/April 2011
would, if death had not ensued,
have entitled the injured party to
maintain an action and recover
damages, in each case the
person who would have been
liable if death had not ensued
is liable to an action for
damages notwithstanding the
death of the party injured.”
The legislation represented
a departure from the older
common-law position that any
cause of action available during
the life of an injured party died
when the person died.
The issue of the husband’s
entitlement to bring the new action,
given the wording of the act, was
brought before a chamber’s judge
for a preliminary ruling.
The chamber’s judge held that
section 2 of the act required that the
deceased be entitled to maintain an
action and recover damages at the
moment of her death.
Since she had given up that
right by signing a Release, she no
longer had such a right. The judge
found that the portion of the Release
that purported to exempt the Fatal
Accidents Act was ineffective and,
therefore, there was no cause of
action remaining for the husband.
A good part of the reasoning
revolved around an examination of
the development of the act. The
legislation represented a departure
from the older common-law position
that any cause of action available
during the life of an injured party
died when the person died.
Legislation such as the Fatal
Accidents Act was enacted to preserve
the rights of survivors. But it was
clear from a review of the history of
the legislation that, in order for the
cause of action to vest in the survivors,
it must exist at the moment of the
injured person’s death.
Before the Court of Appeal, the
appellant husband tried to argue
that social and economic times had
evolved and that different damages
were now available to survivors and
others who previously would not have
been entitled.
The Alberta Court of Appeal upheld
the decision of the chamber’s judge.
In doing so, the court pointed out that
the appellant spouse had confused two
separate aspects of an action under
the Fatal Accidents Act: entitlement
to bring the action, and the types of
damages dependents could claim.
 The decision by the chamber’s

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However, the courts’ response was pecialized, inc.
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the Release preserved the right to
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Simply because the Release
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That issue, as this case makes
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Alberta Doctors’ Digest • March/April 2011 19

 Mind Your Own Business
You take care of patients,
what about your staff?
PMP Staff
It is easy to
believe employees
leave your practice
because of “better
offers,” often understood to mean an
increase in pay.
Human resources research
indicates this is not usually the case.
In fact, competent employees tend not
to leave for greener pastures. Rather
they leave due to unmet needs that
effectively “push” them to leave.
Perhaps a better question than
“Why are they leaving?” is “Why are
they not staying?” and “What can I
do about it?”
Leigh Branham’s book, The 7
Hidden Reasons Employees Leave,1 looks
at the root causes of employee turnover.
Four fundamental human needs
emerge as themes in the surveys of
more than 19,000 departing employees.
They are:
• The need to trust – I expect my
employer to keep promises, be
open and honest with me and
treat me fairly.
• The need to hope – I believe that
I will have opportunities for
growth and development.
• The need to feel a sense of worth
– I will be recognized and
valued for my commitment and
contributions.
• The need to feel competent – I
am able to apply my talents and
20 Alberta Doctors’ Digest • March/April 2011
strengths and feel successful in
my job.
When these basic needs are not
being met, an employee’s reaction
can be as obvious as a resignation, to
more subtle signs such as increased
absenteeism, poor commitment to
tasks, lack of productivity or even
negativity and sabotage.
The latter can be especially
damaging as the employee has “left”
without leaving or becomes a negative,
de-motivating influence on other staff.
Competent employees tend not
to leave for greener pastures.
Rather they leave due to unmet
needs that effectively “push”
them to leave.
Branham lists seven top reasons
employees leave (see page 21), all
symptomatic of underlying unmet
needs or not feeling taken care of by
their employers. We have aggregated
these reasons into four major themes,
with some suggestions to address each.
Recruitment
If employees leave within the
first six months, it’s generally due
to a misalignment of expectations
rooted in the recruitment process.
It is imperative expectations of both
the physician and the employee are
clear up front.
1. Start with an up-to-date and
clearly written job description
that includes the skills and
behavioral attributes required to
perform the role successfully.
2. Use interview questions that
look for evidence of the skills
and behaviors expected in the
candidate.
3. Be honest and frank with
the candidate about the job
requirements, your office and
opportunities for employee
growth. Overselling or
underselling the position
seldom leads to success.
4. Don’t look for the “best”
employee, look for the best
“fit.” Consider the culture of the
office and existing personalities.
To understand some of the
candidate’s expectations, ask
about what motivates him or
her in a job or provides a
feeling of a job well done.
5. As part of the interview process,
have him or her meet existing
staff and physicians, tour the
office and extend an invitation
to observe office activity for a
glimpse into “a day in the life.”
Feedback and recognition
One of the major reasons staff
underperform is lack of feedback, both
for improvement and for recognition.
As per Maslow’s Hierarchy of
Needs, human motivation requires

achievement and recognition. When
this is missing, employees tend to
feel unimportant and undervalued.
1. Build informal feedback and
communication into your office
culture. Talk to them. Listen
to them.
2. Formal written feedback should
be provided at least annually
and signed off by the employee
and employer. Written feedback
should recognize strengths,
identify development and
training needs, as well as set
goals for the upcoming year.
3. Part of feeling valued means
staff feels fairly compensated
relative to their colleagues and
market rates. Use a consistently
applied wage grid based on
good market data and human
resources best practices.
4. The most overlooked tool for
motivation is non-monetary
recognition. Be creative in
recognizing staff for their
contributions. Understanding
your employees will give you
insight into what they value as
recognition. A simple monthly
staff lunch in which the
physicians mingle with staff
is an inexpensive but valuable
way to build relationships and
show appreciation.
Growth and advancement
Providing opportunities for
learning and advancement is
especially challenging for smaller
offices with few staff. Even with
this limitation, however, you and
your employee can come up with
agreed-upon opportunities to enrich
and grow the job.
1. Be creative in enhancing a job.
You could delegate the employee
to be the “go-to person” for
projects or new programs
such as: implementing a new
Top seven reasons employees leave
1. Job is not what they expected
2. Mismatch between the job and the person
3. Lack of feedback/coaching
4. Limited opportunities for growth and advancement
5. Feeling undervalued and unrecognized
6. Stress from work-life imbalance
7. Lack trust/confidence in leadership
electronic medical record,
developing patient handouts,
drafting clinic policies, etc. Ask
the employee what ideas he or
she may have or projects for
which he or she has a passion.
2. Besides external training courses
or seminars, growth opportunities
can be built in by bringing in
lunch-time speakers on topics of
interest, conducting peer-to-peer
in-services or brainstorming
sessions on better ways to tackle
a particular clinic issue.
Leadership and respect
Physicians, by virtue of their
profession, are leaders of the clinical
team. As employers, physicians need
to provide organizational leadership
to their staff as well.
Inspire confidence in your staff by
sharing the clinic’s values and goals.
This goes beyond patient care by
including the “health” of the staff.
There are no step-by-step
instructions to becoming a good
leader. However, physicians who
encourage communication, ideas,
teamwork and integrity will be
rewarded with staff trust and
confidence, contributing to a
cohesive and engaged workforce.
Successful recruitment, motivation
and retention of the right employees
is a major factor in creating a practice
environment that is productive,
1
satisfying and able to meet the needs
of your patients.
If you are losing employees or
experiencing staff performance issues,
it might be time to reflect on how well
you are taking care of your staff.
As physicians, you understand how
prevention and health promotion are
a good investment of time to avoid
acute or adverse events in the future.
This principle, true for your patients,
is also true for your staff.
For more information or assistance
in implementing human resource
processes and tools for recruiting,
retaining and motivating clinic
staff, phone the Alberta Medical
Association’s Practice Management
Program staff at 1.800.272.9680.
References
1. Branham, Leigh. The 7 Hidden Reasons Employees Leave,
2005. Saratoga Institute.
2. Maslow, A. H. "A Theory of Human Motivation," Psychological
Review 50(4) (1943):370-96.
Alberta Medical Association Practice
Management Program (PMP) staff
Susan M. Black, Stephanie A. Crichton,
Cindy C. Michetti and Sean T. Smith
in Calgary, as well as Lucy L. Grenke,
Glenda M. Nash and C. Grant Sorochan
in Edmonton, contribute articles to
the Digest. PMP provides high-quality
business consulting services to Alberta
physicians as they develop and implement
primary care networks. Contact PMP at
pmp@ albertadoctors.org, 780.733.3632
or toll-free 1.800.272.9680.
Alberta Doctors’ Digest • March/April 2011 21
 F ea t u r e
PCNs are changing
primary care delivery
Evidence shows primary care networks (PCNs) are
changing the health-care landscape in Alberta through
positive changes in the delivery of primary care.
Innovation and local solutions are driving these
encouraging changes. From their origins in 2004,
PCNs have addressed patient needs at the local level. If
a community has an area of need, the PCN can target
resources directly to it.
PCNs are a product of the eight-year trilateral master
agreement (2003-11) between Alberta Health and Wellness
(AHW), Alberta Health Services (AHS) and the Alberta
Medical Association (AMA).
Primary care at the Edmonton Oliver PCN with Dr. Malinowski (
As of January 2011, 39 PCNs were operating in Alberta
with five others in various stages of development. In total,
2,299 core family physicians – 77% of Alberta’s 2,991
family physicians – are participating in PCNs.
Dr. Allan Bailey, Co-chair, PCN Physician Leads
Executive, describes PCNs as a vehicle that supports family
physicians in their provision of comprehensive care.
22 Alberta Doctors’ Digest • March/April 2011
“The financial support provided by PCNs enables family
physicians to work with a collaborative team in which all
health-care professionals can practise to the full extent of
their scopes of practice," says Dr. Bailey.
He adds, “Family physicians have been able to improve
access to care, chronic disease management, and screening
and prevention initiatives because of the additional
resources and team approach that the PCN provides.
"Teams are a valuable asset, but there are some
challenges. Both physicians and team members are still
defining the best ways to work together effectively.
“Physicians have seen the benefits of working with a
team and proactive panel management, but we need to find
the most cost-effective way to develop the team.
"What is the best ratio of providers to physicians?
Which health-care professionals do we need in a PCN
team? Do we need all of our nursing staff to be registered
nurses or licensed practical nurses, or can we train other
providers to assist us with some of the proactive care – for
example, reviewing charts for screening purposes? These
are all important questions to sort out.”
How are PCNs changing primary care?
Recently, the PCN Physician Leads Executive created
the Primary Care Network (PCN) Backgrounder, which
highlights the unique nature of PCNs and numerous
examples of local initiatives that are improving access,
coordination and integration of health services.
supplied.)
PCNs were invited to submit results of their evaluations
and examples of the evidence they are collecting about
how they are improving access, integration of services,
after-hours care, etc.
The PCN Leads Executive recently shared examples
of PCN successes with Jay Ramotar, Deputy Minister of
Health and Wellness.
PCN success stories (backgrounder excerpt)
Although PCNs are contributing to an increasing ripple
effect of improvement across the entire system, the impact
of any one network is uniquely local.
Primary care networks are diverse, each tailor-made
to address the greatest needs in primary care in a specific
community.
When planning a PCN, family doctors take into account
the geographic setting, patient demographics, physician
supply, local health indicators, strengths and gaps in AHS
programs and the general accessibility of comprehensive
primary care.
Here are only a few of the local solutions that various
PCNs have delivered.
• Organizing the community’s physicians' clinics to
ensure after-hours or weekend access to a primary
care physician and, thus, reducing emergency
department visits for issues that are more
appropriately managed in a primary care office.
• Hiring mental health navigators to act as the bridge
between the family physician’s office and the
complex mental health system, linking patients to
the appropriate care and socio-economic supports to
ensure they don’t “fall between the cracks.”
• Integrating licensed practical nurses and registered
nurses directly into physician clinics to provide health-
promotion education to patients and perform other
delegated tasks in a primary care setting. Meanwhile,
physicians are able to reduce their wait times for
appointments and take on unattached patients.
• Keeping the frail elderly healthy and in an
independent lifestyle as long as possible through
regular case conferencing for a roster of supportive-
living residents. This may include the primary care
physician, facility care staff, pharmacists, occupational
therapists or home care nurses to proactively address
health issues, preventing illness and injury and
avoiding the need for acute care, hospitalization or
long-term care facilities.
• Providing prenatal care and deliveries on a rotating
on-call schedule in an area lacking low-risk obstetrical
services, incorporating nurses, dieticians, lactation
consultants and other health professionals to provide
education and prenatal and postnatal care.
PCNs are the connective tissue that is allowing better
integration and coordination of family physician services
with new or existing health resources, resulting in more
efficient, patient-focused care.
PCN initiatives integrate services, increase access and
provide multi-disciplinary care
Integration of PCN services
π Edmonton Oliver – Referral coordination program
> Referral coordinators handle approximately
24,000 specialist referrals annually on behalf
of family physicians, improving timeliness of
patient-specialist appointments and freeing family
physicians for direct care.
π Wood Buffalo – Guaranteeing next-day appointments
in PCN for Health Link referrals with early morning
appointments set aside
> Next-day appointments met for 100% of referrals
(Health Link audit). Evening- and weekend-
extended hours offered by 10 of 30 physicians.
π Calgary Foothills – PCN In-Hospital Program facilitates
communication/transition for admitted patients
> 80% of physicians rate patient transitions from
hospital to home as smooth.
> 75% of physicians indicate satisfaction with
timeliness of information from PCN in-hospital care.
> 74% were satisfied with the quality of the
information from the program.
Increase screening
Chinook (Lethbridge) – Increased screening of patients
for disease and illness
2007-09 increases
Mammograms 47-59%
Pap smears 62-66%
Colorectal cancer screening 29-44%
BP recorded 47-63%
BP <140/90 73-75%
Diabetic HgA1C 44-59%
Alberta Doctors’ Digest • March/April 2011 23
 Health promotion
π Red Deer – Health Basics Program focusing on healthy
living choices for weight loss
> Of patients completing the workshop program, 64%
indicated they were exercising more, 72% changed
eating habits, 13% reported reduced medication
need for blood pressure or cholesterol reduction,
49% had more energy for routine activities and
28% felt more positive about themselves.
Increase in access to primary care services
π Edmonton Southside – Geriatric care program
> Access increased from an annual average of
2.87 visits per patient pre-PCN to 3.38 visits
post-PCN. Emergency-room visits dropped from
an annual average of 1.77 visits pre-PCN to 1.68
visits post-PCN. In-patient admissions dropped
from annual average of 1.61 visits to 1.35.
> 97% of PCN physicians were co-located with
a multi-disciplinary team member.
For more information
For more specific examples and initiatives of PCNs,
read the Primary Care Network (PCN) Backgrounder (visit
www.albertadoctors.org/PrimaryChronicCare/Index).
The PCN Physician Leads Executive invites all
PCNs who did not submit their examples, evidence
and evaluation results to do so now so the data can
be added to the backgrounder.
Please email your information as soon as possible
to Linda Ertman, Project Coordinator, AMA’s Practice
Management Program (linda.ertman@albertadoctors.org).

After-hours access

π Westview (Spruce Grove) – After-hours clinic

> In 2009-10, 44% of patients who attended an
after-hours clinic indicated that they otherwise
would have gone to the emergency department.

π Leduc-Beaumont-Devon – After-hours clinic

> In 2008, 41% of patients who attended an
after-hours clinic indicated that they otherwise
would have gone to the emergency department.
The Leduc Community Hospital documented
a significant reduction in semi-urgent patients
showing up at the emergency department
following the opening of the after-hours clinic.

Multi-disciplinary care

π Edmonton Oliver – Nurse-led Anti-Coagulation

Management Program for monitoring and patient
education
> Estimated time savings are 30 minutes per day
for 100% of participating physicians plus 30
additional minutes per physician assistant.

π Calgary Foothills – Incorporating other health

professionals in the team

24 Alberta Doctors’ Digest • March/April 2011

 Students' Voice
Political boot camp
helps students become
effective advocates
In late November 2010, medical
students from across the province
spent a power weekend at the
University of Alberta (U of A) to
learn how to exercise their clout and
become effective advocates. This was
the students’ third annual Political
Advocacy Day at the Legislature.
Putting their skills to good use,
they met with MLAs at the Legislature
to pitch the importance of having
a more diverse medical student
population and how government
leaders could make changes to help
achieve this goal.
About 50 U of A and University
of Calgary (U of C) medical students
attended discussions with various
speakers. Kevin Taft, Liberal MLA
(Edmonton-Riverview), spoke about
how to effectively approach politicians
about advocacy issues.
Roger Palmer, a business professor
and former government official in
various portfolios, including health and
education, discussed the importance of
being an advocate and how doctors may
initiate this type of action.
Students also met in small groups to
prepare questions and rehearse their
answers prior to meetings scheduled
with 30 MLAs. After meeting with
MLAs, the students heard from
Dr. Raj Sherman, Independent
MLA (Edmonton-Meadowlark), about
his political journey, and they sat in
on question period.
“When asked to list some of
the qualities that make a good
doctor, people usually suggest
everything from intelligence to good
communication skills,” says Sahil
Gupta, U of A Medical Students’
Association delegate for the Political
Advocacy Committee.
We feel having more diversity
among medical school students
will help fill current gaps of
care in the system.
“Understanding the mechanics of
the political process to advocate for
patients and social change is not a
quality that generally makes that list,
but it is incredibly important.”
Currently, a disproportionately high
number of medical students come
from high-income families. There
is a lack of representation across
Canada from rural communities,
Aboriginal communities and those
who come from a low socio-economic
background, say the students.
“It has been shown that medical
students who come from under-
represented groups have a higher
propensity to work and stay with those
under-serviced communities,” said
U of A medical student Stephane
Doucette-Preville. “We feel having
more diversity among medical school
students will help fill current gaps of
care in the system.”
(Left to right) Front: Adil Abdulla, Ambica Parmar, Sahil Gupta, Ling Ling,
Haitham Kharrat; Back: Mischa Snopkowski, Allan Pickard, Harbir S. Gill,
Kelsey M. Macleod, Anthony C.K. Lott, Ameer Farooq, Alistair W.G. Waugh.
( supplied.)
Independent MLA Dr. Raj Sherman, far right, speaks to medical students
(left to right) Aisling E. Campbell, Scott I. DeGraff and Keith A. Lawson.
( by Sahil Gupta.)
The students proposed a
new initiative to MLAs: That a
comprehensive study be undertaken
to closely examine demographics of
medical students who attend Alberta
post-secondary institutions and that
government more directly engage
in outreach efforts to these under-
represented groups.
Under-representation in the three
aforementioned groups is also an
issue in medical schools in other
countries, noted the students.
In the US, students from low-income
backgrounds are eligible for subsidized
MCAT exam fees and their medical
school application fees are waived.
In Australia, the government gives
monetary incentives to medical schools
that increase admission of students
from rural and remote locations.
Alberta Doctors’ Digest • March/April 2011 25

In Alberta, many positive efforts
are already being made at having
a more diverse medical student
population. In the U of A’s Faculty of
Medicine & Dentistry, the student-led
MD Ambassador program promotes
medical school as a feasible option
to rural and low-income high school
students, and the faculty reserves spots
for rural and Aboriginal applicants.
Both the U of A and U of C
medical faculties have created offices
AMSCAR: Prepare for life as a physician
“AMSCAR was a great blend of
clinical skills, personal wellness and
inter-school socializing in beautiful
Banff,” reflected Brianne Tetz,
first-year University of Alberta
(U of A) medical student.
AMSCAR is the annual Alberta
Medical Students’ Conference and
Retreat, sponsored generously by the
Alberta Medical Association (AMA)
with welcome support from others,
too (see www.amscar.ca/AMSCAR/
Sponsors.html).
At the seventh annual event,
February 4-6 at the Banff Conference
Centre, 295 U of A and University
of Calgary (U of C) medical students
relished the offerings.
The welcome reception and
icebreaker contest encouraged
mingling. The next day students took
in, with delight, various sessions about
“In the ultrasound session I got to do
an echocardiogram on my friend's
heart. It was exhilarating to see the
chambers and valves in real time.”
Patricia Lee, second-year medical student,
AMSCAR Committee 2011, VP Internal, U of A.
26 Alberta Doctors’ Digest • March/April 2011
students’ exposure to rural and
Aboriginal communities. Also, the
province-wide Rural Physician Action
Plan (RPAP) encourages medical
students to consider practising in
rural communities.
Again, Political Advocacy Day
provided an interesting glimpse into
the complicated relationship between
politics and health care, and gave
Medical student Stephane R. Doucette-Preville speaks students a chance to consider the
with students. ( by Sarah Stonehocker.) dynamics and challenges of policy
making and moving an agenda
related to Aboriginal and rural health forward through government.
in an effort to increase medical
AMA President Dr. Patrick (P.J.) White with Committee on Student Affairs representatives, left to right, Matthew Karpman (U of C),
Maryam Soleimani (U of A) and (far right) Aisling Campbell (U of A). ( supplied.)
clinical skills, the power of negotiating, Oldest Profession.” She spoke of her
financial management, professionalism experiences as a family physician and
and ethics, mindfulness in medicine dispelled some of the myths about
and nurturing creativity. family medicine.
At an evening banquet, AMA “AMSCAR offered a mix of clinical
President Dr. Patrick J. (P.J.) White training and student wellness,” said
shared his perspective on life and Sean Fair, first-year U of A medical
well-being as a physician, emphasizing student. “A major emphasis of the
the importance of looking after conference was to encourage medical
ourselves and our relationships. students to put work into learning how
to deal with stress in healthy ways and
also how to stay afloat in the financial
Greg Quinn, from TD Financial
Group, spoke about the importance tidal wave that comes to wash over
of financial well-being. our debt when we begin practice.”
Dr. Raegan Kijewski, Department During the last day, students had
of Family Medicine, Faculty of time to ski, snowboard, explore Banff,
Medicine & Dentistry, U of A, take ballroom-dance lessons and relax
presented “A New Look at the Other at the Banff Centre.
An affair
of the heart
Shannon Sarro
Medical Student, Class of 2013,
University of Alberta
In an Affair of the Heart,
second-year University of Alberta
(U of A) medical students raised
more than $13,000, in October 2010,
for children diagnosed with cancer.
In an Affair of the Heart,
Guest-of-honor Sara Weidmann,
a seven-year old cancer survivor and
KWCS member, presented a touching
talk about her experiences with cancer.
During the lighter aspect of the
evening, the fashion show featured
students, faculty members, Sara and
her brother, Eric.
The previous two Affair of the Heart
evenings raised more than $15,000
Sarah Weidmann, a brain-tumor survivor, participates in the Affair
in support of Save a Child’s Heart, a
charity that provides overseas life-saving
of the Heart fashion show with her mom, Linda. ( supplied.)

heart surgeries in developing nations.

second-year U of A medical Society, an organization that helps
Next year, an Affair of the Heart purchase medical equipment, toys
aims to raise more than $20,000 and comforts for children with
students raised more than $13,000, in support of the Children’s Heart acquired and congenital heart disease.

in October 2010, for children

diagnosed with cancer. PHYSICIAN(S) REQUIRED FT/PT

Also locums required

This was the students' third annual

fundraising dinner, silent auction and
fashion show in support of Edmonton
pediatric charities.

Approximately 250 medical

students, faculty and members of the
public turned out to assist Edmonton's
Kids with Cancer Society (KWCS),
which supports children diagnosed
with cancer, and their families, through
ALL-WELL
research, counselling services, summer PRIMARY CARE CENTRES
camps and a variety of other services.
MILLWOODS EDMONTON
At the Delta Centre Suites, in
downtown Edmonton, guest speaker Phone: Clinic Manager (780) 953-6733
Dr Paul Grundy, Director, Paediatric
Dr. Paul Arnold (780) 970-2070
Hematology, Oncology and Palliative
Care, Stollery Children’s Hospital,
and the chair of KWCS, highlighted - Signing bonus or guarantee -
society services.

Alberta Doctors’ Digest • March/April 2011 27

 Balance Night:
Students appreciate down-to-earth
perspectives about common worries
Dr. Patrick J. (P.J.) White, students who likely learned as
Simon Bow and Chris Korol much as the medical students
President, AMA, expressed his
Class of 2013,
optimism about increasing support
Student Affairs Representatives,
for physicians that can improve These activities incorporate an
Medical Students’ Association,
University of Alberta lifestyle and minimize stress, and the important interaction between
corresponding increase in the quality mind and body, which often goes
How do first- and second-year of patient care provided. unheralded among medical students
University of Alberta (U of A) and practitioners alike.
medical students gain perspectives Dr. Kelly Dabbs, general surgeon
on establishing balance and wellness and recent William A. Shandro Award Approximately 120 student
in their lives now and as future winner, focused on some practical attendees, speakers and session
physicians? aspects of physician health, such as leaders voiced their support to
ways to minimize stress, when to get continue such events. Collectively
The U of A Students' Association married, the importance of taking they agreed that this is an important
offers an opportunity at the annual addition to medical education, as well
holidays and the benefits of seeking
Balance Night. as an initiative for self-preservation.
diversity in medical practice.

During the November 1, 2010 Not only can students benefit from
Dr. Marc Cherniwchan, representing
event, while students dined, they taking part in wellness activities, but
the Physician and Family Support
appreciated hearing down-to-earth they can increase their knowledge of
Program, discussed the variety of community resources that could be
perspectives about their common resources available for physicians
worries. Speakers spoke about their useful for future patients.
and medical students in Alberta.
experiences in and beyond medicine,
how to manage stress and finances, In addition, students say they
Students also appreciated hearing can increase the quality of care they
and life as a physician. from Dr. Wilson Chan, fifth-year provide when they take care of their
resident in Medical Microbiology, own physical and mental health.
and Abel Tsang, Financial Consultant,
MD Financial.

After dinner, through unique

interactive learning experiences, Not only can students benefit
students were introduced to activities
that focused on enhancing physical from taking part in wellness
and mental well-being:
activities, but they can increase
• Painting, at the McMullen Art
Gallery, in the U of A Hospital
their knowledge of community
• Yoga
• Salsa dancing resources that could be useful
Chris Korol (left) and Simon Bow, Student Affairs representatives, • Creativity in medicine
Medical Students’ Association, U of A, helped students at for future patients.
Balance Night find ways to keep well. ( supplied.) • Massage therapy, led by
registered massage-therapy

28 Alberta Doctors’ Digest • March/April 2011

U of A med students
help others prepare
for OSCE
The Canadian Objective Structured
Clinical Examinations (OSCE) can be
nerve-wracking. How do University of
Alberta (U of A) medical students help
others across Canada get prepared?
Frustrated with few examination
preps, U of A medical students Aaron
Knox, Shaheed Merani, Ryan Gallagher
and Jasmine Pawa spearheaded
development of a user-friendly
Approach to the OSCE: The Edmonton
Manual of Common Clinical Scenarios,
better known as the Edmonton Manual.
Created for students, by students.
The first edition was released in
March 2010 and sold more than 600
copies country-wide. No longer did
students have to rely on passing scraps
of miscellaneous, home-made notes to
each other, one year to the next.
The second edition of the
Edmonton Manual is now available
(www.edmontonmanual.com).
For more information, email
Lina Wang, Director of Sales and
Marketing, Edmonton Manual, at
info@edmontonmanual.com.
As the website explains, “Drawing
on the experience of 125 U of A
medical students, residents and staff
physicians, the resource provides an
approach to more than 190 common
clinical scenarios.
“It helps students focus their
history and physical examination and
The second edition of
the Edmonton Manual is
now available.
Left to right: Second-edition editors David Lesniak, MD/PhD
candidate; Ryan Gallagher, fourth-year medical student, MSA
president 2008-09; Jasmine Pawa, third-year medical student,
MSA president 2009-10. ( supplied.)
quickly arrive at relevant differential
diagnoses. Abbreviated formatting allows
for a quick review targeted specifically
for OSCE preparation.”
However, as the website also
indicates, “This book should only
be used in combination with other
textbooks and resources, and strong
clinical mentorship and teaching
offered through an accredited medical
educational institution.”
The Edmonton Manual is a non-profit
initiative; all proceeds go to the U of A
Medical Students' Association (MSA)
to support student activities. A portion
of the net profits will be donated to the
graduating class and to a local charity.
Two of the original founders, Mr. Knox
and Mr. Merani, have moved into residency.
Current editors are Mr. Gallagher, Ms Pawa
and David Lesniak.
Alberta Doctors’ Digest • March/April 2011 29
 PFSP Perspectives
Relationships:
What works for physicians?
Monica Hill, MD
PFSP ASSESSMENT
PHYSICIAN
What do we know about what
works well in personal relationships?
• What challenges does our
marriage face if one of us
is a physician or both are?
• What can I do to increase the
chance my partner will care
and listen to what I’m saying?
• Is it important to be influenced
by his or her opinion? What
about when we disagree?
• What can we do to feel more
of the fondness that brought
us together in the first place?
There is a lot known now about
relationships that are working well,
thanks largely to the research of
Dr. John M. Gottman and his
many colleagues.
For more than 30 years they
have examined couples and learned
much about constructive conflict,
what nurtures a couple’s connection,
and how they find a shared purpose
through the years.
A grand overview of these areas
follows and I invite you to explore them
through the resources provided.1-6
Drs. Wayne and Mary Sotile are
psychologists who have spent their
careers working with physicians and
30 Alberta Doctors’ Digest • March/April 2011
Research tells us only 31% of
our conflicts can be considered
solvable. This leaves 69% as
ongoing areas of disagreement.
increasing an understanding of what
is challenging in physicians’ personal
relationships. Their book, The Medical
Marriage, is practical and valuable.7
Conflict
“Can’t live with you, can’t live
without you.” Not “you,” your partner,
but, you, conflict.
According to Dr. Gottman’s
findings, this would be more accurate
when it comes to conflict in thriving
relationships as, “We’ve gotta live with
you so let’s make it the best possible.”1
Every relationship over time will
have conflict. Research tells us only
31% of our conflicts can be considered
solvable. This leaves 69% as ongoing
areas of disagreement.
It seems with whomever we make
a match, we will need to live with our
differences, which are at the heart of
these chronic conflicts. The first step
to living with them is recognizing
our differences in personality, some
values and needs, and expecting these
differences to endure.
Having a way to talk about them
when they cause conflict is how
thriving couples cope. If we can
“be on the same team” when we
approach these issues and “yield
to win,” our relationship can be
victorious in defeating the differences
that could pull us apart.1
As for the solvable problems, there
are specific skills that work to get
past them.
• Being able to deliver a message
in a way that increases the
chance your partner can hear
it and care about it. Sticking to
speaking up for yourself using
“I” statements is one of the best
ways to avoid blaming, which
will turn off your partner.
“When I see/hear this, I feel
this and I need this.” A gentle
delivery is one of the most
important communication
skills practised by couples
who are doing well.1-4, 5
Research backs this up in an
astonishing finding. The tone
of the first three minutes of
the conversation predicts
accurately the outcome of
the conversation, as well as
the likelihood of the couple
remaining together happily.1
• The next skill starts with
an attitude – the belief that
my partner has a right to be
influential in our relationship.
This means his or her opinions,
feelings and needs are
important and deserve
attention and consideration.
 This is really an attitude of
respect. This is not a requirement
to agree with or even experience
the same feelings or needs
but to hear him or her out
and accept him or her, even
while we disagree (gently!).
Dr. Gottmann’s resources
provide important information
about these and other ways to
make conflict constructive.1-6
Friendship
Remember when you met your
loved one? Typically, when we meet, we
cannot get enough of each other. We
invest energy to spend time together,
we are curious about each other, we
look for ways to have fun together.
As the years pass and the
responsibilities and to-do list
lengthens, we do not invest in our
relationship in the same way. We
can become strangers if we do not
keep updated on who our partner is.
The key to knowing your partner
is asking open-ended questions. Who
and what’s important to you at this
point in life? What are you excited
about? What are your worries?5
For most couples, especially if they
have children and both work outside
the home, much of their opportunity
to connect will be in day-to-day life.
Finding ways to spend time
together that fits with the weekly
routine is key. Many couples find
time to talk by sharing the homework,
dishes, home and yard maintenance,
and child-care responsibilities.
Going out as a couple can seem
intimidating if out-of-touch. But
finding ways to get out and relax or
have fun together, as a twosome,
is one of the best opportunities to
nurture the friendship.
Creating shared meaning
What dreams do you share?
What do you or your partner want
to accomplish before you die?
What is most important to you,
as a couple, to teach your children?
What would you like to be known for
as a couple?
These are the kinds of issues
thriving couples know about each
other and work towards.
So how does this apply to a
relationship when one or both people
are physicians?
As a married physician myself,
and as a couples therapist, I find this
material applicable to physicians in
the same way as non-physicians.
We can best apply this to our own
lives by asking ourselves questions like:
• Can we disagree agreeably?
• Do I speak to my partner or
spouse with the same kindness
and respect I offer colleagues?
• Do I speak up clearly but gently
from my perspective or am I
quick to point the finger at
my spouse?
• Am I willing to share power in
this relationship or do I prefer
to “give orders” as I do at work?
• Am I truly open to my partner’s
point of view and preferences?
• Are we both aware of our
differences and willing to accept
them, figuring out a way to live
alongside them in a win-win way?
• What do I know about what is
going on in my partner’s life and
how he or she feels about it?
Calls regarding intimate
relationships are among the
most common reasons people
contact PFSP.
• When did we last go out as a
couple and spend time relaxing or
doing something we found fun?
• Do my partner and I share
hopes and dreams for the
future and what are they?
• How do I make sure I have time
and energy for our relationship?
Calls regarding intimate
relationships are among the most
common reasons people contact
the Alberta Medical Association’s
Physician and Family Support
Program (PFSP).
Although there are no perfect
people or relationships, we are here
for you, to help you have comfortable
and satisfying relationships with
whom you choose to spend your life.
References
1. Gottman, J. The Marriage Clinic, 1999. W.W. Norton &
Company, New York.
2. Gottman, J. Silver, N. The Seven Principles for Making
Marriage Work, 1999. Three Rivers Press, New York.
3. Gottman, J. Schwartz Gottman, J. De Claire, J. 10 Lessons
to Transform Your Marriage, 2006. Three Rivers Press,
New York.
4. Gottman, J. De Claire, J. The Relationship Cure: A 5
Step Guide to Strengthening Your Marriage, Family and
Friendships, 2001. Three Rivers Press, New York.
5. Level II Training Manual (Gottman Method). Assessment,
Intervention & Co-Morbidities.
6. www.gottman.com
7. Sotile, W. Sotile, M.A. The Medical Marriage: Sustaining
Healthy Relationships for Physicians and Their Families,
2000. American Medical Association.
Alberta Doctors’ Digest • March/April 2011 31
 Insurance Insights

Raising doubts about

locking in life-insurance rates
J. Glenn McAthey,
CFP, CLU, RHU
DIRECTOR / SENIOR
INSURANCE ADVISOR,
ADIUM INSURANCE
SERVICES INC.
Out of interest,
I picked up a 1990
Alberta Medical
Association (AMA)
Term Life Insurance
plan rate card recently to see how our
life-insurance rates have changed over
the past 21 years.
The plan operated on the similar
“refund-accounting” group insurance
model that we still use today.
Simplistically, refund accounting
is the annual return of unused
premiums to the AMA by
our insurance company.
The AMA keeps these unused
premiums in reserve to insulate our
rates against claim spikes that can
happen from time to time. With
sufficient reserves, the excess is used
to fund premiums for members. We
call this the AMA Premium Discount.
The AMA used unisex life
insurance rates in 1990 (see table to
the right). Premiums were refunded
at the end of each year.
Today, we discount rates in
advance and use the reserve to fund
the difference. That eliminates the
need to send cheques to all members
at the end of the year.
AMA rate comparison — 1990 to 2011
Annual premium for $100,000 coverage
1990
Age Male Female Refund Net
25 $ 113 $ 113 30% $ 79
35 $ 147 $ 147 30% $ 103
45 $ 430 $ 430 30% $ 301
55 $ 998 $ 998 30% $ 699
2011
Standard Non-Smoker
Age Male Female Refund Male Net % of 1990 Female Net % of 1990
25 $ 44 $ 24 25% $ 33 -58% $ 18 -77%
35 $ 66 $ 50 25% $ 50 -52% $ 38 -64%
45 $ 186 $ 134 25% $ 140 -54% $ 101 -67%
55 $ 434 $ 280 25% $ 326 -53% $ 210 -70%
Preferred Non-Smoker
Age Male Female Refund Male Net % of 1990 Female Net % of 1990
25 $ 40 $ 24 25% $ 30 -62% $ 18 -77%
35 $ 58 $ 48 25% $ 44 -58% $ 36 -65%
45 $ 140 $ 114 25% $ 105 -65% $ 86 -72%
55 $ 322 $ 248 25% $ 242 -65% $ 186 -73%
Elite Non-Smoker
Age Male Female Refund Male Net % of 1990 Female Net % of 1990
25 $ 36 $ 22 25% $ 27 -66% $ 17 -79%
35 $ 54 $ 46 25% $ 41 -61% $ 35 -66%
45 $ 126 $ 102 25% $ 95 -69% $ 77 -75%
55 $ 296 $ 214 25% $ 222 -68% $ 161 -77%
To summarize the rate comparison:
• Female non-smokers: Rates have dropped 64-79%, depending on risk category.
• Male non-smokers: Rates have dropped 52-69%, depending on risk category.
• This represents an average annual decrease in life insurance rates of 2.5-3.8%.

32 Alberta Doctors’ Digest • March/April 2011

What does this mean for
the future?
No one knows how mortality
rates will change in the future.
But I recently spoke with one of
Canada’s most respected actuaries
who stated that mortality rates are
improving at the rate of approximately
2% every year for the working
population.
In the past 40 years Canada has
seen a reduction of 50% in mortality
owing to reduced numbers of smokers
and improved medical treatments.
Does locking-in premiums
make sense?
Many insurance advisors are • During the first 20 years,
recommending locked-in term policies the “street” term-20 and the
for five-, 10- or 20-year terms. AMA-discounted (25%) rates
have virtually the same present
I’m not convinced that’s the best value premium. If AMA rates
way to go. A term-insurance plan were to improve an average of
that can change to reflect prevailing 2% per year, you’d pay $2,546
mortality rates seems to be most less through the AMA plan.
logical (i.e., group model), as
evidenced by our own plan experience • Through to the AMA’s
and the ever-improving mortality rates maximum plan age of 75,
of Canadians. AMA-discounted (25%) rates
are $40,956 less than the
The comparison below illustrates “street” term-20 rates. If
how current and reducing AMA AMA rates were to improve an
life insurance rates compare to a average of 2% per year, you’d
competitive locked-in 20-year term pay nearly $51,000 less in
plan available on the “street.” present value premium.
Of course, it has to be stressed that
the AMA rates are not guaranteed.

Male, non-smoker, age 45 But even without any improvement

$500,000 eligible for lowest life insurance rate offered (i.e., Elite rates) in rates over the next 30 years and,
assuming no discount, you’d pay at
AMA (25% AMA
least $30,000 less in present value
discounted reducing by “Street”*
premium through the AMA than
Age AMA* rates) 2% per year term-20
through the “street” term-20 plan.
45 $ 630 $ 473 $ 473 $ 955
I guess that is the premium
50 $ 860 $ 645 $ 583 $ 955 (pardon the pun) you pay for
guaranteed rates.
55 $ 1,480 $ 1,100 $ 907 $ 955

60 $ 2,600 $ 1,950 $ 1,440 $ 785 For more information about the

AMA Term Life Insurance plan, contact
Total premium ADIUM Insurance Services Inc.:
paid to age 65 $ 27,850 $ 20,888 $ 16,346 $ 18,420
• 780.482.0692 or
Present value 1.800.272.9680
of premium
paid to age 65 $ 19,538 $ 14,653 $ 11,683 $ 14,229 • adium@albertadoctors.org

65 $ 3,260 $ 2,445 $ 1,632 $ 12,195 • www.albertadoctors.org/

AdiumInsurance/Index
70 $ 6,840 $ 5,130 $ 3,096 $ 12,195
ADIUM Insurance Services Inc. is a
Total premium wholly owned subsidiary of the Alberta
paid to age 75 $ 78,350 $ 58,763 $ 39,123 $ 140,370 Medical Association. ADIUM administers
the group Disability, Office Overhead
Present value Expense, Term Life, Critical Illness,
of premium
Accidental Death & Dismemberment,
paid to age 75 $ 43,462 $ 32,597 $ 22,556 $ 73,553
AMA Health Benefits Trust Fund,
* Both the AMA and the “street” term-20 include Disability Waiver of Premium, which waives Student Disability Insurance and PARA
premiums if totally disabled. Disability and Life Insurance plans.

Alberta Doctors’ Digest • March/April 2011 33

 Web-footed MD
My iChristmas Present
J. Barrie McCombs,
MD, FCFP
Medical Information
Service Coordinator,
the Alberta Rural
Physician Action Plan
Santa Claus gave
me an Apple iPad
for Christmas. This
was quite unexpected
and I’m not sure if
it was because I was
naughty or nice. Perhaps someone
told Santa that I had recently written
a lukewarm article about this popular
tablet computer.
This article describes some of my
initial experiences with the iPad.
The Out-of-Box Experience
Usually, each of my new computers
has come in a large box containing
a computer and a collection of
cables and accessories. The tiny iBox
contained only the iPad, an iCable
and an iGadget with folding iProngs
to fit into an electrical wall socket.
Being an impatient techie, I
hooked them all together, plugged
the gadget into the wall and pressed
the On button. Nothing happened!
After a few minutes of deciding
if "iPad" was a four-letter word,
I remembered what I used to
preach when teaching computer
workshops – when all else fails,
read the user manual.
34 Alberta Doctors’ Digest • March/April 2011
The User Manual
I actually enjoy reading computer
manuals, even when they have been
translated from Japanese into English
by someone whose first language is
Portuguese.
The iPad manual was only a tiny
iPamphlet with tiny iPrint. So I put
on my iFocal glasses and discovered
that my first task was to download
the iTunes program from the Apple
website to my desktop computer.
Only then was I supposed to
connect the iPad to that computer
so it could be synchronized. At this
point, I felt more like the proverbial
iVillage iDiot than an experienced
computer user.
The iTunes Download
When I initially visited the Apple
website Christmas morning, I was
unable to get a connection. After
several tries I realized I was not the
only one who had received an iPad
for Christmas. We were all trying to
download iTunes at the same time.
So I went back to the Christmas
tree and opened my other presents.
That evening the online-traffic jam
had cleared and I was able to set up
an account and download iTunes,
which took about 20 minutes. I’ve
since learned that whenever Apple
upgrades the iTunes program, it
always takes this long to download.
The Software Upgrade
I got a message, after I downloaded
iTunes, that the operating system
on my brand new iPad was already
out-of-date and that I needed to
download version 4.2.
So after another 30 minutes, my
new toy was finally ready to use.
I spent the rest of Christmas Day
playing with the iPad’s different
features, which were described in a
previous article (see the July/August
2010 Alberta Doctors’ Digest).
The iTunes Software
The name “iTunes” is confusing.
It dates back to when the program
was first used to download music to
Apple’s earlier iPod music players.
On the iPad, the software is also
used for downloading application
programs (usually called just “apps”)
and backing up all iPad-related files.
The Apple iStore
The online iStore has an amazing
collection of music, videos, movies and
applications. However, I was annoyed
to discover that whenever I try to
download something, I first have to
provide my credit-card number –
even if the application is free.
I browsed the site for useful
medical applications but found most
of the medical apps were intended
for patients rather than physicians.
The iBooks Reader
My friend, Ted, regularly uses his
iPad to download and read books. I
look forward to trying this since the
iPad has a nice bright screen and I
can change text size by just touching
the screen with two fingers and
spreading them apart.
The book reader can also display
PDF files, which might make it useful
for teaching patients or students.
The iBottom iLine
There are many iPad features left
for me to explore. I have connected it
As research for a future
article, I would be interested to
hear from other iPad, iPhone
or smartphone users about
which medical applications
they have found useful.
to a friend's home wireless network
but haven't yet tried it on a public
wireless "hot spot." It has not yet
replaced any of my other computer
or communications devices, but I
am excited by the possibilities.
As research for a future article, I
would be interested to hear from other
iPad, iPhone or smartphone users
about which medical applications they
have found useful.
Your comments and suggestions
are welcome. Please contact me:
barrie.mccombs@rpap.ab.ca
T 403.289.4227

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Alberta Doctors’ Digest • March/April 2011 35

 In A Different Vein
Ten pet peeves
for 2011
Alexander H.G.
Paterson,
MB ChB, MD,
FRCP, FACP
Co-editor
Most people
lead lives of quiet
desperation, putting
up with indignities,
stupidities and
insults for the sake
of peace and quiet.
Protesting the bullies, know-alls
and change-meisters of this world
is an exhausting and sometimes
fearsome activity. But, at a certain
stage, one must express irritation.
And I’ve reached that stage.
Sometimes someone hits the
jackpot with a peeve and people say,
“Yeah, I hate that too . . . .” Then
there is a chance of change.
So here are some of my pet peeves.
If any ring a bell with you, go forth and
whinge and maybe we’ll effect a change.
Peeve 1: Waiter presents the
day’s specials in flowery language,
invariably interrupting something
interesting I’ve been saying (inspired
by Bill Bryson, I'm a Stranger Here
Myself, published by Broadway Books,
New York, 1999)
All the dishes on a menu should
be special, not just the stuff the chef
wants rid of. . . .
“The special this evening is a
young Scottish female haddock caught
36 Alberta Doctors’ Digest • March/April 2011
napping off the Mull of Kintyre,
smoked in damp pine chips, brine
coddled in an inverted Stetson hat,
drizzled in Drambuie and served on
a soft bed of turnip shavings over
a cornucopia of unskinned baby
Alberta potatoes.”
This is more information than I
can hold while the rest of the specials
have been recited. I have to ask,
“What was the kipper thing again?”
Sometimes someone hits
the jackpot with a peeve and
people say, “Yeah, I hate that
too . . . .” Then there is a
chance of change.
Peeve 2: Clothing loathings: White
Stetsons, baseball hats and clothing
with a manufacturer’s name on it
Let's take the white Stetson, so
beloved of Tourism Calgary and the
little ladies and elderly gentlemen,
in red waistcoats and outsized white
Stetsons, with a hail of "Welcome to
Calgary" when meeting people from
Calgary-arriving aircraft.
The white Stetson has now become
a verb – to “white hat” someone,
usually an innocent bemused visitor.
Show me any real rancher or
cowpoke who wears these dude duds.
I like cowboy hats and there are many
cool styles from which to choose.
Those who wear white hats declare
themselves elderly city-bred fakes.
Baseball hats are ugly, emphasizing
everyone’s tendency to Prince
Charles' ears. Why wear this eastern
vulgarity when there are some great
western-style hats.
People who wear clothing with the
name of the manufacturer should also
have a sign on their backs: “I am a
naive sucker providing free advertising
for. . . .”
Peeve 3: Heat-activated toilets and
hand-wash basins
I prefer the control of a hand flush
and then turning a tap clockwise to
produce water in a basin, followed
by a towel to dry the hands. What
was wrong with this uncomplicated
system? I even miss the old chain-pull
system for flushing.
I recently had an extreme experience
with an unflushable heat-activated
toilet pan. It did not respond to rising
from the seat. This embarrassment
led to wild back-and-forward thrusting
movements of the lower trunk and
still it did not respond. I had to leave
surreptitiously in shame.
Locating the heat-sensitive point in
a basin is sometimes an intelligence
test. I have looked over a basin for the
sweet spot and eventually given up.
Foreigners from developing countries
are at a particular disadvantage. Less
insightful observers will label them as
idiots straight off the boat whereas, in
fact, they are responding in a rational
way to idiot designers.
Peeve 4: Air-blowers, the most
irritating invention of the century

The inventor who started these
beasts should be arrested, keel-hauled
and sentenced to stand naked in front
of one to dry off.
Not only do air-blowers take
three minutes to either dry or
burn your hands, but they create
a deafening roar, spray bacteria-
containing droplets round the toilet
for easy inhalation, and consume
large quantities of power, apparently
contributing to floods, cyclones and
other extreme-weather conditions.
Owners of these monstrosities
should be required to buy 100,000
carbon credits annually, to be
transferred to owners of toilets with
clean towels.
Peeve 5: Hospitals, previously
places of quiet and serenity
A harmony destroyer (apart from
Alberta Health Services [AHS]) is the
Zamboni-style floor cleaner, which
is usually put to use shortly after a
sensitive discussion has started with
a dying patient.
The background whine is pitched
to the level of a South African
vuvuzela. The old bucket and mop
did a much better job getting into
awkward corners.
Its bratty cousin, the gas-powered
leaf-blower, is to be heard in
November. An ear-splitting roar
warns you about impending grit in
the eyes, particularly on a windy day,
when often used.
Lads wielding them always
wear earphones and listen to
thumping-heavy metal, so they’re not
affected.
The slightly longer time it might
take to sweep with a large broom is
outweighed by the peace and quiet.
The Swiss city of Basle has banned
leaf-blowers and it is lovely to see
teams of men sweeping the streets
with brooms.
Peeve 6: Undeserving honorifics
This really riles me. Why do
journalists in Canada insist on writing
the honorific “Mister” or “Monsieur”
before the names of “reptiles” like
Clifford Olsen or Paul Bernardo?
“Mr. Pickton has been convicted
of murdering six women. . . .” Or
“Mr. Bin Laden is thought to be. . . .”
At the same time, these lunch-time
O’Booze’s will write “Harper” or
“Mulroney” without any honorific.
Someone tell me what that’s all
about. I really don’t get it.
Peeve 7: Copying the latest
platitude, cliché or management jargon
Be on the look-out for a few more
from 2010. “Let me be clear . . .”
is a favorite of politicians, finding
currency with the great unwashed.
The aim, of course, is to sound
decisive and on the offense. It is an
attempt to shovel something down
your throat without reasonable
negotiation. The “let-me-be-clear”
gambit is the adult equivalent of the
“choo-choo train” scam, where an
abusive spoon is thrust into one’s
unsuspecting mouth with some
awful goo on it.
Special defenses are required here.
Most will recall that the best way to
deal with unwanted choo-choo trains
is to breathe in, pucker the mouth and
splatter the stuff back in the face of
the choo-choo train driver.
“Pay not taken” is a breath-taking,
bare-faced nonsense phrase for the
honest word “bonus.” An effective
way of making fun of this is to use it
all the time for “bonus,” as in, “How
much did your pay not taken amount
to this year?”
So effective has this been that
I suspect another euphemism for
“bonus” is being actively sought and
will emerge shortly.
“Conversation” for the perfectly
good word “discussion" has crept in,
apparently, with the connotation that
participants in any conversation are
equal. This is rarely the case.
A discussion implies a more formal
interaction with, hopefully, a decision
at the end of it. A conversation sounds
more informal, being a friendly
exchange of ideas and may make
some innocents more comfortable.
Using “conversation” where
“discussion” is more appropriate
should put you on guard.
“Climate-change denier” is, of
course, a nasty attempt to equate
someone who wishes to question
existing data, or wants more accurate
data, for making decisions on
environmental effects of man-made
greenhouse gases on the same level
as a holocaust denier. It deserves
contempt only.
“Get” instead of “have.” “Can I get
a burger?” I hear this in the Foothills
Hospital Doctors’ Lounge from the
under-30s. I have not yet embarrassed
anyone by saying, “OK, leap over the
counter, pal. The buns are over there.”
But it’s tempting.
The word “like.” “Like” is a
convenient preposition to introduce a
simile and not a substitute for “um”
or “said” as in: “Like, she’s like –
Hi – and I’m like – whatever.”
Peeve 8: Men in shorts
Men’s legs are ugly and painful
to view. Shorts wearers tend to be
older men who should know better.
Unpleasantly hairy, misshapen,
knobbley, flabby or over-muscled,
spindly, veined and best kept hidden,
they are unavoidable eyesores on golf
Alberta Doctors’ Digest • March/April 2011 37
 courses and on the streets of tropical-
tourist spots like Singapore.
I have missed innumerable
easy putts because of the sight of a
hairy leg. A recent pleasure was to
see a male in shorts shivering in a
golf shelter during an unexpected
snowstorm.
Peeve 9: AHS
While we want to keep our powder
dry and give Dr. Chris Eagle a chance
to make his mark, I bridled at the
suggestion from Mr. Duckett, quoted
in Pulse, that his “greatest achievement”
had been "to end the arms race
between Calgary and Edmonton.”
Is that why we have had the
Provincial Bone Marrow Transplant
Unit in Calgary and the Cyclotron
in Edmonton? Come off it, cobber.
We’ve been talking between north
and south for years and making
sensible divisions of labor before
“We Are One” hit us.
Peeve 10: People whom I have not
met and don't know calling me by my
first name
I was in the periodontist’s office,
in January, waiting for an implant to
be inserted. Quietly reading the paper,
I heard the teenage receptionist shout
out, “Sandy!”
This could not possibly be for me, I
thought, and I continued reading. But
it was! Apparently meant to put me at
ease, it converted me into a resentful,
angry, offended old fart.
In every country of the world except
Canada, to call someone you don't
know by his or her first name is quite
impolite and it’s about time this place
learned that.
This might be difficult since John
Buchan, author of the adventure novel
The Thirty Nine Steps, and the 15th
governor general of Canada since
confederation, said, “In Canada, you
have to know someone really well to
call them by their family name.”
I said to my daughter, Feonagh,
who has a dental practice in London,
Ontario, “I hope you don’t have your
receptionists calling people by their
first name.”
“Oh sure we do,” she said. “But,
like, not to people your age. . . .”
And, dear reader, if you don’t like
these peeves, I have lots more.

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38 Alberta Doctors’ Digest • March/April 2011

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CALGARY AB
Medical Express, new state-of-the-art
clinic in downtown Calgary, is
looking for physicians to join our
team. We have high support-staffing
levels, including registered nurses
and pharmacists, on site. Attractive
overhead and great medical team. If
you are interested in receiving more
information, please call.
Contact: Aamir Chaudhary
T 403.930.1007
aamir.chaudhary@medicalexpress.ca
CALGARY AB
Seeking part-time family physicians
for the Urban Aboriginal Health
Centre. Join a newly established,
team-based model that concentrates
on delivering high-quality care for
the specific needs of the urban
Aboriginal population of Calgary.
The Elbow River Healing Lodge
(ERHL) is an Alberta Health
Services-funded program within
the downtown Sheldon Chumir
Health Centre. The centre houses
core services including laboratory,
diagnostic imaging, pharmacy and
urgent care, as well as other key
diverse services as public health
and mental health that offers
the opportunity for multi-service
collaborations. The ERHL’s in-house
team includes clerical, nursing,
pharmacy, behavioral therapy,
advocacy and research. The ERHL
is based on a philosophy of
considering and addressing the
broader determinants of health
and strives to innovate primary
health service to achieve this.
Remuneration is sessional.
Contact: Dr. Lynden (Lindsay)
Crowshoe
T 403.955.6600
lynden.crowshoe@
albertahealthservices.ca
Alberta Doctors’ Digest • March/April 2011 39
 CALGARY AB
Part- and full-time physicians required
to join our practice with walk-in shifts,
either start or bring your current
practice. Very attractive service split,
flexible hours, fully computerized and
very competent staff. No overhead
expenses. Glenwood Medical Centre
is part of the Calgary West Central
Primary Care Network.
Contact: Bernie Borromeo
T 403.383.9016
glenwoodmed@shaw.ca
CALGARY, EDMONTON AB,
TORONTO ON AND
VANCOUVER BC
Join our dynamic team. Wellpoint
Health requires physicians for family
practice, walk-ins and occupational
health at the above locations.
Signing bonus, minimum daily
guarantee, attractive split and
above-average income potential
will be provided.
Contact:
C 403.880.2040
sdada@wellpointhealth.ca or
C 403.680.8885
jlewis@wellpointhealth.ca
www.wellpointhealth.ca
CANMORE AB
Partnership opportunity available.
Silent business partner/developer
seeking doctor(s) for a new medical
walk-in clinic. We will provide all
leasehold improvements and there
are no lease payments. Turn-key
operation in exchange for negotiated
percentage of revenue. Easy access
to new building in prime location.
Surface and underground parking.
We have new condos in the same
complex – accommodations can be
negotiated in the package.
Contact: Gurmeet Sidhu
C 780.264.1200
mtnviewinn@gmail.com
40 Alberta Doctors’ Digest • March/April 2011
EDMONTON AB
The Glenrose Rehabilitation Hospital
is seeking interested candidates for
position(s) of attending physician(s)
for the Inpatient Geriatric Assessment
and Rehabilitation Program.
The Glenrose has developed an
international reputation for excellence
in rehabilitation and specialized
geriatrics. The Glenrose participates
in academic training programs
for physicians and allied health
professionals and offers continuing
education courses.
The successful candidate will be
the most responsible physician for
patients admitted to the inpatient
geriatric assessment and rehabilitation
program. The physician working
within an interdisciplinary team will
provide ongoing medical care for an
assigned number of inpatient beds.
Hours are flexible. Remuneration is
competitive and on a per-hourly basis
through a clinical ARP. After-hours
in-hospital coverage is provided.
The ideal candidate is a member
of the Canadian College of Family
Physicians. Certificate in care of the
elderly and/or five years’ clinical
experience working with older
adults would be an asset.
If you are interested in pursuing
geriatrics in a friendly, supportive
interdisciplinary environment or
have any questions, please contact us.
Contact: Dr. Hubert Kammerer
T 780.920.4773
hkamm@yahoo.com or
Dr. Elisa Mori-Torres
elisa.mori-torres@
albertahealthservices.ca
T 780.910.2509
EDMONTON AB
Part- or full-time family physicians
required to join a well-established,
busy family practice in west
Edmonton. X-ray, laboratory,
ultrasound, mammogram, MRI/CT,
stress test, MIBI, holter recording
and pharmacy on site. Excellent
environment, state-of-the-art clinic
with professional staff. Reasonable
overhead.
Contact:
T 780.483.1777
780.907.4234
HIGH RIVER AB
Medical clinic has space available for
two-or-three physicians, specialists
or general practitioners. Clinic is
currently occupied with a full-time
female obstetrician. Terms flexible,
from rent only to complete office
set-up and clinic management.
Level 1 hospital, three minutes from
the clinic and a 25-minute drive to
Calgary city limits.
Contact: David Baker
T 403.262.2222
C 403.660.8551
mdbaker@shaw.ca
LETHBRIDGE AB
Meyer Clinic is looking for a family
physician to join the new clinic.
Building is four-years old. Physician
Office System Program-approved
electronic medical records, perfect
location, excellent overheads and
negotiable (20-25%, maybe less). Be
your own boss, make your own hours.
Lethbridge has everything you need
year-round for you and your family.
Contact: Dr. Johan Meyer
T 403.381.6797
RED DEER AB
Five-doctor clinic in Red Deer,
population of 90,000, requires
a family practitioner to replace
departing physician. Established busy
clinic, we offer electronic medical
records and low overhead expenses.
Hospital privileges available
with excellent specialty coverage.
Obstetrics is optional. Congenial call
group is one-in-10. Fee-for-service
remuneration and retention benefit.
Contact: Dr. Bruce Benson
T 403.346.9945
(Monday-Friday, 8:30 a.m.-5 p.m.)
blben@shaw.ca
ST. ALBERT AB
Physician opportunities available.
Incentives for full-time physicians.
Contact: Sheila Cousineau
Business Manager
St. Albert and Sturgeon PCN
T 780.418.6721
sheila@saspcn.com
www.saspcn.com
STRATHMORE AB
Valley Medical and Dental Clinic
has an immediate opening for a
full-time physician in Strathmore,
due to the sudden death of one of
our colleagues. Strathmore has a
population of 12,000 and draws from
a wide geographic area including
Canada’s second-largest native reserve.
Geographic advantages include close
proximity to Calgary and the Rocky
Mountains. Earning potential is
unlimited and the blend of practice
can be tailored as there is an active
ER (more than 30,000 visits per year)
and an acute-care hospital. Emergency
and acute-care skills are preferred, but
not mandatory. The group stresses
team work and collegiality.
Contact: Dr. Ward Fanning
T 403.934.5205 (office)
T 403.934.3934 (home)
DELTA BC
The Tsawwassen Medical Clinic,
a friendly six-doctor group, has an
opening for a family physician in July.
This position will appeal to someone
looking for an excellent medical group
with superior facilities, excellent staff
in a great community and just 30-35
minutes south of Vancouver. Schools
and recreational facilities are excellent.
Easy access to nearby marinas. On-call
schedule is one-in-six. Hospital
and obstetrics involvement is not
necessary, but available. This is a
great opportunity for a young doctor
to build his or her practice quickly,
as well as take over the practice of a
retiring doctor.
Contact: Susan
T 604.943.9922
info.tmc@eastlink.ca
KELOWNA BC
Medi-Kel Clinics Ltd. seeks
physicians from across Canada for
well-established family practice.
International medical graduates also
welcome. Kelowna is in the heart of
the Okanagan in south-central BC
and has excellent schools, recreational
facilities, restaurants and wineries.
Truly a great place to live and work.
Contact: Belinda Harris
officemanager@medi-kel.net
Physician and/or
locum wanted
CALGARY AND EDMONTON AB
Is your practice flexible enough to
fit your lifestyle? Medicentres is
a no-appointment family practice
with clinics throughout Calgary and
Edmonton. We are searching for
superior physicians with whom to
partner on a part-time, full-time and
locum basis. No investment and no
administrative responsibilities. Pursue
the lifestyle you deserve.
Contact: Lorna Duke
Manager, Physician Services
Medicentres Canada
T 780.483.7115
edmphys@medicentres.com
Shannon Klassen
Coordinator, Physician Services
T 403.291.5599
calphys@medicentres.com
Space available
SALMON ARM BC
Premiere medical clinic space for
lease in Piccadilly Mall. Lease area
of 1,951 sq. ft. is available, next to
a new Shoppers Drug Mart, in a
well-established shopping centre
with easy access and abundance
of parking. Skilled tradesmen
and project manager on staff can
facilitate all phases of construction
quickly and cost-effectively.
Contact: Lori Cymbaluk
Mall Manager
T 250.832.0441
lori@piccadillymall.com
For sale
CANMORE AB
Canmore vacation Shangri-la. Three
new units for sale with choice of
main deck views: Sunrise Crest (east),
Chili Pepper (south) and Sunset
Purple (west). Each boasts a master
bedroom, second private deck on top
floor. These condos, in the newly
constructed Alpine Village Centre,
are a short 10-minute jaunt from
downtown Canmore. Our special
Tourist Home zone allows use as
permanent residence or vacation
property (or both, your choice). Enjoy
revenue stream if you wish. Two
levels with good bedroom separation.
These townhouse-style condos feature
hardwood flooring on the main level.
Nicely decorated kitchen has solid
maple cabinets, granite countertops,
stainless built-in dishwasher, fridge
and stove. Bedrooms are carpeted
and have vaulted ceilings. Bathroom
has ceramic tile that surrounds a
soaker tub. Each condo has a private
storage unit right outside your door,
plus titled parking stall in the heated
parkade. Elevator access is available.
Alberta Doctors’ Digest • March/April 2011 41
 Contact: Jim Ridley, realtor bathrooms, pool table, large-screen Ship: Noordam
Royal LePage Rocky Mountain HD TV and high-speed Internet.
Realty, Canmore Outdoors, the premises boast a December 26-January 2, 2012
T 403.493.4663 (direct) picturesque farm view, heated Focus: Metabolic syndrome and
TF 1.888.363.4551 swimming pool, palatial lawns, obesity
F 403.592.6703 (confidential) fountain and delightful flower gardens. Ship: Celebrity Solstice
jimridley@shaw.ca
Skype: canmorerealestatepro Contact: Ann Stafford, realtor March 11-18, 2012
www.canmorerealestate.pro Immuebles Royal, Ayer’s Cliff Focus: Women’s health, dermatology
Quebec and infectious disease
T 819.838.4678 Ship: Freedom of the Seas
Vacation rental/sale F 819.838.4241
stafford@abacom.com
March 18-25, 2012
www.annstafford.ca/en/home.html
Focus: Endocrinology and cardiology
EASTERN TOWNSHIPS/ www.immeublesroyal.ca
Ship: Freedom of the Seas
L’ESTRIE QUEBEC
FIELDSTONE MANOR/MANOIRE
EN PIERRE DES CHAMPS Courses AUSTRALIA AND NEW ZEALAND
CME CRUISE
This is a gorgeous four-bedroom January 18-30, 2012
luxury home in the heart of the Focus: Rheumatology and cardiology
SEA COURSES CME CRUISES
Eastern Townships, a 75-minute Ship: Celebrity Century
drive from Montreal. This vacation Companion cruises FREE.
rental offers the unparalleled privacy Contact: Sea Courses Cruises
of a country estate. Fieldstone Manor ALASKA GLACIERS CME CRUISE TF 1.888.647.7327
is in Ayer’s Cliff, a quaint village cruises@seacourses.com
July 10-17
built on the shores of the beautiful, www.seacourses.com
Focus: Endocrinology and
sparkling Lake Massawippi. In
sports medicine
close proximity to many sport and
Ship: Celebrity Century
recreational activities, this getaway Symposium
is suitable year-round. In addition
August 19-26
to all water sports afforded by Lake
Focus: Cardiology and
Massawippi, visitors can, within
occupational medicine 45TH ANNUAL MACKID
this area, enjoy golf, downhill and
Ship: Celebrity Infinity SYMPOSIUM
cross-country skiing, snowmobiling
and hiking trails. DEPARTMENT OF FAMILY
MEDITERRANEAN CME CRUISE MEDICINE
Mount Orford Provincial Park offers September 5-17 MOUNT ROYAL UNIVERSITY
25 kilometres of hiking trails with Focus: Psychiatry, cardiology and CALGARY AB
splendid panoramic view. Coaticook physician health MAY 6
Gorge Provincial Park is home Ship: Celebrity Solstice
to the world’s longest suspended “Managing trauma in
bridge. Leisure and cultural activities PACIFIC COASTAL CME CRUISE community-based practice:
are many, including horseback Prevention and beyond.” Keynote
September 9-19
riding, boat cruises out of Magog, presentation: Injury – the silent
Focus: The challenging patient
birdwatching (Isle du Maris bird Ship: Celebrity Millennium (and expensive) epidemic, by
sanctuary), museums and art Dr. John Tallon, MSc, FRCPC,
galleries. The Piggery summer Medical Director, Trauma
TAHITI AND TUOMOTUS
theatre, music, wine tasting, two CME CRUISE Programs, Nova Scotia & Queen
of the world’s finest inns boasting Elizabeth II Health Sciences
October 19-29 Centre Professor, Dalhousie
world-class dining, are all in close
Focus: Cardiology and gastroenterology
proximity to Fieldstone Manor. University. All family physicians,
Ship: Paul Gauguin
residents and interdisciplinary
You will find no finer, fully appointed health providers are invited to attend.
holiday home anywhere in the region. CARIBBEAN CME CRUISE
Indoors are sheerly delightful with December 2-12 For more details:
two magnificent stone fireplaces, Focus: Infectious diseases and T 403.955.9225
breathtaking verriere, three luxurious general surgery www.talksfordocs.com

42 Alberta Doctors’ Digest • March/April 2011

Services
2ASCRIBE MEDICAL
TRANSCRIPTION SERVICE
Telephone dictation and digital
recorder files, PIPEDA-compliant,
excellent quality, next business-day
service. All specialties, patient notes,
letters, reports including IME.
Canada-wide since 2002.
Contact:
T 866.503.4003
www.2ascribe.com
ACCOUNTING AND
CONSULTING SERVICES
EDMONTON AB
Independent consultant, specializing
in managing medical and dental
professional accounts, to incorporating
PCs, full accounting, including payroll
and taxes, using own computer
and software. Pick up and drop for
Edmonton and areas, other convenient
options for rest of Alberta. Display or
Classified Ads
Contact: N. Ali Amiri, MBA
Financial and Management
Consultant To Place or renew, contact:
Seek Value Inc.
T 780.909.0900
Daphne C. Andrychuk
F 780.439.0909
aamiri.mba1999@ivey.ca
Secretary, Public Affairs
Alberta Medical Association
DOCUDAVIT MEDICAL
SOLUTIONS
T  780.482.2626, ext. 275
Retiring, moving or closing your
TF  1.800.272.9680, ext. 275
family or general practice, physician’s
estate? DOCUdavit Medical Solutions F  780.482.5445
provides free storage for your paper
or electronic patient records with no daphne.andrychuk@albertadoctors.org
hidden costs. We also provide great
rates for closing specialists.
Contact: Sid Soil
DOCUdavit Solutions
TF 1.888.781.9083, ext. 105
ssoil@docudavit.com Canada Post Publications Mail Agreement No. 40070054
Return Undeliverable Canadian Addresses to
Alberta Medical Association, 12230 106 Ave NW, Edmonton AB T5N 3Z1
Alberta Doctors’ Digest • March/April 2011 43
AMA seeks nominations
Recognize outstanding
achievements in health care
The Alberta Medical Association science of medicine while raising the education and/or
(AMA) is calling for Achievement standards of medical practice. health promotion to the public.
Awards nominations for individuals
who have contributed to the In 2010, three physicians The 2010 Medal of Honor recipient
improvement of the quality of health were recognized with Medals for was Austin A. Mardon, who was
care in Alberta. Distinguished Service: pediatrician diagnosed with schizophrenia in
Tajdin P. Jadavji, neurosurgical 1992 at the age of 30, and has since
Nominations must be submitted by pioneer M. Elizabeth (Betty) MacRae become an outspoken advocate and
April 29. The awards will be presented and palliative care specialist and public educator on mental illness.
at the AMA annual general meeting, clinical ethics consultant Eric A.
September 23, in Calgary. Wasylenko, all from Calgary. To request a nomination form
for these awards, please contact
The Medal for Distinguished The Medal of Honor is awarded Ava L. Butterworth, Administrative
Service is given to physicians who to a non-physician who has raised Assistant, Public Affairs, AMA:
have made outstanding personal the standards of health care and ava.butterworth@albertadoctors.org
contributions to medicine and to the contributed to the advancement of or visit the AMA website
people of Alberta, and in the process medical research, medical education, (www.albertadoctors.org/Awards
have contributed to the art and health care organization, health Scholarships/AchievementAwards).

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