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Fundamental change needed to sustain health care, delegates told at 2022 Fall Representative Assembly

Saskatchewan’s physicians understand fundamental changes in the health system are needed to sustain family medicine over the long term, Saskatchewan Medical Association (SMA) President Dr. John Gjevre told delegates to the SMA’s 2022 Fall Representative Assembly (RA).

“Family practice faces some very serious challenges. There is simply no other way to put it,” Dr. Gjevre said on Friday, Oct. 28, in his president’s address to the RA. “In discussions with colleagues from other provinces, some even describe their primary care system as ‘collapsing.’ These are strong words. They are words that should cause concern for everyone in this room.”

Many family physicians are unable to take on more patients. They are struggling with their current patient loads, lament the lack of time they can dedicate to elderly and chronically ill patients, and don’t feel supported by the health system, he said. An SMA survey in February 2022 found 62% of family physician respondents said they would reduce clinical hours, while one in five would likely retire in 24 months. Medical students are turning away from family medicine.

“Physicians understand substantive, meaningful change is required to sustain the health care system,” Dr. Gjevre said. “Without such transformative change, the viability of the health workforce – and services to patients -- will be compromised.”

Dr. Gjevre told delegates the SMA has asked the Ministry of Health for immediate funding to ensure short-term sustainability, specifically targeted at fee-for-service family physicians providing essential primary care services.

The SMA has also asked the ministry to continue to collaborate on transformational change over the next several years. He pointed to the work of the Primary Care Compensation Working Group, which is signaling the necessity of multidisciplinary health care teams - led by family physicians - and compensation models that align with improved health care and health outcomes.

“I believe the SMA’s message is falling on receptive ears and I am hopeful that we will make our way through these challenging times,” Dr. Gjevre said.

Primary Care Compensation Working Group

Delegates to the 2022 Fall RA heard a presentation from members of the Primary Care Compensation Working Group: Dr. Kirsty Sanderson, Dr. Sean Groves, and Tahirih North, representing the working group, and Drs. Gjevre, Annette Epp, and Carla Holinaty, representing the SMA Board of Directors.

Working group members said the aim is to tackle root causes that are creating challenges in primary care, rather than simply address the symptoms, and it means strengthening the bedrock of the health system – family medicine in the community. The College of Family Physicians of Canada’s Patient’s Medical Home provides the framework for the work ahead, with funding a key foundational pillar of that framework (i.e., practices need staff and financial support).

The working group was negotiated as part of the last MCRC agreement. It is a joint project between the SMA and Ministry of Health, in close collaboration with the SHA. Recommendations will be considered by the principals, deputy minister of health and SMA Board of Directors by Dec. 16.

Dr. Sanderson, Chair of the working group, told RA delegates that the group acknowledges any recommended changes are not small tweaks or temporary Band-Aids - they are transformative. The vision has medium- and long-term phases over a one- to 10-year horizon, and the integral roles of and current barriers for family physicians to lead the transformation are the main considerations.

Addresses from ministers of health

Health Minister Paul Merriman, and Everett Hindley, the Minister of Mental Health and Addictions, Seniors, and Rural and Remote Health, referred to feedback they received on travels throughout the province this summer.

“What we heard is we need more people,” Merriman told the RA. Staff shortages in many areas are leading to service disruptions.

He pointed to investments such as a $60-million human resources action plan that has four main goals: recruit, train, incentivize, and retain. The government is also investing in recruitment and retention of physicians, has added residency training seats, and has expanded the intake for the SIPPA program.

Merriman added the ministry is committed to working with the SMA on primary care compensation models that connect to the Patient’s Medical Home model.

Hindley said the government is recruiting nationally and internationally for full-time staff positions, which he also heard this summer are needed. New urgent care centres – one under construction in Regina and one planned for Saskatoon – will help provide a better continuum of care for mental health patients, he said.

Physician wellness and support model

Brenda Senger, Director, Physician Support Programs; Jessica Richardson and Lorraine Scott, Clinical Coordinators, Physician Health Program; and Dr. Nnamdi Ndubuka, Physician Lead - Equity, Diversity, and Inclusion, made a presentation on the SMA’s new physician wellness and support model.

The plans include the new position of Director, Physician Wellness & Support Programs, and new positions of Physician Advocate and Workplace Wellbeing Consultant for both northern and southern Saskatchewan. Other plans include:

  • Supporting physicians in need of health services and supports.
  • Providing timely and robust support for workplace-related conflict and stressors.
  • Developing an action plan to address systemic biases that affect the profession.
  • Supporting physician-led physician advocacy and advice to members.
  • Providing a strategic advisory service to the broader SMA organization with respect to embedding a physician wellness lens into all programs and services.

Special Committee on SMA Governance

Dr. Briane Scharfstein, Consultant, made a presentation to delegates on the SMA governance review. Current members of the Special Committee on SMA Governance were also in attendance at the RA, including Drs. Nnamdi Ndubuka, Johnmark Opondo, Lenny Pillay, and Grant Stoneham. Other committee members include Dr. M.S. Renuka Prasad (current member) and Dr. Cecil Hammond (former member).

Dr. Scharfstein noted the committee had met 17 times since it was established in November 2021, reviewing the SMA’s governance model to ensure modern, transparent processes that promote equitable access to leadership, diverse representation, and regular renewal. A number of structural and procedural recommendations were approved by RA delegates that aim to:

  • Maximize efficiency and effectiveness in achieving organizational objectives.
  • Preserve and enhance transparency, fairness, accountability, and equity, diversity, and inclusion.

Work will begin on implementing the recommendations via a re-constituted Legislation and Policy Committee, including amendments to the SMA bylaws and relevant policy development. The proposed bylaw amendments will be presented to SMA members at the 2023 AGM in May.

SMA honours award recipients

Dr. Pieter Maree was honoured as the 2022 Physician of the Year at the 2022 Fall RA. Click here for the full story.

The SMA also presented 2022 leadership awards to Dr. Justina Koshinsky (Physician Leader of the Year), Dr. Ingrid Tam (Resident Leader of the Year) and Elecktra Laxdal (Student Leader of the Year). Click here for the full story.

The SMA’s RA is held twice a year, in spring and fall. The 2023 Spring RA and AGM is scheduled for May 5-6 in Saskatoon.

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