Vol. 12 no. 4 December 2010 LESPÉCIALISTE LE MAGAZINE DE LA FÉDÉRA TION DES MÉDECINS SPÉCIALISTES DU QUÉBEC Votre assurance invalidité voir texte p.35
DESCRIPTION DU CONCOURS Le Conseil consultatif d’information sur la santé d’IMS Brogan a créé les Prix IMS Brogan pour souligner les travaux de médecins et pharmaciens concernant l’utilisation clinique efficiente des médicaments. Ces prix représentent une valeur totale de 30 000 $ qui est répartie de la façon suivante : ƒ à la Fédération des médecins omnipraticiens du Québec (FMOQ) et à la Fédération des médecins spécialistes du Québec (FMSQ) deux prix de 3 000 $ à chaque fédération pour un article sur l’utilisation appropriée des médicaments; ƒ aux pharmaciens, par l’entremise de l’Association québécoise des pharmaciens propriétaires (AQPP), deux prix de 3 000 $ chacun pour un article sur l’utilisation appropriée des médicaments; ƒ à chacune des quatre facultés de médecine, un prix de 2 000 $ à un étudiant pour la meilleure note en pharmacologie; ƒ aux facultés de pharmacie (Université de Montréal et Université Laval), deux prix de 2 000 $ aux étudiants méritants pour un stage à l’extérieur.
DESCRIPTION DES PRIX DÉCERNÉS Deux bourses de 3 000 $ seront décernées à deux médecins spécialistes (ou deux groupes de médecins) s’étant distingués par l’excellence de leur article sur l’utilisation efficiente de médicaments, à titre d’exemple : ƒ importance de l’observance du traitement médicamenteux; ƒ meilleur traitement dans le cas d’une maladie donnée; ƒ revue de l’utilisation de médicaments dans un contexte clinique; ƒ utilisation efficiente de médicaments les uns par rapport aux autres dans un contexte clinique.
RÈGLEMENTS L’auteur principal (premier auteur) de l’article doit être un médecin spécialiste membre d’une association affiliée à la Fédération des médecins spécialistes du Québec.Tout article original paru dans une revue pharmaceutique ou médicale spécialisée (excluant les entrevues et articles de journaux) au cours de l’année civile (de janvier à décembre 2010) peut être soumis à condition qu’il appartienne à l’une des catégories précisées ci-dessus. De plus, ƒ les traductions, adaptations ou reproductions d’articles ne sont pas admissibles; ƒ les articles acceptés pour publication mais non encore publiés ne sont pas admissibles; ƒ les articles en deux parties comptent pour un seul texte; ƒ si un article a été rédigé par plus d’un auteur, le prix sera remis à l’auteur principal.
SÉLECTION DES ARTICLES Les articles seront soumis par leurs auteurs qui devront les faire parvenir, avant le 31 janvier 2011, au directeur de l’Office de développement professionnel de la Fédération des médecins spécialistes du Québec, 2 Complexe Desjardins, porte 3000, Montréal (Québec) H5B 1G8. Ils seront ensuite évalués par un comité de sélection mis sur pied par l’Office et composé d’un représentant de chacune des quatre facultés de médecine du Québec. Le directeur de l’Office communiquera à IMS Brogan le nom des auteurs des deux articles retenus comme étant les meilleurs. IMS Brogan remettra officiellement le prix lors d’une conférence de presse.
Concours Prix IMS Brogan 12e édition Deux bourses de 3 000 $ à gagner
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Q LE SPÉCIALISTE VOL.12 NO. 4 DECEMBER 2010 5 THIS EDITION’S ADVERTISERS:
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- Services aux médecins MD 39 Summary WORD FROM THE PRESIDENT The Importance of Participation IN THE NEWS A Cry for Help! DID YOU KNOW... LEGAL ISSUES The Federation Files Suit Against the MSSS FOLLOWING SEPTEMBER’S EDITION Leaving Medicine... or Leaving Quebec! GREAT NAMES IN QUEBEC MEDICINE Dr. Ernesto Schiffrin, internist CONTINUING PROFESSIONAL EDUCATION An Infrastructure Needed... and the Means! SOGEMEC ASSURANCES FINANCIÈRE DES PROFESSIONNELS LE MOT DU PRÉSIDENT L’importance de la participation MEMBERS SERVICES Commercial Benefits 13 15 DOSSIER HAÏTI The 1st Year...
- Centre for International Studies and Cooperation ___ 18
Médecin du Monde (Canada ___ 21
Médecins Sans Frontières ___ 23
GRAHN, a Universal Vehicule of Hope ___ 25
Rebuilding Haïti ___ 27
Learning from Others ___ 28
16 40 32 30 37 36 34 31 10 7 EDITORIAL COMMITTEE Dr. Bernard Bissonnette Dr. Raynald Ferland Dr. Diane Francœur Maître Sylvain Bellavance Nicole Pelletier, APR, director Patricia Kéroack, communications consultant DELEGATED PUBLISHER Nicole Pelletier, APR RESPONSIBLE FOR PUBLICATIONS Patricia Kéroack REVISION Angèle L’Heureux ASSISTANT Annie Bissonnette GRAPHISME Dominic Armand TRANSLATION Anne Trindall Annette Grimaïla PUBLICITY France Cadieux PRINTING Impart Litho CIRCULATION 13,200 copies TO JOIN US EDITION Telephone: 514 350-5021 Fax: 514 350-5175 E-Mail: firstname.lastname@example.org PUBLICITY Telephone: 514 350-5274 Fax: 514 350-5175 E-Mail: email@example.com www.magazinelespecialiste.com Fédération des médecins spécialistes du Québec 2, Complexe Desjardins, porte 3000 C.P. 216, succ. Desjardins, Montréal QC H5B 1G8 Telephone: 514-350-5000 PUBLICATIONS MAIL Mailing Indicia 40063082 Legal Deposit 4th quarter 2010 Bibliothèque nationale du Québec ISSN 1206-2081 All pharmaceutical product advertisement's have been approved by the Pharmaceutical Advertising Advisory Board (PAAB).
CCAB audits the medical specialists and residents database (10,770 copies audited for June 2010) The FMSQ also distributes around 1,000 copies to Researchers and Professors of the 4 Medical Faculties in Quebec,as well as managers and leaders of the Québec healthcare system. The authors of signed articles are sole responsible for the opinions expressed therein. The Fédération des médecins spécialistes du Québec represents the following specialties: Allergy and Clinical Immunology, Anesthesiology, Cardiac Surgery, Cardiology, Community Health, Dermatology, Diagnostic Radiology, Emergency Medicine,Endocrinology,Gastroenterology,General Surgery,Geriatrics,Hematology and Medical Oncology,Internal Medicine,Medical Biochemistry,Medical Genetics, Medical Microbiology and Infectious Diseases,Nephrology,Neurology,Neurology, Nuclear Medicine, Obstetrics and Gynecology, Ophthalmology, Orthopedics, Otorhinolaryngology,Pathology,Pediatrics,Physiatry,Plastic Surgery,Pneumology, Psychiatry, Radiation Oncology, Rheumatology and Urology. LE SPÉCIALISTE IS PUBLISHED 4 TIMES PER YEAR BY THE FÉDÉRATION DES MÉDECINS SPÉCIALISTES DU QUÉBEC
ramatically, on October 21, 2010 the name of the person selected to be President of the Collège des médecins du Québec (the CMQ) was drawn by lot! In actual fact, this election was a fantastic case that should be studied in all universities and even in society at large when the time comes for people to be convinced not only to become involved, but that their vote actually counts. But, how does it really count? First of all, at the level of the CMQ Board of Directors, where the first difficulty arises. The Board is composed of 28 members, 20 of whom are elected physicians with the right to vote. It may be thought that the intention when the CMQ statutes were drawn up was that the two groups making up the medical community in Quebec – i.e. generalists and specialists – should have equal representation. That would be logical, because their numbers are still more or less equivalent today. However, such equal representation can never truly become reality precisely because it is inevitably skewed by the CMQ’s method of election. Since the vote is “by region”, it is easy to see that it is impossible to achieve the 10-10 split desired as, apart from the Island of Montreal, Sherbrooke and Quebec City, general practitioners are in a strong majority. Let’s look at the Montérégie, for example. There are 1,443 general practitioners on the Order’s rolls versus 1,013 specialists – i.e. 42.5% more generalists. It is therefore clear that it is virtually impossible for a medical specialist to achieve election outside Montreal, Quebec City or Sherbrooke. Only one conclusion can be drawn from this demographic: if balanced representation of both groups is desired, this intention must be stated in the statutes of the CMQ itself.
Now, what about the election of the Board of Directors and the President? Let’s take the FMSQ. Its Board is composed of 9 members elected by an assembly of 125 delegates who themselves are designated by the Executive of an affiliated association’s Board which, in its turn, is elected by the members of each association. If you take the delegates alone, the representation is 125 for around 8,500 paid-up members, or approximately 1 delegate for each 70 members. The CMQ equivalent is 20 elected members – or around 1 elected member per 800 members! At the FMSQ, the President is elected, by name, by 125 delegates; at the CMQ, the person is elected by name by only 20 elected members. If you take a closer look at the FMSQ, your opinion – even if you do not actively participate in your association – has a greater chance of being heard because your representatives are aware of the realities of your life, if only by dint of practising in the same field. So it is difficult for them to act in a vacuum. Furthermore, to be heard, you only need to attend meetings very occasionally or contact your association. Instances where associations have acted or taken a position that differed greatly from that of their members have rarely been seen. Consequently, there is a far greater chance that the positions defended by your association’s delegate are close to your own. The opposite is true at the CMQ, however. Except in very rare cases, most of you do not know the positions that will be defended by those for whom you have voted. Usually, the vote is based on perception, a candidate’s reputation, specialty or the university to which they belong. In short, the degree to which this vote is “blind” is greater than that for a vote cast in your association. The same goes for many candidates; they only have a more or less accurate idea of how the CMQ functions.
Is the vote too blind? Not necessarily: perception, reputation, specialty and university affiliation remain relevant criteria with regard to “regional” selection. But is compulsory equalization with regard to candidates for the presidency too blind? We believe that it is. The detailed voting results in this respect are very instructive. First of all, it is obvious that, despite similar participation levels in previous years, voters took an uncompromising attitude to Dr. Lamontagne’s slate of candidates: all but one were beaten. That sends a very clear message. In fact, if it were not for what follows, it is likely this last member would also have gone down to defeat. The number of votes obtained by each person elected clearly indicates not only what happened but, above all, the value, true importance, weight and absolute necessity of taking part in a vote of whatever kind. Yes! Each vote does count – and voting works!
Many groups and organizations strongly urged their members to vote. We ourselves did so several times, particularly to improve the representation of medical specialists, and we IF YOU TAKE THE DELEGATES ALONE, THE REPRESENTATION HFOR THE FMSQI IS 125 FOR AROUND 8,500 PAID=UP MEMBERS, OR APPROXIMATELY 1 DELEGATE FOR EACH 70 MEMBERS. THE CMQ EQUIVALENT IS 20 ELECTED MEMBERS C OR AROUND 1 ELECTED MEMBER PER 800 MEMBERS! CMQ Elections The Importance of Participation LE SPÉCIALISTE VOL.12 NO. 4 DECEMBER 2010 7 WORD FROM THE PRESIDENT Dr.Gaétan Barrette D
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WORD FROM THE PRESIDENT FSUITEG partially succeeded. But specialists’ response to the FMSQ’s call varied greatly “geographically”. Other groups and organizations did the same, particularly with regard to family medicine and FM Groups, as well as at McGill. Hence the slate effect. Dr. Desbiens’ team, even though very incomplete (only eight candidates instead of ten) included two leading lights in the field of family medicine (Dr. Lajeunesse and, in particular, Dr. Authier), whose outstanding reputations speak for themselves. Two other candidates practise at McGill: Dr. Côté and Dr. Freeman. It is interesting to note that it was their first election to the Collège in each case. Drs. Fiset and Martin (Dr. Bernard’s team) were elected; both practise at McGill. Finally, and this is what is most fascinating, the candidates who received the largest number of votes were, Dr. Freeman, Dr. Authier, Dr. Fiset, Dr. Martin, Dr. Lajeunesse, Dr. L’Espérance and Dr. Garner. Again, the message could not be clearer! McGill and family medicine practitioners obviously looked after their own affairs and answered the call – and we say “Bravo!” to them. Voting works! And, more than ever before, it can be said that those who were absent were the ones at fault.
But that is what led to the random drawing which, in itself, is most disturbing. In actual fact, this vote should in a way be that of “delegates” only – representatives of certain regions. Period. Unfortunately, the election became a campaign for the presidency, which in our opinion was inappropriate. Physicians cast their individual votes with a normal level of interest, which is how it should be. Perception, reputation, specialty and university affiliation were relevant criteria for “regional” selection. We believe that that blindly took precedence. Locally-justified slates were perhaps blindsided with respect to the candidacy for the President’s position.
But there is a clear lesson here and an obvious parallel with the FMSQ. When the time comes to vote and above all get mobilized, everything counts and those who are absent or inactive will always be at fault. Moreover, they will get exactly what they deserve. That’s it. That’s all. Yours in solidarity! The Collège des médecins du Québec (the CMQ) has been working for several months on harmonizing Quebec’s medical specialties with those recognized by other Canadian authorities. This work is now finished. The final Regulation respecting Medical Specialties was published on November 10 in the Gazette officielle and became effective on November 25, 2010.
The new Regulation recognizes 19 new medical specialties by the CMQ, thus bringing the number of specialties recognized in Quebec to 54. Changes have sometimes been made to the length of training. Slight alterations have been made to the names of six existing specialties. For example, Endocrinology becomes Endocrinology and Metabolism. You can consult the Regulation respecting Medical Specialties at www.fmsq.org (in French). At the time of writing, the CMQ should have forwarded a notice to all physicians informing them of the creation of these new specialties and the modalities for applying for certification. It appears that the deadline for submitting an application is six months after the CMQ’s* notice is sent out. Recognition of these new medical specialties has already caused a number of medical specialists to wonder about their possible impact, particularly with regard to the remuneration provisions already contained in the FMSQMSSS Agreement. There is no doubt that adjustments and changes will have to be made to the Agreement to meet the situation. It is, however, important to understand that the extent of the changes will depend on the number of practitioners who will be recognized with regard to these new specialties and their decisions as to setting up specific measures of remuneration or new associations to represent them. In the latter case, it will also be necessary to assess the impact on the Federation’s Bylaws and the manner in which associations are represented.
Before submitting an application for certification in a new specialty, it is obvious that some physicians might first want to know the impact such action could potentially have on their remuneration. However, this may not be possible given the six-month deadline for submitting an application, the need for recognized physicians to make decisions on how they will be grouped and subsequent discussions on methods of remuneration. For the moment, it appears that the physicians concerned will therefore have to make such decisions without the benefit of such details. To follow... * Other provisions in the Regulation may allow certain physicians to disregard this time period and apply for recognition after the deadline. This is, however, not yet certain and will only be able to be studied on a case-by-case basis by the CMQ, with the risk that the physicians concerned may have their application rejected. That is why the CMQ has informed us that the notice being sent out will lay particular emphasis on the specific rule applicable in the circumstances, which provides for a six-month deadline for presenting an application.
New medical specialties... By Maître Sylvain Bellavance LS LS LE SPÉCIALISTE VOL.12 NO. 4 DECEMBER 2010 9 LS
10 LE SPÉCIALISTE VOL.12 NO. 4 DECEMBER 2010 In my role as a delegate from the Association des médecins psychiatres du Québec (AMPQ) to the FMSQ, I was surprised during a meeting to hear a colleague question the mission of the Quebec Physicians’ Assistance Program (Programme d’aide aux médecins du Québec – PAMQ). She was especially surprised by the nature of the health problems treated. Ever since, as a clinical professor at Hôpital Charles LeMoyne, I have got into the habit of discussing this with my students who, almost always, are also surprised to learn that mental illness is the main cause of disability for Quebec physicians. In itself, there is nothing really surprising about this fact, since psychiatric illnesses are in the process of becoming the principal cause of disability in our society, if this is not already the case. What is astounding is physicians’ reaction of surprise, even denial, when faced with this data. It is hard to ignore a certain medical culture that, too often, seems to deny that a physician is, more than anything else, a human being. Could it be that the taboo that seems to persist concerning these illnesses is, sadly and paradoxically, more tenacious within the medical community (and, in all humility, I have to include my own specialty)?
Simply consider how peers judge an affected colleague: it certainly does not encourage anyone to ask for assistance. We should not forget the impact of a disability on peers in clinical settings where a precarious balance already exists between work overload and the impossibility of getting replacements. The inevitable increase in stress and pressure on colleagues, which certainly does not foster empathy towards those affected, places colleagues still in place at risk. And so we get into a vicious circle.
In the spring of 2010, the General Manager of the PAMQ, Dr. Anne Magnan, advised the AMPQ of her concern. Between 2007-2008 and 2009-2010, new applications by medical specialists for assistance from the PAMQ have increased substantially, from 56 to 105 (without counting those who go elsewhere or who do not ask for help...). The new cases are people who had never before dared get in touch with the PAMQ and who were therefore more or less familiar with the program. The history of the PAMQ clearly shows how its clientele has evolved. The creation of an assistance program for Quebec physicians in 1990 was based on the realization that physicians, too, could become ill... and that most of them remained isolated, without help, not knowing where to turn. Towards the end of the 1990’s, retirement programs met with a great deal of success (too much!). The first signs of burn-out began to appear among physicians who continued practising. Shortly afterwards, the PAMQ started to see a new clientele among physicians for whom the work environment posed problems. Since 2003, the PAMQ has also been accepting individuals whose distress is mainly related to professional factors (pressure and burn-out). Its expertise is often called upon by teams that have become dysfunctional because of a lack of manpower, inappropriate behaviour and, unfortunately, regrettable events that upset colleagues.
Since its creation and in spite of the changing and complex needs of its clientele, the three main principles of the PAMQ’s mission have always been the same: intervention, prevention and research. Contrary to popular belief, addiction is not the chief factor behind calls for assistance; instead, it tends to be mental health problems (in the broadest since of the term) that lead physicians and residents to consult. The problems can include psychiatric illnesses (burn-out, anxiety, stress, posttraumatic stress); substance abuse or dependency (alcohol, medication, drugs, sex, gambling); interpersonal difficulties (family or conjugal problems, financial stress, physical conditions having a psychological or professional impact, bereavement); professional problems (complaints, lawsuits, professional investigations, academic failure or difficulty, harassment, intimidation, professional misconduct, ageor retirement-related problems, career change). During the last few years, many voices have attempted to break the silence and fight the taboos. In February 2010, the Canadian Medical Association produced a strategic report in order to optimize the assistance available to physicians with mental health problems. In Quebec, a third conference on physicians’ health will take place in September 2011. And, on an individual basis, more and more physicians with a mental illness agree to speak out publicly.
The AMPQ is already well aware of the increase in mental health problems among physicians, and has recently assured the PAMQ that its members would be available to assist colleagues in difficulty, in particular by facilitating access to care. In short, physicians will be helping physicians for the improved wellbeing of all members of our profession. A Cry for Help! By Mylène Bédard, MD PSYCHIATRIST IN THE NEWS Editor’s note: The Fédération des médecins spécialistes du Québec took part in setting up the PAMQ and provides a portion of its financing every year. In 2010, the FMSQ’s annual contribution paid was of $370,000. In addition, the FMSQ takes part in organizing the medical federations’ golf tournament in aid of the PAMQ. LS
FIQ-MSSS Agreement in Principle The Fédération interprofessionnelle de la santé (FIQ) has reached an agreement in principle with the government on the renewal of the collective agreement covering its 58,000 members (nurses, nursing assistants and respiratory therapists). The agreement includes an increase of approximately 3.45% in work shift overlap payments for full-time nurses employed in a hospital, a 40% reduction in the external workforce (personnel from private agencies) within five years, overtime pay for clinical nurse specialists working in centres where services are available all the time, and a substantial increase in premiums for evening work (from 6% to 8 %), night work (maximum premium from 11% to 16%) and critical care (premiums from 12% to 14%). All increases are in addition to the salary increase of 7% over five years negotiated with the Common Front. The agreement must be ratified by the FIQ membership.
Another Proposed Private Member’s Bill to Watch Out For The MP for Winnipeg, Rod Bruinooge, tabled a private member’s bill last April that would impose penalties on any person who might induce or push a woman to have an abortion. This new private member’s bill appears to join the parade of other private member’s bills like C-484, C-291 and C-43 all of which have so far been defeated or dropped. Called Roxanne’s Law, this bill was named for a young Winnipeg woman, Roxanne Fernando, who was beaten to death in February 2007 after having refused to have an abortion.
According to many observers, this private member’s bill is, once again, a pretext for giving legal status to a fetus. The FMSQ is actively following developments since, if the bill passed, it could have serious repercussions on the work and professional liability of medical specialists in Quebec. A (Small) Opinion Poll On its Internet site, L’Actualité médicale, a private publication belonging to the Rogers Group, asked physicians what their position was on the lawsuit brought by the Conseil de protection des malades, which claims $7 million in damages from medical specialists as a result of their three-day strike in 2002 and 2003.
Rate of response: 50 physicians in total!!! Of these, 63% replied, “It was unfortunate for our patients, but we have to be able to say what we think”; 29% said, “It could have had serious consequences for patients. It is normal that they should be compensated”; and 5% indicated, “Financial compensation, why not? But $7 million? That’s a joke!” IN THE NEWS LE SPÉCIALISTE VOL.12 NO. 4 DECEMBER 2010 11
12 LE SPÉCIALISTE VOL.12 NO. 4 DECEMBER 2010 LS FOLLOWING THE NEWS Building the new UHCs MUHC Since September, we have been reporting photographically on how construction work is advancing on the new university hospital centres being built in Quebec. As a picture is worth a thousand words, it's a pleasant way to keep track of these projects! The new McGill University Health Centre will open its doors in the fall of 2014, while the CHUM is expected to open in 2018. CHUM Picture taken on November 14, 2010 Picture taken on November 16, 2010
LE SPÉCIALISTE VOL.12 NO. 4 DECEMBER 2010 13 International Society of Nephrology Prize Dr. Daniel Bichet, a nephrologist and researcher at Hôpital du Sacré-Cœur Research Centre in Montreal, has received the International Society of Nephrology’s Jean Hamburger Award. This medal, the highest distinction given by this organization, underlines the outstanding contribution of Dr. Bichet’s laboratory to the understanding of hereditary diabetes insipidus. 2010 André-Dupont Prize The Club de recherche clinique du Québec has awarded the André Dupont Prize to Dr. Paul Khairy of the Montreal Heart Institute to mark the excellence of his work in the field of biomedical research. This prize is awarded annually to a young researcher who has no more than 10 years’ experience as an independent researcher. Dr. Khairy’s research has already had a major impact with regard to electrophysiology and congenital heart disease. Montreal Heart Institute Foundation To underline Dr. John D. Rioux’ contribution to the advance of personalized medicine, the Montreal Heart Institute Foundation awarded him the 2010 Martial G. Bourassa Prize. Dr. Rioux is an associate professor of medicine at Université de Montréal, director of the Laboratory in Genetics and Genomic Medicine of Inflammation at the Montreal Heart Institute, and also holds the Canada Research Chair in Genetics and Genomic Medicine of Inflammation.
An Avalanche of Honours for Dr. Michel L. Roy The Society of Obstetricians and Gynaecologists of Canada has awarded the President’s Medal for 2010 to Dr. Roy to mark his contribution and commitment to the promotion of excellence in the practice of obstetricsgynecology and women’s health. During the 26th International Conference on the Human Papilloma Virus (HPV), Dr. Michel L. Roy received the International Papilloma Virus Society Prize for Excellence for his exceptional contribution to HPV research and teaching. Lastly, in 2010 the Argentinian Society for Gynaecological Oncology and Colposcopy named Dr. Roy an Honorary Member for his contribution to the development and teaching of conservative surgical techniques in the field of gynecological cancer. Annual Prizes – Société canadiennefrançaise de radiologie The SCFR recognized the work of a number of radiologists during its annual meeting, as well as their outstanding contribution to the profession or in a parallel field of activity. Four prizes were awarded, three of them to radiologists.
Prix Albert Jutras 2010 (awarded posthumously) Dr. Marie-Claire Descary who passed away a few short months ago, is considered a radiology pioneer. The first woman with a subspecialty in cardiopulmonary imaging, she was a career-long clinician, teacher and administrator, mainly within a CPDP. Interested in ethical issues, she helped develop the specialized higher studies degree (DESS) teaching program, the Master’s program in bioethics and the Université de Montréal ethics teaching program for residents.
Prix Bernadette Nogrady 2010 Highlighting both her academic/ scientific accomplishments and her human qualities, Dr. Isabelle Trop is a leading figure in breast imaging in Quebec. An assistant clinical professor, clinician, researcher and the person responsible for the radiology fellowship program, a speaker and member of a scientific review committee, Dr. Trop has also authored thirty or so scientific articles, many of which have received recognition Prix Personnalité SCFR 2010 Since becoming certified, Dr. Robert Fradet has rapidly become a notable and dynamic figure in the profession. With both a hospital and office practice at Sherbrooke, Dr. Fradet is also a department head in various hospitals in the region (Asbestos, Memphrémagog and the Institut de gériatrie). In 2008, he became president of the RadiologiX group, which has the mission of protecting the integrity of radiological care delivered and promoting the business development of private radiology clinics. Prizes and Awards DID YOU KNOW...
2010 Mental Health Champion Prize As part of Mental Awareness Week, the Canadian Alliance on Mental Illness and Mental Health presented its Champions of Mental Health Awards to mark the contribution of people who have had a positive impact regarding the issue of mental health in Canada. The Alliance awarded the Mental Health Champion Prize in the Research Category to Dr. Brian G. Bexton. Award for Excellence in Research The Journal of Continuing Education in the Health Professions gave its 2009 Award for Excellence in Research to Réjean Laprise, Dr. Robert Thivierge, Dr. Gilbert Gosselin et al for their article on Improved cardiovascular prevention using best CME practices: A randomized trial. Réjean Laprise, Ph. D., is a senior research consultant in the FMSQ’s Office of Professional Development. This prize is given annually by the JCEHP in conjunction with the Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education and the Association for Hospital Medical Education. Things are buzzing at the AMLFC The Association des médecins de langue française du Canada (or AMLFC) revamped its image. With a new name and new logo, the Association is now better equipped to meet the changing needs of Frenchspeaking physicians. This repositioning is the outcome of deliberations that began some years ago. The new name – Médecins francophones du Canada (AMFC) – and the logo were unveiled during the 5th French-Language Symposium on Medicine held in Montreal at the end of October. The Association’s new President is Dr. Conrad Pelletier. Médecin de coeur et d’action Prizes Médecin de coeur et d’action” prizes were awarded to 10 recipients to mark the quality of their work and commitment. Four Quebec medical specialists were honoured: Dr Pierre Drouin obstetrician-gynecologist Dr Horacio Arruda community health medical specialist Dr Hubert-Antoine Wallot psychiatrist Dr Jean Robert microbiologist and specialist in infectious diseases Reconnaissance Prize from the Institut de Cardiologie de Montréal Dr. Robert Blain, anesthesiologist at the Institut de Cardiologie de Montréal was awarded the Reconnaissance Prize for his exceptional contribution, his commitment and his contribution to the institution’s development. Dr. Blain, a former head of anesthesiology from 1998 to 2007, is recognized for his legendary patience and is a constant inspiration source for his colleagues. DID YOU KNOW... FSUITEG Croisière seulement, prix par personne en occupation double, vol, taxes et pourboires en sus. Cette offre de même que les itinéraires sont sujets à changement sans préavis. Plusieurs conditions s’appliquent; consultez les brochures 201 1-2012 ou l’un de nos conseillers. Tous les détails en agences. Immatriculation de navire: Malta. Club Voyages est une division de Transat Distribution Canada Inc. Permis No 753141 au Québec. Siège Social : 300, rue Léo-Pariseau, bureau 1601, Montréal, Québec H2X 4B3 Consultez les conseillers SPÉCIALISTES-CROISIÈRES de votre agence partenaire.
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LE SPÉCIALISTE VOL.12 NO. 4 DECEMBER 2010 15 On October 28, 2010 the Federation took legal action against the MSSS with the aim of having certain provisions of the Act respecting health services and social services (AHSSS) as it applies to specialized medical centres (SMC) declared null and void. Filing suit against the MSS is a very unusual occurrence. Indeed, legal action by the FMSQ against the MSSS has only happened a few times over the years. And that in itself is a good thing, because when we have to take such a step it calls for two unfortunate conclusions.
It means that the government has exceeded the acceptable limits of its role and has adopted a line of conduct or action with regard to physicians or their patients that we consider must be condemned, that rights have been infringed.
It also means that the government and its institutions, as well as those working in them, have not known how to listen sufficiently well to modify their approach, and that the Federation’s efforts and representations to correct this situation have been unsuccessful. It indicates nothing more nor less than a failure of our democratic system and our institutions. There is, therefore, no other option than to apply for the intervention of the Courts. A brief reminder of the situation The SMC issue first surfaced in 2006 when we were in the middle of a dispute with the government. On December 13, 2006 the National Assembly passed Bill 33 tabled by Philippe Couillard, the then Minister of Health.
Some of the provisions of this Bill covered the setting up of SMCs. The explanatory notes specified that “The bill provides for supervision of the quality and safety of the medical services provided in a specialized medical centre.” ” The services in question were hip or knee replacement, cataract extraction or other specialized medical treatment determined by regulation of the Minister. The Federation supported the measures intended to foster the quality and safety of treatments in centres. The Bill provided that a majority of the owners of such a centre must be physicians, that a medical director should be appointed to ensure the quality and safety of care and that the SMC must be certified by a competent body.
The Federation however opposed all measures and requirements that did not relate to the objectives of quality and safety, including those that effectively called into question the rights and fundamental freedoms of physicians, their professional independence or their relationship with their patients. Among these was one that provided that an SMC must be composed only of physicians participating in the Quebec health insurance plan or only of physicians not participating in the plan. Physicians were thus banned from grouping themselves in another manner, placing restrictions on their freedom.
The Federation has made various representations in an attempt to correct these measures.
This process finally stretched over a period of more than three years, during which time a new regulation was adopted by the government specifying 50 other specialized medical treatments covered by the SMC requirements. The effective date of this regulation was postponed, thus permitting the adoption of new SMC measures within Bill 34, passed in June 2009. We had to wait until March 31, 2010 for the different rules on SMCs to really come into effect and be enforced by the government. The Federation’s representations over the years achieved some leeway in the SMC rules. However, the government still wanted to hear nothing about the restriction on participating/nonparticipating physicians’ freedom to practise.
The Federation argued for a long time that such a restriction infringed physicians’ rights and freedoms and was unacceptable. We emphasized the fact that there was no valid reason for preventing participating and non-participating physicians from being in practice together, that there was absolutely no justification for the ban with respect to the quality and safety objectives identified from the beginning. We stated that the ban would have the effect of ending alreadyexisting physician partnerships and thus cause various types of harm, notably to their patients.
The government refused to withdraw the restriction. The most it did was pass a temporary provision allowing certain participating/non-participating physicians to continue their joint practice for a certain period of time. The legal action taken In its suit, the Federation asks the Court to declare the provisions contained in the AHSSS banning the joint practice of participant and non-participant physicians null, void and inoperative. The text of the action (available in the Federation’s website at www.fmsq.org – In French only) gives a fuller explanation of the various problems arising from the passage of this ban.
The legal action was taken jointly with a medical specialist, Dr. Claude Trépanier, an anesthesiologist, in order to support the problems identified.
It is unfortunate that we have to have recourse to the Courts to defend the rights of medical specialists. The Federation will never hesitate to take such action when circumstances justify it, whatever the number of physicians affected by a discriminatory measure. The Federation Files Suit Against the MSSS By Maître Sylvain Bellavance DIRECTOR, LEGAL AFFAIRS LEGAL ISSUES LS
16 LE SPÉCIALISTE VOL.12 NO. 4 DECEMBER 2010
LE SPÉCIALISTE VOL.12 NO. 4 DECEMBER 2010 17 In a few short weeks from now, Haiti will be remembering the day when, just a year ago, the earth took away the lives of hundreds of thousands of persons and destroyed daily life for all Haitians.
In just a few minutes on January 12, at 4:53 p.m., an earthquake measuring 7.0 on the Richter scale, with an epicentre located a few kilometres from Léogâne, destroyed the capital city of Port-au Prince which alone had more than 2 million inhabitants, along with some coastal villages on the southern side of the island. Because of the extent of the disaster, the entire world would unite and organize immediate rescue plans. The needs were considerable, especially supplying the population with the basic necessities of life and survival, such as water, food and first aid.
As a result of the catastrophe, the Fédération des médecins spécialistes du Québec took action on several fronts. It first responded to the many requests from physicians who, touched by the distress of the Haitian people, wanted to know how to get there and give their time to deliver first aid. The Federation then donated $70,000 to be divided between the three organizations that have a direct link with the work of our medical specialists in Quebec (Doctors Without Borders, Doctors of the World (Canada) and the Centre for International Studies and Cooperation). Lastly, it set up a vast fund-raising campaign covering the whole community of medical specialists, both active and retired.
This latter initiative brought in close to $160,000, in just a few days.
What has been happening, then, over almost a full year? Le Spécialiste has invited the three organizations who received the sums donated by the Federation to bring us up to date. One reports on what has been accomplished in the field; the second takes a critical look at the situation that still exists; and the third, managing yet another health crisis in Haiti, deals with the current situation including the cholera epidemic. Le Spécialiste also wanted to take another look at the media storm surrounding the request made by orthopedic surgeons, and asked the President of the Association at that time to talk about what happened.
The editorial team has added a summary of the events and action taken in this regard. But, Haiti has still not been rebuilt. Far from it. What about the rebuilding projects that were covered so extensively by the media during the first summit meeting in Montreal? Le Spécialiste has met a few members of a citizens’ group within the Haitian community who are totally dedicated to the sustainable reconstruction of their native land. The group includes several Quebec medical specialists, and has just published its vision for a new Haiti: a Haiti they hope to see rebuilt, with a more open, fair society that will one day be able to meet its own needs.
Dossier The editorial team wishes to thanks the Centre for International Studies and Cooperation, Doctors of the World (Canada) and Doctors Without Borders for having granted us permission to use their photos in this present dossier.