Legal weed, tax fight leads to busy year for head of doctors’ group

Dealing with marijuana legalization was not a high point of Dr. Joanne Sivertson’s one-year term as president of the Saskatchewan Medical Association (SMA).

At last year’s Spring Representative Assembly, members voted in favour of the SMA encouraging the province to set the age of legal recreational use of cannabis in Saskatchewan at 21.

“However not all physicians in the province agreed with the SMA’s stance,” Sivertson said. “We got a little pushback on that.”

The SMA advocated on behalf of its members on another issue that was stressful to the profession — the federal government’s changes to the small business tax.

“I had the opportunity to testify to the Senate — that was a whole new experience for me as well,” Sivertson said. “But we, as physicians in the country, had some success, we think, at getting our message across because some of the changes were modified.

“But we still think that there might be some detriment to rural and remote practice because of the income splitting changes that were implemented.”

It’s with mixed emotions she will pass on the torch to the yetunnamed new president who will be installed Friday night at the SMA’s Spring Representative Assembly, being held in Regina on Friday and Saturday.

Sivertson said some of the perks of the position have included learning a lot about herself, the province and the doctors in the province.

She added the SMA appreciated the involvement physicians had in the amalgamation of 12 health regions into one.

“We had a physician advisory network to the amalgamation team, and when we made comments and recommendations, they were by-and-large accepted and incorporated,” she said. “The consultation felt very authentic and respected.”

However, she’s less pleased about pharmacists expanding their scope of practice to include prescribing birth control pills and drugs for recurrent bladder infections.

“We feel that this runs the risk of fragmenting care rather than making it more continuous,” Sivertson said.

She noted some pharmacies are quite isolated from the family physician offices.

In the case of recurrent bladder infections, it’s important to find out why it’s an ongoing issue, and that might require a urine culture, she said.

“Pharmacists cannot (order) that and in this age of antibiotic resistance, antibiotic stewardship is increasingly critical,” Sivertson said. “Opening the ability for pharmacists, or for anybody, to prescribe without a proper workup is our great concern.”

A recurring problem might not even be an infection, she said.

“The pharmacists are prescribing for a self-diagnosed issue,” Sivertson said. “Patients don’t always realize that what feels like a bladder infection could actually be an infection in an adjacent structure, like the vagina, or it could be a sign of something more ominous up to and including cancer of the bladder.”

The SMA is advocating for full diagnostics and workups with more teamwork.

“If this were happening in a setting where the pharmacist and physician were working as a team and the proper tests could be ordered, this wouldn’t be so much of an issue,” Sivertson said. “We’re worried about safety and we’re worried about appropriateness of care.”

She acknowledges everyone wants easier and quicker access to medical care.

“We’ve had a long-standing issue with access in the province,” Sivertson said. “Despite having 900 more doctors in the province, we are still the second-lowest per capita in the country ... We’re seeing great improvement, but we’re not there yet.”

Overall she believes it was a positive year for her and the SMA.

“This year, looking ahead at negotiations, we have a contract that has expired so I’m happy to hand that over,” Sivertson said, laughing.

Opening the ability for pharmacists, or for anybody, to prescribe without a proper workup is our great concern.