SMA president meets with physicians during spring tour stop in Swift Current
mliebenberg@prairiepost.com
Physicians from the South West Medical Staff Association had an opportunity to discuss issues with the president of the Saskatchewan Medical Association (SMA) during a meeting in Swift Current.
Dr. Annette Epp, a gynecologist in Saskatoon, was elected as SMA president at the organization’s spring representative assembly in early May. The spring tour provides an opportunity to hear from physicians in different areas of the province.
“For me personally very important,” she said about these meetings. “For the SMA equally important. We’re a member-based organization and we’re only as strong as our membership. It’s really important for us to go out to communities and see where physicians are living and working to really get in touch with the issues on a local level. So I think it’s a fantastic tradition that’s been going on for many years and I feel very privileged to be here.”
Her visit to Swift Current on May 16 was the second stop of the spring tour during May and June. The meeting was not open to the media, but she was available for media interviews before the start of the event.
The four-stop tour kicked off in Prince Albert a week earlier and the other two meetings will be in Regina and Saskatoon. The annual SMA president and vice-president’s tour usually takes place in the fall, but she felt it made sense to already have a few stops this spring.
“It’s more of a pragmatic approach,” she said. “I was elected as the president for this year. It’s kind of nice to get out of the gate and meet people early just to see what the issues are locally, but also to try and reach as many communities as we want to reach. It makes for a very tight schedule. I’m a working physician, and so to try and coordinate all of the travel and reach all of the communities is a difficult thing to do. So we thought we would try a spring/fall approach and so far it’s been excellent.”
A key goal is to hear from physicians during these meetings, but it is also an opportunity for the SMA leadership to share information with members. The organization is a voluntary, memberbased, professional association for physicians, medical students and residents in Saskatchewan.
“We’re in a year of probable negotiations for a contract,” she noted. “Our physician contract expired a year ago in March and so we have a committee struck to start work on that. It’s just in its preliminary stages, but I think it’s going to be very important this year.”
The terms and conditions of the previous five-year contract with the Ministry of Health will remain in effect until a new contract for physicians are ratified.
According to Dr. Epp the SMA feels it is a priority to move ahead with a new made-in-Saskatchewan funding model for family physicians that aligns with a new model of practice.
“The current model of care is really based on a compensation model from the sixties, which is called fee for service, and unfortunately it has not kept pace with the changing demographics of the population or the health care needs of the population, particularly for what family doctors see,” she said.
It has become difficult for family physicians to provide comprehensive longitudinal care, because patient health care needs have become much more complex.
“There’s a lot of elderly people in the population and that is the fastest growing segment of the population,” she said. “They have unique health needs. Many people need what we would consider to be multi-disciplinary teams to actually give the kind of health care that they need and family physicians are currently practising mostly in isolation, trying to manage all of these things without much support. And so the whole impetus is to go to a new model, which is a family physician-led, team-based model.”
The intention is to use a team-based model as a way to provide patients with the level of quality care suitable to their specific needs.
“The hope is that the family physician can utilize their highly specialized skill set to the top of their game, but they also have wrapped around them a team where they can also have access for their patients to get services from allied health care professionals who have their own areas of expertise,” she said. “There is a whole host of other health care professionals that we need to lean on to help us look after the population and the way it currently exists, everybody is in their own little silo. Although we’re all doing the best job we can, the system doesn’t allow us to work together very well.”
The SMA views the current compensation model for physicians as part of the problem, because it does not promote a team-based approach.
“Research has shown that a teambased model of care with family physicians as the quarterback is the most cost effective and delivers the highest quality of care to patients,” she said. “The way that the current compensation model works isn’t allowing them to do that, because unless they actually see the patient and actually provide a designated service, they can’t be paid and of course they have to be able to keep the lights on in their offices too.”
The traditional fee-for-service model means a family physician receives payment for the services provided. The proposed compensation model, which is called blended capitation, will provide different streams of remuneration to family physicians.
“It allows physicians to be paid for having a roster of patients and providing a basket of services for those patients,” she explained. “Then it has another where, when they provide additional services that each patient might need, they can be paid additionally for that. It is also broken down even more into the complexity of the patient, because a 25-year-old young man would not be the same as an 85-year-old man. It’s meant to be broken down by age, by gender, by complexity so that there’s a level playing field in terms of payment for physicians and they can actually do the job the way it should be done.”
Dr. Epp welcomed the recent announcement by the Saskatchewan government to proceed with the development of a new family physician payment model based on blended capitation. She noted the new model is a result of an intensive effort by a collaborative working group involving representatives from the SMA, Saskatchewan Health Authority and the Ministry of Health.
“This small but mighty group has actually looked at the problem and different models, and really done extensive research to try and come up with a new way of approaching family medicine in this province,” she said. “So we are very excited that the government has agreed that this is the way to go. … The minister did announce that he wanted this to be operational in 12 months and we’re going to work really hard to make that happen.”
She felt the new compensation model will help to address the issue of family physician retention, because it will offer them the opportunity to practice medicine the way they were trained. However, she acknowledged that retention is a complicated issue.
“The grass is definitely not always greener elsewhere, but we have a pretty harsh climate and it’s important for us to recognize that we need to look at the students we’re training, because most of them have roots in Saskatchewan and are much more likely to choose to stay for personal reasons,” she said. “And then people who come here who are not from Saskatchewan, we need to make sure that we wrap supports around them so they don’t feel isolated. The SMA is really good at that, but of course we can always do better and it is one of the things that’s top of mind for us.”
The SMA has created a formal program to support physician wellness and it has been enhanced recently with the creation of four new positions. There are now two physician advocates as well as two workplace wellbeing consultants as part of an expanded team.
“The program has been enhanced multiple fold with the idea of physicians being able to access it for work-related or personal-related issues and to really provide a service so that we can keep our physicians healthy at work doing the jobs that they were trained to do,” she said.