Newly elected Saskatchewan Medical Association (SMA) president Dr. Annette Epp feels she is “taking over the reins at a time of impending change.”

The pandemic showed the medical profession is adaptable, resilient, and enduring, she said. Physicians learned to adapt when sudden change over which they had no control was thrust upon them unexpectedly.

“Now we have the opportunity to direct change that will have a positive impact for the future of our profession and the patients that we serve,” she told delegates at the 2023 Spring Representative Assembly on Friday, May 5, following her election as president for 2023-24.

Physicians can direct and influence change in primary care, Dr. Epp stressed.

“The foundation of our system is primary care,” she said. “Nationwide, it is recognized that historic practice plans and the compensation models in place are no longer working. They do not serve the patients or physicians well and need to change.

“Our province must invest in the building blocks to fix what is broken with primary care.”

She pointed to the significance of the Ministry of Health’s announcement, made earlier on May 5, that the government plans to develop a made-in-Saskatchewan payment system for family physicians based on a blended capitation model. The ministry stated the payment model will allow physicians to work with a team of health care professionals that will improve access and quality of care for patients, and better distribute work among team members.

Saskatchewan can be a leader in changes to improve family medicine, Dr. Epp said. “We have a long history of collegiality and cooperation within the profession, among health system colleagues, and with the government. Our province is in a good place financially. The federal government has pledged more funding for health care and we should be active stewards of this additional money.

“We need to work together and with government to put in place investments in those things that members see as priorities,” Dr. Epp said. “These investments must improve care for patients and improve the working environment for doctors.”

Dr. Epp is a gynecologist and has been in practice in Saskatchewan for 29 years. Canadian Medical Association (CMA) president Dr. Alika Lafontaine invested Dr. Epp as SMA president during an evening ceremony on May 5.

New SMA executive elected

A new SMA Board of Directors and executive for 2023-24 were declared at the 2023 Spring RA:

• Annette Epp, president, Saskatoon
• Andre Grobler, vice-president, Prince Albert
• Pam Arnold, honorary treasurer, Regina
• John Gjevre, past-president, Saskatoon

Directors to the SMA Board for 2023-24:

• Sanchit Bhasin, Regina
• Braden Bouchard, Battleford
• Geethan Chandran, Saskatoon
• Breanna Davis, Prince Albert
• Susan Hayton, Saskatoon
• Carla Holinaty, Saskatoon
• Stephen Loden, Meadow Lake
• Mohamed Moolla, Regina

Four physicians received honorary memberships from the CMA during the May 5 evening ceremony. They are Drs. Peter Kapusta, Barb Konstantynowicz, Stan Oleksinski and Karen Shaw.

Primary care compensation

Outgoing SMA president Dr. John Gjevre touched on themes related to primary care during his farewell address to the 2023 Spring RA. He noted that change to the family practice model is urgently needed. The SMA during his term pressed the government for interim support and a new payment model.

“There’s no doubt in my mind that our efforts – to secure a new compensation model for family doctors and to adopt team-based care in the community – are keys to both attracting and retaining doctors in this province,” he said. “We must change how we approach medicine. We must change the compensation for some physicians, and we must rediscover the joy of practising medicine.”

Dr. Gjevre presented a session, along with SMA board member and Saskatoon family physician Dr. Carla Holinaty, entitled “Primary Care Compensation.” Joining them were members of the Primary Care Compensation Working Group, including Drs. Craig Cantin, Sean Groves, Ginger Ruddy and Kirsty Sanderson. They presented recommendations, including:

• Build a Saskatchewan-designed blended capitation compensation model for family physicians over the next 10 years.
• To stabilize family medicine prior to the full implementation of the blended capitation model, develop pathways for family physicians (who choose so), to transition toward a blended model. For fee-for-service (FFS) physicians, a physician working group is preparing a transitional pay model plan and expects to submit a plan by June 30 to the Minister of Health. For non-FFS physicians, a project team will be identified by June to develop a non-FFS pathway.
• The SMA, Ministry of Health (MoH) and Saskatchewan Health Authority (SHA) re-establish shared governance to stabilizing family medicine. An operational team will be established prior to June 2023.
• The SMA, MoH and SHA collaborate to develop supports for physician-led health care teams in the community by building objectives and identifying leads by June 2023.
• Develop a provincewide strategy for grouping (in person or virtual) health professionals into family practice clinics.

Equity, Diversity, and Inclusion (EDI); physician health

Dr. Nnamdi Ndubuka, Physician Advocate for EDI, updated delegates on activities of the SMA’s EDI Committee. He made the following points:

• A one-day in-person EDI conference is scheduled for Sept. 22, 2023, featuring workshops and guest speaks from Saskatchewan, Alberta and Ontario.
• Four online learning sessions facilitated by Dr. Manuela Valle-Castro were held between September 2022 and January 2023.
• A reporting and complaints process is being developed.

Dr. Tracy Danylyshen-Laycock (PhD), Director, Physician Wellness and Support Programs, and Jessica Richardson, Clinical Coordinator, Physician Health Program, made a presentation titled “Physician Health Risk Factors:  Being human and the cost of providing care – Prioritizing Physician Wellness.” The presentation included the following points:

Individual strategies to help physicians manage stress, burnout, and moral injury include:

• Establishing healthy boundaries,
• Developing self-care and personal coping strategies; creating time/space to process and reflect on experiences,
• Connecting with trusted others,
• Accessing professionals supports.

System-wide strategies to help physicians manage stress, burnout, and moral injury include:

• Optimizing call schedules,
• Peer support programs,
• Access to timely ethical consults,
• Creating strong and supportive teams.

The Canadian Medical Association, MD Financial Management Inc. and Scotiabank together proudly support initiatives that comprise our 10-year, $115-million commitment to supporting the medical profession and advancing health in Canada.

SMA governance initiatives

Drs. Jay Kalra and Susan Hayton, members of the Legislative and Policy Committee, and Reché McKeague, K.C., SMA Legal Counsel, made a presentation to delegates on proposed SMA bylaw amendments. RA delegates voted to present the proposals to the SMA Annual General Meeting, which was held on Saturday, May 6. The AGM subsequently approved the amendments.

SMA Bylaws were last amended in 2016. Since then, several “housekeeping” amendments and “alignment” amendments resulting from the transition to Medical Staff Associations (MSA) were identified. In addition, the 2022 Fall Representative Assembly accepted the recommendations of the Special Committee on SMA Governance that required amendments. 

The amendments include requirements for MSAs and SMA sections to file budget and financial statements with the SMA for informational purposes, and include representation by population formulas for choosing delegates to future RAs. MSAs must consider values of equity, diversity, and inclusion in electing delegates.

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, noted recruitment and retention of family physicians are high priorities of the provincial government.

Merriman said competitive compensation is key to attracting and retaining physicians. He cited the ministry’s pledge to develop the blended capitation payment system model for family physicians. He said the ministry will work with the SMA on this model, which is a long-term proposition. In the meantime, the ministry will look at incremental improvements for primary care.

Merriman also noted the government and the SMA have agreed to enhancements to physician compensation designed to improve patient access to family physicians. Funding is available to urgent care clinics offering after-hours, urgent care services, and community-based, fee-for-service family physicians are eligible to receive an additional payment per visit service.