CMA Election 2018 Archive

CMA Election 2018 Archive

This year I took a chance and ran for President Elect of the Canadian Medical Association.  What a tremendous experience!

Dr. Sandy Buchman was, in the end, elected and I support his Presidency fully.

The opportunity to think through ideas, write prolificly and craft a series of policy pieces once in a life-time. I am quite proud of what was offered up on my website and want to capture some of that thinking here.  What follows are posts that keep this writing around on my more general blog for a long time.

Feel free to comment if you missed the election yourself!

Cheers,

Darren

Archived Posts from Larsen4CMA.com

And in closing… my thanks!

April 3, 2018

Friends and colleagues,

This is the last post you will receive from me in my campaign to become President-Elect nominee of the Canadian Medical Association. (Phew, you say!!)

The past three months have been really exciting for me.  One of the best things about “putting myself out there” has been the interaction I have had with all of you.  You have challenged my thinking, provided me with ideas, offered support and critiqued my views allowing me to produce a campaign that was authentic, honest and multi-dimensional. It was much more than I expected it to be!

I want to thank all of the many, many people who helped me along the way.  You know who you are! You corrected my writing.  You pushed me to go deeper in my thinking.  You caused me to see both sides of every story.  You propped me up when I was feeling tired.  And you shared with me that you thought I was doing the right thing even when I doubted it myself. Having each of you as part of this process has been one of the most unique privileges of my life.  I have forged incredibly strong relationships as a result that will go on for years.

Voting ends tonight at midnight.  If you have already cast your ballot (despite the effort involved due to the voting platform glitches we saw) I applaud and thank you. Your persistence is so appreciated!   If you have not yet cast your vote, there are a few hours left, so I hope you will do so now with your CMA member number and PIN that was emailed twice over the past three weeks.  Results will be shared with the candidates tomorrow at 9:30 am, so keep your ears and eyes open!  If I end up as the winner I will be incredibly happy as all my effort will have borne results.  If another candidate wins I will be content knowing that the CMA will be in very good hands as each of us would do well as President-Elect.

It has been a distinct honour to run in this election with three other exceptional candidates:  Dr. Sandy Buchman, Dr. Mamta Gautam and Dr. Atul Kapur.  The campaign has been respectful and forward-looking.  We always stayed above the weeds and showcased our unique strengths without coming close to negative talk about each other.  We have spent a lot of time together on the road, visiting medical schools, and in conversations about effective leadership.  I have learned so much from each of you and I know that our collective thinking has done much to improve the culture of respect and professionalism in our profession.  We have changed the conversation and advanced the optimism of our peers. Thank you so much.

In closing, I am attaching a fun infographic about my campaign activities over the past few months.  It has been such a great experience for me.

Again, my sincere thanks.

Darren

Archived: Pat Rich: an excellent piece on the use of social media in the CMA election.

January 28, 2018

I would encourage you to give it a read!!

The @CMA_Docs election and Twitter redux

And my reply:

Pat… this is such a great article. Thanks so much for producing it. You are right… considering how difficult it is to physically meet with our physician colleagues to have conversations about advocacy, policy and a modern CMA the online space may be our best outlet for respectful and open dialogue. I have embraced this for some time, as well as the advancement of thought through my blog. I am not stopping at Twitter (although this is the most real time). I am using as many of the channels as I have access to to spread my thoughts on #BoldPhysicianLeadership. And I welcome opinions that do not match my own in the same space. There is more than enough room for solid debate online, and this can be the most engaging aspect of a campaign!

Although social media has been given a bad rap in the physician community in the past couple of years as it has been used for bullying and intimidation by those who hide in secret online groups or behind anonymous avatars, for those of us who are transparent and public the opportunities held within it are mind boggling!

Thanks again for making this real!!

Darren

Archived: Endorsements

January 3, 2018

Darren has been one of my most influential mentors. He’s the type of leader who genuinely extends a hand during the good times and most importantly, during the bad. I would not be the physician and leader I am now without him!

Dr. Ali Damji

Family Medicine Resident, U of T
Previous Co-chair, Ontario Medical Students Assoc.

 

I have known Darren as a friend and mentor for over 2 years. Darren is a connector. I’m always struck by his natural ability to really understand the challenges I’m going through as a medical student. He listens with an open ear and works patiently with me to find solutions. Darren not only excels at connecting with people, but with connecting people. He has an uncanny sense for identifying and fostering budding relationships. I’ve learned so much about business, leadership, medicine and, importantly, myself from both him.

Nicola Sahar

Medical Student, University of Toronto
Innovation Fellow, The Next 36

 

Having known Darren a very long time, personally and professionally in both Alberta and Ontario, I have complete trust in his capability to represent physicians all across Canada. Darren has a clear vision to advance physician interests while upholding and promoting highest quality patient care. His organization and attention to detail combined with his personable nature make him an ideal leader for the CMA!

Dr. Nancy Vyse

Family Physician, Rural Medicine

I have yet to hear Darren say the words “There’s nothing we can do about that.” There’s always an idea, an innovation, an improvement. We as physicians as hard-wired to be “fixers”, and there’s no one more dedicated to practical solutions that are relevant to physicians than Darren is. I am thrilled to support his candidacy for President Elect of CMA!

Dr. Mario Elia

Family Physician
Peer Leader, OntarioMD

Darren has a rare combination of exceptional empathy, authenticity and integrity as a physician, and a keen curiosity for innovation with the ultimate goal of providing better medical care across Canada. Darren is the leader Canadian physicians need to today to address the issues of the future.

Al Akdari

National Public Sector Lead
MongoDB

Dr Larsen is a great collaborator who listens closely to the opinions of others.  He has been a supportive mentor to many learners and new physicians, including myself, and has a progressive vision for medicine in Canada. He has my support and deserves your vote!

Dr. Steve Hawrylyshyn

Family Physician
Chair, First Five Years in Practice Committee, CFPC

Dr. Larsen is a visionary leader who enables progress by partnership and with deep compassion for the people we serve, the patients and their loved ones.

Dr. Andrew Loblaw

Radiation Oncologist,
Odette Cancer Centre
Professor of Medicine, U of T

Darren has a unique ability to understand a diversity of opinions and find common ground. His leadership qualities are critically important in today’s climate of increasing divisiveness in our profession and our society.

Dr. Hasan Sheikh

Emergency Physician
Medical Lead, META:PHI Addictions Program, UHN

I have known Darren for over 10 years. He is one of the most intelligent, passionate, intuitive leaders I have ever met. I have seen his leadership in person in many different scenarios. He has an ability to see the core issue. then synthesize a solution and build consensus around an action plan. He has demonstrated he has what is required to build, encourage, and represent for varied stakeholders in healthcare. This is type of leader we need in medicine today.

Dr. Sanjay Acharya

Anaesthesiology, Pain and Intensive Care, Queensway Carleton Hospital
Past President Academy of Medicine of Ottawa

Darren Larsen is an excellent and compassionate leader who should be CMA President. Working with him at OntarioMD where he is CMIO, he showed a willingness to engage in conversations and give a thorough, non-biased feedback no matter who the other individual was. His passion for furthering the interests of the medical community is highlighted in every decision he made. His experience at OntarioMD will help move the CMA and itsIt’s constituents into the next stage of digital health.

Dr. Neil Naik

Family Physician.McMaster Univ.
Waterloo, ON

Darren is a pragmatic and collaborative innovator, a dynamic leader, and an engaging physician whose reach and capability are recognized at both Canadian and provincial levels. A pleasure to work with too on a diverse range of issues from EMRs to policy reform.

Matthew Lister

Senior Director, Office of Stewardship and Sustainability, University Health Network

For me, Darren has been a colleague, friend and mentor. I have valued his willingness to trust, and to test and enrich his ideas through conversation with colleagues of diverse perspective. I have also been inspired by his willingness to maintain optimism in challenging times, and I believe that is truly the new mark of #BoldPhysicianLeadership.

Dr. Sarah-Lynn Newbery

Family Physician, Northern and Remote Medicine
Past President, OCFP

Darren has been steadfast in his respect for medical learners, highlighted by his actions denouncing coercion and bullying of medical students last year. As CMA president, I know he would continue to be an ally and mentor to medical learners across the country. Looking through a lens of innovation, he is a pragmatic visionary that can bring the organization to new heights in terms of member engagement and professional advocacy. He has a successful track record serving patients and leading high-quality healthcare organizations. We would be lucky to have him leading the charge at the CMA.

Dr. Justin Cottrell

Resident, Otolaryngology, U of T Past co-chair OMSA

Honesty, Integrity and a full-scope vision of excellence in the medical profession – add in dynamic communication skills and you have the ideal CMA leader. That’s Dr Darren Larsen.

Dr. Adam Vyse

Family Physician, Rural Medicine, ER

Throughout my career as a female physician and in the many leadership roles I have held at the local and national levels, Dr. Larsen has been one of the most outstanding mentors I have had. He played a part in helping me break through several glass ceilings in the medical community. Sheer honesty, bold vision and pragmatism are strong pillars that guide him in his leadership. He will undoubtedly be one of the best leaders CMA will ever see.

Dr. Jemy Joseph

Family Physician, Northern and Remote Medicine

Darren has been an immensely meaningful mentor of mine in leadership and humanism. I support him wholeheartedly in his journey to serve Canada’s doctors and patients.

Dr. Dominik Nowak

Chief Resident, Family Medicine, McMaster University

Darren has demonstrated the ability to deeply empathize with his peers, patients and the public allowing him to divine important lessons about what matters now and what could be. These insights, combined with a strong set of system leadership experiences and operational roles make him a smart choice to lead the profession during a unique and challenging time.

Sophia Ikura

Executive Director, Population Health Lab Solutions, Sinai Health Systems

Darren has been my mentor for the past five and half years. He has helped me to accomplish my goals, and now he wants to do the same for others as President of the CMA. I hope Ontario’s doctors will vote for him next month, as I believe he has their best interests at heart!

Dr. William Parker

Radiology Resident, UBC

I have so appreciated your firm commitment, light touch and good humour in our efforts to work together in service of patients and their primary care providers. It’s not always easy to hold divergent perspectives in balance long enough and lightly enough to eventually settle on a workable compromise but you make it look that way. I suspect you will do the same on behalf of CMA. Best wishes in your campaign.

Dr. Carol Mulder

Provincial Lead, Quality Improvement and Decision Support, AFHTO

I’m voting for Darren! He’s a problem solver and a visionary. His mentorship and kindness have been an inspiration to me and those around him. We need this upbeat, tenacious gentleman to lead us toward a happier, more sustainable healthcare system.

Dr. Doug Kavanagh

Family Physician
Co-founder and Medical Director CognisantMD/Ocean

Darren cares deeply about his patients, his colleagues, and the future of health and medicine in Canada. He has earned the utmost respect of his colleagues through his exceptional teamwork, collaboration and communication skills, and he always strives to help and advocate for those around him. Canada’s physicians would hugely benefit from Darren’s vision and leadership as President of the CMA.

Dr. Stephen Pomedli

Family Physician
Co-Founder Consult Loop

Darren is a charismatic, engaging, inclusive leader who is dependable and supportive of physicians and patients from the clinic exam room to the big chair in a national committee.

Dr. Norman Yee

Family Physician

Darren’s is a bold and inspiring platform that I know will resonate with physicians across Canada. I look forward to seeing and hearing more from him as the campaign unfolds.

Young Lee

Vice President – Quality, Performance and Clinical Systems Transformation
Grand River Hospital

 

 

Archived: Platform pillars

January 3, 2018

Supporting Physicians and Innovating in our Health System

I believe strongly in the need to support physicians as the health system changes around us.  This will involve innovative thinking and co-creation.  My pledge for being President is to:


  • Foster the role of mentorship and education. Established and new physicians do best learning from each other.  It is not an us vs. them mindset that is required.  It is an open mind to new ideas that make us stronger together. I gain more from my mentees than they gain from me.  As President I will foster mentorships and communities that allow us to share nationally across boundaries.  Technology can help.  I have a deep understanding of how to make it work for us not against us.
  • Celebrate medicine as an incredible career which gives us as many opportunities as challenges. I will work to end the feeling of beleaguerment felt by so many of us.  I will use all my experience to help my colleagues feel the same way I do about the role of our leadership in making progressive change happen around us.
  • Actively include the voices of students and residents in CMA strategy.  I will fight for solutions on major issues affecting you.  CaRMS matching must be overhauled to ensure fairness and matched to a national work force initiative that looks at least 8 years ahead with strong predictive data.  I will push for freezing skyrocketing tuition fees that will soon make medicine an option for only the rich.  Debt is becoming overwhelming for learners and is strongly influencing specialty choices favouring procedure-based sub-sub specialties rather than generalism.  I will act to manage this issue nationally.
  • Celebrate new thinking in medicine and push innovators to scale up their ideas into practice.  Our profession is a wealth of intelligent creative minds.  We know what the system needs.  I will fight to bring innovative ideas to the forefront producing real health system solutions.  I will push for startup thinking to stop endless pilot projects and move to rapid cycle assessments getting ideas and products to market quickly and safely.  I will never forget the idea that in many cases “less is more” for those who are well, and that data and evidence can direct treatments producing better outcomes.  I will always be open to change and your ideas as President.

Decisive Action for Canada’s Election in 2019

My commitment to advocacy in the Federal Election year of 2019 is clear.  As President I will push CMA’s  represention of doctors and our patients, to:


  • Become a fighting force on Pharmacare, slicing through the red tape and taking on the lobby groups which prevent this from becoming a reality.
  • Advocate for a government that believes in reconciliation and wants to actively build a healthy partnership with indigenous communities.
  • Ask for commitments to ensure the next government will protect and care for the people who protect us – Canada’s veterans, RCMP and active Armed Forces.
  • Establish a federal commitment to resources and coordination throughout the youth mental health sector.
  • Ask for a respectful, consultative relationship with the government, and avoid examples like the 2018 tax changes.
  • Work with the 2019 Government of Canada to prevent seniors from living in hospital beds.

Diversity, Respect and our Medical Culture

I believe that our profession is better for supporting diverse thinking, treating each other well and showing leadership across the healthcare space.  My Presidency would focus on:

  • Leadership. Physicians are inherent leaders in the health care system. We need more who are willing to step up, from every background.  Sponsorship and promotion of people and ideas that our not like ours makes our profession strong.  I will ensure this happens.
  • The ability to adapt. Doctors are beleaguered and buffeted by waves of change. We need to channel our energy into productive leadership. We’re either at the table, or we’re on the menu.  I want to be part of the conversation on behalf of the profession, showcasing our shared values and a modern view of the Association.
  • Professionalism. We should promote a medical culture with less bullying and more support.  This is done by walking the talk.  I have not, and will not, tolerate the belittling of one group of physicians to make another look stronger.  I will stand up to incivility and raise up those who are under attack.  I will defend the right of all to have an opinion on policy and practice and work constantly to translate ideas building bridges between us.

 

  • Taking care of each other. We need to focus on physician health and the concept of career wellness.  Being connected to our careers via the strong relationship we have with patients and each other is a certain path to recreating the joy we felt when we were accepted into medical school.  I will start and nurture conversations that bring forth an optimistic view.  I will promote a culture that connects, not isolates.  I will provoke the CMA to think creatively in finding permanent fixes for the issues that face us every day producing feelings of burnout.  I want our jobs to be seen as adding to our lives, not taking away from them.  I will work endlessly toward these efforts as President.

Archived: Why me?

January 3, 2018

My Mission

Bring Modern #BoldPhysicianLeadershp, based on optimism, trust, mentorship and a culture of respect to the national level, from an Ontario perspective and for Canada’s doctors.

I am striving to change the culture of medicine in Canada through supportive mentorship of our future physician colleagues, the advancement of physician-led innovation and technology helping us deliver better quality care, and authentic conversations about the demands of medical work on professionalism, our patients and ourselves.

My Story

It was at the 2017 General Council of the CMA that I was asked if I would consider running for President.  At first I was taken aback… I was not sure why the physician leaders who approached me would want me to be a candidate.  But through a series of real and probing conversations I began to understand their fears about the future of CMA’s leadership.  Their request for me to run was an honour, as I saw that they respected my views, policy thinking and leadership style enough to support me and help me move a campaign along.

The conversations I have with patients, the respect I show my peers and the love I have for our healthcare system is exactly what the country needs from an Ontario-elected CMA President-elect.  I see the need for bold physician leadership and for a person who connects with the issues and medical landscape in a way that allows all to thrive.  This is my passion.

My credentials

Teaching is at my core – about diversity, advocacy, quality improvement and patient centred care – Mentorship focus –  helping new doctors develop their own skills and talents with confidence and purpose.

  • Family physician for 26 years –  Ottawa, rural Alberta, two decades in Thornhill, now at Women’s College Hospital
  • Leadership
    • Undergraduate BSc at the University of Alberta – active in student politics.
    • Medical School at the University of Calgary – Medical Student Society President –  committees of the Alberta Medical Association.
    • Rotating internship and PGY2 year in Internal Medicine in Ottawa
    • First years of practice – Sundre, Alberta – hospital administrative and leadership work
    • Early career, Thornhill/Richmond Hill – York Central Hospital (now Mackenzie Health)
      • Medical Executive for five years; President of the Medical Staff
      • Lessons in crisis leadership – under quarantine for SARS, with the second case in Ontario
      • Board of Directors and Foundation Board for two years.
    • Provincial level – Ontario Family Health Network (agency of the Ministry of Health) as Medical Consultant
      • Created the first Family Health Networks, Groups and Teams.
    • Nationally – taught Practice Management Curriculum for CMA at 7 medical schools over 14 years until 2016.
      • Medical Advisor to CMA’s Knowledge for Practice
      • K4P Physician Advisory Group co-chair
      • Joule Board of Directors
        • formation of the Joule Innovation Council sponsoring physician technological, policy and social innovation
  • Education – Certificate in Physician Leadership at the Schulich School of Business (York University)
    • Business and medical leadership skills and knowledge
  • Work
    • OntarioMD
      • Currently Chief Medical Information Officer; previously Senior Peer Leader
    • OMA
      • Physician Advisory, Quality, Innovation and Leadership
      • Chief Medical Information Officer (technology, e-health policy, and innovation)
  • Academic
    • Clinical Lecturer in the Department of Family and Community Medicine at the University of Toronto
    • Adjunct Lecturer at the Institute for Health Policy Management and Evaluation (IHPME), Faculty of Medicine, University of Toronto
    • Guest Lecturer, Masters of Health Information Technology program, McMaster University

Teaching and mentoring builds strong connections with emerging health and technology professionals – I learn more from students and residents than they do from me.  

Click to see my complete CV

Archived: Beleaguerment and Joy in Our Work

January 3, 2018

My last post on Optimism in Leadership generated a fair bit of conversation between myself and others in medicine, nursing and beyond.  I had identified pessimism as running rampant in doctors, and offered up suggestions for optimistic leadership.  One of my friends and trusted colleagues looked at the topic from a different angle and  suggested that physicians are less pessimists than they are “beleaguered”.  She stated that the beleaguered physician “wears his status as a badge on this sleeve”.  She posited that a doctor in such a state “takes real facts and puts them out there as the centre of his or her own story, rather than starting for the tremendous intellectual, emotional and financial privilege we have as physicians, then taking a hard look at what needs to be better and working toward it in that context.”  She stated the believes “beleaguerment is the enemy of system reform, especially because many physicians who do not identify as pessimists are the first to exhibit signs of being beleaguered”, and this would prevent them from getting involved.

This conversation really got me thinking.  What exactly is beleaguerment?  And if it everywhere, what are the causes and most importantly how do we counter it as a profession to ensure that we are active participants in change as it occurs around us, rather than passive observers (which makes us irrelevant) or constant resistors (which makes us unapproachable).

BELEAGUERED: having so many difficulties that you feel as if you are being attacked from every direction ~ Cambridge English Dictionary

It is true that doctors feel attacked from every direction these days.  They are under increasing financial pressure.  They are dealing with many older and more complex patients.  They feel the burden of hundreds of requests for information on their patients every week.  They have more work than they know what to do with.  They tend to operate as armies of one in their personalities of perfectionism and high performance.

I wonder if beleaguerment is not a symptom of physician burnout.  The 2016 Medscape Physician Lifestyle Report which surveyed 15,800 physicians from 25 specialties,  shows that burnout rates by specialty range from 40 – 55%.  Major contributors to this feeling include too many bureaucratic tasks, long work hours, the effect of computerization and technology, income levels, loss of leadership, certification requirements, accountability, demanding (and more informed) patients and time constraints.   This is an American survey admittedly, but the most recent large Canadian study was in 2009 by Micheal Leitner at Acadia University as published in Canadian Family Physician.   This speaks to burnout rates nearing 50% in Canadian doctors, and I presume that things have likely gotten worse, not better. But is beleaguerment the same as burnout?  Burnout is a symptoms of chronic stress, of being pushed past the ability to effectively cope.  It happens when the traits listed above are not balanced by equally uplifting forces.  It shows up as emotional exhaustion, compassion fatigue, detachment from important things in life, decreased feelings of personal accomplishment, and an ongoing sense of pessimism or unhappiness.   They are not the same.  But I think that both are inextricably linked.

And yet despite all of this no profession is better suited for battling beleaguerment than ours.  We advise our patients constantly on how to improve their heath and situation.  Why do we not do the same for ourselves?  We have a deep knowledge of humanity, the heath care system and our businesses, so why don’t we turn our skills inward to provide joy at work.

How can we as physicians and care providers, who teach our patients techniques that produce the ability to bounce back and find joy , find the same in ourselves?  There is much we can do to bounce back into our work and create a greater sense of optimism.  The ideas that follow represent a sampling of what is possible and are a place to start rather than an exhaustive or prescriptive list.  All of these can help us if our profession is feeling downtrodden or attacked:

  • understand the unique opportunity it is to be a health care provider, playing a pivotal role in people’s lives
  • get involved … locally, regionally, or broader in things that matter to you and which provide meaning
  • find ideas that are positive and people who are working toward change and connect with them
  • build a support system… associate with others
  • reconnect with the moment – learn the background behind problems and ask the question “why” constantly
  • become an active participant in the world which is changing around you, rather than a passive observer
  • share stories
  • be aware of and happy with where you are, even if you are not entirely content
  • laugh more
  • own your state of mind and opinion and use it to challenge the current state of affairs

There is no doubt we work and live in incredibly fast paced and challenging times.  Sometimes it feels like everything is happening to us rather than with us.  Even when this is the case,  beleaguerment is not a useful condition for physicians to adopt if we want to have a role in making things better for our patients, ourselves and the health care system.  There is no better time than now to adopt an attitude and approach to finding or re-connecting with joy at work both personally and professionally.  We must attach to change in a way that embraces it and shows huge leadership in influencing it.  Beleaguerment allows us to be convinced that we cannot make a difference in our environment professionally and politically.  If we resist it, despite the tremendous effort involved, we have won the fight and the battle!

Archived: The Small Business Tax Issue

January 3, 2018

The federal Finance Minister has announced his second attempt at reforming Canada’s tax system, specifically the rules around private corporations and those reforms came into effect January 1st.

There’s no doubt that these decisions will have reverberations that impact the health system, not just the taxation system. Over the last few months, there has been a lot of conversation about what physicians will do to respond to this effort by the government. There has been discussion about the Minister’s personal motives. There has been a review of the reasons behind why Medical Professional Corporations are so prevalent. I’d like to focus on three very different things.

The first is that no matter how you slice it, the consultation process used by the government was certainly a failure. Launching a short consultation period in the middle of the summer is bad optics at best, and judged by many to be in bad faith at worst. This kind of process makes doctors feel like the decisions have already been made and leads a lot of people to react. Even the best ideas in the world deserve honest debate, and a lot of doctors don’t feel like these tax proposals were transparently brought forward by the government.

credit: gapingvoid.com

The second is that as our national body, the Canadian Medical Association must continue to rise to the challenge of lobbying on our behalf. This issue affects doctors from coast to coast, and the CMA needs to take on a very proactive approach to lobbying. We need national advocacy more than ever. Our national physician leaders crisscrossed the country in opposition to these moves, and their energy helped launched a coalition with groups like the Canadian Federation of Independent Business. It was when they and hundreds of thousands of other small business owners got involved that we saw traction. The CMA absolutely has a role in helping voice the concerns and interests of doctors in this discussion.

The third is that as a profession, we did not live by the principle of “be tough on the issues, and easy on the people.” There were many doctors who were in favour of or against these changes who had to deal with personal attacks from other doctors. This can’t be a productive approach to have a conversation about a very important policy issue. We as a medical profession need to be respectful of each other, even when we wholeheartedly disagree.

I’m curious to see what financial experts say on the recent round of revisions. This is a political issue and it has prompted a lot of concern, especially in provinces like Ontario where doctors already feel under attack. In a time of great challenge when doctors and government need to work together, this initiative has pushed us apart. I will work to change this.

Archived: Planning for the Future of Our Profession

January 3, 2018

My decision to run for President of the CMA has brought me many great opportunities. The largest of these, by far, continues to be my contact with students and residents across the province. When I meet with trainees, I feel refreshed, enlightened, and optimistic. This great profession belongs to these future leaders. Today’s medical learner is sophisticated, bright, passionate, connected, and value-based. They are ready to innovate care for patients beyond what established docs could ever have imagined.

Despite this positive sentiment, there is no doubt that learners face tremendous pressure. I am dedicated to being an ally and advocate for students and residents. To this end, I feel strongly about the following issues:

A pan-Canadian health human resources strategy

I believe HHR cannot be done justice in provincial silos.  Identifying needs and matching interested minds to them must be driven by data, not politics and campaign cycles. We must plan and project for the next year as well as the next decade, paying close attention to a changing population, aging, workforce demographics, and regional needs.

CaRMS matching

There were 68 unmatched grads in CARMS this year. These are not all people who have chosen small specialty subjects; they include generalists. It is unacceptable and socially irresponsible for us to trainmore medicall students than there are residency spots. Rebalancing must occur so that no Canadian medical student is forced out of the country for a residency. Ultimately, there should be a small surplus of positions to make way for repatriation of Canadians studying abroad and for immigration

Tuition Fees

Student debt is at an all-time high. As a result, graduates may face pressure to select high-paying specialties and subspecialties and avoid generalism. We need generalists now more than ever, especially in the face of our aging population. Moreover, high tuition excludes those who do not come from wealthy families. It is heartbreaking to see that some students graduate with up to $300,000 of debt, while 20% of students leave medical school with no debt at all. We are creating a situation where only the privileged can afford medical school.  I will work to address this systemically.

 

Hidden Curriculum

It is well-known and accepted that we have a hidden curriculum that disadvantage minorities, women, generalism, diversity, and alternative voices. I will fight for equity and transparency in medicine.

Unequal playing fields

I will not stand back and watch rules being created that disadvantage younger colleagues over established ones. Their future careers are our concern and they are an equal and forward looking part of our profession.

A relevant modern CMA

It is up to us to create a CMA where young leaders are valued and nurtured. There is so much room for new thoughts and ideas in healthcare, and certainly we must create space for our young leaders to develop these ideas. I’m dedicated to ensuring this happens.

We have much to do to support our students, residents and new in practice physicians.  Teaching and mentorship are my passion. It is, therefore, my privilege to fight for the future of our profession.

Archived: My Promise to Medical Students, Residents and New Graduates

January 3, 2018

Supporting Medical Students, Residents and New-in-Practice Physicians is incredibly important to me. 

I have a long history of being by your side in my teaching practice, bolstering your OMSA leaders during very difficult times last year, mentoring individuals, and speaking at practice management and leadership forums throughout the country.  I strongly believe you are our biggest hope and the future of our profession lies in your able hands.

There are three pillars to my platform that I want to tell you about today.

First, we must create a medical culture of respect, inclusion, and diversity.

Second, we will support each other through our conversations, actions and innovative thinking.

Third, I will lead decisively on the issues of election 2019 for Canada’s doctors.

So what does this mean for students and residents? My promise to you is this:

  • I will push hard for a solid permanent approach to rising tuition costs and your unbridled debt, via ideas like tuition freeze, debt relief for residents, loan forgiveness programs with less red tape etc.
  • I will fight for a fair CaRMS match where no Canadian graduate is left behind or forced to leave our country.
  • I will advocate for supporting students who do not match maintaining meaningful work and education until they match again.
  • I will prioritize the creation of a national health human resources strategy that uses data to look ahead 8 to 10 years and plan upstream to match supply and demand for jobs.
  • I will stand up against bullies who treat you unfairly and act unprofessionally.
  • I acknowledge that our current approach to resilience has missed the mark with students and residents and want to talk about how to find joy in this amazing career path you are on.
  • I will help students who decide not to pursue clinical medicine find equal respect and value in the health system in using their unique thinking and skills.  Your education is not lost on me.
  • I will promote and sponsor your leadership and place at the table with mentorship and effective support for your valued opinions.
  • I will protect voting rights for students and residents in medical associations
  • I will support students driving education reform toward inclusion of quality and advocacy

The Election begins February 15th. I hope you will vote Larsen4CMA with the promise of #BoldPhysicianLeadership and a modern CMA that reflects your values.  We are stronger together!

Archived: Leading a Modern CMA

January 3, 2018

Every organization calls itself “innovative” these days. None wants to be seen as stuck or old.  Disruption and Innovation have become buzzwords.

CMA does not fall into this category.  It is walking the walk.

The Association is undergoing a huge transformation. It is taking a radical approach in redefining its governance, reducing the number and size of its board by nearly half. These board members will be more and more skills-based and will represent important national communities as well as geographies.  Importantly, the patient voice will be included so that policy direction is always taking the best patient care into account.  This is not to say that CMA does not represent physicians.  It absolutely does.  But it wants to stay modern and there is nothing to be done in health care in this generation that should exclude their perspective.

The 2019 presidential year will be pivotal to the success of this transformation. Bold Physician Leadership will be required to ensure that the fledgling structure is effective and nimble enough to produce meaningful change.  Internal reorganization preoccupied those who are concerned with fairness and equity.  It involves staff.  It must be measured with constant evaluation to note the effect of change. These kinds of governance reforms are happening around the country.  OMA Council, AMA’s Representative Forum, and Doctors British Columbia are all watching our governance changes closely.

While looking inward is important, 2019/20 will also have a lot going on outside. The Association must provide advocacy and represent the values of its members during a Federal Election year.  During this period, I believe we must be the most vocal we have ever been in our 150-year history.

I am the kind of leader required for this transition.  There are skills required to for cohesion during changing times, and my strengths and experience support that.  First, I am a clear and deliberate communicator, believing in transparency and honesty in everything I say.  Second, I am skilled at building bridges between opposing opinions and seek to find a common ground that meets the needs of many.  Third, I thrive on connecting dots and bringing forward new ideas or finding commonality between existing ones that allow progress to continue.

My endorsers speak to this in spades.

Beyond its own Board, CMA believes deeply in innovation. Three years ago it spun off a new subsidiary called Joule.   This company is behaving like a start-up. It invests in physicians by offering top notched leadership training through the Physician Leadership Institute and the Practice Management Curriculum. It awards grants to physician innovators not only in technology but also importantly in more difficult social policy spaces. It incubates physician-led companies that are changing the landscape of healthcare in Canada and internationally through investment and co-marketing. I have been part of this work for years.  First I helped to plan Joule’s inception from an idea launched in the Knowledge for Practice advisory group at CMA, which I co-chaired.  When Joule became a reality I applied and selected to be one of its first Directors, a position I still hold today.

I understand the CMA.  I live innovation. I work to enable physicians through the best use of working technology. And I flourish in watching incredible social policy ideas come to life.

Can CMA innovate? Not only can it, but it must. It has to disrupt the status quo to remain relevant in the healthcare system.  We have a brave new future ahead of us nationally and I will contribute to that with #BoldPhysicianLeadership.  I hope you will support me in this quest for President-Elect Nominee.

Archived: Professionalism and Civility in Medicine

January 3, 2018

This year, we have been forced to examine professionalism in medicine like never before Civility (or lack of civility) has been called out in the media, by our regulatory College and by learners that have been at the centre of it.

What is happening to our noble profession? Why do we become creatures with the most primal instinct to defend ourselves when others challenge our thinking or world view?

Many attribute the issue to physician stress, burnout, and financial challenges. Certainly, these factors contribute, but we have all learned resilience through our medical training and practice. There must be more to it.

Much of the behaviour seen in these cases has happened in the presumption of anonymity in secret online groups, email chains and via social media. With this false sense of anonymity, it is easy to speak in a way one would never speak face-to-face. Fuelled by a crowd, conversations can easily escalate to unacceptable and unprofessional levels.

Medicine is a humane profession. We can and should be above this behaviour.

In my opinion, there is much to be done nationally to ensure a year like this one never happens again. As CMA President I will stand and advocate strongly for civility in promoting:

  1. A culture where alternative views are welcomed, not discouraged. I will promote a safe and dignified space for creative dissent.
  2. Talking witheach other not about each other.
  3. Showing compassion for our colleagues, including residents and students, so that they feel supported in their day-to-day leadership of a movement in civility and professionalism. No doctor or trainee should feel alone in carrying their daily burden.
  4. Being accountable in what we say as professionals, which means not hiding behind internet anonymity. My conversations and advocacy will be done publicly.
  5. Standing up for colleagues who become victims of internal fighting within the profession. I will encourage them to be brave, and in fact to act, as has been my history this past year. I will ensure that CMA is a support to these courageous people.
  6. Identification of the causes of stress that produce incivility. I will push CMA to addresses these root causes nationally.
  7. Support of new CMA Charter of Shared Values, which reflects modern thinking for modern times

I believe that civility and professionalism should not just be talked about. They must be modeled and championed as a professional competency.  This has been my life’s leadership work and will be until the end.

I am hoping you will see this priority and vote for me in the upcoming election February 15th.

Archived: What about Physician Burnout?

January 3, 2018

I am mindful that physician burnout is a serious problem today. It leads to loss of empathy and fatigue, errors and poorer quality of care.

The causes of burnout are varied and complex. We throw blame at hospitals, paperwork, patients, compensation, technology, responsibility. None of them alone are enough. Neither is it merely a matter of personal resilience. The pressure of our work weighs on us daily in the administration of medicine, but also in clinical care itself. When patients experience loss, death, grief, injury, suffering or barriers to access, we feel it too. These losses are especially difficult when related to systems issues such as overcrowding, poverty, or wait times. We cannot give up empathy, but rather we must use it to inspire change in the system.

But how?

First, we create a safe space. I promote a culture of honest conversation and open feeling. Burnout is not a sign of weakness. We must encourage doctors to reach out, recognizing symptoms in themselves. Formal and informal support networks should abound. Relief comes with time for reflection and self care.

I will support communities of interest to keep specific passions alive, driving meaning in our work. We need to remember and recreate that awe of our first weeks of medical school, reconnecting with the human part of medicine to find joy.

Advocacy fights burnout. Joining together in a common cause of improving our cherished health system will buoy us up. I would bring innovation and creativity to CMA, making us stronger. There is much that is good to build upon.

Can CMA Association fix every problem? Not all. But as a collective voice for 85,000 physicians it has tremendous influence. We need a bold modern leader to head it. This is what I bring to the table in running!

Archived: What have I learned from Presidents before me?

January 3, 2018

This is an excellent question, as I have had a chance to speak in-person or by email with many pastPresidents. Doing so was pivotal in my decision to run in this election campaign. I needed to be sure that I was right for the role, and that the role was right for me.

Each President was honest and candid, and I appreciated that. They helped me to see that there were really two phases: the campaign to be elected, and then the period after being elected. In some cases there is a tendency to make these distinct. There are may conversations to be had to convince physicians to pay attention and think about voting, hopefully for me. Some would argue that one set of conversations is necessary for this phase, but that they should be abandoned as soon as the election was over. I don’t want this to happen.

The issues I care about and the promise I make to lead boldly are not going to change once elected. Everything I talk about is something that I plan to do over the next three years. It may be that the cause takes longer, but at least if not finished by the time I am done I will take joy in having helped to start it. So what did they teach me?

From Jeff Turnbull I learned the value of being true to yourself. He led the CMA into very different conversations about equity and social determinants of health at a time when this was not high on the political radar. He forever changed the face of the CMA in thinking about ourselves as more than just leaders of physicians, but leaders of a healthcare system. He entered the CMA with convictions about issues that needed to be thought about upstream, and he left with the same. We are all better for it.

From Chris Simpson I learned the value of connecting with physicians across the country in a modern way, through the use of electronic interchanges and social media. His positions were always clear and heart-felt and made that much more meaningful by the emotion imparted by video that had never been tapped into before.

From Louis Hugo Francescutti I learned that leadership is difficult. Telling a story that others may not want to hear can be controversial and painful. Yet sometimes difficult stories need to be heard and alternative voices can be given life. Louis led the CMA with passion and excitement and imparted into a modern way of thinking. He caused me to think about being bold.

From Cindy Forbes I learned that leadership can be gracious and fun. Presidents come from different parts of the country and represent a broad mix of urban and rural, academic and clinical, primary care and specialities. Cindy gave me wisdom on the value of connecting with each and every one, and of being genuine and caring with the people. She taught me patience in seeing an idea through to conclusion. She saw the creation of Joule, where I have been involved for three years. She saw the need for innovation. I carry that torch.

There are many other past Presidents I did not get a chance to consult. But in general, from example and watching them over the past 6 General Councils I will always:

  • fight for the little guy
  • enthusiastically support and sponsor the inclusion of our younger colleagues in medical school and residency
  • listen. Before I say anything, listen.
  • not stand for incivility shown by one member toward another, no matter how rare
  • promote the professionalism inherent in our calling of medicine
  • think hard about systemic causes of beleaguerment and burnout in my peers and fight for our collective health
  • understand the differences shown by our provincial medical associations, yet strive for unity whenever possible

I want to lead the CMA with the same passion and vigour that came from Presidents before me. I want to continue their legacy of caring and trust.

Archived: Politics and Physicians

January 3, 2018

It seems like every day last week, Ontarians woke up to news of another political career imploding. It is an interesting time in Ontario politics, as we look to a provincial election just six months away. As doctors, we might like to think we can afford to be disinterested in classic politics and political tactics, but we most certainly cannot.

Doctors need to be active participants in politics.

Regardless of what you think of the Ontario Medical Association, it is an advocate for doctors and patients and a political organization. The OMA has had a tumultuous last few years, but I’m a big believer in the role of our political organizations to bring voter attention to health care challenges that matter. If medical political bodies don’t do this the health care system in general, and the medical profession in particular, is in trouble.

There is no more important time for bodies like the OMA than a provincial election. Discussions held during the election and the influence on political party platforms set the tone for negotiations, health care lobbying, legislation, and more.

Likewise, the Canadian Medical Association must play a major role in the 2019federal election. The winning candidate for CMA nominee for President-elect will be the President of the CMA during this important electoral milestone. The CMA must bring issues related to national Pharmacare, indigenous peoples, active service and veteran armed forces members, seniors care, and mental health to the forefront. The leader of the CMA during this time has to be an effective and energetic communicator. They must be modern and agile. They must be prepared to stand up.

This is what I will bring to the CMA for Election 2019. I’m pleased to be running in this election with modern vision and #BoldPhysicianLeadership as my biggest asset.

Voting begins February 15th. I hope to gain your trust and support.

Archived: Four questions answered in HealthyDebate.ca

January 3, 2018

1) Parents who don’t want to have their children immunized are…

…as deserving of our care as anyone else. Of course, we ought to emphasize the personal and public benefits of vaccines. Several patients in my practice initially opted against vaccinations. Usually, this was due to fear from inaccurate stories shared online and in popular press. Over time, I earned their trust. As the family’s main physician, I was able to have authentic conversations that addressed their fears. I was able to understand their concerns, and give them my best advice. They usually ended up following it. Their children got the vaccinations they needed to stay healthy before entering school. Each time, I did not approach the topic through condescension or coercion. I valued the love they had for their children, and I was a partner in their child’s care. It took time. The work paid off in a meaningful, robust, and enduring doctor-patient relationship.

2) There is increasing concern about physician burnout. How would you help the physician community? 

I am mindful that physician burnout is a serious problem today. It leads to loss of empathy and fatigue, errors and poorer quality of care. The causes of burnout are varied and complex. We throw blame at hospitals, paperwork, patients, compensation, technology, responsibility. None of them alone are enough. Neither is it merely a matter of personal resilience. The pressure of our work weighs on us daily in the administration of medicine, but also in clinical care itself. When patients experience loss, death, grief, injury, suffering or barriers to access, we feel it too. These losses are especially difficult when related to systems issues such as overcrowding, poverty, or wait times. We cannot give up empathy, but rather we must use it to inspire change in the system.

But how?

First, we create a safe space. I promote a culture of honest conversation and open feeling. Burnout is not a sign of weakness. We must encourage doctors to reach out, recognizing symptoms in themselves. Formal and informal support networks should abound. Relief comes with time for reflection and self-care.  I will support communities of interest to keep specific passions alive, driving meaning in our work. We need to remember and recreate that awe of our first weeks of medical school, reconnecting with the human part of medicine to find joy.  Advocacy fights burnout. Joining together in a common cause of improving our cherished health system will buoy us up.  I would bring innovation and creativity to CMA, making us stronger. There is much that is good to build upon.

Can CMA Association fix every problem? Not all.  But as a collective voice for 85,000 physicians it has tremendous influence. We need a bold modern leader to head it. This is what I bring to the table in running!

3) The greatest benefits and downsides to the increasing emphasis on patient-centredness are …

The benefit of increasing emphasis on patient-centredness is obvious:  improvement in health outcomes we see when patients are true partners in decisions made in their care.  It is impossible for doctors to know everything their patients value, think and feel.  Taking a patient-centred approach ensures there is no guessing what is right for the patient. It creates space for meaningful conversations about difficult choices.  It brings humanism to the person sitting in front of us who we want to help with our experience and knowledge. When as physicians we put aside things we want for our patients, and instead act on what they want, even when we don’t completely agree, we build a stronger bond and sense of trust.  This creates an enduring relationship that is good for both of us.

There is only one downside to an emphasis on patient-centred care.  This is that it is has become so easy to say that its losing its meaning.  Many institutions say they focus on patients, but far few can actually demonstrate how. Does it take more time? Overall, no.  In the long-term patients become more independent and care for themselves better when partners, and this will save us time.  Does it fly in the face of evidence?  On the contrary.  There is increasing proof that patient partnerships produce far better outcomes and adherence to treatment plans.  Does it challenge the old paradigm of paternalistic care?  Absolutely.  But with training about care co-design, and data that shows improvement it is impossible to argue that this is isn’t the right thing to do.

It is possible for the CMA to move toward a patient centred approach and still represent the thoughts and feelings of its physician members.  This will take Bold Leadership.  I believe in this work and will fight to see that it happens in a way that is good for all of us.

4) When it comes to the federal government’s proposed tax changes on incorporated businesses, I feel physicians….. 

I feel that physicians were unfairly vilified in the press over the tax change issue.  The media and government highlighted legal tax deferral opportunities afforded physicians through medical practice corporations as being evidence of greed.  But there is a more honest story. Physicians pay significant taxes both before and after take home pay.  For instance, we are zero rated for HST.  Therefore, doctors must pay HST on purchases but cannot recoup it from our patients as retailers scan from their customers.  Many doctors are in a high tax bracket and pay consistently, in line with other professionals.  Physicians in Ontario were offered incorporation as an alternative to fee increases in a PSA negotiation over a decade ago.  This uploaded a cost from the province to the federal government, perhaps unfairly.

I believe that physicians should pay their fair share of tax as part of a socialized democracy.  I also believe that we do. We should not be given extra advantages, but neither should we be unfairly singled out.

I want to see significant tax reform happen in Canada.  The world has changed significantly in the decades since this was last done, and the tax system has become far too complex.  But large-scale change cannot be done with 75 days of consultation.  It will take a few years of significant work to simplify and provide fairness in our tax structure.  CMA can hold the federal government accountable as it is one of the most influential voices on Parliament Hill.

I am not afraid to have these tough conversations.  I am bold enough to stand up and make our collective opinion heard and to promote fairness. I believe in innovating and modernizing, and know that a good solution can be found.  More details are in my recent online post at http://larsen4cma.com/the-small-business-tax-issue/ . Have a look.

Archived: Recent interview about my Candidacy in The Medical Post – by Dr. Sunny Malhotra

January 3, 2018

I recently had the opportunity to speak with Dr. Darren Larsen. He is Chief Medical Information Officer at OntarioMD, and a candidate for the position of President-Elect Nominee of the Canadian Medical Association. Dr. Larsen has leading-edge insights about the state of medical care in Canada and the application of technologies that could solve current problems.

  1. M:  Tell us about yourself.
  2. L:  I have been a comprehensive care family physician for 26 years, along with my wife Janet (also a FP).  We practiced first in rural Alberta in a remote rural location at the edge of Banff’s wilderness, then in the GTA (Thornhill) taking over a 56-year-old practice from two retiring physicians, joining a group of 4 in a classic medical style with hospital inpatients, ER work, obstetrics and palliative care.  That group grew with maternity leave coverage locums staying on to five then six physicians.  We became a Family Health Network in 2004 and then a FHO when that contract was offered.  It was easy to step into these models as we were already practicing everything the model demanded in full comprehensive care.  Thornhill Village FHO is now 9 physicians, with 5 women and 4 men.  I departed that clinic in 2014 handing my practice over to a younger colleague to become CMIO initially at the OMA and now at its digital health subsidiary OntarioMD.  I joined Women’s College Hospital Family Practice Health Centre in 2015 doing urgent care in an integrated FHT.

Creating the role of Chief Medical Information Officer at OntarioMD has been an amazing career progression.  This job puts me squarely in contact with physicians as I bridge the gap between medical practice, technology and innovation for clinicians.  It is also rewarding to sit at 23 provincial advisory and steering tables from quality with HQO and CCO, to policy as with the Clinician Digital Health Council. I witness incredible advances in practice using technology mentoring and nurturing startups who are trying to navigate the maze of attachment to EMR products and services. I work with an amazing executive team of big thinkers and doers.  I am very lucky.

DR.M: What are the areas you would focus on as President Elect of the CMA?

DR.L: I have three pillars to my CMA election platform.   The first is Creating a Culture of Respect, Diversity and Inclusion.  Ontario physicians have had a difficult few years.  We are feeling beleaguered and are being bombarded with so many stories of the negative aspects of our health care system.  Long waits, no physician services contract, downloading onto primary care, excessive paperwork, more chronic disease in our practices, less time to connect with our patients. Much of this is related to system level change which we feel little control over.  We forget about incredible stories of the very real relationships we have with patients; the trust placed in us by our community and practice population; the daily positive influence we have on people’s lives.  We have forgotten to talk about the joy we felt entering medical school, and still feel when things go well, which they very often do!  When feeling beleaguered, we have conversations that begin to define us negatively, with pessimism, helplessness and hopelessness.  We start to internalize these negative feeling and this leads to a much higher risk of burnout, and defensive behavior.  This issue, I believe, is responsible for the rash of incivility and bullying we saw last year directed at our young colleagues.  Some lashed out behind the cloak of nameless avatars on social media.  Things were said publicly, virtually, that would never have been said to a colleague face to face.

There is a different way.  Connecting to the unique joy of being a doctor again, connecting to the strongly positive relationships we have with our patients, connecting to the development of our peers and younger colleagues — these are all ways to change the conversations that define us.  I want to see this happen and am trying hard to lead with optimism and respect.
The second pillar stems from the first.  It involves supporting colleagues and standing up for them when they are under attack, either real or imagined.  It comes from working closely with medical students and residents, seeing them as peers and equals. Learners need support in their leadership thinking and work; they benefit from strong mentorship.  I am lucky to be able to mentor many younger colleagues whose histories are complex and fascinating.  We must also be there with advocacy over issues that affect them directly like massive debt loads post-training (many have $300k in loans now!), uncertainties over matching through the CaRMS process (68 med students were unmatched this year!) and a nonexistent national Health Human Resources strategy that mismatches demands for care in specialties with supply, as well as regional differences in training and job availability post-graduation.

The third pillar is strong advocacy and action during the federal election in 2019. High on my radar screen is national Pharmacare, the need for expanded and coordinated indigenous health care, a seniors’ healthcare strategy involving more home and community care, and improved access for young patients with mental health challenges. Although some of this is a provincial responsibility, it is clear that federal government transfer payments for healthcare play a strong role in the direction of each of these priority areas.  The Canadian Medical Association is already working assertively promoting each of these domains, however vigilance and due diligence is required as the federal government undertakes to expand programs to ensure that they match the needs of the community. Also, equity has to be taken into account.  The CMA has a vital role to play in guaranteeing that equitable access to services is available to all Canadians. We are a strong lobby. We must always respect that responsibility.  I feel confident that I am able to lead this work with humility, respect, and bold leadership.

  1. M:  Can you elaborate on senior care, Pharmacare and indigenous health goals?

DR L.:  National Pharmacare is likely to be on the agenda for election 2019. Although this may already be in play, the way the program will be rolled out in partnership with provincial ministries of health will have a lot to do with it success. The CMA needs to be front and center in these conversations to ensure that pharmacare meets the needs of all Canadians. It should not be political. This should be purely an equity conversation. There are huge economic factors influencing decisions to endorse pharmacare. It’s clear from multiple studies that this would be a financial benefit, by incorporating bulk buying, reducing the retail price of drugs. There are many citizens who cannot afford to pay for the medicines we prescribe for them now and therefore are being treated sub-optimally for many of their chronic complex diseases. This is unacceptable in a nation as wealthy as ours.

In terms of indigenous healthcare issues, it is fantastic that the health portfolio for our First Nations people has moved from Health Canada to Indigenous Affairs under Dr. Jane Philpott. She is a huge champion of improved living conditions and health service provision on First Nations. As a physician, she understands the problems well. As an incredible policy planner she has the capacity to incorporate care, social determinants of health, and broader areas like education justice and social services, to produce the best fighting chance for Indigenous people living autonomously, healthily and well. I am very happy about this transition. If elected president I will do my utmost to ensure that her policies are enacted in a most robust way.

DR M: What is the biggest move in technology you hope to see, and the appropriate use of health data you have, as a goal for CMA?

  1. L: As was highlighted in a recent article in CMAJ by Drs. Mamdami and Laupacis, it is clear that there is room for a national perspective on healthcare data being used for strong public planning and policy purposes. Although this data is collected very locally in Canada leadership is required around the reuse of patient data at the health system level. I have worked hard championing the appropriate use of EMR data and how it might be liberated. For two years I co-led a program for the OMA called Insights4Care (I4C). In this program, we wanted data collection by physicians to be unobtrusive.  We sought to make our EMR systems more intuitive and yet produce higher quality data sets.  OntarioMD is still working on this today.  In I4C data would be extracted standardized and anonymized.  It could then be shared for research, policy, and planning. We foresaw feeding it back to clinicians for clinical quality improvement work, benchmarking against peers, and clinical decision support. This was a fantastic opportunity for our profession, but it ended as an unfortunate victim of bad timing. I would love to see this resurrected in some form. It could well happen provincially, as most care is delivered locally, but the rules of engagement and policy surrounding privacy and security, for example, are also within the federal domain. As well, money is spent funding agencies like Canada Health Infoway, CPAC, CADTH, etc. and some of this should be earmarked for big data planning. It is no longer be necessary to move data to large repositories in order to do analytics. The Cloud has changed everything in the business world but has hardly been adopted in healthcare. It is possible to source data when required, keeping it intact in its local environment, and then move the analytic engine to the data rather than the data to the analytic. All of this is possible with current, technology.

Another major tech shift in healthcare is the implementation of virtual care tools. Although much of our work as physicians involves hands-on, face-to-face, and real-time meetings, there is a fair bit of work that can be moved into the virtual space. This allows care to be delivered where patients require it, or to be moved to times that are convenient for both patients and physicians and ensures that timeliness, access and appropriateness are maintained in the physician-patient interaction. Small startups have quickly become national players here. We must promote and assist some of these companies in either development, incubation, or marketing of their services. This is a perfect a role for the CMA’s subsidiary Joule. My three years on the Board of Directors of Joule has given me insight into this. I want to see more opportunities given to Canadian physicians to promote their own innovation in the development of policy, social and tech innovation. Both CMA and Joule have the capacity to scale and spread. This will be one of the biggest things we can show our physician members in terms of value.

  1. M: What advice do you have for younger doctors who want to get involved?
  2. L: Leadership by our younger colleagues is both desired and appreciated. They have a unique perspective on the future of healthcare. They understand technology and new models of care better than many of us who have been working for years. They have a sense of wonder and joy around their career that needs to be nurtured. They have a strong voice and ability to act collectively, especially on items like social justice, social determinants of health, and equity. They have tremendous energy. They want to contribute. It is our job as senior leaders to both encourage their leadership potential and training, and to promote them when their ideas need to be seen on the national stage. We must also create a space where leadership is welcomed from groups of physicians who find it more difficult to take on leadership roles. This includes woman leaders, those from underrepresented populations, and those who simply have a diverse position that may not be part of mainstream medical thinking. All of these ideas are welcome under my leadership. I believe we are stronger in diversity and inclusiveness. I feel challenged by views that are not my own, in the most positive way. I love listening to stories and having my opinion changed by people who have thought through issues with a lens that I do not possess. This makes my life as a leader and my career as a physician more rewarding and enriched. Advocacy and leadership begin on the ground. It is our responsibility to ensure that it is promoted and encouraged in our younger leaders. We do this best through mentoring their development. More senior physicians need to take on this role with great clarity and a sense of duty. Mentorship of younger colleagues is one of most rewarding parts of my career. It is incredibly rewarding to see young physicians who I have mentored launch their own successful paths. They are taking on big challenges and have become strong voices in the healthcare space. I’m incredibly proud of their stands and their bravery. I want to do more of this in a more advanced leadership role if I become president of the CMA.

Archived: A CMA President who Understands Learners: Solutions to the Problems!

January 2, 2018

In this post I want to tell you a story.  It is one that talks about my values, where I put my energy and how that matters.  As I run for President Elect nominee of the CMA I hope this speaks to you.  

About four times per year I take a student or resident under my wing on a Leadership Elective registered with U of T. In December 2016 I was lucky enough to have the Chair of the Ontario Medical Students Association (OMSA), Ali Damji, join me.  You know Ali. He became a bit of a celebrity in the media last year.  In October of 2016 the OMA presented a physician services agreement to its membership at a general meeting of the membership.  At that time OMSA bravely took a stand that the profession needed to move on in its fight with government and recommended publicly that students vote to ratify the agreement.  This flew in the face of popular opinion as we now know. 

A flurry of incivility was unleashed up on him because of this stand.  In November and December, the attacks began.  Ali was bullied by physicians on social media.  He was threatened and sworn at.  He was told by more than one MD that they would personally see to it that he never got a residency position anywhere in the country.  Imagine how devastating that felt. 

Thankfully Ali was with me at that time.  He was never alone.  It was a privilege to mentor him through the decisions he had to make.  He spoke directly with the Deans of Medicine at the universities he had applied to.  He spoke to CMPA.  He spoke to the CPSO. We pulled in advocates for him.  Besides myself two strong friends, Joshua Tepper and Danielle Martin also weighed in to support him.  Ali made bold and difficult decisions.  He asked for assistance in a safe place.  And many of us were able to deliver. 

I know the pressures and issues facing medical students today.  I have lived them with you. I’m by your side when it comes to bringing the issue to light on a national stage. 

Let’s talk about the CaRMs match.  This is probably one of the most stressful things you will ever go through in your career.  So much is up in the air.  So little feels in your control.  You apply across the country to multiple programs.  You spend thousands of dollars paying for electives at medical schools to support your applications.  You fly across the country for interviews.  There are sleepless nights, constant worry, and you feel very alone in this.  Many of you will match to your first choice.  A whole bunch of you will not.  And last year 68 students did not match at all in the first round of CaRMS!  A second attempt happens in Round 2.  There, applicants are not just competing with each other, but also with immigrant IMGs who also want a chance to practice, and Canadians trained abroad looking to come home.  A few didn’t expand their selections and ended up not being re-matched. 

So what happens then?  This is a very difficult position to be in.  These students are no longer part of the medical school.  They are left to wait, and many times wait alone.  Some pursue a Master’s degree.  Others do research.  Some perform odd jobs or volunteer.  A few repeat a year of clerkship if that option is available to them.  Then they start over again with the same process. 

Unmatched students go through a period of living hell.  They feel abandoned.  They lose confidence.  Many with excellent qualifications have simply applied into small programs and not matched due to a numbers game.  They need support.  They should not lose clinical skills while waiting. They should remain a part of the educational system. 

 So much is wrong with this scenario. There are many causes contributing.   

First, medical school numbers are under the control of the University and are fairly local. The funding for those spots comes from more than one Ministry:  Advanced Education, Health and Infrastructure.  Once funding is obtained, schools are loath to decrease enrolments because their staffing, space and budgets have been arranged based on this income stream.  Numbers of medical students were increased dramatically over the past decade to meet a presumed shortfall.   

Second, post-graduate medical education positions have decreased in number.  The decisions around this are made provincially and often for political or budgetary reasons.  From what was a 1: 1.2 ratio of students to residency positions we are down to 1: 1.02, and it is predicted that this will fall to below 1:1 in the next year.  Frankly, a greater than 1:2 ratio is required to take into account immigration, transfers between programs, repatriation of Canadian students abroad and a buffer zone for variance. 

 What can be done to make change, especially by a national medical association like CMA?  The work happens through advocacy and partnership.  CMA can push for change with AFMC and the provinces. Some ideas: 

  1. The funding of undergrad medical education and post grad medical education positions needs to be calibrated.  This is not a difficult task. 
  2. A NATIONAL health human resources strategy is required that projects 8 years ahead using real data on population change, demographics, changing medical student mix, appropriate work hours, geographical distribution, and system resources.  This means working toward a common purpose with ministries of health, universities and student/resident groups to model, remodel and project. 
  3. Remove HHR planning from the provincial political realm. These are not election or partisan issues. Federally CMA can have something to say about that. I will have something to say about that. 
  4. Take a stand on ever rising medical school tuitions. Many provinces have deregulated tuition fees for professional schools. In some cases, getting an M.D. can’s see costs as high as $30,000 per year. Rising tuition leads to rising debt for many medical students. And a high debt load has the perverse effect of guiding students to choose residencies where earning potential is highest – sub specialty areas which are in low demand across the province. This increases the risk of joblessness after residency. We may have enough ophthalmologists, plastic surgeons, and cardiologists at least in our bigger cities. We need more generalists: geriatricians, psychiatrists, family doctors, internists and general surgeons. These areas pay well but cannot compete with procedure dominated specialties in our current payment model. 
  5. This could be alleviated somewhat with novel approach is to debt relief; debt repayment plans that can be incentives for generalizing. Punitive measures we have seen and provinces like Quebec should never be a choice. 
  6. Student and resident advocacy should be enhanced. You are your own best voice. Leaders in the system must allow you to step up and support your voice being heard. I want to help you expand your voice and advocacy efforts. CMA wants to do that. Your opinion matters so much because you are the future of our profession. 
  7. Support unmatched students with the opportunity to stay in practice and through educational opportunities. Keep their clinical skills up. Provide electives that give them broader reach and more exposure to other fields they may enjoy as much as what they originally applied to. Supply them with mentors that are concerned with their well-being. Give them options. 

 Advocacy issues are your issues.  I will make them mine.

If you elect to me I will supply bold physician leadership to modernize the CMA, making it an association you will want to belong to you without question. Your values are my values. I will represent you and stand up for you. I will bring your ideas forward in other very important areas as well. As CMA President I want to: 

  1. Promote a national Pharmacare platform. This can save at least $4 billion per year nationally to be reinvested in care delivery. 
  2. Pay attention to the care of our First Nations communities. It is never acceptable that indigenous communities are without clean drinking water, being poisoned by mercury from mining tailings, or have suicide packs in groups of teens because they see no future or place in our society. 
  3. Promote the care of our military and their families who in many cases are living just above the poverty line with poor social conditions and affordability. And when returning from combat we must ensure adequate access to mental health supports to fight PTSD as well as physical injury. 
  4. Ensure stable federal transfer payments for the provinces to support healthcare renewal. Priorities must be organized non-politically. Currently seniors care, youth mental health services and community and home care are CMA priorities and I support these. 
  5. Create a national strategy to connect patients to their healthcare providers through ongoing support of the new mandate of Canada Health Infoway. Patient access to their own data is paramount in making a making them partners in their care. 
  6. Deal assertively with taxation reform as the elephant in the room. CMA is doing its best to ensure that doctors and small businesses are not unfairly targeted, but this is only the tip of the iceberg. I believe the wholesale taxation reform is required. This should be deliberate and broad and fair. It should single out no particular group. This will take years to accomplish but must be done. 
  7. Help modernize the CMA. Right now CMA is undergoing governance renewal. Its board is becoming smaller and more skills-based. It is going to include the patient perspective to get diverse thinking in healthcare leadership and a system that does better by all of us. Innovation is at the heart of this values-based work. A brand-new code of ethics and professionalism will soon be with us. A new CMA Charter of Shared Values is trying to express what we collectively feel and value as a profession. This is strong positive work and has been done with broad consultation.  

I am the modern broadly connected leader that can champion and promote these ideas. 

Having been on the Board of Directors of CMA’s subsidiary Joule for three years and acting before that as co-chair of its Knowledge for Practice physician advisory group, I have been part of this renewal from the start. I understand the CMA, it’s corporate structure, its limitations and potential, and its governance. I will represent physicians and the promotion of social, policy and technology innovation to assist them. I believe in partnerships to ensure the right thing happens for a for as many as possible, and in the breaking down of silos that divide and separate us. 

My leadership style is inclusive. I value and encourage different opinions to be listened to and ideas discussed openly. I am optimistic and future facing. I see medicine as an engaging career filled with joy as well as hard work. All of this gives us meaning and allows us to be the best doctors we can possibly be. Let’s lead this system together!

 

 

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