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					 Issue No. 29                                                                                                               Spring / Summer 2009




          The Cutting Edge
      A Voice for Ontario’s General Surgeons
                             ONTARIO ASSOCIATION OF GENERAL SURGEONS
                                                       (OMA Section On General Surgery)



New relativity formula still defective
Hospitals misusing LHIN funds intended for surgery
By Dr. Jeff Kolbasnik                                   ing as well. However, we have been able to ad-        the OMA has decided to undertake further con-
                                                        dress a number of our priorities also. Please see     sultation and study over the next 6 months. This
         The past few months have been extremely        the accompanying article in this newsletter which     issue is critical for all Sections, as it will deter-
busy, particularly in relation to OMA and Minis-        describes some of the highlights on pg. 5.            mine allocation of hundreds of millions of dollars
try issues affecting General Surgeons.                           The recent Agreement calls for half of all   during the course of this Agreement alone.
         We have been heavily involved in the fee       fee increase funds to be distributed based on im-              You have all received, and likely returned,
allocation process determined by the most re-           proving relativity amongst Sections. The OMA          your CPSO renewal package, and have likely no-
cent OMA Agreement. In October, 2009, our               has thus decided to review its existing methodol-     ticed an increased emphasis on the issue of expo-
Section will be allocated a 3.9% increase in fees.      ogy, the RVIC formula, to make suggestions for        sure to Blood Borne Pathogens (mainly HIV
This is not an across-the-board increase, but rather    improvements. We submitted proposals to the           and Hepatitis C). The CPSO has had a long-
we have worked with the Medical Services Pay-           OMA (which can be viewed on the OMA website)          standing policy of seeking such information but
ment Committee (MSPC - a bilateral committee            as did most other Sections.                           appears to be moving in the direction of manda-
of OMA and government) to allocate this money                    The OMA Working Group released its           tory testing for Blood Borne Pathogens for phy-
to specific fees. The total amount of money for         report at the end of March. Several weeks later,      sicians who perform exposure-prone procedures.
General Surgery is just over $9 million.                it released the calculations of what the new for-     Physicians who test positive will then likely be
         This year’s allocation process has been        mula would mean for each Section’s allocation.        required to avoid such procedures, which would
limited and time compressed. There are a number         We have expressed significant misgivings about        obviously be devastating to a surgeon’s career.
of OMA and Ministry priorities that have con-           the new formula. I have described the major con-               We have been active with other surgical
sumed some of the funding, and priorities from          cerns in an accompanying article in this newslet-     groups at the OMA level in pursuing this issue.
other Sections have consumed some of this fund-         ter on pg.4. The new formula has not yet cor-         While we recognize the mandate of the CPSO to
                                                        rected the major complaints about the old for-        pursue this issue and the role of the CPSO in re-

             INSIDE                                     mula – use of old data and use of self-reported
                                                        data – and in the interim has proposed a formula
                                                                                                              stricting a physician’s practice if patient well-be-
                                                                                                              ing is placed at risk, we feel that any such policy
                                                        which does not account for hours of work, and         should clearly identify programs for physician
  Editorial                              p.    2        thus significantly disadvantages physicians who       support and retraining opportunities if needed. We
  CME Events                             p.    2        tend to work longer hours. Many other groups
                                                        have shared and expressed similar concerns, and                          See “President” on page 14
  Billing Corner                         p.    3
  Colonoscopy Reporting                  p.    3
                                         p.    4
                                                          NOTICE: OAGS MEMBERSHIP (Sept. 1, 2008 - Dec. 31, 2009)
  Relativity
                                                          Please be advised that the OAGS board of directors has decided to change the fiscal year to
  Fee Allocation 2009                    p.    5          reflect the calendar year (Jan-Dec). For anyone who has already paid dues for the current fiscal,
  Enema Update                           p.    6          he/she will not have to renew until Jan/2010, but you must still RSVP for the annual meeting/ pay
                                                          for banquet if attending. For more details, please see pg.10 and 12.
  Opinions                               p.   6/7
  Recruiting Slump                       p.    7          15th OAGS ANNUAL MEETING: Saturday, November 7, 2009
  Resident Rostrum                       p.    8          OAGS Board of Directors, President Dr. Jeff Kolbasnik and our new Annual Meeting Chair Dr.
                                                          Angus Maciver would like toinvite members and non-members to our 15th OAGS Annual Meeting
  Annual Meeting ‘09                     p.    9          on Sat., Nov. 7, 2009 at the RenaissanceToronto Airport Hotel, 801 Dixon Rd. (to be renamed
  Meeting Highlights                     p.   10          Sheraton Toronto Airport Hotel). Be sure to visit our website for more details: www.oags.org
Page 2                                                                           The Cutting Edge, Issue 29, Spring / Summer 2009

 Editorial...                                                                      Upcoming CME Events 2009
By Dr. Ciaran Kealy                                                                  DATE                              EVENT
         This edition of The Cutting Edge newsletter contains an eclectic                               2nd World Congress of the International
collection of articles which hopefully will engender some positive feedback                                  Academy of Oral Oncology
                                                                                    July 8-10,
from our members and promote discussion.                                                                 Sheraton Centre Toronto, Toronto, ON
                                                                                      2009
         For example, how should we as an organization respond to manda-                                    Web: www.iaoo.elsevier.com
tory HIV testing? The use of sedation in endoscopy units…particularly,                                        Email: sl.jenkins@elsevie
who should administer it? Hospital use of LHIN funding is another matter.                                 World Congress on Thyroid Cancer
Promoting the attractiveness of our specialty is proving more difficult each       Aug. 6-10,           Sheraton Centre Toronto, Toronto, ON
year, which - through no fault of ours - interests fewer candidates. It is           2009             Ph. 1-888-512-8173 / www.thyroid2009.ca
difficult to compete with the lifestyle and remuneration of other procedural                            Email: help-ENT0909@cmetoronto.ca
specialties, and this is a major source of concern to your board of directors.
                                                                                                            International Surgical Week 2009
One way of making our specialty more attractive would be in having E409
                                                                                                         43rd World Congress of Surgery (ISS)
commence at 4pm, E410 begin at 11pm and increasing the percentages. An             Sept. 6-10,       Adelaide Convention Centre, Adelaide, Australia
opposing argument which has been put forth, however, is the impact this              2009                            www.iss-sic.ch
would have on the global budget as it would apply to all surgical specialties.                                 Email: surgery@iss-sic.ch
Yet apart from ourselves, Anaesthesia, Orthopaedic Surgeons and Obstetri-
cians, I doubt the traditional “mix” will change.                                                            Canadian Surgery Forum 2009
         This will be our association’s 15th Annual Meeting in November.           Sept. 10-13,                     Victoria, B.C.
The meetings get better and better every year and with the generous help of           2009              Ph. 613-730-6280 / www.cags-accg.ca
our sponsors, we have in the last few years been able to attract speakers                                  Email: surgeryforum@rcpsc.edu
with international reputations. This year is no exception and we are lucky                        22nd International Course on Therapeutic Endoscopy
to have been able to get Dr. Dave Williams from Hamilton (former NASA               Sept. 30-
                                                                                                            Four Seasons Hotel, Toronto, ON
astronaut) as our keynote speaker.                                                   Oct. 3,
                                                                                                   Ph. 905-257-1410 / www.thera-endo-toronto.com
         We as an organization are totally dependent on our members. We              2009                    Email: therendo@interlog.com
have achieved a lot for the General Surgeons in this province. That said, we
                                                                                                        72nd Annual Colon & Rectal Surgery:2009
need to achieve a lot more. We cannot do it without your support. To those          Sept.30 -
                                                                                                          Hyatt Regendy Hotel, Minneapolis, MN
of you who have supported us from Day 1, thank you and please continue               Oct.3,
                                                                                                     Ph. 612-677-7810 / www.colonrectalcourse.org
to do so. To those of you who may have reservations about joining, please            2009
                                                                                                           Email: info@colonrectalcourse.org
reconsider. We have no vested interests in promoting our organization apart
from ensuring that it survives and continues as an independent voice for the                               American College of Surgeons
General Surgeons of this province.                                                                          95th Annual Clinical Congress
                                                                                   Oct. 11-15,                      Chicago, IL
- Dr. Ciaran Kealy, OAGS Board Member and Newsletter Committee Chair,
                                                                                     2009                 Ph. 312-202-5000 / www.facs.org
is on staff at Sudbury Regional Hospital.
                                                                                                            Email: postmaster@facs.org

       OAGS Accomplishments                                                                    International Next Generation Eye Surgery, Device and
                                                                                                              Drug Delivery Symposium
                                                                                   October 17,
         for our Members                                                              2009
                                                                                                         The Sutton Place Hotel, Toronto, ON
                                                                                                     Ph 1-888-512-8173/ www.cmetoronto.ca
      OAGS created as an independent voice for General                                                    Email: info-opt0906@utoronto.ca
      Surgeons in 1995                                                                             BC Surgical Oncology Network Breast Fall Update
      Aggressively lobbied for On-Call Remuneration (HOCC                            Oct. 24,            Four Seasons Hotel, Vancouver, BC
      followed)                                                                       2009                  Ph. 1-604-707-5900 ext.3269
      Coordinated the CCO/OAGS Laparoscopic Mentorship                                                     Email: fcengic@bccancer.bc.ca
      Program 2007                                                                                      UofT Update in Surgical Oncology 2009
      Organized CME-accredited and academically/politically                         Oct. 30,               Metropolitan Hotel, Toronto, ON
      relevant Annual Meetings and continues to do so                                2009                         Ph. 1-888-512-8173
      Took on The Toronto Star about its flawed investiga-                                               Email: info-SUR0901@cmetoronto.ca
      tive report of bile duct injuries and forced a retraction.                                           Mount Sinai Hospital Update in IBD
      Advises/participates in OMA/Ministry contract negotia-                         Nov. 6,          Marriott Toronto Downtown Eaton Centre, ON
      tions, fee allocations and Sched. of Benefits changes                           2009             Ph. 1-888-512-8173 / www.cmetoronto.ca
                                                                                                         Email: info-MED0901@cmetoronto.ca
      Active in making recommendations to Cancer Care
      Ontario programs (i.e. breast, colorectal, pancreatic)                                               O.A.G.S. 15th Annual Meeting
      Raised concerns about ramifications of Blood Borne                             Nov. 7,       Renaissance Toronto Airport Hotel, Toronto
                                                                                                   (to be renamed Sheraton Toronto Airport Hotel)
      Pathogen Serology reporting 2008/09                                             2009
                                                                                                  http://www.oags.org / Email: info@oags.org
      Dedicated board members to external groups and
      committees (e.g. CAGS, OMA tariff, etc.)                                        For the complete listing of CME events, check our website:
                                                                                                    http://www.oags.org/events.htm
      OAGS has become authoritative resource for unbiased                             For a listing of medical school CME courses within Canada:
      perspective and support on surgery-related issues                                http://www.ruralnet.ab.ca/medinfo/education/cmedept.htm
Page 4                                                                            The Cutting Edge, Issue 29, Spring / Summer 2009

Proposed new OMA relativity formula devalues most groups
Only Rheumatology and Family Practice sections stand to benefit the greatest
By Dr. Jeff Kolbasnik                                                                  $1,500, while another physician works 6 hours and earns $1,000, the
         Under the current OMA-MOHLTC Professional Services Agree-                     income per hour is equivalent. But when hours of work are excluded,
ment, half of all fee increases are distributed equally to each section, and           it is perceived that the first physician earns 50% more than the
half are distributed based on a relativity formula. The current relativity             second, who would now be slotted for a significant relativity adjust-
formula, the RVIC methodology, was used to allocate 2.5% of fee increases              ment. We have expressed to the OMA that hours-of-work is a
in October, 2009; the Section on General Surgery was allocated 1.4%. For               significant element of any relativity calculation, and excluding hours-
our Section, that amounted to approximately $3.5 million.                              of-work creates inequity and is unfair to specialists who typically
         The OMA also undertook to review the relativity formula used for              work long hours.
future allocations, and the Working Group proposed a new formula at the
OMA Council meeting in May. The new formula drew significant criti-                        Discussions of fee and income relativity are often difficult and
cisms, including from our Section. As such, the OMA Council decided to            divisive. In my discussions with a number of specialty leaders at the OMA
defer the decision on which formula to use until the OMA Council meeting          Council meeting, there is significant anger and frustration of the way this
in November. The proposed new formula would have reduced the relativ-             issue is being handled and significant concern that an unfair methodology
ity allocation of our Section, and practically every other surgical section, to   will be promoted for narrow self-interests. It is my opinion that this issue
zero. It would cost our Section over $7 million in fee allocations over the       may split the organization, and a number of specialty leaders have commit-
next two years. Even chronically undervalued groups such as Pediatrics            ted to meet further to discuss strategies for dealing with these issues.
and Psychiatry would see their relativity allocation shrink under the pro-                 I would urge all members to review this issue further and to write to
posed new formula; the only Sections to benefit are Rheumatology and              the OMA (and copied to OAGS) about concerns and suggestions you may
General/Family Practice.                                                          have. Relativity calculations will be used to allocate literally hundreds and
                                                                                  millions of dollars over the course of the current agreement alone, and it is
The major proposed changes and concerns are as follows:                           essential that any new formula be fair and robust.

1.   The new relativity formula excludes some clinical income, such as            - Dr. Jeff Kolbasnik, OAGS President, is Chief of Surgery at Halton
     non-OHIPincome and after-hours income, but aims to include many              Healthcare Services, Milton.
     other sources, including Alternate Payment Plan (APP) and Alternate
     Funding Plan (AFP) clinical income. APP and AFP income, mostly
     for specialists and mostly for those in academic centres, accounts for                  CANDI Methodology Model
     approximately $1 billion; when distributed across specialty                   CANDI Definition
     groups, it adds over 25% to the apparent income. This funding,                CANDI - Comparison of Average Net Daily Income; recently proposed
     though, is unevenly distributed and thus creates significant relativity       relativity formula as of Spring 2009 to replace current RVIC method.
     maldistributions when applied to individuals who are ineligible for
                                                                                   Current Relative Value Implementation Committee Method
     such funds. We continue to seek more information on the rationale,            RVIC was developed in 2003/04 to narrow inter-specialty disparities.
     application, and impact of this income inclusion.
                                                                                   RVIC Methodology Review Working Group
                                                                                   Formed at request of OMA Council and Board of Directors to review
2.   Under the RVIC formula currently used by the OMA, the goal is to
                                                                                   RVIC fee-for-income relativity adjustment methodology.
     distribute relativity funding to get undervalued specialties closer to
     the all specialties income average, and family practice closer to 80%         Calculation of CANDI
     of the all specialties average. However, the proposed relativity              Gross Daily FFS Income x Non-FFS Modifier x Overhead Modifier x
                                                                                   Training Modifier = Comparison of Average Net Daily Income (CANDI)
     formula determines to eliminate the difference between specialist and
     family physician income, save for 2.5% per year “opportunity cost”            Components
     for the additional years of training to become a specialist. Thus, there      a) Income and Work Hours - gross daily income (GDI); excludes
     is a major shift of funds from specialty groups to family practice. We        after hours, weekend, and holiday billings
     have asked the OMA to determine whether this principle has been
                                                                                   b) Modifiers of Gross Daily Income (GDI)
     applied in other regions, as it appears that throughout North America              • Non-Fee-For-Service (NFFS) Payment Modifier
     and Europe, there are significant differences between specialist and               (i.e. HOCC, APP, WSIB, etc.)
     family practice incomes.                                                           • Practice Overhead Expense Modifier - based on 1997
                                                                                        Canada Customs and Revenue Agency tax file data and self-
3.   The OMA Working Group acknowledges the criticisms of data used                     reported data from 03-07 OMA Human Resources Committee
     in relativity calculations, specifically that much of the income, over             (OHRC)
     head, and hours-of-work data is self-reported and out of date, and                 • Training Period (Opportunity Cost) Modifier - lost income
                                                                                        related to duration of medical training
     thus unreliable. The Working Group has proposed studies to arrive at
                                                                                        • Other Items Discussed - other modifiers for “complexity” or
     accurate data for these elements, but these studies are likely to take             “intensity and risk” were dismissed and best dealt within
     over 2 years to complete. In the interim, the Working Group pro                    respective sections.
     poses to use the existing income and overhead data, but most signifi-         Note: The Working Group admits that the after-hours issue is a “limi-
     cantly chooses to exclude hours-of-work data and assume that all              tation of the Schedule of Benefits and... recommends a time study as a
     physicians work an equivalent number of daytime hours. For surgical           long-term solution to this shortcoming.”
     specialists, who are generally perceived to work more hours than
     many other physicians, this element threatens to create tremendous            SOURCE: OMA Report of the RVIC Methodology Review Working
                                                                                   Group, April 16, 2009.
     disparities. For example, if one physician works 9 hours and earns
 Page 6                                                                         The Cutting Edge, Issue 29, Spring / Summer 2009

The demise of Phospho-Soda and the rise of Pico-Salax
By Dr. Chris Vinden                                                                      It is difficult from a scientific perspective to appreciate the popu-
                                                                                larity and strong patient preference for Pico-Salax over other preps given
         Oral sodium phosphate solution (OSP) has been a mainstay of            that the active ingredients are essentially identical to the vintage, old fash-
colonoscopy preparation since the early 1990’s . It has Canadian origins,       ioned combination of Biscodyl and CitroMag. Perhaps the lower volume,
being first brought to prominence as a purgative by the GI group at Queen’s     more concentrated solution and better flavouring play a role in the better
university. Its superiority over existing preps and its better patient toler-   acceptance of Pico-Salax.
ance and acceptability resulted in rapid widespread adoption. It has no                  One needs to be aware that Pico Salax can also cause significant
doubt afforded improved visibility that has allowed the detection of many       hypermagnesemia which can result in lethargy, neurological changes and
cancers and polyps and has likely saved hundreds of lives.                      arrhythmias. There have been case reports of serious complications with
         OSP has not been without controversy, and adverse effects have         magnesium citrates laxatives including death and that they are also contrain-
been consistently reported at very low rates since its introduction. The        dicated in patients with significant renal disease. Interestingly, Health
association with renal failure caused by phosphate deposition within in the     Canada has reported almost as many adverse reactions from magnesium
renal tubules dates back to the 1990’s and prompted a 2001 advisory that no     citrate purgatives as it has from OSP.
more than one dose of OSP be taken within 24 hours due to risk of dehydra-               Endoscopists need to be aware that the bowel prep is one of the
tion and electrolyte disturbances. In 2005, both the FDA and Health Canada      riskiest aspects of colonoscopy, especially in elderly frail patients and
issued advisories about the rare association with renal failure.                those with renal and cardiac problems. Both over-hydration and dehydra-
         Since 2006, the FDA has had 20 additional reported cases of renal      tion can occur with all preps. PEG-based (polyethylene glycol) preps are
failure associated with OSP; in December 2008, they advised that OSP            the safest in high risk patient groups but have poor acceptance due to the
could only be used as bowel prep by prescription. C.B. Fleet voluntarily        higher volume. Pico-Salax is a reasonable replacement for OSP and is well
withdrew Phospho-Soda from the market at that time; however, Osmoprep           tolerated by patients. It still has risks and needs to be used with care. I
(a pill form of OSP) is still available in the US market by prescription.       suspect that it is only a matter of time before serious cases of
Health Canada followed suit in March 2009 by which time Fleet had               hypermagnesemia from Pico-Salax will prompt the FDA and Health Canada
already withdrawn Phospho-Soda from the market.                                 to issue warnings about its use.
         There are already numerous legal actions against the manufacturer of            Quality endoscopy starts with a high quality bowel preparation, but
Phospho-Soda in the US and although complication rates are very low, one is     unfortunately there are no low risk, high quality preps. Endoscopists need to
likely risking legal action with ongoing use of OSP. In a Straw poll at last    carefully weigh the risk benefit ratio of colonoscopy in elderly patients and
year’s Ontario Association of Gastroenterologists, only 8% were still using     those with renal and cardiac comorbidities. Endoscopists should also be
OSP with the majority having switched to Pico-Salax.                            aware that the benefits of screening are minimal to those over the age of 75 and
         So, what Is Pico-Salax? Pico Salax is the Canadian version of a        harms likely outweigh benefits for those over the age of 85.
purgative that has been widely used in the UK for 15 years under the trade      References:
name Picolax. Pico-Salax is a combination of a stimulant laxative sodium        Barkun A, Chiba N, Enns R, Marcon M, Natsheh S, Pham C, Sadowski D,
picosulphate, the osmotic laxative magnesium citrate, and citrus flavour-       Vanner S. Commonly used preparations for colonoscopy: efficacy, toler-
ing agents. It comes as a powder and is mixed with a small volume of water.     ability, and safety—a Canadian Association of Gastroenterology position
It costs about $5 per dose and typically 2 or 3 sachets are used. The           paper. Can J Gastroenterol. 2006 Nov;20(11):699-710
magnesium citrate is created when magnesium oxide powder and citric acid
powder are mixed with water. The stimulant laxative component, sodium           - Dr. Chris Vinden, OAGS Vice-President, is an Assistant Professor at the
picosulphate is a diphenyl methane and has exactly the same active              University of Western Ontario and also on staff in the Division of General
metabolite as bisacodyl (Dulcolax).                                             Surgery at Victoria Hospital (LHSC), London, ON.


  OPINION: CPSO forces surgeon’s hand to divulge HIV status
By Dr. Philip Barron                                                            cries out for a human rights arbitration, but that is not likely to happen.
                                                                                Any volunteers? The OMA has promised to try to manage the predictable
         The lapsarian belief that the College of Physicians and Surgeons of    situation where a physician tests positive through no fault of his own.
Ontario (CPSO) is concerned about the welfare of the physicians which           Hopefully, mechanisms for appropriate compensation and retraining can
they regulate has been seriously disabused by the position of the College in    be achieved, because in the real world, an infected physician could not
the matter of blood borne pathogens.                                            practice even if, as suggested, they are assessed and approved by a College
         It is understood that the CPSO’s approach is that failure to answer    Committee. There are some fine words on confidentiality, but an ethical
the questions pertaining to performance of exposure-prone procedures and        obligation to know is also an ethical obligation to fully disclose to patients
the knowledge of one’s status in the licence renewal application will lead to   the status of an infected physician. Few patients would wish to have
referral to the Discipline Committee for punishment presumably by re-           surgery by an infected surgeon no matter how high their personal regard for
moval of licensure. Physicians have no cavil with the ethical obligation to     the individual.
know their status regarding these conditions, but a statement that both                 The definition of exposure-prone procedures is also logically sus-
patients and their doctors have similar obligations would have gone some        pect. Anyone handling sharp instruments which would include nurses and
way to assuage the belief that surgeons have been targeted. After all, the      anyone handling a syringe and needle should be involved in this obligation.
greater risk is that a physician is infected by a patient than the converse.    This risk may be low but it is not zero. Surgeons may rightfully be upset by
         The OMA-documented position that testing for HIV and hepatitis         this heavy handed policy and the manner of implementation.
status should not be mandatory and should be event-based would seem to
be an exercise in toothless lexicography since by virtue of the College         - Dr. Philip Barron, OMA Section Chair on General Surgery and OAGS
position the obligation now becomes compulsory in practice. The situation       Board Member, is on staff at the Ottawa Endoscopy and Day Surgery Centre.
Page 8                                                                            The Cutting Edge, Issue 29 Spring / Summer 2009
                                                                                  mandatory testing policy, does state an obligation to inform the Dean of the



                          esident
                                                                                  school and even includes a statement that the student may not be able to
                                                                                  complete their clinical requirements and may be required to withdraw. The
                                                                                  University of Queensland (Australia) policy for students clearly states
                                                                                  that all students must be tested for HIV prior to enrolment and that their



                          ostrum
                                                                                  infection could have significant implications on their future career options
                                                                                  (with respect to exposure-prone procedures).
                                                                                           The American Medical Student Association has a strong stance on
                                                                                  HIV including opposing mandatory testing. They recognize that such ac-
                                                                                  tion violates personal rights to privacy without medical justification. They
                      By Dr. Karen Devon                                          also believe that a student or resident should be allowed to complete their
                O.A.G.S. Resident Representative                                  medical education as long as they are physically able and have no conta-
                                                                                  gious opportunistic infection.
        Blood Borne Pathogen Testing & Future Implications                                 This last position is consistent with the policy adopted by the On-
                                                                                  tario Human Rights Tribunal as well as the Canadian Human Rights Act. The
         The issue of blood-borne pathogen infection risk and therefore test-     Act notes in a 2007 release that no instances in Canada of HIV infection in
ing has always been a sensitive one in the health care profession, particu-       patients resulted from exposure to infected health care workers and therefore
larly to surgeons. Given the ever-increasing emphasis on patient safety and       health care workers should be afforded the opportunity to continue to work
confidentiality, the issue is coming to the forefront of discussions interna-     at their usual occupation, provided they meet performance standards.
tionally and will continue to do so.                                                       As students and residents, we stand to be further disadvantaged as
         Recently, as the OAGS Representative, it was brought to my atten-        we cannot get coverage for our future earning potential. General Surgery is
tion by a medical student that in order to do an elective at one of our Ontario   already becoming less attractive to young trainees. I suspect these occupa-
schools, she was required to provide evidence of HIV testing. After my            tional risks and financial burdens may create even further avoidance of our
bringing it to the OAGS board, there was some investigation and we ob-            specialty. Therefore, we have not yet seen the end of this issue and I think
tained a legal opinion on this matter. The concern was that students were         the opinions of surgeons, whatever they may be, should be an integral part
potentially being discriminated against, as this policy was based on a CPSO       of the process of defining the future of blood borne pathogen testing in
policy which obligates physicians to know their status, yet not necessarily       Ontario.
to disclose this. However, as you know, there has been a change to the                     In closing, if anyone has any opinion pieces that they would like
annual license renewal form by the CPSO asking whether one has tested             included in future newsletters or any issues or questions at all, please feel
positive for Hepatitis B, C , HIV or AIDS. It remains to be seen whether a        free to contact me! - Karen
physician will challenge this new requirement.                                    - Dr. Karen Devon, PGY4 UofT, is the OAGS Resident Representative.
         I believe that the policy of which we were informed, the first of its    Comments and suggestions relating to resident matters can be emailed to:
kind for any professional health care students in the country, may have           karen.devon@utoronto.ca or info@oags.org .
wide reaching implications. The conclusion of the legal opinion was that the
policy was defensible (however, had not yet put to legal test in court) and
that there could be a distinction between testing students and fully licensed       OAGS Resident Liaisons
physicians. Undergraduate Deans have more recently implemented a policy
based on current evidence which is intended to apply to all medical students          During a recent board meeting, there was some discussion on how
in Ontario but does not deal specifically with HIV testing or reporting;              to improve communications with General Surgery Residents from
therefore, this school reserved the right to make changes.                            each of the post graduate programs within Ontario.
         No jurisdiction in Canada has implemented mandatory testing of               Our OAGS Resident Representative Dr. Karen Devon is herself from
physicians, and some haven’t recognized that testing is medically unneces-            UofT (PGY4) and offered to contact each program in search of a
sary. Furthermore, physicians do not have to the right to request patients be         respective resident liaison. These liaisons will be asked to voice the
tested prior to treatment. So, how can the reverse be justified, particularly         concerns/ provide general updates on behalf of the residents from
when the risk to patients is lower than that to physicians? In fact, I often          each program. It is also hoped that they will not only provide sugges-
wonder how the risk to the patient compares to the risks of being cared for           tions but also facilitate encouragement from the OAGS in recruiting
by trainees on the 36th hour of their shift.                                          medical students into the respective General Surgery programs.
         The consequences of disclosure may be career altering, while in
theory confidentiality is promised. There is a recent anecdote from a phy-            As this is an inaugural endeavour, we will begin by inviting these
sician I know who had a solid needle stick injury and positive lab tests. The         liaisons to our 15th Annual Meeting this fall on Saturday, November
physician’s hepatologist involved the lab director at this institution as he          7, 2009. In addition to the academic program, they’ll have their own
                                                                                      session to discuss General Surgery Resident issues/concerns.
suspected (correctly) a false positive result. The lab director, without
consent from the physician in question, alerted the hospital of the test              We are still seeking liaisons from Queen’s University and Northern
result. The physician received an email while away on vacation informing              Ontario Medical School (NOMS), so if anyone is interested, please
him of a committee which was to be set up in order to discuss his practice            contact our res rep at karen.devon@utoronto.ca or info@oags.org.
privileges. How are we as current and future surgeons expected to react to
such a situation when it is entirely unclear how infected physicians will be                     Our OAGS Resident Liaisons thus far are:
treated by licensing bodies, institutions, insurance companies and patients?                  Karen Devon - U of T (PGY4) - OAGS Res Rep*
         What are the responsibilities of the profession and public to sur-                        Nicole Callan - U of Ottawa (PGY4)
geons who are denied the opportunity to work due to an injury they re-                                 Luc Dubois - UWO (PGY4)
ceived serving others? And why are the ground-rules not being defined,                            Joey McDonald - McMaster U (PGY2)
based on the best evidence available, before these policies are being written?              Respective updates will be published in the next issue.
         It is as of yet unclear what would happen to the infected student at              The OAGS looks forward to hearing from each program!
the institution in question. Another Canadian school, while not having a
The Cutting Edge, Issue 29 Spring / Summer 2009                                                                              Page 9




                O.A.G.S.
2009       15th ANNUAL
             MEETING
       Renaissance Toronto Airport Hotel &
               Conference Centre
         (as of July 15, this same venue will be renamed
                 Sheraton Toronto Airport Hotel)
                                                                                             Photo courtesy of National Speakers Bureau
                                                                                                Dr. Dave Williams
                                                                                        This year’s Key Note Speaker is former
                                                                                        NASA astronaut and Canadian surgeon, Dr.
                                                                                        Dave Williams. Born in Saskatchewan, he stud-
                                                                                        ied surgery at McGill and completed his resi-
                                                                                        dency in Ontario. Williams practised emergency
            801 Dixon Rd., Toronto, Ontario                                             surgery at Sunnybrook and was assistant pro-
                                                                                        fessor at UofT until joining the Canadian As-
              Saturday, November 7, 2009                                                tronaut Program in ‘92. After completing two
                                                                                        space missions, he finally hung up his helmet
                                                                                        and picked up the scalpel again in Emergency
                  Website: www.oags.org/agm.htm                                         Medicine at St. Joseph’s Healtcare Hamilton in
                                                                                        March, 2008. He is also Director, McMaster
                                                                                        Centre for Medical Robotics and Dept. of Sur-
                                              Registration for the 15th OAGS            gery Professor. Dr. Williams will be speaking
            Topics ‘09                           Annual Meeting has begun!              on Healthcare and Technology during this
                                                                                        year’s 6th Annual OAGS/Ethicon
                                                See form enclosed, visit our            Endosurgery International Lecture and
        “Healthcare and Technology               website (www.oags.org) or              will also be joining us for the evening banquet
              of the Future”
Dr. Dave Williams, former NASA astronaut          call us for more details:             addressing his amazing experiences in space.
 Dir., McMaster Ctr. for Medical Robotics             1-877-717-7765
Dir., McMaster Space & Remote Care Med.
                                                 Note: The fiscal year has been              Early Bird Rebate
  “Top 5 Causes of Law Suits/ Bill59”          extended until Dec.31/09. Members           (Book a room before Oct.1st)
 Dr. Jacques Guilbert, CMPA, Ottawa, ON        who have already paid for this fiscal          The Ontario Association of
                                                still need to RSVP for the meeting        General Surgeons will be offering
     “Ano-Rectal Surgery Debate”              (and pay for the banquet if attending).    another rebate to its members this
Dr. Marcus Burnstein, SMH, Toronto,ON
Dr. Stanley Feinberg, NYGH, Toronto, ON
                                                                                                 year who make hotel
                                                                                          reservations directly through the
          “Colonoscopy / FOBT”                CME CERTIFICATION                          Renaissance Toronto Airport Hotel
 Dr. Jeff Axler, Gastroenterologist (tent.)                                                 (soon to be renamed Sheraton)
               Toronto, ON                     This event is seeking approval as          under the “OAGS” room block for
                                                an Accredited Group Learning             Friday,Nov.6 or Saturday,Nov.7.
    “Nutrition for General Surgeons”
                   TBA                               Activity (Section 1)                     Group Rate: $133/rm/night.
                                                      as defined by the
 “Deep Venous Thrombosis Prophylaxis”                                                     For each surgeon listed under the
                                                Maintenance of Certification             “OAGS” block, we will award him/her
                TBA
                                               Program of the Royal College of                  with a $34 REBATE.
       “Interactive Billing Corner”              Physicians and Surgeons of               It’s cheaper than booking online!
                   TBA
                                                   Canada, approved by the                   To make reservations, call:
            “Financial Talk”                       Canadian Association of                         416-675-6100 .
        Jason Caldwell, PIM, CMA                      General Surgeons.                      Be sure to request that your
                                                                                            reservation be included in the
        “Resident Session: TBA”               Note: It would be 1 credit per hour            “OAGS” block to be eligible.
                  TBA
                                              attended (approximately 7 in total).      The block will be released Oct. 1st.
Page 16                                                                    The Cutting Edge, Issue 29, Spring/Summer 2009



                                                  O.A.G.S.
                                       P.O. Box 192, Station Main, Peterborough, ON K9J 6Y8
        Ph. (705) 745-5621 Toll Free 1-877-717-7765 Fax (705) 745-0478 E-mail: info@oags.org Website: www.oags.org


                                                   EXECUTIVE & PORTFOLIOS
    President Dr. Jeff Kolbasnik (Hamilton) - AGM, CAGS, CPSO, MSPC/Tariff Chair, Newsletter, Nominations, OMA Council Alt, Sponsorship
 Immed. Past President Dr. Angus Maciver (Stratford) - AGM(chair), CAGS Alt, CCO Alt, Membership, OMA Council Alt, Political Act., Nominations
       OMA Section Chair Dr. Philip Barron (Ottawa) - CPSO, OMA Council Delegate, Nominating Committee, Political Activity,Sponsorship
               Vice-President Dr. Chris Vinden (London) - CAGS Alt., CCO, OMA Council Alt, On-Call Sponsorship, MSPC/Tariff Alt
                                 Treasurer Dr. Suru Chande (Winchester) - AGM, Sponsorship (chair), Treasury
                                                 Secretary Dr. Peter Willard (Welland) - On-Call
                                           Dr. Ian Chin (Oshawa) - AGM, Membership, Sponsorship
                                          Dr. Dennis Desai (Ottawa) - By-laws, Legal Communications
                                Dr. James Forrest (Leamington) - CPSO, OMA Council Alt., HOCC/On Call (chair)
                                                Dr. David Grant (Toronto) - CCO Alt, Sponsorship
              Dr. Ciaran Kealy (Sudbury) - AGM, Newsletter Managing Editor, OMA Council Delegate, Nominations, Political Activity
                                                  Dr. John Long (Elliot Lake) - MSPC/Tariff Alt
                                                    Dr. Alan Lozon (Owen Sound) - On-Call
                                                   Dr. Harshad Telang (Thunder Bay) - Ad Hoc

  EDITOR’S NOTE: This is the 29th issue of The Cutting Edge. None of our work would be possible without your support. Your board
  members are hard-working active general surgeons, like yourselves, who are interested in improving both our working condi-
  tions and our quality of life. Although we would like to send this newsletter to every general surgeon in the province, The Cutting
  Edge is mailed exclusively to paid-up members due to the cost factor. If you have not yet renewed your membership, we
  encourage you to do so. We get very little funding from the OMA as the Section on General Surgery, and your financial support is
  essential to the survival of the O.A.G.S. Thank you. - Dr. Ciaran Kealy, Editor
               GENERAL SURGICAL DUES (Sep1/08-Dec31/09): Active Surgeons - $400; Inactive/Out-of-Province - $100;
                                Fellows/Residents belonging to Ontario Med Schools - $20
                                       Cheques can be mailed to the following address:
                                                         O.A.G.S.
                                                P.O. Box 192, Station Main
                                                 Peterborough, Ontario
                                                         K9J 6Y8

                 Our previous 14th Annual Meeting of 2008 was funded by the following sponsors.
                                      Their support is greatly appreciated.
                                                 Thank you.




                                                        ULTRAMED


Note: Any companies interested in sponsoring/exhibiting at the 15th OAGS Annual Meeting on Saturday, Nov. 7,
2009 are encouraged to contact the OAGS at info@oags.org or Phone: 705-745-5621, TollFree: 1-877-717-7765.

				
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