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: firstname.lastname@example.org 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: email@example.com 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: firstname.lastname@example.org 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: email@example.com 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: firstname.lastname@example.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: email@example.com 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: firstname.lastname@example.org 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: email@example.com 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 firstname.lastname@example.org or email@example.com . 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 firstname.lastname@example.org or email@example.com. 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: firstname.lastname@example.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 email@example.com or Phone: 705-745-5621, TollFree: 1-877-717-7765.