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Our professional organizations have prepared this paper as part of an integrated, multidisciplinary plan to ensure the availability of well-trained practitioner teams to sustain safe, effective and high-quality rural surgical and operative delivery services. Without these robust local (or nearby) surgical services, sustaining rural maternity care is much more difficult. This paper describes the "network model" as a health human resources solution to meet the surgical needs, including operative delivery, of rural residents; outlines necessary policy directions for achieving this solution; and poses a series of enabling recommendations. [ABSTRACT FROM AUTHOR]

Presents a joint position paper on training for rural family practitioners in Canada in advanced maternity skills and cesarean section. Paper prepared by the College of Family Physicians of Canada, the Society of Rural Physicians of Canada and the Society of Obstetricians and Gynecologists of Canada; Benefits to rural women and their infants.

A review of the current literature on issues of maternity care relevant to rural populations underpins 14 recommendations prepared and approved by 5 national physician, midwifery and nursing organizations. This review and these recommendations are intended to help rural obstetric care providers to continue to provide quality care for women in their communities. [ABSTRACT FROM AUTHOR]

The author reflects on the series of white papers written by Royal College of Physicians and Surgeons of Canada (RCPSC) on various topics. It states that RCPSC stated that the in-training assessment must be the dominant method to determine competence. It mentions that RCPSC wants to move toward more assessment exams and it misses the reason why In-training Evaluation Report (ITER) has failed.

resents an article about the use of electronic medical records in the U.S. Percentage of physicians that did not have sufficient electronic access to their patients' records; Motivation of physicians for using electronic medical records; Requirements for an electronic health records system.

The author reflects on the reasons behind the accumulation of a large volume of paper even when physicians are using an electronic medical record (EMR). He explains that physicians with EMRs do not have the ability to talk to all the community pharmacies electronically and that laboratory investigation forms and consult requests for specialists must still be done on hand. He asserts that data standards, secure pipes and digital identities are some of the reasons why EMRs are not widely implemented.

Similarly, despite World Health Organization guidelines suggesting only 10%-15% of women require cesarean section, the researchers found that 29% of physicians giving birth had the procedure, a rate only slightly below that of other patients (31%). Graph: The cesarean rate among physician and nonphysician patients was similar in a recent analysis of US military data. One lesson physicians can learn from this paper, said Jena, is that providing information to a patient about their health and treatments is just one step in providing them with appropriate care. [Extracted from the article]

Background: Dedicated quality-improvement (QI) initiatives within health care systems are of clear benefit, and physicians respond to financial incentivization. The Canadian health care system often lacks this lever, and many financially incentivized QI programs rely on traditional economic principles. We describe our evaluation of financial incentivization for the implementation of QI process metrics in a department of surgery at a Canadian academic hospital system and its impact over a 4-year period.Methods: Quality-improvement processes informed by extant QI incentivization literature and guided by the principles of behavioural economics were implemented within our institution's Department of Surgery. Disbursement of supplemental government funding was modified to be contingent on the ability of divisions within the department to meet predefined QI metrics, including regular multidisciplinary meetings, morbidity and mortality rounds with documented feedback of systemic issues to division members, reviews of adverse events, and implementation of annual patient experience projects. We evaluated the effect of the QI processes from 2015/16 to 2018/19.Results: There was a significant increase in the number of divisions that satisfied all the QI metrics over the study period, from 2 (28%) in 2015/16, to 5 (71%) in 2016/17, to 7 (100.0%) in 2017/18 and 2018/19 (p < 0.01). The application of behavioural economics principles, such as reward versus penalty payoff, loss aversion, payment separation, aligning of values, and relative social ranking, was important to the outcome of the study.Conclusion: Incentivizing QI activities in the Canadian health care system is possible and led to improvement in QI processes as a whole in our department. This paper lays out a method of financial reimbursement to facilitate engagement of physicians and establishment of a foundation of important QI processes and measures within a department. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Rural Medicine (Joule Inc.) is the property of CMA Impact Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A comprehensive, international systematic review, spanning more than 100 years of data collection, suggests that soporific lectures at medical meetings are common, annoying and persistent. Low lights and boring material are prominent risk factors for nodding off during presentations. Extreme remedial measures are warranted. [ABSTRACT FROM AUTHOR]

Reports that data from the Canadian Medical Association's (CMA) 2002 Physician Resource Questionnaire indicate that only a small percentage of Canadian physicians use electronic media to store active patient records. Percentage which use a combination of paper and electronic media; Number of physicians who claim that improving how patient information is shared is an important or very important potential benefit of electronic health records.

Summary: Rural western Canada relies heavily on family physicians with enhanced surgical skills (ESS) for surgical services. The recent decision by the College of Family Physicians of Canada (CFPC) to recognize ESS as a "community of practice" section offers a potential home akin to family practice anesthesia and emergency medicine. To our knowledge, however, a skill set for ESS in Canada has never been described formally. In this paper the Curriculum Committee of the National ESS Working Group proposes a generic curriculum for the training and evaluation of the ESS skill set. [ABSTRACT FROM AUTHOR]

The article reflects on the lawsuit filed against Jameda, an online platform with ratings for German physicians, by a dermatologist demanding the removal of references that could injure her reputation. Switzerland-based medical bioethicist Stuart McLennan notes that physicians fear over online ratings may be overblown anyway. It notes a paper by McLennan and his colleagues which concluded that recommendations from friends, family members, and referrals remain more important than online rating.

An interview with Doctor William G. Kaelin Jr. is presented. He discusses how he became a physician-scientist. He explains how he became interested in studying the von Hippel-Lindau (VHL) tumour suppressor protein and how his work on tumour suppressors would benefit patients. He offers his advise to aspiring young scientists and physician-scientists.

Background: There is evidence to suggest that pharmaceutical companies influence the publication and content of research papers. Most German physicians rely on journals for their continuing medical education. We studied the influence of pharmaceutical advertising on the drug recommendations made in articles published in 11 German journals that focus on continuing medical education. Methods: We conducted a cross-sectional study of all of the issues of 11 journals published in 2007. Only journals frequently read by general practitioners were chosen. Issues were screened for pharmaceutical advertisements and recommendations made in the editorial content for a specified selection of drugs. Each journal was rated on a five-point scale according to the strength with which it either recommended or discouraged the use of these drugs. We looked for differences in these ratings between free journals (i.e., those financed entirely by pharmaceutical advertising), journals with mixed sources of revenue and journals financed solely by subscription fees. The journals were also screened for the simultaneous appearance of advertisements and recommendations for the same drug within a certain period, which was adjusted for both journal and class of drug. Results: We identified 313 issues containing at least one advertisement for the selected drugs and 412 articles in which drug recommendations were made. Free journals were more likely to recommend the specified drugs than journals with sources of revenue that were mixed or based solely on subscriptions. The simultaneous appearance of advertisements and recommendations for the same drug in the same issue of a journal showed an inconsistent association. Interpretation: Free journals almost exclusively recommended the use of the specified drugs, whereas journals financed entirely with subscription fees tended to recommend against the use of the same drugs. Doctors should be aware of this bias in their use of material published in medical journals that focus on continuing medical education. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Rural Medicine (Joule Inc.) is the property of CMA Impact Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses the similarity of the job of surgeons and astronauts in the U.S. Accordingly, the paper outlines the strikingly similar job descriptions and individual characteristics needed for both surgeons and astronauts. Moreover, the paper also discusses the truly dissimilar approaches to training followed by the two professions.

Copyright of Canadian Journal of Surgery is the property of CMA Impact Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article reports on the call of family physicians to develop medical homes in the U.S. It states that U.S. President Barack Obama has shown interest to fund a medical home to oversee the conditions of chronically ill patients in the country. It cites that joining the agenda is the College of Family Physicians of Canada (CFPC) that released a discussion paper and called on governments to establish a medical home. The move of CFPC is not only intended for ill patients but for every Canadian.

Copyright of Canadian Journal of Surgery is the property of CMA Impact Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article offers information related to the data stewardship and role of the physicians in Canada. It mentions that data stewardship refers to the collection, management and security of health information by a health professional. It informs that physician can get assistance over the issue of data stewardship from Canadian Medical Association guidelines for protecting the privacy of individual patient records in an electronic environment and ensuring physicians use of e-health tools.

Background: British Columbia's 8-1-1 telephone service connects callers with nurses for health care advice. As of Nov. 16, 2020, callers advised by a registered nurse to obtain in-person medical care can be subsequently referred to virtual physicians. We sought to determine health system use and outcomes of 8-1-1 callers urgently triaged by a nurse and subsequently assessed by a virtual physician. Methods: We identified callers referred to a virtual physician between Nov. 16, 2020, and Apr. 30, 2021. After assessment, virtual physicians assigned callers to 1 of 5 triage dispositions (i.e., go to emergency department [ED] now, see primary care provider within 24 hours, schedule an appointment with a health care provider, try home treatment, other). We linked relevant administrative databases to ascertain subsequent health care use and outcomes. Results: We identified 5937 encounters with virtual physicians involving 5886 8-1-1 callers. Virtual physicians advised 1546 callers (26.0%) to go to the ED immediately, of whom 971 (62.8%) had 1 or more ED visits within 24 hours. Virtual physicians advised 556 (9.4%) callers to seek primary care within 24 hours, of whom 132 (23.7%) had primary care billings within 24 hours. Virtual physicians advised 1773 (29.9%) callers to schedule an appointment with a health care provider, of whom 812 (45.8%) had primary care billings within 7 days. Virtual physicians advised 1834 (30.9%) callers to try a home treatment, of whom 892 (48.6%) had no health system encounters over the next 7 days. Eight (0.1%) callers died within 7 days of assessment with a virtual physician, 5 of whom were advised to go to the ED immediately. Fifty-four (2.9%) callers with a "try home treatment" disposition were admitted to hospital within 7 days of a virtual physician assessment, and no callers who were advised home treatment died. Interpretation: This Canadian study evaluated health service use and outcomes arising from the addition of virtual physicians to a provincial health information telephone service. Our findings suggest that supplementation of this service with an assessment from a virtual physician safely reduces the overall proportion of callers advised to seek urgent in-person visits. [ABSTRACT FROM AUTHOR]

Background: Care pathways are tools that can help family physicians navigate the complexities of the cancer diagnostic process. Our objective was to examine the mental models associated with using care pathways for cancer diagnosis of a group of family physicians in Alberta. Methods: We conducted a qualitative study using cognitive task analysis, with interviews in the primary care setting between February and March 2021. Family physicians whose practices were not heavily oriented toward patients with cancer and who did not work closely with specialized cancer clinics were recruited with the support of the Alberta Medical Association and leveraging our familiarity with Alberta's Primary Care Networks. We conducted simulation exercise interviews with 3 pathway examples over Zoom, and we analyzed data using both macrocognition theory and thematic analysis. Results: Eight family physicians participated. Macrocognitive functions (and subthemes) related to mental models were sense-making and learning (confirmation and validation, guidance and support, and sense-giving to patients), care coordination and diagnostic decision-making (shared understanding). Themes related to the use of the pathways were limited use in diagnosis decisions, use in guiding and supporting referral, only relevant and easy-to-process information, and easily accessible. Interpretation: Our findings suggest the importance of designing pathways intentionally for streamlined integration into family physicians' practices, highlighting the need for co-design approaches. Pathways were identified as a tool that, used in combination with other tools, may help gather information and support cancer diagnosis decisions, with the goals of improving patient outcomes and care experience. [ABSTRACT FROM AUTHOR]

Conclusion Physician health policies across Canada aim to protect the public by regulating practice for physicians who may be impaired. The UK regulatory model offers the benefits of transparency, explicit efforts to reduce stigma around disabilities and health conditions, and simultaneous reflection of physician responsibilities alongside available health supports. Ideally, such policies should encourage physician self-disclosure of illness, which serves to protect patients while avoiding intrusive questions about physicians' health. [Extracted from the article]

The article reports on addressing firearms safety by Canadian doctors along with their American colleagues. It cites the American College of Physicians (ACP) that caused an online dispute between physicians and the U.S. gun-rights lobby group, the National Rifle Association (NRA). Dr. Ana Maria Lopez, president of the ACP, states that physicians take care of people who are experiencing the impact of gun violence and they see first hand the consequences.

The article discusses the author's experience as a doctor in a rural clinic dealing with long COVID symptoms and the lack of emphasis on preventing long-term effects of COVID-19. The author expresses frustration at the lack of awareness and precautions taken by medical professionals and the public, highlighting the importance of prevention and advocating for clean-air standards and protective measures. Despite feeling isolated in their approach to COVID-19 precautions, the author remains committed to preserving their health and continuing to care for their community. [Extracted from the article]

The article explores the advantages and disadvantages of the medical credit cards in the U.S. It notes that one of the benefits of the medical credit cards is that it increases the likelihood of patients accepting treatments they would otherwise be unable to afford. However, research professor Craig Conway who wrote a paper about medical credit cards stresses that medical credit cards pose a significant risk for consumers with a little downside for physicians.

The article stresses the importance of social determinants, such as income, on health outcomes and the role of physicians in addressing them. Topics discussed include the policy papers of the Canadian Medical Association (CMA) on the role of physicians in addressing the social determinants and health equity and a series of public town meetings across Canada on what makes people sick hosted by the CMA.

Summary: As a physician, temperance advocate, chairman of the Grand General Indian Council of Ontario, the Supreme Chief Ranger of the Independent Order of Foresters, and mistakenly known as a Mohawk Chief, Dr. Oronhyatekha was a well-known, larger-than-life figure in North America and internationally. Since then, his memory has faded in mainstream society. Recently, however, he has re-emerged as a person of historical significance, designated as such by Parks Canada. Now the subject of the first full-length biography, co-authors Michelle Hamilton and Keith Jamieson, have separated out the true stories of his life from apocryphal ones. Although he was much more than a doctor, what follows is the story of how Oronhyatekha, a Mohawk boy baptized Peter Martin at the Six Nations of the Grand River, tenaciously pursued his dream of becoming a physician. [ABSTRACT FROM AUTHOR]

Historical correspondence between patients and physicians offers insights into the way people thought about health and sickness, as well as the relationships between providers and those seeking care. In eighteenth-century Europe, for example, doctors did not consider a physical examination necessary for establishing a diagnosis.[1],[2] Instead, patients often articulated their troubles in the form of a consultative letter. Dr. (and later Sir) Wilfred Thomason Grenfell, the charismatic and prolific British medical doctor, was inspired by the plight of the sick in Labrador and northern Newfoundland. [Extracted from the article]

Background: Differences in physician income by gender have been described in numerous jurisdictions, but few studies have looked at a Canadian cohort with adjustment for confounders. In this study, we aimed to understand differences in fee-for-service payments to men and women physicians in Ontario.Methods: We conducted a cross-sectional analysis of all Ontario physicians who submitted claims to the Ontario Health Insurance Plan (OHIP) in 2017. For each physician, we gathered demographic information from the College of Physicians and Surgeons of Ontario registry. We compared differences in physician claims between men and women in the entire cohort and within each specialty using multivariable linear regressions, controlling for length of practice, specialty and practice location.Results: We identified a cohort of 30 167 physicians who submitted claims to OHIP in 2017, including 17 992 men and 12 175 women. When controlling for confounding variables in a linear mixed-effects regression model, annual physician claims were $93 930 (95% confidence interval $88 434 to $99 431) higher for men than for women. Women claimed 74% as much as men when adjusting for covariates. This discrepancy was present in nearly all specialty categories. Men claimed more than women throughout their careers, with the greatest gap 10-15 years into practice.Interpretation: We found a gender gap in fee-for-service claims in Ontario, with women claiming less than men overall and in nearly every specialty. Further work is required to understand the root causes of the gender pay gap. [ABSTRACT FROM AUTHOR]

Although many studies have shown the performance of machine-learned tools to be at least comparable to the performance of expert physicians, this is not always the case,[24] which underscores the need to conduct clinical verification studies before moving forward with more resource-intensive forms of evaluation. See related articles at www.cmaj.ca/lookup/doi/10.1503/cmaj.202434 and www.cmaj.ca/lookup/doi/10.1503/cmaj.202066 KEY POINTS Evaluation of machine-learned systems is a multifaceted process that encompasses internal validation, clinical validation, clinical outcomes evaluation, implementation research and postimplementation evaluation. Conclusion Evaluation of machine-learned solutions is a multifaceted process that requires the expertise of data scientists, clinician experts and implementation scientists. [Extracted from the article]

Information about several papers discussed during a conference sponsored by the Physicians for Global Survival in Canada on April 17, 2009 is presented. Topics highlighted the recommendation of the Canadian affiliate of International Physicians for the Prevention of Nuclear War for doctors to use diagnostic alternatives to reactor-produced isotopes in health care. Attendees in the event include mathematician and physicist Gordon Edwards, Dr. Christopher O'Brien and Dr. Nancy Covington.

Copyright of Canadian Journal of Surgery is the property of CMA Impact Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: It is unclear whether the clinical burden of postpartum mental illness has increased during the COVID-19 pandemic. We sought to compare physician visit rates for postpartum mental illness in Ontario, Canada, during the pandemic with rates expected based on prepandemic patterns.Methods: In this population-based, repeated cross-sectional study using linked health administrative databases in Ontario, Canada, we used negative binomial regression to model expected visit rates per 1000 postpartum people for March-November 2020 based on prepandemic data (January 2016-February 2020). We compared observed visit rates to expected visit rates for each month of the pandemic period, generating absolute rate differences, incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). The primary outcome was a visit to a primary care physician or a psychiatrist for any mental disorder. We stratified analyses by maternal sociodemographic characteristics.Results: In March 2020, the visit rate was 43.5/1000, with a rate difference of 3.11/1000 (95% CI 1.25-4.89) and an IRR of 1.08 (95% CI 1.03-1.13) compared with the expected rate. In April, the rate difference (10.9/1000, 95% CI 9.14-12.6) and IRR (1.30, 95% CI 1.24-1.36) were higher; this level was generally sustained through November 2020. From April-November, we observed elevated visit rates across provider types and for diagnoses of anxiety, depressive and alcohol or substance use disorders. Observed increases from expected visit rates were greater for people 0-90 days postpartum compared with 91-365 days postpartum; increases were small among people living in low-income neighbourhoods. Public health units in the northern areas of the province did not see sustained elevations in visit rates after July; southern health units had elevated rates through to November.Interpretation: Increased visits for mental health conditions among postpartum people during the first 9 months of the COVID-19 pandemic suggest an increased need for effective and accessible mental health care for this population as the pandemic progresses. [ABSTRACT FROM AUTHOR]

Background: In all Canadian provinces, physicians can decide to either bill the provincial public system (opt in) or work privately and bill patients directly (opt out). We hypothesized that 2 policy events were associated with an increase in physicians opting out in Quebec.Methods: The 2 policy events of interest were the 2005 Supreme Court of Canada ruling on Chaoulli v. Quebec and a regulatory clampdown forbidding double billing that was implemented by Quebec's government in 2017. We used interrupted time-series analyses of the Quebec government's yearly list of physicians who chose to opt out from 1994 to 2019 to analyze the relation between these events and physician billing status.Results: The number of family physicians who opted out increased from 9 in 1994 to 347 in 2019. Opting out increased after the Chaoulli ruling, and our analysis suggested that between 2005 and 2019, 284 more family physicians opted out than if pre-Chaoulli trends had continued. The number of specialist physicians who opted out rose from 23 in 1994 to 150 in 2019. Our analysis suggested that an additional 69 specialist physicians opted out after the 2017 clampdown on double billing than previous trends would have predicted.Interpretation: We found that the number of physicians who opted out increased in Quebec, and increases after 2 policy actions suggest an association with these policy interventions. Opting out decisions are likely important inputs into decision-making by physicians, which, in turn may influence the provision of publicly funded health care. [ABSTRACT FROM AUTHOR]

The article presents the first part of a series on physicians in Canada who are innovators in using electronic medical records (EMRs) and technology, focusing on three Calgary-area physicians. Wes Jackson is a full-time teacher at the University of Calgary who is committed to using online clinical resources. Neil Cooper has been using EMRs since he graduated from medical school. Jacques Branch helped form a company to develop an integration appliance to encode lab data into the EMR.

Background: Different primary care delivery models exist for mothers and their infants. We examined whether primary care system performance measures differed when mother-infant dyads received primary care from the same or different providers.Methods: We conducted a population-based cohort study using Ontario health administrative data from 2004 to 2016. We included primiparous women and their singleton term infants and classified the primary care practitioners who provided the majority of care to the infant and the mother as concordant (same family physician for both; reference group), discordant (a different family physician for each) or pediatrician (pediatrician for the child, family physician for the mother). The primary outcome was nonobstetric maternal hospital admissions between 42 days and 2 years after delivery.Results: Among 481 721 mother-child pairs, 239 033 (49.6%) received concordant care, 114 006 (23.7%) received discordant care, and 128 682 (26.7%) received pediatrician care. Mothers in the pediatrician group were older and had greater comorbidity. Relative to concordant care, maternal nonobstetric hospital admissions occurred similarly under discordant care (adjusted odds ratio [OR] 1.00, 95% confidence interval [CI] 0.96-1.04) and in the pediatrician group (adjusted OR 0.99, 95% CI 0.95-1.02). Maternal deaths were similar under discordant care (adjusted OR 1.00, 95% CI 0.62-1.63) but lower in the pediatrician group (adjusted OR 0.55, 95% CI 0.34-0.89). Maternal primary care visits were lower in both the discordant group (adjusted relative risk [RR] 0.68, 95% CI 0.68-0.69) and the pediatrician group (adjusted RR 0.75, 95% CI 0.75-0.76). Healthy children were more likely to miss the enhanced 18-month well-baby visit under discordant care (adjusted OR 1.06, 95% CI 1.03-1.09) but less likely to miss this visit under pediatrician care (adjusted OR 0.47, 95% CI 0.46-0.49).Interpretation: Concordant care provided to a new mother and her infant by the same family physician was not associated with better primary care health system performance. The reason that pediatric primary care is associated with better maternal and child outcomes remains to be determined. [ABSTRACT FROM AUTHOR]

Editorial. Introduces two articles that examine the issue of advanced skills practiced by rural family physicians in Canada. Focus on physicians' contributions to the accessibility of medical services in rural settings; Joint position paper of the College of Family Physicians of Canada, the Society of Rural Physicians of Canada and the Society of Obstetricians and Gynecologists of Canada.

The article presents the author's views on the importance of information technology (IT) in medical care in Canada, highlighting the efforts of the Canadian Medical Association (CMA) to ensure physicians are well-equipped in the transition from paper-based systems to digital systems. She states that CMA aims to support members in their adoption of IT that will help them deliver care effectively and efficiently. She comments that IT is crucial due to its potential to improve patient care.

The article presents information on the history of pain management. In the article "A Capsule History of Pain Management," which is published in "Journal of the American Medical Association," Marcia Meldrum states that pain is the oldest medical problem which has never been fully comprehended by physicians.

The article profiles Dr. Rajendra Kale who was the new senior deputy editor of the "Canadian Medical Association Journal." It relates that Kale is a native of Mumbai, India and a former senior editor of the "British Medical Journal (BMJ) ". It notes that Kale graduated from Grant Medical College in Mumbai, where he specialized in neurology and has completed a research fellowship in Dublin, Ireland. He practiced as neurologist in Pune for several years. In January 1994, he started as editorial registrar at the BMJ, wherein his duties include writing articles, editing the letters section and providing critical appraisal of scientific papers.

Background: Induced abortion is a common procedure performed by physicians with varying degrees of clinical experience. We aimed to determine whether a physician's procedure volume influences complications after induced abortion.Methods: We obtained population-based retrospective data on surgically induced abortion procedures in Ontario between 2003 and 2015 from Ontario health administrative databases held at ICES. Physician procedure volume was defined as the number of surgically induced abortions performed in the 1-year period preceding the index procedure date, categorized as low (< 10th percentile of yearly volume) or higher (≥ 10th percentile). The primary outcome was a severe adverse event (maternal end organ damage, severe maternal morbidity, intensive care unit admission or death) within 42 days after an induced abortion. The secondary outcome was any adverse event within 42 days.Results: Among 529 141 surgical abortion procedures, we found 850 severe adverse events (1.6 per 1000 procedures, 95% confidence interval [CI] 1.5-1.7), and 5664 any adverse events (10.7 per 1000 procedures, 95% CI 10.4-11.0). Severe adverse events occurred in 194 out of 52 889 procedures in the low-volume group (3.7 per 1000 procedures, 95% CI 3.2-4.2) compared with 656 out of 476 252 procedures in the higher-volume group (1.4 per 1000 procedures, 95% CI 1.3-1.5), an adjusted odds ratio (OR) of 1.91 (95% CI 1.41-2.59). The odds of any adverse event were also higher in the low-volume versus higher-volume group (adjusted OR 1.19, 95% CI 1.02-1.40).Interpretation: Low physician procedure volumes are associated with an elevated risk of a complication after surgically induced abortion. Future investigation should compare processes of care between low- and higher-volume physicians to facilitate quality improvement in abortion care. [ABSTRACT FROM AUTHOR]

Describes results from the Physician Resource Questionnaire, administered by the Canadian Medical Association. Respondent comments regarding the condition of the medical profession; Complaints about increase in the administrative work load from the Workers Safety and Insurance Board; Unhappiness with the cost of running a medical office; Stress associated with running a family practice; Lack of personal time.

Burnaby Hospital in British Columbia has been "undergoing a re-engagement process" since 2017 to repurpose its doctors' lounge as a "communications hub" for a broader range of health professionals, according to Donna Sue, an emergency physician involved in the project. Seven years ago, the hospital attempted to revive the space with new furniture and a coffee maker, but "it didn't bring the doctors back", Zacharias said. Facing high rates of burnout and loneliness, some doctors are calling for the return of physician lounges. [Extracted from the article]

The article presents a message from the president of the Society of Rural Physicians of Canada (SRPC) where he discussed a planning workshop held by lead volunteers and staff of the SRPC to develop a strategic plan for the society. He also talked about the series of meetings in Banff, Canada in January 2016 which showed its mission statement of championing rural generalist medical care through education, collaboration and advocacy in action.