Archives > March 2018

Mainpro+ Manual and Video Tips

Mainpro+ User Manual

Mainpro+® (Maintenance of Proficiency) is the College of Family Physicians of Canada (CFPC) program designed to support and promote continuing professional development (CPD) for family physicians.

The Mainpro+ Manual is aconcise resource that will guide you through everything you need to know about earning and reporting credits in Mainpro+. Developed based on feedback from Mainpro+ users, the manual includes a frequently asked questions section, helpful screenshots to guide you through credit reporting, and links to informative videos

Check Out the Mainpro+ Platform Tutorial!



Not enough time to take in the full tutorial? Then visit the following video summaries for a quick review of the frequently visited areas on the Mainpro+ member portal.

Overview of your Dashboard

View past activities

 

View and print reports

How to enter an activity

 

Overview of the Holding Area

 

Learn more about the CPD Planning Tool

Research Showcase: 2018 Recap

One of the most valued opportunities in Alberta for primary care and family medicine researchers to share their projects–the ACFP’s What’s Up Doc? Research Showcase–was held on March 2, 2018 in Banff, AB. The selection process for abstracts is very competitive and often sees over 50 research abstracts submitted each year.

In 2018, a total of 45 research abstracts were selected for presentation or display at the Showcase. We are honoured to acknowledge our 2018 What’s Up Doc? Research Showcase award recipients:

Poster Display Category

1st Place: Integrating Elements of Observable Behaviour Into an Effective Progress Report to Make High Stakes Decisions About Resident Competence

  • Adam Mullen, University of Alberta
  • Deena Hamza, University of Alberta
  • Shelley Ross, University of Alberta

2nd Place: Development of Multi-Faceted Education Workshops to Enhance Safe Opioid Prescribing

  • Katrina Nicholson, PLP, University of Calgary
  • Sampson Law, PLP, University of Calgary
  • Ashi Mehta, PLP, University of Calgary
  • Antonia Stang, PLP, University of Calgary
  • Kelly Burak, PLP, University of Calgary

3rd Place: Physicians as Teachers and Lifelong Learners: The Roles of Basic Pscyhological Need Satisfaction and Involvement in Clinical Teaching

  • Mao Ding, University of Alberta
  • Oksana Babenko, University of Alberta
  • Sudha Koppula, University of Alberta
  • Anna Oswald, University of Alberta
  • Jonathan White, University of Alberta

Oral Presentation Category

1st Place: Chaperon Use–What Do Patients Want?

  • Sonya Lee, University of Calgary
  • Sarah Jacobs, University of Calgary
  • Maeve O’Beirne, University of Calgary

2nd Place: Knowledge Synthesis and Actionable Recommendations for Better Wise: Improving Cancer Surveillance for Breast, Colorectal, and Prostate Cancer Survivors

  • Melissa Shea-Budgell, University of Calgary
  • Denise Campbell-Scherer, University of Alberta
  • Carolina Aguilar, University of Alberta
  • Kris Aubrey-Bassler, Memorial University of Newfoundland
  • Aisha Lofters, University of Toronto
  • Eva Grunfeld, University of Toronto
  • Isabella Carneiro, University of Alberta
  • Donna Manca, University of Alberta

3rd Place: A Funny Thing Happened on the Way to an App

  • Lee Green, University of Alberta
  • Sylvia Teare, PaCER
  • Jean Miller, PaCER
  • Deborah A. Marshall, PaCER
  • Jolanda Cibere, Arthritis Research Canada
  • Behnam Sharif, University of Calgary
  • Jacek Kopec, Arthritis Research Canada
  • Kelly Mrklas, Alberta Health Services
  • Tracy Wasylak, Alberta Health Services
  • Nancy Marlett, PaCER
  • Denise Campbell-Scherer, University of Alberta
  • Peter Faris, Alberta Health Services
  • Tanya Barber, University of Alberta
  • Brittany Shewchuk, University of Calgary

Congratulations to all our Research Award Winners! 

Award recipients were determined through a peer-review process and evaluated based on the following criteria:

  1. Relevance and importance to family medicine;
  2. Relevance to primary care research and researchers;
  3. Innovations/originality;
  4. Clear, well-written description, well-defined objectives, and appropriate learning methods/style.

Saturday Morning Research Workshop Presented at ACFP’s 63rd ASA

Asking Questions and Finding Answers

10:15-12:00 ONLY (PRESENTED ONLY ONCE)
Tanvir Turin Chowdhury, MBBS, MS, PhD, Calgary, AB; Donna Manca, MD, MCISc, FCFP, Edmonton, AB; and Maeve O’Beirne, Calgary, AB

In this workshop, participants had the opportunity to identify and explore their own questions. Working in small groups, participants learned how to navigate evidence.

The workshop was conducted in an interactive manner and was built around the following manuscripts. These manuscripts are meant to provide a simplified outline for the beginner researcher.

Making “Cents” of Travel Vaccines

Oral Cholera Vaccine for Traveler’s Diarrhea Prophylaxis

While we might be through the worst of winter, many Albertans still have vacations planned for the upcoming months. What do you do when patients ask what vaccines they should get prior to traveling, and should you recommend the oral cholera vaccine to prevent traveler’s diarrhea?

Though diarrhea affects up to 50% of travelers to developing countries, most cases of traveler’s diarrhea (TD) happen because of consumption of contaminated food and water and are caused by organisms not prevented by the vaccine. TD usually resolves spontaneously in 3-4 days, but cure rates can be improved by taking antibiotics at onset. Travelers to high-risk areas can be prescribed antibiotics to self-administer should they develop diarrhea. Azithromycin 500mg twice daily for two doses is equivalent to longer courses of antibiotics, costs less than $20, and is covered by many drug plans. The oral cholera vaccine, on the other hand, is not recommended by North American guidelines, costs approximately $90, and is not covered by any provincial health care plans.

If you have a proactive traveler in the office, encourage vaccinations for other infectious diseases with high prevalence or potential morbidity, like Hepatitis A. You can also consider referring travelers to local clinics, public health units or pharmacies that specializes in travel medicine consultations.

About the Author

Tony Nickonchuk, BSc Pharm
Clinical Pharmacist, Alberta Health Services

Tony practices pharmacy in Peace River as a clinical pharmacist at the Peace River Hospital. He rotates with one other pharmacist between direct clinical care on the acute care ward and remote support for regional facilities. He is also site lead for the pharmacy team there.

Tony is a member of the Practical Evidence for Informed Practice (PEIP) Conference Planning Committee, is a contributor to Tools for Practice and the Best Science Medicine Podcast, and is a co-author of the popular Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta document.

Outside of work he is a busy dad of three kids under 12, all three being active in swimming, gymnastics, and drums. In his infinitesimal free time, he’s an avid follower of politics.

Financial Freedom for the (Young) Family Physician

Answering Your Tax Questions

One of the focuses of the ACFP’s First Five Years in Practice (FFYP) Committee this year is to empower our membership with skills to achieve financial independence.

As a member of the FFYP Committee, I have been asked to review the Federal Tax changes for the benefit of the ACFP membership. Please note that I am not an accountant or tax expert, and all decisions made using this information should be done in consultation with a professional.

The Committee is in the process of organizing several education events for our membership in this regard. If you are a physician in your first five years of practice, residency, or even a medical student, feel free to join our FFYP Facebook group or visit our website.

Federal Tax Changes
For years, physicians have been encouraged to incorporate as a means to offset reduced compensation at the provincial level by saving on taxes. The two primary ways in which tax bills were reduced by incorporating was by income splitting and tax deferral of retained earnings. Firstly, a corporation could give dividends to a shareholder (usually a spouse or a child over the age of 18), lowering the overall family tax bill by taxing personal income in the lower income shareholder rather than taxing personal income in the hands of one person. Secondly, a physician could retain their earnings within a corporation, avoiding personal income tax on those earnings, investing those earnings to earn passive income, and withdrawing money from the corporation in years where earnings are lower (i.e. parental leave, years of illness/disability, or in retirement). However, the Federal Government has committed to two tax changes that limit these advantages.

Firstly, to avoid being taxed at the highest marginal tax rate, dividends paid to family members who are also shareholders must pass a reasonability test. That is, the amount of dividends matches the amount of contribution the family member shareholder has given to the corporation. A different reasonability test has been in place for salaries for some time, but now the concept of “reasonability” is applied to dividends as well. There are several ways to assure dividends to a family member shareholder will not be subject to the reasonability test which include if the shareholder is:

  • A spouse that is aged 65 or over,
  • Adult aged 18 or over who have made a substantial labour contribution (generally an average of at least 20 hours per week) to the business during the year, or during any five previous years,
  • Adult aged 25 or over who own 10 per cent or more of a corporation that earns less than 90 per cent of its income from the provision of services and is not a professional corporation.

This is especially unfortunate, as the income splitting benefit of corporations was an excellent way for young physicians to save on taxes to pay off debt and begin saving for retirement. Some corporations can respond to the increased taxes by raising the price on its goods and services, which unfortunately, a medical corporation can not.

Secondly, the Federal government was concerned that corporations were receiving a tax benefit on business income earned at the small business corporate tax rate and then reinvested in passive investments. The Small Business combined Federal and Provincial corporate tax rate in Alberta for 2018 is 12% on the first $500,000 of Active Business Income (the tax rate on Business Income in excess of this limit is 27%). This means a corporation could earn $500,000 of Active Business Income, pay tax at 12% = $60,000, leaving $440,000 of cash left to invest in passive investments. If the $500,000 was earned as an individual, the tax rate would be much higher–leaving less for the individual to invest. This gives a distinct tax advantage to the corporation if the money is used for passive investments.

Commencing with corporate tax years beginning AFTER December 31, 2018 (so the first full corporate tax year end subject to these new rules is December 31, 2019, giving taxpayers some time to adjust to the changes), two new rules are put in place:

  1. Corporations will have reduced access to the Small Business tax rate when their “passive income” exceeds $50,000 in a tax year. This reduced access begins at $50,001 and is graduated in until the corporation reaches $150,000 of passive income. Once $150,000 of passive income is reached, the corporation no longer has any Small Business tax rate. “Passive Income” for purposes of this test is defined to include interest, rent, royalties, and dividends from portfolio investments and capital gains. However, there is an exception for certain capital gains such as disposition of property used in an active business (including goodwill) and capital gains on disposition of shares or interest of another active business corporation or active business partnership. Additionally, the prior year passive investment income of all associated corporations is used to calculate the reduced Small Business tax rate, so you can’t use multiple corporations to eliminate this issue. Additionally, there is NO Grandfathering of existing investment pools. The only relevant calculation going forward is the “AAII” – Adjusted Aggregate Investment Income which does not take into account any grandfathering of currently held investments and is basically the current years investment income,
  2. There will be a new regime of two Refundable Tax pools. Currently there is one pool where a corporation pays an additional temporary tax on investment income which accumulates in a pool. Once the corporation pays a taxable dividend, the pool is refunded to the corporation. Now there will be two pools for different types of tax on investment income.

Tax Planning
In Alberta, the corporate tax rate on active and passive combined business income will be either 12% (Small Business rate) or 27% (General Rate). Alberta Personal Tax rates are in nine different tax brackets, but generally personal incomes over $100,000 will incur personal tax of at least 36% and will increase to 48% once personal income is over $300,000. This means that active and passive combined business income earned in a corporation will still enjoy a Tax Deferral even at the General Business Rate of between 9% (36% – 27%) and 21% (48% – 27%). This Tax Deferral, if enjoyed over a long period of time, may still be preferential even if the Small Business tax rate is eliminated.

However, this Tax Deferral can be a Tax Penalty if the cash extracted out of the corporation by way of dividends in the same year as the corporate active and passive combined business income is incurred at the General Rate. For example, if a corporation is taxed at the General Rate, then pays out the leftover cash as dividends, the Tax Penalty (considering the combined corporate and personal taxes) is over 2%.

As a result, physicians are encouraged to meet with their accountants to discuss how to limit passive income earned on corporate investments, including using investments that don’t distribute interest or dividends or investments that favour capital gains. They may also decide that paying salaries from the corporation and then investing in RRSPs and TFSAs may be a stronger option for retirement planning with limits on growth on corporate retained earnings.

This article was written in consultation with an accountant. If you have questions pertaining to the information found in this article, please contact your personal or business accountant.

About the Author

Dinesh Witharana is a family physician in Spruce Grove who primarily focuses on community primary care of palliative patients. He often brings residents with him to his hospice rounds and home visits. He also enjoys participating on The Provincial Palliative Tumor Group as an Executive Member, the AMA Section of Palliative Care Fee Committee, The ACFP’s First Five Years In Practice Committee, and soon the Core Committee for the Cancer Strategic Clinical Network. He lives in Spruce Grove with two amazing children, Nala (3 years old) and Kaius (4 months old) and a extraordinary wife, Wing.

 

 

 

Leadership Is About the “Little Things”

 

Read the full March eNews and President’s Message.

“It takes team, grit, determination, and perseverance. If you trust in your people, and equally importantly, they trust you, amazing things can happen.” Darby Allen, Former Fire Chief, Fort McMurray, Alberta (Keynote, 63rd Annual Scientific Assembly)

As in emergency response, leadership in family medicine is not for the faint of heart. Primary care is being asked to lead and contribute through changing clinical delivery and practice, taking on more coordination and collaboration roles, reaching out to problem solve, and seek resources to achieve better results.

If you want to gain skills as a leader for your practice, your Primary Care Network, your Zone, or for the province, you will have to seek them out. You will find a great line up of speakers and leaders at ACFP’s second annual LeadFM Conference in Calgary on April 20 and 21, 2018. We hope that you can join us to start your leadership journey or to continue to network and collect leadership tools and resources that will support you and your team in your day to day delivery of family medicine.

But let us not forget, “it is about the little things.” I think what Darby Allen said about leadership also holds true for me. When working with my teams at the University of Alberta, Sylvan Family Health Centre, or the ACFP, I have to be purposeful about my actions to show appreciation for all of the work that everyone does that contributes to the delivery of medical student and resident education, patient care or good governance. I trust my team members to play their role to the best of their abilities and to do what they were trained for.

This year’s 63rd Annual Scientific Assembly was a true success and example of what can be achieved when you have an engaged team of physician leaders. Featuring inspiring and thought-provoking keynotes, like the one delivered by Darby Allen, to workshops focused on using integration and continuity to lead system transformation, our team of committee members and staff came together with grit and determination to deliver what one delegate said was “The best ASA I have ever attended!”

In this way we are all successful and “amazing things can happen.” We all can do our part to show leadership through appreciation. And in building strong leaders and strong teams, we can continue to produce exemplary events—our Annual Scientific Assembly being no exception.

 

Opioid Response Grant Announced

Primary Health Care Opioid Response Initiative

Alberta has dedicated $56 million towards urgent actions to address the opioid crisis, including $30 million dedicated to recommendations made by the Minister’s Opioid Emergency Response Commission. Of the $30 million, $9.5 million provincial grant (over three years) has been established for primary health care. The grant will support increased access to services and provide training for primary care providers to offer treatment, medication, and care to patients and families affected by the opioid crisis.

The Alberta College of Family Physicians, Alberta Medical Association (AMA), and Alberta Health Services (AHS), have committed to work together with Alberta Health (AH) to lead this essential work for primary care.

The ACFP will be the secretariat for the grant and will work alongside with key stakeholders to ensure the response includes engagement and guidance from primary care physicians, their teams, and Primary Care Networks (PCNs), and their patients. The ACFP’s support and focus in the Opioid Crisis response began since in late 2016 when it struck the Opioid Crisis Response Task Force—it is with their dedication, determination, and also the commitment of the Board, that ACFP remains driven to support the needs of their members and patient communities.

Primary Health Care Opioid Response Objectives
As front-line primary care providers, family physicians are well positioned to understand the complexity and scope of the opioid crisis and, therefore, must contribute to the design and delivery of a response that is both swift and decisive, and that can be implemented with the flexibility to work with supports available in any community. The response includes:

  • Urgent Opioid Response: Addressing urgent needs of those in crisis through distribution of naloxone kits and provision of Opioid Agonist Therapy (OAT) within primary care settings;
  • Enhanced Provider Decision Support, Knowledge Translation and Education: Changing current practice within primary care clinics and PCNs to better care for individuals using opioids;
  • Enhanced Opioid Related Service Delivery through PCN Zone Committees Engagement, Planning, and Implementation: Developing new integrated service delivery models coordinated with partners including Alberta Health Services (AHS) addiction and mental health services and community services.

Watch for opportunities to respond to the opioid crisis within your clinic and PCN and take part in upcoming training and practice planning to improve support for your patients using opioids or with opioid use disorder.

More information is available in the Alberta Health press release on the Primary Care Opioid Response Initiative.

Meet Your Newest Board Members

Dr. Anila Ramaliu, MD MSc CCFP
Director-at-Large (Term ending AMM 2021)

Dr. Anila Ramaliu is a practicing Family Physician in Calgary and a graduate of training programs in Family Medicine and Public Health and Preventive Medicine from the University of Calgary. She holds a Master of Sciences in Health Research and has been involved both in applied research and teaching, with the University of Calgary and Alberta Health Services.

Her prior experiences include work with international, national and local government and non-government organizations, leading various health and social programs for women and children, marginalized and immigrant populations while building inter-sectorial and inter-disciplinary collaborations to advance the health of populations. Her professional interests also include quality improvement, evaluation, organizational performance, and governance, alongside preventive health in primary care, mental health, and chronic disease management.

She currently serves as a Director of the Board of Directors of the Calgary West Center PCN.

Why did you decide to join the ACFP board?

Behind my motivation to join the ACFP board, it was a sense of personal and collective responsibility that I felt. We are at a point of change and transformation being demanded from our health care system; and the best outcomes in a system and organizational change are achieved when its players, at all levels, are involved, engaged, and contributing. We have a collective responsibility as physicians, on behalf of the patients we serve and along with them, to provide our input into shaping the health care and, specifically, the primary health care system of the future.

If you had the power to fix one thing in the health system today, what would you fix?

I am not sure that fixing one thing can do the trick because of the complexities inherent in a system, and specifically the health system. So, I guess, I am suggesting that we move away from trying to fix one thing and hope for every other component of the health system to fall into place. Whatever “the fixing,” it should consider each integral part of the system; and indeed be considered at all times a fluid and dynamic system. However, to satisfy your question, transforming primary care with a focus on population health outcomes, and improving integration of services within health system are much needed “fixes” in our health system today.

 

Dr. Vishal Singh Bhella, MD CCFP
President-Elect (Term ending AMM 2021)

Dr. Vishal Bhella completed a PGY 3 Academic Fellowship in Family Medicine at Western following his residency. He worked in Ontario in various capacities including clinic, hospitalist, and ER work during early practice.

Dr. Bhella relocated to Alberta to join the University of Calgary Department of Family Medicine as a Clinical Assistant Professor and Lead Preceptor at the South Health Campus Family Medicine Teaching Clinic in 2013.

He has previously served as an active member on the ACFP’s First Five Years in Family Practice Committee.

What are you most proud of as an ACFP Board member?

As an ACFP Board member I am proud of the commitment to Family Medicine shown by members of our board, staff, committees, and membership. It is important to have a strong Family Medicine voice and there are many initiatives that the ACFP is involved in and many people behind the scenes to move these initiatives forward and it is inspiring to see the hard work and dedication of so many members in supporting and promoting the role of primary care in our health care system.

What do you want to accomplish in the next year as an ACFP Board member?

Over the next year as an ACFP Board member, I hope to see continued engagement of our organization in important issues facing health care today. Over the last year, the ACFP’s leadership in creating an Opioid Task Force was instrumental in developing a set of key recommendations in the opioid crisis response as well as in securing a significant provincial grant in supporting the primary care response to the opioid crisis. It is just one example of how the commitment of our staff and members can impact an important system and societal issue and I hope to see continued examples in the year to come.

 

2018 Price Comparison of Commonly Prescribed Drugs Guide – Revision Made to Page 14 (Testosterone Replacement)

Please note, page 14 (Testosterone Replacement) has been updated as of Mar 31, 2018.

In Canada, prescription medications are the second most costly component of health care, upwards of $29 billion per year. These costs largely reflect the treatment of chronic medical conditions predominantly cared for by family physicians, including heart disease, high cholesterol, hypertension, diabetes and depression.

The ACFP is pleased to share with you the annual Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta document. Authored by Dr. Mike Kolber, Tony Nickonchuk, and Jayson Lee, the document identifies generic products (generally cheaper) from brand name products, a 90 day cost for standard doses (unless otherwise noted), and Alberta Blue Cross and Indian Affairs coverage.

The document is grouped by medication class and then ordered by cost. Please read the introduction for further explanation and specifically how the costs were calculated. While this document is not exhaustive, it contains many medications potentially used by office based primary care providers.

Simplified Guideline for Prescribing Medical Cannabinoids in Primary Care

Primary care physicians can incorporate medical cannabinoids into their prescribing practices by being informed with best available evidence and using a simplified, shared decision-making approach with their patients.

Visit the Toward Optimized Practice Clinical Guidelines page for more information.