Canada’s Attention to MD Health Gets Noticed

By Matt Borsellino

Medical Post

January 13, 2004

OTTAWA - The Canadian Medical Association's fledgling centre for physician health and well-being is attracting attention within this country and beyond. As a sign of the emerging significance of physician health concerns-and the impact major health-care changes have had on the profession across Canada and internationally-visits to the CMA centre's Web site are approaching 200,000. The Journal of the American Medical Association took the is­sue of physician health to the po­tentially tragic extreme, noting last summer that a "systematic review" of 14 international stud­ ies of suicide in physicians published from 1963 to 1991 found a higher incidence rate than for the public. Relative risks, JAMA reported, ranged from 1.1 to 3.4 in male physicians and 2.5 to 5.7 in females.

Of course, many more physi­cians suffer numerous other forms of compromised health resulting from substance abuse, psychiatric conditions and emotional and family problems. "The culture of medicine accords low priority to physician mental health, despite evidence of untreated mood disorders and an increased burden of suicide," JAMA reported. "Barriers to physicians seeking help are often punitive, including discrimination in medical licensing, hospital privileges and professional advancement...

''As barriers are removed and physicians confront depression and suicidality in their peers, they are more likely to recognize and treat these conditions in patients, including colleagues and medical students." CMA officials say their centre makes Canada the first country to promote physician health at national level. That may, indeed, be one reason why 41 % of all the visits to its Web site have so far come from other countries.

Hanson's effort

The centre, a natural progression of the CMA's 1998 policy on physician health and well-being, was set up after discussion at the last two annual meetings of the CMA's governing council. It was one of the personal priorities of immediate past-president Dr. Dana Hanson.

Its official mandate is to "provide leadership and ad­vocacy on issues affecting the health and morale of Canadian physicians," with a focus on health promotion and illness prevention. Each of the CMA's 10 provincial divisions has a physician health program to deal with individual cases. When the centre was announced last Au­ gust (see the Medical Post, Aug. 26), it caused some con­fusion about whether there would be any overlap or how it would relate to those programs.

Much of that was cleared up during a visit to CMA House here last month. As CMA President Dr. Sunil Patel put it: "It's a national co-ordinating body and repository set up to begin collecting information and facilitate research and awareness.

"There isn't a lot of Canadian information, and the physician health community in this country is relatively small," he said. While the centre compliments the work of provincial programs, it doesn't provide specific services to treat individual cases. "That's a clear distinction," Dr. Patel said. As such, doctors who recognize there may be a problem either with themselves or a col­league but who don't know how to begin dealing with it can con­tact the centre for resource information as a start and be assured anonymity. Those seeking treatment should consult their provincial physician health program directly.

Four priorities

The CMA centre has four pri­orities. Its staff, led by Dr. Todd Watkins, will endeavour to provide information and resources needed to better manage their health and well-being and assist colleagues. The centre is set up to raise awareness and reduce the stigma over seeking assistance for personal health matters. Its goal, Dr. Patel said, is to reduce all barriers to treatment.

Promoting research and filling gaps in understanding physician health and well-being issues is an­ other goal. Toward that end, the CMA has earmarked $50,000 a year to fund research projects, and it continues searching for ways to increase the amount of that seed money.

The CMA hopes that out of the centre's co-ordinated work will come an ability to advocate aggressively on issues affecting physician health and morale and to encourage development of poli­cies that help doctors attain a favourable balance between their personal and professional lives, Dr. Patel noted.

"Our key message is that physicians are people too," he said. The centre has been modelled after a faculty wellness program at the University of Ottawa also set up to supply education, prevention, research and advocacy.

Expert advisory panel

When it comes to intervention, though, cases are referred to provincial programs, according to Dr. Mamta Gautam, a local psychiatrist specializing in treating physicians who is also founding director of the Ottawa university's program and head of an expert advisory panel to the CMA centre.

That group brings together experts smaller provincial pro­ grams probably don't have easy access to, such as representatives of students and residents, academics, clinicians, administrators and the Canadian Medical Protective Association.

"That's how the centre differs from provincial programs," Dr. Gautam said. "We can best plan and co-ordinate programs and interests at a national level. ... The centre's biggest strength is to openly and nationally proclaim this is an important issue for Canada and to promote and de-stigmatize physi­cian health issues."

She'd like to see that done through workshops that help train more field-based personnel, among other things, organizing a national physician appreciation day (similar to one held recently in Ottawa) or lobbying on behalf of Canadian physicians on insurance needs or other health-care reforms.

"It is both an opportunity and a responsibility for our national medical organization to visibly in­ vest in the well-being of its physi­cians," stated Dr. Gautam's Nov., 2002 proposal for a CMA centre for physician health and well-being.

The CMA centre can be reached at 1-877-CMA-4-YOU (262-4968), and its Web site is www.cma.ca.Click on the "Centre for Physician Health and Well-being" icon on the left side.