Dr. Mamta Gautam

1. Many associations face challenges engaging new and prospective members. How do you envision residents and first-fifteen physicians engaging with the CMA? What actions would you, as CMA President, take to accomplish this?

We need our younger members, who are bright, thoughtful, and dedicated, to be engaged in the CMA, and we must focus on offering tangible value to attract them. New members join associations to gain opportunities to network, be part of a group that is working toward something meaningful and bigger than themselves, make a difference and give back to the community, gain new skills and have opportunities for learning and growth, community outreach, connection to professional resources, and help in finding jobs to match their skills and talent. To engage this group of colleagues, I would:

Reach out directly to residents and young colleagues, to listen and learn from them and their experiences, so we can best identify and support issues of importance to this group.
Form an advisory group of this demographic to advise the CMA, and help to engage their peers, and give the advisory group an official position in the association.
Ensure that membership cost is affordable for learners and those starting out in practice, with an option to place fees on hold fees while on parental leave.
Interact in a meaningful way, using social media and technology, to engage junior colleagues.
Create experiences that are fun, interactive and creative.
Create chances to get involved, contribute, make a difference, and be heard.
Offer free resources, such as clinical guidelines, white papers, blogs posts and videos, mentoring, job postings, and interview preparation.

The CMA must be relevant, accessible, inviting and low-cost to attract, engage and retain new, younger members.

2. In your view, what are the biggest challenges residents will face in the next 10 years? What are your proposed solutions to those challenges?

Residents will face multiple significant challenges in the years ahead. These include:

Ensuring a supportive and safe learning environment in training.
I would make sure that we adopt and enforce a policy of zero tolerance for behaviors such as intimidation, harassment, and bullying in the training environment. We also need to create a culture of openness and learning aimed at improving patient safety, and not close down discussion of medical errors for fear of litigation.

Access to practice, and ability to get a job in their chosen area of practice.
The CMA needs to advocate to ensure a thoughtful, balanced, evidence-based health human resource strategy; make sure there are enough residency training spots in the CaRMS match for Canadian medical graduates with at least a 1-1.2 ratio; and ensure that the fee schedule, call schedule, and access to OR time and clinics does not disenfranchise new graduates.

Staying motivated to practice.
Physician dissatisfaction is increasing, with burnout rates of up to 50%, driven by increasing workloads and frustration at being unable to spend sufficient time with patients. The 2017 CMA National Physician Health survey shows 38% of residents reporting high burnout rates. The CMA has made physician health a priority, and updated its Physician Health policy, identifying physician health as a shared responsibility of the individual physician, and the systems in which they train and work. System-level initiatives must be developed to address this effectively.

3. An increasing lack of alignment between the Canadian medical workforce and the healthcare needs of the general population has been well documented. What do you believe is CMA’s role in advocating for better alignment?

While highly regarded, our health-care system is expensive and faces several challenges. There are problems in finding a family doctor, accessing timely care in urban, rural and remote communities, long wait lists and overflowing Emergency Departments; all further challenged by rapid changes to care delivery, advances in technology, the aging Canadian population and increasing health care costs. Strong leadership is needed at the CMA to act now and advocate for better alignment by bringing together key stakeholders to focus on:

Integration – Hospitals, primary care, social care, home care and long-term care silos need to be integrated, with better communication and information sharing.
Innovation – We will need to find effective ways and processes to treat patients, and technology will play a role to improve communication, knowledge transfer and service delivery.
Enhanced accountability to focus on patient and population outcomes, not outputs.
Redefine comprehensive health care beyond hospital and doctors’ care, to include universal pharmacare, and address social determinants of health.
Health human resources strategy – medical education and training to make sure that we have the number of doctors needed, with the areas of specialization and the knowledge, attitudes and skill sets to meet the needs of Canadians; working in communities with health inequities and healthcare shortages (homeless, indigenous, rural, remote, isolated); and the government funding to ensure this.
Interprofessionalism – explore and establish collaborative models of care to improve access to care, and reduce wait times for patients, shortages and burn out for professionals.

4. What do you perceive to be the main causes of burnout among residents, and what actions would you advocate for to correct them?

The 2017 CMA National Physician Health survey shows 38% of residents reported high burnout rates. Other studies cite resident burnout rates up to 70%. The main drivers are internal (our personality traits, high expectations of self), external (heavy workloads, lack of sleep, electronic medical records, high debt load) and cultural (stigma, pressure to be strong and perfect, a culture of denial). Burnout can lead to physical and mental illness; it can be fatal. Suicide is the second leading cause of death among medical residents and the most common cause of death among male residents. We need to open up and speak about this, and create a culture where self-care is the norm.

I would strongly advocate for shared responsibility, in which both the individuals and the system work to create a healthier medical workplace. The system must offer policies to support resident health, such as Nutrition (healthful food options, scheduled time to eat), Fitness (access to fitness facilities), Emotional health (peer support programs), Preventive care (dental care, primary care physician), Financial health (debt management, emergency fund support), and Mindset and behavior adaptability (mindfulness meditation training). We also need system-level changes such as creating a formal wellness program, wellness education sessions, medical scribes or dictation services to help with documentation, ensure shifts maintain circadian rhythm, encouraging maintenance of work life balance, and including significant others in program. As well, we need to monitor, measure and track resident wellness and satisfaction to benchmark, and assess effectiveness of programs.

5. Organizations involved in medical education are under increasing pressure to create efficiencies and share information. How would you approach the need to guarantee the legally protected privacy rights of learners within this context?

More and more information about residents is being collected by medical organizations in an effort to understand the current landscape, improve the residency training and initiate wellness initiatives. Yet, much of this is of a highly personal nature, and must be properly collected and stored to ensure confidentiality and privacy protection. RDoC has developed clear principles to guide this process, available on their website; and I support these wholeheartedly.

Before the data is even collected, there must be a clear, ethical and legitimate purpose articulated for this and provided at the outset, with appropriate consent obtained, and maintenance of anonymity where possible. During data collection and analysis, best practices in safeguarding information must be followed. After collection, residents must be assured that the data is stored safely, with limited authorized access, and that they retain ownership of their own personal information. It is imperative that this data is only used for its explicit purpose, and never used or made available to the learner’s training program where they are evaluated, disclosed to third parties such as regulatory bodies without consent, or used to discriminate against the learner. While medical organizations appreciate the willingness of learners to participate in obtaining data to assist in understanding and responding to specific situations in healthcare, they must respect and never misuse this trust and confidence placed in them. This is the ideal role-modeling of professionalism and positive application of ethics in medicine.

Email: mgautam@rogers.com | Web: votemamtacma.ca | Twitter: @peakmd