Hello. Bonjour. Aaniin. Boozhoo.

As summer comes to an end and the leaves begin to change, we’re gearing up for yet another academic year. Of course many of us have been working throughout the summer and in fact our post graduate programs have been well into their academic year.  I hope everyone was still able to revel in the smells of sunscreen, bonfires, the lake and camp, fresh fish, and forest air. I have to say that I have never seen such bright sunsets, heard such bounding thunder, nor experienced such brilliant rainbows as I did in Northern Ontario.

To me, the mixed weather is a perfect metaphor for my first two months and mixed expectations of what’s to come with a jam-packed academic year ahead for NOSM. I’m wishing all of you a Happy Labour Day weekend – the last real weekend of summer.

Most physicians do not take too much time off. The majority seem to sprinkle their holidays between the summer and winter, depending upon their tastes. I know quite a few were involved in a new initiative to become one of the Ontario Health Teams, announced by the Ministry of Health a few months ago. Apparently, Ontario Health Teams are being introduced to provide a new way of organizing and delivering health care that will be more connected to patients in their local communities.

Under these teams, it’s expected that all the health-care professionals in hospitals, community settings, clinics, and in long-term care will work together as one coordinated team. Several organizations have come together in the North to apply to become Ontario Health Teams (OHTs) and a small list of teams were invited to provide the full application. The Northern Ontario School of Medicine is involved in many of these applications because our faculty and our sites are part of the regions where health care will be delivered by these teams.

The academic mission, especially that of training physicians, will be an integral part of what happens in these teams. Some teams who are being considered for the full application include: Équipe Santé Sudbury and Districts OHT, Algoma OHT, Near North Health and Wellness OHT, All Nations Health Partners OHT in Kenora, and the Muskoka and Area OHT. A full list is accessible here on the Ontario Health website.  The Canadian Addiction Treatment Centres has also been named as one of the innovative models that will be invited to full application. I am hopeful that many, if not all, will succeed.

This is a very exciting time for Ontario and especially for the North if we, together as a unified group, are able to accomplish all the expectations of an Ontario Health Team. NOSM stands ready through its advocacy strategy and its social accountability mandate to support any or all Ontario Health Teams in our geographic area, and to assist in studying whether this will be an initiative that will improve health care in Northern Ontario.

It’s expected that some of the improvements and integrated health care will fundamentally change how patients will experience the system. If teams are successful with the expectations that have been laid out, there will be much more opportunity to have virtual care and easy access to primary care; plus, navigating the system will be made much more flexible to allow for an open transition between health care providers.

For instance, did you know that the new apps can now read your blood pressure by taking a selfie? Or take an ECG on demand using your smart watch? As we speak, personal health data will be as easy to access as the fitness information on a FitBit.
I have often wondered why the health system is the slowest to evolve. Maybe new OHTs will be the answer?

I’m interested in how you’re going to experience these Ontario Health Teams and what you think about them. Certainly, in my opinion, they will require a significant amount of technology to share information and to provide the kind of advances in health care accessibility that I see coming down the pipeline. Also, I’ll be interested to see whether the funding models will create efficiencies. NOSM will be happy to work with our partners to study their impact and the outcomes for the people of the North.
I’m curious about your opinion. Let me know what you think.

Speaking of team work, I want to send a shout-out to the collaboration of our MD students led by Ben Lafleur (fourth year MD student), and by Dr Lee Toner, Phase 3 (Clerkship) Director and faculty member, that resulted in a 98% response rate by 2019 NOSM graduates to the Association of Faculties of Medicine of Canada’s annual Graduation Questionnaire (GQ).

As NOSM’s Senior Director Undergraduate Medical Education, John Friesen says, “Ben brought his positive and collaborative nature to the entire UME student body for the Independent Student’s Assessment which set the stage nicely for the Year 4 students to participate in the 2019 GQ report that we knew would be critical to our UME accreditation visit in April 2020.”

The GQ results are really remarkable and reflect the teamwork of the students, teaching faculty and UME leadership. Your commitment achieved the highest standards of excellence in our MD program. The GQ data released last week by the AFMC shows a major, positive shift in that direction.

By all accounts, the students reported improvements in all areas, especially in accessibility to leadership, in wellness, and with the curriculum. We noted an ongoing issue with career advising and elective choices, to which NOSM is addressing by undertaking several new initiatives. The GQ is a very good measure of the pulse of the medical student experience, and I am delighted to see that, at this time, that experience is good. Thank you to Interim Associate Dean Brian Ross, Senior Director John Friesen, our students and the entire UME team for a job well done! As everyone already knows, we are gearing up for our Accreditation visit next year and this means we are in a good position to do well.

Students, please note: The Dean’s office will be hosting a pub night meet and greet on September 30 at Spacecraft Brewery in Sudbury from 5-7 p.m. Another will be held in Thunder Bay at the Sovereign Room on October 18 from 5-7 p.m. Keep your eye out for a formal invitation.

As usual, you are invited to follow my journey on Twitter @ddsv3 using #WhereisDrVerma. If you have feedback or ideas about how I can better communicate with you, please let me know by emailing me at dean@nosm.ca or by taking a quick survey here at any time.

Hello. Bonjour. Aaniin. Boozhoo.

These two weeks have taken me to Thunder Bay several times and meetings around Ontario, with more plans to travel to where NOSM must be represented; including communities further north, and at the Council of Ontario Faculties of Medicine, and the Association of Faculties of Medicine of Canada and the Colleges.

It is critical that NOSM is seen in all these places, because NOSM is truly unique. No other voice can adequately represent the Northern perspective on health-care education. If not, we risk being unheard or left out of competing province-wide decisions and national strategies in resource allocation and policy-making. No other school of medicine has a mandate such as NOSM, and no other part of Ontario suffers the health disparities and inequities as the North.

NOSM was the first medical school in Canada established with an explicit social accountability mandate. This means that NOSM is dedicated to addressing the priority health concerns of the people and communities of Northern Ontario. The health factors that make the North unique are difficult issues to highlight but in the next five years I intend to keep the “pedal on the metal” to ensure that progress is made. I intend to reopen our definition of social accountability. I will be asking all of you  What do you think it really means to be socially accountable?  That mandate, in my humble opinion, needs to be opened up to reinvest in aggressive advocacy, influencing policy and the renewal of our commitment to the North.

The HARD Facts: The needs of the North are different. So are our doctors.

Northern Ontarians have shorter expected lifespans than people in Southern Ontario, and are far more likely to die prematurely (before age 75) from suicide, heart disease or respiratory disease. Northerners have less access to primary care providers, and higher rates of suicide, complex chronic diseases, obesity and are more likely to report having multiple chronic conditions.[1]

Mental health and addictions in the North are some of its greatest challenges. The youth suicide rate of Indigenous people is six times higher than non-Indigenous youth in Canada.

The northeast and northwest have the first- and second-highest rates of opioid-related deaths in the province, which poses intimate, heart-wrenching challenges for the well-being of families, workplaces, and communities in the North. Children and youth are presenting at emergency departments with opioid addictions every day.[2]

Delivering health care in the North involves navigating between two systems of health services by two levels of government. One is provincially funded and the other is federally funded. Our learners and graduates must maneuver a complex system depending on where they choose to work. Are they prepared for this?

Northern and rural physicians must have a uniquely northern skill set – this must be intentionally taught and it must be properly remunerated. Northern docs have 24/7, 365 day workloads, inadequate specialty support and increasing numbers of unattached patients. Advocacy is required for sustainable workforce planning and appropriate payment models.

Social Determinants of Health

The North of Ontario has unique social determinants of health. Climate change is affecting these in the most powerful way, but where is this taught in our curriculum?

What we’re noting as a collective academic medical community are the new, emerging social determinants of health that I’ve mentioned before, including: barriers to nutritious food, lack of clean safe water, lack of safe housing and threats to personal safety. For example, climate-related changes including wildfires, flooding and shorter seasons of ice road access have a direct impact.

Chronic disease – such as diabetes is endemic. And is not only limited to an aging population but children and adolescents are severely affected. I met with our TBRHSC Department of Pediatrics faculty last week and they expressed grave concerns about their ability to meet the growing needs of the children of the North.

These are unique social determinants of health and realities for communities in the North of which NOSM learners must be familiar. NOSM must push the boundaries of curricular change to prepare rural physicians. To this end, NOSM will be developing a new pathway- the rural generalist pathway – with defined sets of competencies and expectations for physicians who practice here.

So, Here’s the Bottom Line

Since 2011, there are 214 NOSM-educated family physicians and 31 NOSM-educated specialist physicians now practising in the North. We strive to increase these numbers.
Being unique is a strength. We admit applicants who, in most cases, already have a lived experience and deeper understanding of the North. For physicians to become “agents of change,” our curriculum must prepare them for the unique challenges of practice in the North.

As medical academics, we are a key voice at the table of health care transformation. These are exciting times as provincial and federal policy-makers and influencers recognize that we have evidence-based knowledge and appropriate solutions that are unique to the North and that work. Having just been at the Canadian Medical Association Health Summit this week, and hearing Dr. Mike Kirlew speak eloquently about Indigenous health, I hope that by raising our voices on behalf of the North at policy forums and at meetings and conferences, we will bring attention to our needs for medical school expansion, innovation in models of education and advocacy for our challenges in health care delivery.