COS 2018 Advocacy in Action (First quarter update)

National Advocacy Initiatives

COS Advocacy and Public Awareness Fund: Thank you to all who have supported the COS and our efforts by contributing to the Advocacy and Public Awareness Fund. To date, we have reached over 80% of our target goal and we continue to see great support! The monies gathered from the Advocacy and Public Awareness Fund, along with a significant investment from the COS, will be used to support the COS to continue its strong advocacy and public awareness work at a federal level and empowering the provinces, subspecialty societies, and academic community with advocacy tools, training, and resources to help raise the profile of the profession.

If you have not yet contributed to the COS Advocacy and Public Awareness Fund, you may do so by contacting Rita Afeltra at [email protected] or at: 613.729.6779 x300 for details.

Thank you to everyone who has contributed to the COS Advocacy and Public Awareness Fund! As our way of saying thank you for your generosity and support, COS wants to publicly recognize your contribution through our Contributor Recognition Wall on the COS website.

See The Possibilities (STP) Kicks off Q1 with a focus on AMD Awareness Month and World Glaucoma Week:

As a result of our targeted media pitching for AMD Awareness Month (February) and World Glaucoma Week 2018 (March 11-17), the COS, the Canadian Retina Society (CRS) and the Canadian Glaucoma Society (CGS) secured a combined total of 1.7 million media impressions in Q1.

For AMD awareness month, CRS physician spokesperson Dr. Alan Berger was featured in a Global News article What is age-related macular degeneration and why should older Canadians care? Dr. Alan Berger also authored a by-lined article which will be featured in the May issue of the 50+ magazine Forever Young and Healthy Living magazine. The article also appeared in the Oakville Beaver community newspaper.

To mark this year’s World Glaucoma Week, the COS secured an in-studio interview with CGS physician spokesperson, Dr. Neeru Gupta, with popular radio show What She Said. Dr. Gupta shared information and facts on glaucoma, the importance of regular eye exams in order to detect eye diseases like glaucoma, and spoke to the differences between ophthalmologists, optometrists and opticians. Dr. Gupta was also joined by her patient, Christof, who shared his personal story of living with glaucoma and spoke to how Dr. Gupta helped save his vision. To hear the interview, please visit the What She Said website and click on the segment dated March 25, 2018. What She Said has a total reach of 69,500 impressions (50,000 broadcast, 19,500 online). In Quebec, the COS worked with 50+ online magazine Cité Boomers to promote a special Glaucoma Information Session at the Centre hospitalier de l’Université de Montréal which was held on March 12.

A special thank you to all of our provincial and sub-specialty society physicians who agreed to work with the COS on Q1 media relations including (from West Coast to East Coast): Dr. Priya Gupta, Dr. Steve Schendel, Dr. Eddie Moss, Dr. Jamie Taylor, Dr. Dennis Bhui, Dr. Steve Levasseur, Dr. Karim Damji, Dr. Mike Dorey, Dr. Patrick Gooi, Dr. Bryce Ford, Dr. Jonathan Wong, Dr. Matt Tennant, Dr. Ian MacDonald, Dr. Geoff Williams, Dr. Patrick Mitchell, Dr. Lisa Gould, Dr. Jennifer Rahman, Dr. Frank Stockl, Dr. Ravi Dookeran, Dr. Yvonne Buys, Dr. Catherine Birt, Dr. Enitan Sogbesan, Dr. Neeru Gupta, Dr. Alan Berger, Dr. Netan Choudhry, Dr. Phil Hooper, Dr. Varun Chaudhary, Dr. Harmanjit Singh, Dr. Hady Saheb, Dr. Karim Hammamji, Dr. Paul Rafuse and Dr. Marcelo Nicolela.

As part of Q2 See The Possibilities activities, COS is preparing a national survey of Canadians 18+ to gauge their knowledge of eye health; coordinating patient video testimonials; developing dedicated See The Possibilities Facebook and Instagram pages to expand the campaign’s social media reach; and gearing up for Vision Health Month in May. For more information about the campaign, please visit /

Canadian Ophthalmological Society (COS) Council on Advocacy Updates:

The COS Council on Advocacy held its first teleconference of the year on January 22, to discuss key advocacy priorities for 2018 and to review the final version of the COS Advocacy Toolkit – Phase I – How to Work with Government. The Advocacy Toolkit contains information on how to work with government and templated materials that can be customized by individual province/sub-specialty societies. The Toolkit is now available to COS members in the members only section on the COS website.

The Council on Advocacy has also created four new Regional Physician Representative roles. These new positions will work with the provincial physician representatives to identify, evaluate, and/or report issues of importance at a multi-province or regional level, in order to help the COS identify cross-Canada advocacy trends. The four Regional Physician Representatives include: Dr. Geoff Williams (Western Canada); Dr. Andrew Budning (Central Canada); Dr. Côme Fortin (Quebec and French Canada); and Dr. Paul Rafuse (Eastern Canada).

On May 31, 2018, members of the Council on Advocacy will also participate in an Advocacy 101 training session, being held at the 2018 COS Annual Meeting and Exhibition in Toronto. The session will feature a talk by government relations expert Ryan Clarke from Advocacy Solutions Inc. on how physicians can effectively communicate with governments at all levels. Mr. Clarke will also lead two interactive role-playing exercises designed to mimic a real-life meeting between an ophthalmologist and a government official on a relevant topic. The second half of the session will feature a Media 101 Session with speakers from COS’s public relations firm Cossette Health/The Colony Project, who will talk about media relations as an effective tool in advocacy.

Sub-Specialty Advocacy Initiatives

Canadian Glaucoma Society (CGS) and the Canadian Ophthalmological Society (COS) continue to consult with the Canadian Agency for Drugs and Technologies in Health (CADTH) on micro-invasive or minimally invasive glaucoma surgery (MIGS). COS continues to support CGS on this initiative and will provide updates as this evolves. CADTH considers CGS and COS as key stakeholders and as the recognized medical and surgical experts in this space.

Canadian Ophthalmological Society (COS) and the American Academy of Ophthalmology (AAO) continue to work closely on areas of mutual interest:

COS has regular calls with key physician leaders from the AAO, including Dr. David Parke, Dr. Dan Briceland and Dr. Michael Brennan to discuss issues of importance, including Advocacy. COS also appreciates the support of AAO staff members on key advocacy issues.

Sub-Specialty Advocacy Initiatives

Canadian Ophthalmological Society (COS) attends Canadian Retina Society (CRS) Annual General Meeting (AGM) to discuss Advocacy Priorities: On March 3, 2018, COS President, Dr. Guillermo Rocha attended the CRS AGM at the CRS Annual Meeting in Mont Tremblant, Quebec. He was joined by Dr. Phil Hooper, Chair of the Council on Advocacy who presented with CRS Advocacy Representative, Dr. Alan Berger, to provide an update on advocacy issues and to work with CRS members to identify advocacy priorities for the sub-specialty moving forward. Identified priorities will be used to help inform advocacy efforts in retina moving forward.

Canadian Glaucoma Society (CGS) and the Canadian Ophthalmological Society (COS) continue to consult with the Canadian Agency for Drugs and Technologies in Health (CADTH) on micro-invasive or minimally invasive glaucoma surgery (MIGS):

On March 9, 2018, CADTH posted the environmental scan that was conducted to support the Health Technology Assessment (HTA) on MIGS to the CADTH website for stakeholder feedback. The environmental scan is a result of consultations conducted with targeted key informants from the CGS, COS and the Canadian Society of Ophthalmic Registered Nurses (CSORN). These societies support new and innovative technologies within ophthalmology. COS continues to support CGS on this initiative and will provide updates as this evolves. CADTH considers CGS and COS as key stakeholders and as the recognized medical and surgical experts in this space.

Retina Area of Focused Competence (AFC) Application:

On March 16, 2018, COS President Dr. Guillermo Rocha, Dr. Fred Mikelberg, Chair, RC Specialty Committee in Ophthalmology, Dr. Amin Kherani, CRS President and Dr. Matt Tennant, Former CRS Vice-President participated on a call with the Royal College of Physicians and Surgeons of Canada (RCPSC) as part of the Royal College’s ongoing stakeholder consultation on the CRS’ proposed Area of Focused Competence (AFC) in medical and surgical retina. The discussions focused on the letter of non-support that the RCPSC received in the late fall of 2017 from the RC Specialty Committee in Ophthalmology, as this represented a change from the previously espoused letter of support dated March 9, 2016 from this same committee. The RCPSC Committee on Specialties will be determining if the recent letter of non-support from the Royal College Specialty Committee in Ophthalmology constitutes a veto. The Chair of the RC Specialty Committee in Ophthalmology, the President of the COS and the President of the CRS have asked the RCPSC to postpone this decision until the entire RC Specialty Committee in Ophthalmology has an opportunity to review the proposal again at their in-person meeting on May 31, 2018, held in conjunction with the COS Annual Meeting.

Provincial Advocacy Activities

Please find below the latest updates from the COS and the provinces regarding advocacy and lobbying efforts.

  • British Columbia
    • BC Society of Eye Physicians and Surgeons (BCSEPS) is continuing to work with the Tariff Committee of the Doctors of BC (BC Medical Association) regarding proposed cuts to cataract surgery fee codes. Currently, the BC government has based their suggested fee code of $80 per cataract on a $5 per minute measurement. This model assumes each surgery takes 7 minutes per eye to complete, however the equation does not include follow-up time, among other important factors. Fee codes for follow-up appointments have been listed as taking 3 minutes per patient. The process is expected to continue over the next several months.
  • Alberta
    • On March 14, 2018, the COS and EPSAA submitted a letter in response to recommendations put forward in the Alberta Health Services (AHS) Medical Device Reprocessing (MDR) of Semi-Critical Devices used in Ophthalmology Briefing Document, dated February 26, 2018, with regard to higher level sterilization of ultrasound probes and ultrasonic pachymeter probes. COS and EPSAA are currently awaiting a response from AHS and will provide updates accordingly. View a copy of the letter. Special thanks to Dr. Karim Damji, Dr. Michael Ashenhurst and Dr. John Huang for leading this work. COS is currently exploring the opportunity to formalize a position on this issue through a national position statement.
    • On March 21, 2018 COS and EPSAA issued a media statement in response to a Global News article entitled Have an eye emergency? Find out where you can go to get help. The article recommended that Albertans experiencing an eye emergency could see an optometrist in lieu of going to a hospital emergency room. COS and EPSAA’s media statement reinforced that anyone experiencing an eye emergency, no matter how severe, should go to the emergency room as delaying treatment could lead to vision loss or even blindness. Special thanks to Dr. Geoff Williams, Dr. John Huang and Dr. Stephanie Dotchin for this work. View a copy of the media statement.
    • The Eye Physicians and Surgeons Association of Alberta (EPSAA) are in cataract fee code negotiations with the Alberta Medical Association (AMA).
    • EPSAA is continuing to work with the COS and the Alberta College and Association of Opticians (ACAO) on the formation of a provincial Eye Health Council (EHC).
  • Manitoba
    • On March 6, 2018, EPSOM President Dr. Jennifer Rahman presented to a provincial committee studying Organ and Tissue Donation, regarding the need to increase corneal tissue donation. This presentation resulted from a joint effort by the COS and EPSOM in October 2017 for further consultation on a Private Member’s Bill regarding presumed consent for organ and tissue donation. The Manitoba all-party Standing Committee and Task force will be compiling a final report with a deadline of June 2018. Special thanks to Dr. Jennifer Rahman, Dr. Guillermo Rocha and the EPSOM Policy Committee for their work on this.
    • EPSOM is organizing an Eye Day and CME for primary care physicians.
    • On April 6, 2018 EPSOM launched its new website:
  • Ontario
    • The Eye Surgeons and Physicians of Ontario (EPSO) and Ontario Medical Association (OMA) have been negotiating with the Ministry of Health on the new proposed physician services agreement for ophthalmology. In January 2018, they reached a standstill and the OMA triggered binding arbitration. Similar to BC and AB, Ontario is facing significant cuts to fees for cataract surgery as well as many other procedures.
    • EPSO conducted a study on the issue of new graduates being unable to secure sufficient publicly funded operating time and the impact of this on physician resources in Ontario given the current long wait times and increasing demand for care by a rapidly aging population. The results were summarized in a whitepaper called “Ensuring Access and Excellence in Cataract Surgery”. The report was shared with the provincial government/Ministry of Health and the feedback has been positive. EPSO has requested increased Quality-based procedures (QBP) funded allotments tied to new graduate hires. EPSO will continue to meet with the OHA and members of Queens Park on this initiative.
  • Quebec
    • The Fédération des médecins spécialistes du Québec (FMSQ) has come to an agreement with the Quebec government for an 8-year contract renewal, effective until 2023.
    • As part of the agreement, AMOQ will be working with the FMSQ to review fee codes, including cataract and injections like other provinces.
  • New Brunswick
    • The New Brunswick Health Minister denied the New Brunswick Association of Optometrists’ (NBAO) request for increased prescribing privileges and independent glaucoma care based on the recommendation of the New Brunswick Medical Society (NBMS) Section of Ophthalmology and the COS.
    • The New Brunswick Medical Society (NBMS) has recognized the uniqueness of overhead costs associated with ophthalmology and thus dropped the profession from the list of the top three highest billers, to the fifth highest, compared to other specialities.
    • The New Brunswick government has created a committee to investigate fee codes, however ophthalmology is not represented on this committee. Dr. Ken Robert’s request for a seat on the committee was denied.
    • Optometry has effectively secured provincial government funding to provide one pediatric eye exam at age 5 and one pair of glasses.
  • Nova Scotia
    • Nova Scotia is currently managing a GP shortage – 100,000 residents are without a GP – which is affecting patient referrals and follow up for Ophthalmology.
    • Dr. Paul Rafuse is working on a referral guide for GPs, Optometrists and Ophthalmologists for how urgent care should be managed. Guidelines will include: referrals from Family Physicians, Pediatricians, Emergency Physicians, nurse practitioners, etc. to optometrists and ophthalmologists; guidelines for referrals from optometrists to ophthalmologists (when and how to refer, i.e. phone call, fax, letter); and guidelines for ophthalmologists on response back to Family Physicians and optometrists.
    • Optometrists have been given soft approval from NS Ophthalmology to have the ability to manage glaucoma the same way they do in Ontario, however optometrists still cannot prescribe glaucoma medication.
  • Newfoundland
    • On February 13, 2018, the Newfoundland Minister of Health, John Haggie is quoted in the media as saying that eye physicians in the province are engaging in “criminal” activity when it comes to cataract surgery billings in private clinics. On February 16, 2018, COS worked with APOS to issue a media statement in response to NL Health Minister’s comments, clarifying insured vs. uninsured services in ophthalmology, as per the COS’s 2015 Uninsured Services Report. View a copy of the statement.
    • The Newfoundland Medical Society (NLMS) has agreed that any reduction in monies as a result of government negotiated fee cuts will remain in Ophthalmology and can be re-allocated to other ophthalmic fees as needed.
    • The provincial government is currently reporting wait times that are not aligned with physician wait times. Current wait times for cataract surgery is only based on one eye, rather than both, reducing the reported wait times by almost 50%.

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