And dig in is what we did recently in response to a proposal by the Alberta College of Optometry (ACO) to expand its scope of practice enormously. Requested changes to the Alberta Health Professions Act would allow optometrists to:

• independently manage glaucoma medically
• prescribe all Schedule 1 drugs pertinent to their profession
• perform some eyelid surgery
• do intraocular laser surgery
• order any imaging (including CT, MRI and ultrasound) or laboratory tests felt necessary to investigate systemic diseases with ocular involvement

Added together, this goes far beyond the scope of practice of optometry in any Canadian province or US state. This same issue arose two years ago and, thanks to the efforts of COS Past-President, Dr. Lorne Bellan, the Eye Physicians and Surgeons Association of Alberta and the American Academy of Ophthalmology, Alberta Health and Wellness decided not to allow any of these regulatory changes to take place.

This time around, working once again with the Eye Physicians and Surgeons Association of Alberta (EPSAA), the COS has responded in a clear and detailed fashion to explain why we feel this application is poorly conceived, has lacked the proper consultation with the affected stakeholders in the medical profession and (quite bluntly) would put the health of Albertans at risk. We have respectfully implored Alberta Health and Wellness to carefully examine and validate the appended claims of education and training purported by the ACO. We don't think they are accurate.

With the leadership of EPSAA President-Elect, Ken Romanchuk, and COS Council on Provincial Affairs Chair, Andrew Budning, the COS board and administration is continuing to help the Alberta government appreciate the protean implications of the proposed changes for patient safety and health care costs. We will be recruiting help from the Royal College of Physicians and Surgeons of Canada, as well as the Alberta Medical Association, the Canadian Medical Association and the Canadian Medical Protective Association. The American Academy of Ophthalmology has written a strong objection, and its experience and recommendations have been greatly appreciated. We will meet directly with the president and CEO of the Canadian Association of Optometry to determine its level of support for this proposal as well.

It is clear that we need to work with optometry in a constructive and coordinated fashion to best serve the needs of our patients. Many of us have good working relations already. The scopes of our professions will evolve, and it is critical that we all regularly convene with the provincial health ministries to develop and deliver eye care in the best and most cost effective ways. The Eye Health Council of Ontario is an excellent model for doing just that, and the COS board encourages Alberta and other provinces to consider setting up a similar panel of expert representatives from the medical and optometric groups.

Bill C-313 receives royal assent

On December 14, 2012, an Act to amend the Food and Drugs Act (non-corrective contact lenses) gained royal assent (see Governor General grants...). Once enacted, this private member's bill, introduced by Pat Davidson MP for Sarnia-Lambton, will bring non-corrective contact lenses into the Class II medical device category, bringing them in line with the regulations for prescription contact lenses. Bill C-313 was unanimously endorsed by members of the House of Commons at each stage of debate and passed easily through the Senate.

The COS was among the stakeholders who supported Bill C-313. Other key eye care stakeholders included the Canadian Association of Optometrists and the Opticians Association of Canada. In February 2012, the COS testified before the House of Commons Standing Committee on Health on the dangers of improperly used cosmetic/decorative contact lenses, including corneal injury, such as microbial keratitis, corneal abrasions and neovascularization from hypoxia to the cornea.

The Medical Devices Bureau of the Therapeutic Products Directorate (TPD) is the national authority that monitors and evaluates the safety, effectiveness and quality of diagnostic and therapeutic medical devices in Canada. To determine which devices need a license, all medical devices are categorized based on the risk associated with their use (see Safe Medical Devices in Canada, Health Canada). Class I devices present the lowest potential risk (e.g., a thermometer) and Class IV devices present the greatest potential risk (e.g., pacemakers). Classifying cosmetic contact lenses as Class II medical devices will require the products sold in Canada to be licensed through Health Canada. In addition, distributors of the products will require a medical device establishment license and must provide assurance to the TPD that regulatory requirements related to post-production activities have been met.

A coming-into-force provision has been built into the legislation to allow a grace period for Health Canada to allow those who will be affected by the new regulatory oversight to bring themselves in line with the new provisions. This will include a public consultation, resulting in publication of draft regulations for the new Act in the Canada Gazette, Part I (see Consultation). Interested groups and individuals, as well as Canadians in general, have a final opportunity to review and comment on a proposed regulation at the last stages of the regulation-making process, before it is enacted ("comes into force") and is published in Part II of the Canada Gazette. The process is expected to take approximately 18 months.

As the right to sell non-corrective lenses and the requirements for a prescription are regulated at the provincial level, each province will need to adjust the language of their current contact lens regulations to include non-corrective contact lenses. The new Federal regulation will provide a solid foundation for updating wording at the provincial level. The COS will work with its Council on Provincial Affairs to determine next steps.

CMA recognizes need for physician human resource data and planning

In March 2013, the Board of Directors of the Canadian Medical Association held a strategic discussion on the growing issue of physician under-employment in certain specialties. There was consensus about CMA playing a leading role in bringing stakeholders together and being more vocal on the topic and the need for a national planning body, possibly similar to what exists in the United Kingdom, to ensure that the proper number and types of physicians are being trained.

Royal College - national specialty societies human resources for health dialogue and specialty medicine summit

On December 3 and 4, 2012, the COS was represented at this summit, which focused on physician employment.

Key points and trends

• delayed retirement (due to the economic downturn)
• shortage of hospital resources
• lack of a national job bank
• some medical specialists disciplines experiencing difficulties finding employment
• possibility of oversupply or surplus of physicians

The Royal College Medical Specialists Employability Study is researching whether medical specialists are having difficulties finding employment in Canada because there are too many physicians in their specialty to meet the population needs, or whether these difficulties are a by-product or consequence of other factors. The drivers behind unemployment and underemployment are multifactorial and complex, but key factors include economics (e.g., hospital cutbacks, delayed retirements, prolonged fellowships), health system issues (e.g., increased use of residents and the physician remuneration system), individual factors (e.g., job preference and family obligations), and models of inter-professional care.

The Canadian Association of Interns and Residents (CAIR) 2012 National Resident Survey revealed that 19% of the residents who were looking for a job could not find one, and almost 50% were not satisfied with the counseling they had received. CAIR recommendations include the better alignment of resident positions and societal needs, support for a pan-Canadian workforce observatory, support for a coordinated needs-based projection approach to inform workforce decision-making, and support for the Future of Medical Education Post Graduate Project recommendations to ensure the right mix, number and distribution of physicians. CAIR recently established a Standing Committee on Health Human Resources; it also provides residents with a Transition into Practice Service (TIPS), in order to help and to advise residents having difficulties finding employment.

Stakeholder consultation on the future of medical education in Canada (FMEC): continuing professional development (CPD)

This December 12, 2012 meeting brought together a number of key stakeholders, including provincial colleges of family physicians, provincial medical associations, national societies and universities. An environmental scan of CPD activities shows that while the mission statements of many stakeholders are similar, there is fragmentation, duplication, competition and lack of synergy in the present system.

A successful FMEC-CPD initiative would need to be carefully constructed to ensure a future system that would attract collaboration and the effective and efficient use of resources. There are several growing fields and organizations, outside of the traditional CPD organizations, that could make important contributions to the evolution of CPD in Canada including knowledge translation and implementation science, performance improvement and other quality improvement initiatives.

CMA Specialist Forum

The CMA Specialist Forum, held February 8, 2013, brought together senior leaders from all 60 national specialty societies to discuss issues of common concern. COS Board member, Dr. Yvonne Buys, and CEO, Jennifer Brunet-Colvey, serve as the official representatives on this group.

Choosing Wisely - Participants explored specialties' interest/capacity to participate in a Canadian version of an American program, Choosing Wisely. The Choosing Wisely program is currently led by the American Board of Internal Medicine along with 10 specialty society partners and Consumers Reports. The goal is cost control through consumer education about appropriateness by physicians.

The Council of the Federation (CoF) Working Group on Clinical Practice Guidelines, of which CMA is a member, has had its mandate expanded for 2013 to include work on appropriateness; specifically, it is charged with developing a list of five clinical activities/procedures that are generally viewed as problematic. The government representatives have suggested in future developing an approach to appropriateness that could include a program similar to Choosing Wisely. The purpose behind Choosing Wisely is primarily to assist the physician-patient communication process in those clinical situations in which the benefits of some actions may be marginal or negative. As a by-product of reducing the consumption of marginally useful care, the overall quality of care will increase and costs will decrease.

Other highlights

• An excellent presentation by Dr. Shoo Lee on clinical practice variation
• Discussion regarding physician manpower issues and underemployment and results from the RCPSC survey
• Anesthesia in cataract surgery
• Prescription renewals by pharmacists

New Canada Not-for-Profit Corporations Act

Compliance with the new Act will require COS to review and revise its existing documents including its bylaws. A committee has been created consisting of Dr. Paul Rafuse, Dr. Mona Harissi-Dagher, Susan Gemmell and Jennifer Brunet-Colvey to review and revise the COS bylaws in time to present them for ratification at the COS Annual General Meeting in 2014.

Strategic planning

To ensure that COS continues to remain member-centric and relevant to its membership, COS will be undertaking a strategic planning process. More details to follow later this year.

RCPSC re-accreditation due this spring

COS must apply to maintain its status as an accredited education provider every five years through the Royal College of Physicians and Surgeons of Canada. Our re-accreditation application is due later this spring. COS received very high marks during its last round of accreditation and we are working towards a successful outcome again this year.

Cornea donation

Canadian Blood Services has been working diligently over the past three years around the design of an integrated interprovincial system for cornea and tissue donation and transplantation in Canada. COS and CNIB have partnered with Canadian Blood Services to raise awareness about the importance of cornea donations. Full-page ads appeared in Metro newspapers across the country on March 26 and in the Toronto Star on March 30, 2013.

CORS partners with the AAO's Young Ophthalmologists (YO) International Subcommittee

The Canadian Ophthalmological Residents Society (CORS) collaborated with the Academy's YO International Subcommittee on a pilot networking event at the 2012 Academy "YO Neighbor! Cross Border Conversations with Canada". The event was well attended. Special thanks to Dr. Mona Harissi-Dagher, COS Board member, and Drs. Mike Brennan, Michael Price and Dan Rootman (photos).

Canadian Retina Society inaugural meeting a huge success

From March 7 to 10, 2013, over 100 delegates attended the inaugural Canadian Retina Society (CRS) meeting in Banff, Alberta. International guest speakers included Dr. Philip J. Ferrone, Dr. Daniel F. Martin, Dr. H. Richard McDonald and Dr. Srinivas R. Sadda. Special thanks as well to our Canadian guest speakers and to industry partners for supporting this meeting.

COS Board of Directors proposes small increase in membership fees

At their Sunday, February 24, 2013 meeting, the COS Board proposed that membership fees be amended as follows: fees for Life Member (Retired) will be raised to $85 to cover the cost of the CJO subscription for these members, and membership fees will increase annually to keep pace with inflation. It had been nine years since the last fee increase, and it was felt that regular incremental increases to cover rising costs are preferable to less frequent but larger increases. These proposed fee changes will be brought to a membership vote at the June Annual General Meeting in Montreal.