The Northwest Territories is “uniquely poised to be a leader in virtual care,” but change shouldn’t come at the expense of practitioner autonomy, according to the secretary of the (NWTMA).
Dr. Katherine Breen made the comments at a meeting of the Legislative Assembly’s Standing Committee on Social Development on May 16.
The meeting was convened to discuss proposed amendments to the territory’s Medical Profession Act; If passed, these amendments would allow NWT residents to receive virtual care from physicians, including those outside the territory.
The proposed changes to the act include exempting physicians from elsewhere in Canada from getting an NWT licence if they’re providing virtual care to NWT residents, so long as those residents have a referral from an NWT medical professional; Creating a new licensing and registration category for physicians offering virtual care without a referral; and allowing registers of doctors to be posted on the internet.
One of the NWT’s advantages in implementing virtual care, Breen said, is that all regular full-time physicians in the territory are employees of the GNWT, making it easier to coordinate changes to territory-wide practices. This is also facilitated by the territory-wide electronic medical record system.
She said the territory’s unique geography, featuring many small and highly isolated communities, is also a significant motivator to introduce new virtual options. “We need to be innovative in delivering virtual care,” she said.
However, Breen said the virtual care registry proposed as part of the amendments is “not necessary” and “could open up for problematic practice.”; Rather, physicians from outside the territory who want to provide virtual care in the NWT should be licensed in the same way as doctors in the territory are, to ensure they are knowledgeable about the particular NWT context.
Creating an NWT college of physicians would be too expensive
The proposed amendments also include changes to the regulation of the medical profession in the territory.
Currently, the commissioner of the NWT may, on the recommendation of the minister of Health and Social Services, make regulations related to the practice of medicine in the territory. If adopted, the bill would expand this power to include “establishing or adopting standards of practice, codes of ethics, continuing competency programs and the nature of those programs, and scope of practice frameworks and guidelines,” according to the text of the bill. This would amount to creating a standard of practice specifically for NWT doctors.
However, Breen said this amendment would have negative consequences for the independence of doctors in the territory; Instead, she said the creation of standards should be taken up by an organization “at arm’s length from the government.”
Having a minister, themselves usually not a doctor, regulate the medical field could put practitioners in conflict other codes of conduct, such as the Hippocratic Oath or the Canadian Medical Association Code of Ethics and Conduct, said Breen: “It has to do with the fact that autonomy and self-regulation is at the very heart of the medical practice.”
Every province in Canada has its own arm’s length-body that regulates the profession; In Alberta, this duty is fulfilled by the College of Physicians & Surgeons of Alberta.
The NWTMA doesn’t have this power, and as Breen explained, creating an NWT college of physicians would be too resource intensive for the territory.
Yellowknife North MLA Rylund Johnson asked how much work would need to be done to adopt Alberta’s standards for the NWT. Breen said that although the proposed new standards are very similar to those in Alberta, there are some challenges associated with adapting them for the NWT: For example, the Alberta regulation has rules about physicians mainaining personal boundaries that would be difficult to adapt for smaller communities like Inuvik. “We want physicians to be uniquely integrated into the community, and to take part culturally and socially,” said Breen.