Offshore energy boom providing opportunities outside Medicare's umbrella.

Physicians upset by limits imposed by the medicare system are getting a chance to spread their entrepreneurial wings on the East Coast. A boom in offshore exploration, led by Newfoundland's massive Hibernia project, has led to numerous business opportunities for physicians.

Harmonized sales tax a taxing issue for MDs in Atlantic Canada.

Physicians in 3 atlantic provinces say the linking of provincial sales taxes with the GST exacerbates the inequity physicians face because it yet again adds to their overhead costs. Physicians in Nova Scotia have already won an annual rebate to compensate them for the heavier tax burden. Doctors in the Maritimes warn that heavier taxes make recruiting there even more difficult.

The prevalence, etiology and management of tooth wear in the United Kingdom.

STATEMENT OF PROBLEM: Recent epidemiologic evidence suggests that tooth wear is now a significant problem in both children and adults. There is growing evidence that a major cause of severe wear in patients is regurgitation erosion due to a variety of factors including gastroesophageal reflux disease. PURPOSE: The purpose of this article is to discuss the prevalence of tooth wear in the United Kingdom. Emphasis in management should be on accurate diagnosis, and in some patients, long-term monitoring before embarking on any irreversible, interventive treatment. Even when treatment is necessary, a period of monitoring is helpful to assess the rate of progress of the wear, the effectiveness of preventive measures, and therefore the extent of the treatment necessary.

Interest in physician-buyout packages grows as more doctors contemplate retirement.

Provincial governments are turning to voluntary retirement programs, buyouts and phase-outs to help manage physician supply. Demographic data show that in 1996 nearly 27% of Canada's active physicians were aged 55 or older and that the average age of retiring physicians was 68. Although 1 goal of such programs is to give willing older physicians the financial ability to retire, provinces also hope to do away with some billing numbers.

Micmac medical student becomes role model for his community.

When Robert Johnson graduates from medical school in 1998, he will become Canada's first Micmac physician. For him, going to medical school is a major responsibility because he is a role model for an entire community. He hopes he is only the first of many Micmacs to make this career choice.

Sedation in dentistry. Part 1: assessment of patients.

This is the first in a series of articles on the uses of sedation in general dental practice. This paper reviews current recommendations for the practice of sedation, and the importance of patient assessment as a part of treatment. The dental and psychosocial indications, as well as medical contraindications, for sedation are discussed. Future articles will expand on other areas where sedation may be a useful tool in the general dental practitioner's armamentarium. It is hoped that these articles will encourage all practitioners to consider a wider use of sedative techniques in dentistry.

Telecare acting as an "electronic grandmother" for New Brunswickers.

A telephone information line is easing demand at the emergency departments of two hospitals in Moncton, NB. Although information lines aren't new, this program is different because nurses are using computer software that provides protocols for more than 900 areas of patient complaint. It helps them direct patients to the most appropriate care, which may range from treatment at home to an immediate visit to an emergency department.

Some physicians remain sceptical as metamorphosis of health care continues in PEI.

Prince Edward Island has restructured its health care system by dismantling former decision-making bodies and establishing provincial and regional health boards and a policy council. The province hopes this move will make people think about health care in a more comprehensive way and strengthen community involvement in it. However, some sceptical physicians think the impetus behind the reforms is the desire to save money, not improve health care. "Health reform is strictly fiscal reform," says Dr. Robert Colborne, immediate past president of the PEI Medical Society.

Where is the silver lining? Anxious doctors ask.

When Nova Scotia elected a Liberal government in September 1993, a wave of optimism washed over the province's medical community. One of their own, Dr. John Savage, was now premier, and another, Dr. Ron Stewart, was minister of health. However, anticipation soon turned to anger as Stewart took aim at physician fees and hospital costs to help reduce the province's health care budget by $62 million. Last November, relations between him and the Medical Society of Nova Scotia (MSNS) hit bottom. In an uncharacteristically political move, the society launched an ad campaign featuring slogans such as "Death by 1000 cuts" and "Uncle Sam want me. Ron Stewart doesn't." Four months later, the health department and the MSNS called a truce, with an agreement that many physicians consider a positive step. Today the province and its doctors are speaking again, and the medical society is working hard to help define physicians' roles in a new, regionalized health care system. But has the mood of doctors really improved? Last spring, CMAJ interviewed a cross section of Nova Scotia physicians to find out.

Some suffer adjustment pains as Blue Cross changes drug-benefit program on East Coast.

Blue Cross of Atlantic Canada has revised its drug-benefit program by restricting the number of drugs eligible for automatic benefits. The program still covers more than 3000 medications, but not items such as nicotine-replacement products, antihistamines, or cough and cold medications. The centrepiece of the revised program is a "special-authorization" process that affects about 140 expensive but "commonly prescribed" drugs such as antidepressant products and medications for migraine treatment. Although may applaud the not-for-profit corporation's intentions, some doctors and patients have experienced difficulty adjusting to the changes.

The message will be in the patient's receipt as New Brunswick prepares high-tech information system.

An effort to make the public appreciate the real cost of medical services has led to the development of an extensive medical-information and billing system in New Brunswick that uses a personal-information card. Likened to a credit card with unlimited credit, each has a magnetic strip with essential personal information with which to feed a province-wide computer system that eventually will link medicare, patients, doctors, prescription-drug programs and hospitals. The province hopes to have a pilot project running by year's end and then to introduce the system region by region.

The environment was right for Nova Scotia's new environmental health clinic.

With a $1-million contribution from the Nova Scotia government, Dalhousie University medical school is establishing an environmental health clinic that will research and treat the controversial condition known as multiple-chemical sensitivity. Already several hundred Nova Scotians, including about 100 former employees of Halifax's Camp Hill Hospital, have been referred to a part-time clinic that addresses environmental illness and other unexplained conditions. Some physicians contend that the sensitivity is largely psychosomatic and treatments provide little more than a placebo effect, but proponents believe research will support environmental health's goal of becoming a new, recognized speciality.

Controversy still simmers over plan to build plasma-fractionation plant in Nova Scotia.

Controversy still simmers over a plan by the Canadian Red Cross Society and a US biopharmaceutical manufacturer to build a plasma-fractionation plant near Halifax. The unilateral decision to go ahead with the plant was taken as the Krever inquiry into Canada's blood-supply system was holding public hearings across the country. A panel created to evaluate the proposal has supported the fractionation plant, but made additional recommendations concerning product pricing, research and development, plasmapheresis centres and membership of the Board of Directors.