Olva Odlum BDS MSc LDS, the First Female Faculty Member in Manitoba and Dentist to the Indigenous Population.

Olva Odlum qualified as a dentist in England but went on to make a professional life in Canada. She became the first female member of the Manitoba dental faculty and provided care for many dentally-deprived groups, including disabled patients, those with cancer and members of the First Nation tribes.

Funding models and medical dominance in interdisciplinary primary care teams: qualitative evidence from three Canadian provinces.

BACKGROUND: Primary care in Canada is the first point of entry for patients needing specialized services, the fundamental source of care for those living with chronic illness, and the main supplier of preventive services. Increased pressures on the system lead to changes such as an increased reliance on interdisciplinary teams, which are advocated to have numerous advantages. The functioning of teams largely depends on inter-professional relationships that can be supported or strained by the financial arrangements within teams. We assess which types of financial environments perpetuate and which reduce the challenge of medical dominance. METHODS: Using qualitative interview data from 19 interdisciplinary teams/networks in three Canadian provinces, as well as related policy documents, we develop a typology of financial environments along two dimensions, financial hierarchy and multiplicity of funding sources. A financial hierarchy is created when the incomes of some providers are a function of the incomes of other providers. A multiplicity of funding sources is created when team funding is provided by several funders and a team faces multiple lines of accountability. RESULTS: We argue that medical dominance is perpetuated with higher degrees of financial hierarchy and higher degrees of multiplicity. We show that the financial environments created in the three provinces have not supported a reduction in medical dominance. The longstanding Community Health Centre model, however, displays the least financial hierarchy and the least multiplicity-an environment least fertile for medical dominance. CONCLUSIONS: The functioning of interdisciplinary primary care teams can be negatively affected by the unique positioning of the medical profession. The financial environment created for teams is an important consideration in policy development, as it plays an important role in establishing inter-professional relationships. Policies that reduce financial hierarchies and funding multiplicities are optimal in this regard.

The importance of assistive technology in the productivity pursuits of young adults with disabilities.

BACKGROUND: Young adults with disabilities often use assistive technology (AT) to address personal needs, engage in communities and pursue educational and vocational goals. Little is known about their personal experiences and challenges of accessing and using AT for productivity-related activities. OBJECTIVE: This study aimed to learn from young adults about their experiences and use of AT in supporting their productivity. METHODS: Using a qualitative approach, 20 young adult AT users engaged in semi-structured interviews and a photovoice process. Data were analysed inductively. RESULTS: Three primary themes were identified: I Have to Figure it out Myself, With the Right AT, and Relational Aspects of AT Use. Although participants were experienced AT users, they were often left alone to figure out their emerging needs. They relied on AT to participate in productivity pursuits however stigma around AT use in unsupportive work environments were new concerns. CONCLUSIONS: Young adults with disabilities draw on their experiences of AT use but may need to develop advocacy skills to ensure their needs are met in productivity-related environments. Employers and supervisors should recognize AT as essential to young adult's engagement with productivity-related activities and have an important role in developing inclusive work environments.

Growing old together: the influence of population and workforce aging on supply and use of family physicians.

Canadians have expressed concern that access to a family physician (FP) has declined precipitously. Yet FP-topopulation ratios remained relatively stable over the last decade, and there were perceptions of physician surpluses, at least in urban centres, 10 years ago. We evaluated whether demographic changes among patients and FPs, and in the volume of care received and provided over the period, contribute to this paradox. Given the relationship between age and FP use in fiscal year 1991/1992, an aging population should have been associated with a 2 per cent increase in visits by 2000/2001. Likewise, given the relationship between FP age and workloads in 1991/1992, an aging workforce should have been associated with a 12 per cent increase in service provision a decade later. Yet visit rates and average FP workloads remained unchanged. There was an increase in age-specific rates of FP use among older adults and a decline in rates among the young, and an increase in age-specific workloads such that older FPs provided many more services than their predecessors (30%) and younger FPs provided many fewer (20%). In terms of impact on future requirements for FPs, both changes in age-specific rates of use, and changes in age-specific patterns of FP productivity, trump population aging as key drivers.

Homebound Learning Opportunities: reaching out to older shut-ins and their caregivers.

Homebound Learning Opportunities (HLO) represents an innovative health promotion and educational outreach service for homebound older adults and their caregivers. It provides over 125 topics for individualized learning programs delivered to participants in their own places of residence, an audiovisual lending library, educational television programming, and a peer counseling service. Shut-ins are recruited as instructors and as participants in service projects that benefit the greater community. Preliminary assessments reveal high levels of participation and satisfaction with the program.

Access to and use of physician resources by the rural and urban populations in Manitoba.

This paper examines access to and use of the physician resources for ambulatory care by residents of Winnipeg and rural areas in Manitoba. Analyses were conducted on physician claims submitted to Manitoba Health in the fiscal years 1986-87 and 1991-92. The percentage of people who made contact with physicians, the number of visits per 100 residents, and the number of visits per user were used to asses changes between 1986 and 1991. There were important variations between residents of Winnipeg and the rural regions in access to and use of physicians' services across the years, and by physician specially. These variations accompanied a decrease in physician supply in the province.

Northern practices offer a challenge but few MDs willing to make the move.

Manitoba's Norway House offers a ruggedly beautiful location and a challenging medical practice, but the physical and professional appeal has not been strong enough to entice physicians to make a long-term commitment to the community, which has needed medical service since September 1994. A physician who left there this spring said concerns about practice restrictions convinced him to move south.

The relation between personal characteristics of physicians and practice location in Manitoba.

A questionnaire survey of 562 physicians in Manitoba who had graduated from the University of Manitoba was carried out to assess the effect of personal characteristics on choosing a practice location. The results closely resemble those of studies performed in the United States: the choice of a nonurban practice location is significantly more likely if the physicians and their spouses have nonurban backgrounds and if the physicians have had a nonurban preceptorship during undergraduate medical education. In this study practitioners who were male and whose fathers were farmers or health care professionals were also more likely to practise in nonurban areas. These findings will help in making physician distribution more equitable.

Storm of protest greets motion to restrict specialty exams.

A motion by the Royal College of Physicians and Surgeons of Canada to restrict specialty examinations to Canadian- and US-trained physicians has met a storm of protest from provinces facing acute physician shortages in remote areas. The motion was called a "recipe for disaster" for provinces such as Saskatchewan, Manitoba and Newfoundland that traditionally have recruited specialists from Commonwealth countries to fill positions. The protests prompted the college to postpone action on its motion until June.

Controlling overservicing by physicians: review of office practices in Manitoba.

The Manitoba Medical Review Committee is a peer review body that monitors the patterns of practice of the province's 1800 physicians in order to prevent and control overservicing. This study examined the effectiveness of the committee in reducing the unnecessary use of complete examinations, regional examinations, special calls, nursing-home visits and diagnostic testing. In 1983-84 the practice patterns of 44 physicians were reviewed because of the higher than average volumes of services. By the end of 1987-88 the number of services per 100 patients dropped. In most cases the decrease was not offset by increases in other services or in the number of patients. The estimated savings resulting from the utilization review amounted to more than $2 million during the 4-year period.

How many general surgeons do you need in rural areas? Three approaches to physician resource planning in southern Manitoba.

OBJECTIVE: To assess critically the results of using three different approaches to planning for the number of general surgeons in rural areas. DESIGN: Estimates of the number of general surgeons needed using a ratio approach, a and a population-needs-based approach. SETTING: Rural southern Manitoba. OUTCOME MEASURE: Number of general surgeons needed. RESULTS: The ratio approach supported the recruitment of 7.8 to 14.5 additional general surgeons to rural southern Manitoba. The repatriation approach suggested that the area might support five additional general surgeons, if residents could be persuaded to undergo their surgery closer to home. The population-needs-based approach suggested that the health status of area residents was similar to that of residents of other areas of the province and that they had a higher rate of surgery than residents of other areas; no additional surgeons were apparently needed. CONCLUSIONS: Each method has certain advantages, and none is necessarily useful in isolation. Hence, the most effective approach to planning for general surgeons is likely a combination of all three methods. Other factors that may be important include the type of payment structure and the need for professional groups to monitor variations in rates of surgery.