Supporting Physicians in Extraordinary Times
CPSO’s new President Dr. Janet van Vlymen says priority is addressing physician exhaustion, burnout
It’s tempting to chalk up Dr. Janet van Vlymen’s success in the medical profession to her competitive nature. Born, raised and educated in Kingston, Ontario — a community she continues to call home — Dr. van Vlymen channeled her early drive to succeed into the sport of gymnastics. This extracurricular activity not only helped her express her desire to succeed, but also taught her valuable lessons around time management that would serve her well throughout her academic pursuits and into her medical career.
The competitive spirit did not leave Dr. van Vlymen after graduating high school. She arrived at Queen’s University in Kingston to do an undergraduate degree in life sciences, but soon switched to medicine after she started dating a guy — now her husband — who was already in medical school. “I was competitive, even about that,” she says. “I basically thought, if he could do this, so can I. By the end of second year, I was enrolled in medicine.”
Since then, Dr. van Vlymen has become an accomplished anesthesiologist at Kingston Health Science Centre, an administrator of perioperative services, and an associate professor in Queen University’s School of Medicine. She has been CPSO Council’s academic representative for Queen’s since 2016 and has sat on numerous College committees, including as chair of our Quality Assurance Committee (QAC). “QAC has been a good fit for me,” she says, “because it is really about helping physicians be the best they can be, and ensuring they are meeting the standard of care.”
In her new role as CPSO President, it is Dr. Van Vlymen’s skills as a collaborator and consensus builder, and as someone able to absorb multiple perspectives on an issue and help steer a group toward making effective decisions, that will serve her and the College well.
Mary Bayliss, the director of CPSO’s Quality Programs division, has seen these skills in action. She says that, if her work on QAC is any indication, Dr. van Vlymen has all the abilities — including listening to varying points of view, staying well-informed about issues facing our members and the public, and being highly adaptable to changing priorities — to be an excellent President. “She’s really engaged [and] very supportive of our new direction around quality improvement,” Bayliss says. “I’ve been impressed by her initiative. She’s very self-directed. She doesn’t wait for CPSO staff to nudge her — she nudges us!”
We caught up with Dr. van Vlymen to ask a few questions about her life, career and priorities for CPSO in 2022. We also have a video 🎥 in which she describes what drove her to work in medical regulation, as well as her goals for her Presidency.
What do you see as your priorities as CPSO President for the year ahead?
The first priority is supporting physicians. After the year we’ve had with COVID-19 itself, with anti-vax movements, physicians are fearful for their own safety and the safety of their patients. The emotional distress, the fatigue and burnout are overwhelming.
We also need to manage our way through the latest wave of COVID-19, rebuild capacity, and get through the surgical backlogs. The College needs to have clear messaging of support for doctors as we come out of the pandemic.
On the policy front, our new social media policy has garnered substantial feedback. We recognize that social media is a tremendous tool for sharing information — in fact, it’s been indispensable during the pandemic. But the downside is, of course, mis- and disinformation. This policy could not have come at a better time.
Telemedicine/virtual care is also another important policy priority for us. Virtual care was so critical during the pandemic — it was literally a lifeline for some people. It plays a very important role and physicians were able to get it in place for their patients, even when they didn’t think they could. But we need to get the balance correct. The balance is off now. We’re seeing instances of family physicians who are not doing in-person exams, of doctors giving inappropriate referrals and so forth, and that’s a problem. When we speak of striking the right balance between in-person and virtual care, it’s always about what is in the patient’s best interest.
I think the principles of right-touch regulation and alternative dispute resolution (ADR) here at the College will continue to be big in 2022. ADR has been a great tool for us — it’s about using the right hammer for the right nail. We’re seeing tremendous results around resolving low-level complaints in a timely manner without a full investigation, and that is going to continue.
COVID-19 has been hard on all health care professionals, especially physicians. Can you share your take on the pandemic?
My take is that vaccines remain one of our strongest protections against this deadly disease, along with public health measures. I’m very proud of CPSO’s mandatory vaccine stance for staff and our statement regarding vaccine exemptions for patients. And having a clearly worded statement from CPSO about vaccine exemptions has been tremendously supportive and encouraging for physicians. I’m a big believer in vaccine mandates.
It’s morally depressing and distressing to see the anti-vaccine misinformation. We need a lot of strong support to ensure accurate information is being provided and misinformation is shut down.
The next few years are going to be challenging with the enormous backlog of patients waiting for surgery and procedures. There will be a huge need for additional resources to support this care at a time when we are seeing all types of health care workers leaving the profession.
Anesthesiology is your main specialty. What is it about this area that interests you?
During my internship, I went to the University of Ottawa to do an elective in anesthesiology, and I fell in love with it. It’s a high-paced environment, for sure. One that combines physiology and pharmacology. It’s about watching blood pressure, about keeping someone alive during a procedure. But you also need to have great interpersonal skills. People are trusting in you during a difficult time in their lives and so the interpersonal element is very strong. That’s probably an underappreciated aspect of anesthesiology.
You also have perioperative medicine as an area of focus. What are some of the rewards of that type of work?
Continuity of care is a big one. I was the medical director of pre-surgical screening at Kingston Health Science Centre for many years and I’m proud to say we were a bit ahead of the curve when it comes to preoperative assessment. In 2003, we redesigned our preoperative screening process to ensure all patients were well-prepared for surgery with appropriate tests ordered, while eliminating unnecessary testing. There was a strong focus on patient education and communication with our surgical colleagues and primary care physicians, and test results management. It’s such exciting and important work. As the literature on perioperative medicine has evolved, we’ve had to evolve as well, and so much of our policy making has been centred around the perioperative experience. It’s very exciting and rewarding space to be in.
What do you see as the unique perspective(s) that an academic rep can bring to discussions at the Council table?
The academic reps bring a different perspective than our elected physician and public Council members. Coming from an academic centre, the academic reps can bring a real focus on education and training. This is so important, as CPSO does have a significant role to play in physician education and in policy development. So, I think we bring an important lens to these issues.
You are a member of our Policy Review Working Group. How has your perspective of CPSO policies changed now that you are so involved in this work?
Traditionally, most physicians knew that the College has policies, but they didn’t read them. They were, after all, quite long. Policies were hard for some physicians to implement. When I started on CPSO Council, each policy would have its own separate working group.
But things have changed. We rewrote our policies to move away from vague phrases like “should” and instead focused on making the polices clearer by using “musts” and “must not.” We also now have a single Policy Review Working Group. Its members have really helped to make CPSO policies easier to read and easier to implement. But some things haven’t changed, including how rigorous the College’s consultation process is on its policies. We always provide a tremendous opportunity for feedback — from physicians, from organizations, from patient advocates, and [from] the public. Sometimes we get a draft policy right, and sometimes we get advice where we really need to make significant revisions to the final policy. Being a part of that process is one of the most rewarding experiences I’ve had thus far at CPSO.
2022 Council President Dr. Janet van Vlymen tells us about what drove her to work in medical regulation, as well as her goals for her Presidency in 2022.
Q: What motivated you to get involved with medical regulation and CPSO’s work?
Yeah, well, I’ve always been really interested in hospital administration, I have had administrative roles, really, since the beginning of my work in anesthesia at Kingston Health Science Centre. And I initially got involved with being Medical Director of our Pre-Surgical Screening Clinic, and I really enjoyed that work, and then I started to really get interested in policy development for my department, and I really enjoyed that work. So, I think that was a really good stepping stone to work within regulation.
I was actually invited to participate in developing standards for an Independent Health Facility a number of years ago, and that was really the first work I ever did for the college, and I found it to be very rewarding and interesting work. And so, I was really happy to get involved with that. And then I got involved in doing some investigations through ICRC, and again, that was very, very interesting and compelling type of work. So, I was really – I was very happy to be working with the College. And then I had an opportunity to be appointed as the Academic Advisor for Queen’s [University] on the CPSO Council. So, then that opened up a whole new window into opportunities at the College, and so it’s really been a very rewarding and exciting five years, and I’m really looking forward to next year to be serving as President.
Q: What’s your experience with the policy review process? Why should people provide feedback on policy consultations?
So, I’ve been lucky to be part of the policy review working group now for several years, and so, I’ve really been able to see in action, how important the feedback is on policies as we develop them. So, you know, there are a number of policies of the College, and they go through a regular review process. So, every five to seven years, those policies are looked at in a very comprehensive manner. We do a jurisdictional scan to get information about what’s happening in other jurisdictions, and then we send the policy out for feedback, both to the public and to all physician members, as well as to our various stakeholders like the OMA and PARO, medical students. There’s tremendous feedback that we get from these organizations on all of our policy review. And what we find is that, you know, even though we’ve done the work and the background work, and we think we have a really great draft, and really seeing it from another person’s perspective, and really having a full understanding of how a policy might affect a certain group of individuals, both public and physician members, really can influence the final version of the policies. So, I think that feedback is really key, and it’s certainly taken very seriously by the working group, and really helps to develop and create a policy that is really workable for our members and ensures that the public is well protected.
Q: What are some challenges or opportunities that physicians might encounter in 2022? What are your goals for your term as President?
I think you know, 2022, we’re hoping is going to be a really exciting year with us coming out of the pandemic. Of course, we sort of probably thought that that was going to be the case for 2021 as well, but I think with you know, the broad use of vaccinations that we’re going to be seeing, hopefully, moving to truly the endemic phase of COVID-19. And, getting back to our regular work, which is very, very important. Unfortunately, we have an enormous backlog of work that didn’t occur during our various slowdowns, and this is going to be very difficult for physicians to not be able to provide necessarily all of the care that they’d like to for their patients. And this has a tremendous impact on physician wellness. There’s a certain moral injury that happens when you know that there’s care that patients need that you may not be able to help them with. So, I think physician wellness coming through two years of tremendous work and burnout. We’re going to be seeing, you know, difficulties with physician wellness and we’re really going to need to support our physician colleagues. So, that’s one area that I’m very committed to.
I think we’re also going to be seeing some very interesting and challenging and important policies that are going to be coming through their final version. So. that will include what used to be the Telemedicine policy but is being renamed as Virtual Care, and we know that virtual care was essential in the early stages of the pandemic, and that we’re facing some challenges now with finding the right place for virtual care as we move forward. Obviously, it’s a very useful tool for physicians and for their patients, but we need to find that right balance that we’re using virtual care in the right way. Also, social media – The College has had a Social Media Statement since 2013, but they’re currently drafting a new policy around the use of social media. And we’ve seen, you know, the tremendous benefits of social media during the pandemic – to be able to pass along important information in a timely way. We’ve also seen some of the downsides of social media around the use of misinformation as well as unprofessional behavior. So, I think these are two very important policies, and the implementation of these two policies will be key next year.