Interview with Dr. Sam Benaroya  

Role

Interview with Dr. Sam Benaroya, RUIS McGill Coordinator
Source: in Focus, Faculty of Medicine Newsletter
Spring 2005 issue

The Faculty of Medicine at McGill has assumed a much higher profile in the delivery of health care in Quebec. The provincial government’s new Réseau Universitaire Intégré de Santé (RUIS) plan divides the province into four geographic regions – to be served by McGill and the Universities of Montreal, Sherbrooke and Laval – with tertiary services, education and research coordinated by each university’s faculty of medicine and its associated teaching hospitals. “We are taking on major new responsibilities,” says Samuel Benaroya, BSc’73, MDCM’75, McGill’s Associate Dean, Inter-Hospital Affairs, and the Faculty’s RUIS coordinator.

The goal of the plan is to improve access to health care by streamlining relationships between primary care providers – doctors and regional hospitals – and upper level care providers for specialized procedures. To organize primary care services, the government divided the province into 95 local networks (réseaux locaux), each with a “centre de santé.” For more specialized care, the local networks would have an agreement with the faculties of medicine and the teaching hospitals; for McGill, these include the McGill University Health Centre (MUHC) as well as the Sir Mortimer B. Davis Jewish General, St. Mary’s, and the Douglas Mental Health University Institute. RUIS McGill  includes central and western Montreal, the western part of the southshore, Outaouais, Abitibi, the Cree territories, Nord du Québec and Nunavik, and will support a population of 1.7 million. The RUIS McGill’s leadership alternates every two years between the Dean of Medicine and the Director-General of the MUHC. Dr. Arthur Porter, Director General of the MUHC, is the current chair.

“Under the present system, the healthcare provider can experience a lot of frustration in the process of transferring a patient to see a consultant, or have a procedure done,” says Benaroya. For patients in remote regions, the RUIS system provides more direct access to the kind of specialized care provided by the MUHC. To meet its new clinical responsibilities, McGill has created an inventory of the tertiary clinical services offered by its teaching hospitals. “Local network partners would see what they could do; anything they couldn’t manage could be sent to the RUIS McGill,” says Benaroya. “Theoretically, the universities provide upper level care, but everything interacts. We’re developing contacts with our partner institutions in the local networks, some of which are new to McGill,” Benaroya says. “And we’re planning a network development office, with something like a ‘1-800-McGill-RUIS’ number; the whole point being to simplify communications.” Students and residents will also notice changes under the RUIS initiative. The government is pushing for more rotations outside of Montreal at both undergraduate and postgraduate levels, in the hope that, by experiencing a non-urban milieu, young physicians may be encouraged to practice there later. Under the new plan, 30 percent of the rotations in family medicine and 15 percent in basic specialties, such as internal medicine and general surgery, will be in outlying regions. “This is a big challenge, as there may not be an infrastructure to meet the educational requirements in some of these settings,” says Benaroya. “So we're building on the regional rotations we already have, such as our family medicine unit in Gatineau. Another option would be to develop hubs with a variety of special-ties, where students at different levels of experience could work together.” Of course, the University must ensure that education received in these hubs meets the objectives of the training programs, and that proper faculty development programs are in place.

Technology will play a critical role. There is already a telehealth program in place, providing a long distance means of communication, diagnosis and treatment, which can be used for both clinical work and education. “And because technology is developing so quickly, we can be creative in this area,” says Benaroya. “Our RUIS McGill Telehealth committee is very busy these days.” The Faculty is also planning to make the library’s electronic resources available at the regional sites.

The RUIS system will entail certain research responsibilities. “Fortunately, research is extremely well developed at McGill,” Benaroya says. “We already have close links with the other faculties.” There will also be potential for McGill to place more research teams in regions, and to forge links with regional partners. As David Eidelman, MDCM’79, Chair of the Department of Medicine, says, “Some of the remote regions include populations that have high rates of diseases like tuberculosis, or have inadequate access to health care. The RUIS provides opportunities to make important contributions in learning how to deliver care to those populations, and also in understanding how certain circumstances may result in difficulties for the population.”

The changes coming with the RUIS will affect the University’s clinical, educational and research activities, and will increase McGill's role – and responsibilities – in the province's medical community. “It’s a big challenge,” says Benaroya. “But it’s also a good opportunity to make a difference.”