Posted 2021/06/24 & filed under Updates.

The Specialists of BC (SBC) was created thirty years ago to be a forum for all Specialists to meet and share
ideas, successes and problems. The SBC continues to this day serving that function and advocating for
Specialists and their patients.

Although there are many flavours and varieties of specialist physicians and surgeons, we all focus on an
area of excellence, and we see patients on referral from another doctor.

This year the COVID-19 pandemic has radically altered society and our practices. Funding for the
explosion of virtual patient care was an early success promoted by the SBC.

The supply and provision of personal protective equipment was an early problem that we pushed hard to
find a solution for. We were involved in obtaining $1,000 per Specialist to help with reconfiguring offices
and dealing with COVID-19. We continue to advise and follow closely virtual medicine initiatives on our
collective behalf. Even after the pandemic, the provision of virtual care is likely here to stay and, going
forward, funding needs to be present as well.

A new Physician Master Agreement negotiation has started, and we are working hard on behalf of BC
Specialists.

We have been meeting with our family practice colleagues on a number of issues. The mechanism and
frequency of referrals are currently being debated. The BC Family Doctors are hoping to label themselves
as Specialists in Family Care. We believe that family medicine is a cornerstone of medicine. We stand with
them as they seek the recognition they are due without confusing patients, colleagues or government.
There is a lot going on, and the SBC is here to support all of our Specialists. I will be retiring from the SBC
president role as of May 1, and we welcome the SBC’s incoming new president, Dr Chris Hoag – Urology.
Thanks to our Executive Director, Ms Andrea Elvidge, our Council, and the Specialists who support our
work through their dues.

 

Posted 2021/06/24 & filed under Updates.

Pandemic year in review

An eventful year is drawing to a close, though clearly not without problems carrying on to the New Year. The Specialists of BC (SBC) has been very active in 2020. We transitioned to virtual SBC Council meetings because of the COVID-19 pandemic, and our attendance numbers have increased considerably. Avoiding the need for travelling, be it across town or across the province, we are getting more skilled and comfortable with this way of meeting. On the down side, I miss the conversations and networking that happens at in-person meetings. Once COVID-19 settles down, should we consider a mix of in-person and on-line meetings?

SBC has been monitoring the impact of COVID-19 on specialists and advocating for assistance for you. As clinicians, we have moved to mostly on-line appointments with our patients. But when should patient interactions be in-person? The requirement varies among specialties and based on patient presentations. I believe that even post-COVID-19, we are all going to be continuing virtual care as a major component of our practices. Like our SBC Council meetings, it is not the same dealing with a patient on-line or by telephone versus in-person but the efficiency is undeniable for both parties. What is clear is that specialists should not be taking a financial hit trying to adapt to a raging pandemic. The SBC was instrumental in getting rapid approval of virtual fee codes and expanding payment for telephone visits, a legitimate life saver — we have prevented infections while caring for our patients!

The pandemic has also brought with it the need for a whole lot of personal protective equipment. Again, as we struggle to keep us and our patients safe, we should not have to bear the cost of provisioning PPE unilaterally. The SBC has been advocating diligently with the Doctors of BC and Health Authorities. I do believe progress is being made and the government is stepping up to supply the PPE needs of specialists.

Most organizations need to change and adapt over time. The SBC certainly does. We are proactively examining the role, finances and governance of the SBC through our Renewal Working Group to best meet the needs of the specialist physicians and surgeons in BC. We must examine our dues and membership models to ensure we can function effectively. But let’s face it: Where else can all the different specialties talk together about the common and specialty-unique needs of specialists?

I hope you all stay safe and productive in the coming year, and that those of you who celebrate Christmas have a peaceful holiday season. As always, we are here if you have questions, and we hope you will join/rejoin the Specialists of BC for 2021 when you receive your membership renewal package from Doctors of BC this month. 

 

 

Posted 2021/06/24 & filed under Updates.

Your priorities in the pandemic

Like so many things since the beginning of the pandemic, this president’s bulletin is going to be a little different. I’ll be directly asking for feedback on several issues, topics and questions. We can’t help specialists if we don’t know what is happening to you! Please feel free to answer any questions you can in any form that is convenient (call 604-739-1334; email [email protected])

  • Covid
    • Day to day practice
      • On call and backup on call planning (isolation). Asymptomatic doctors (with positive contact) told to isolate for 14 days should be allowed testing if providing essential call services. Though we understand the BCCDC is going to revise for critical service areas which would be applicable to specialists (no symptoms, negative COVID test), we need to hear from you to make a strong case about the impact of these requirements!
      • Is COVID-19 slowing down your practice? Tell us how.
      • Can you get PPE? How are you managing to pay for it if it’s not free from your HA? PPE is six months behind but community physicians will become part of the supply chain soon, we hear.
    • Rise of virtual care
      • How are your patients responding to virtual care? Do they want to see you or are they happy to talk to you through a computer screen or phone line?
      • Many of the telemedicine discussions, including policy and proposed regulations, have thus far been focused on the primary care experience but each specialist group has local, national, and international guidance available for appropriate use. Are you comfortable with the access to and use of specialist virtual care currently?
    • Fee codes/payments If your specialty group is applying for a fee, please let us know. Also please be advised that MOH has signalled strongly that any fee change proposals are to go back to the Tariff process and the temporary COVID-19 fee codes and pre-amble changes will need to be entrenched in a PMA package but are unlikely to be withdrawn or capped in the medium term.
    • New contracts for those affected/interested: We’ve been advised a temporary COVID service contract will be available by the end of 2020 in the form of bridge funding, not a transfer to contract from FFS with the stabilization of income as the goal, not the replacement of incomes to pre-COVID levels. Would such a contract interest you?
    • Planning for second, third and beyond waves – especially ICU, ER, Anaesthesia

Are you aware of future plans? Happy with them? Should specialties support/promote new public COVID-19 strategies?

  • Next PMA negotiations are underway. What are your priorities?
    • Disparities
    • Change or continue negotiation style and strategies: To sustain the physician office the Business Cost Premium (BCP) is one potential model. BCP is a percentage of daily billings (to a daily max) that is added onto your daily fee-for-service depending on the city of practice. Have you noticed a benefit from the BCP? Should the values be increased? Should the cities covered by expanded/changed?Rather than introducing Urgent and Primary Care Centres (UPCCs) that often have not had consultations with local doctors as they go up, government money would be better spent on grants for physician community infrastructure.  It is important to hold space for specialists in the community so we can continue to provide good patient care in conjunction with full-service family practitioners. To that end, we will continue to work as closely as possible with the BC Family Doctors (formerly SGP)

Specialists of BC changes: renewal and support

We’ve been through a lot (including a name change) and it is time to look at whether the Specialists of BC is still relevant. We are forming a Renewal Working Group and would be pleased if you’d care to take part. There will be a modest honorarium, evening meetings and a short-term commitment. Please let us know if you are interested.

Also if you haven’t joined SBC for 2020, there’s still a small window to do so. Log in to doctorsofbc.ca and go to https://www.doctorsofbc.ca/account/sections where you can scroll down alphabetically to find us. Thank you.

 

Posted 2021/06/24 & filed under Updates.

The rise of virtual care

The topic of virtual care, also referred to as telemedicine, has emerged in fits and starts over the past decade. Virtual care promises increased convenience for the patient and potentially the practitioner. It can allow improved access to services for patients in remote and rural areas and with mobility issues. Many specialists across the province already provide a variety of these services and we are seeing best practices evolve.

With the launch of the Telus Babylon app this year, patients can access virtual visits with a GP via their smartphones. The GPs are paid a salary and Telus keeps the MSP billings associated with the visit. In BC, currently, the patient does not pay anything additional to use this service. The public is hungry for this service and utilization rates have increased dramatically. There are concerns that this form of virtual care is amplifying the walk-in-clinic model of episodic care rather than promoting a longitudinal relationship with a family doctor.

In relation to specialists, we have heard from a number of you that referrals are escalating through these services. Specialists have complained that the referrals they have received show very little to no work-up. Oftentimes, no attempt at a physical examination has been documented (understandable given the nature of virtual care), prompting some specialists to complain to the College about this technology and the apparent inappropriate care.

What are your thoughts on virtual care? Is this something that should be covered by MSP (in many provinces it is not)? Should specialists using virtual care be treated differently than in a primary care setting? What should best practices for specialist virtual care look like? Have you experienced inappropriate referrals from GPs about patients seen through virtual care?

Changing the nature of the College

With the release of the Cayton Report earlier this year, there have been a number of discussions by the government about modernizing the regulatory Colleges. The result was a set of recommendations released last month, “Modernizing the provincial health profession regulatory framework: A paper for consultation.” Key recommendations include equalizing the number of public board members to the number of physician board members and moving to a system of appointment by the government, rather than election of physician board members. A body will oversee all the regulatory colleges and be accountable to the legislative assembly. Finally, the disciplinary process will be updated so that it is separate from the investigative process regarding complaints to the College. These changes will also allow the College to disclose publicly limited amounts of information about on-going investigations before they have concluded.

Another major development, which the College of Physicians and Surgeons of BC (CPSBC) was already embarking on, is the incorporation of the 85 podiatrists in BC within the CPSBC. It is not clear if they will be required to follow the same standards that physicians already adhere to, including limiting or prohibiting selling of products and advertising of services.

You can provide your own feedback by January 10, 2020 at https://engage.gov.bc.ca/govtogetherbc/consultation/regulating-health-professions-2/. The Specialists of BC will be preparing a formal submission and welcome any feedback. Also, the Doctors of BC is seeking feedback until the end of this week to inform its submission (https://haveyoursaydoctorsofbc.ca/).

Thinking about issues through a specialist Lens

I am often asked why it continues to be important to support and maintain the Specialists of BC. Our Society is the only BC forum that is specifically for discussing the issues relating to specialist practices. The board of the Specialists of BC consists of a council of 32 specialty sections and our executive. We work very closely with our partners including Doctors of BC, the Specialist Services Committee (SSC), and the Society of General Practitioners (SGP).

We firmly believe that specialists know best what is relevant and important within their own section. However, it is important to have a forum that allows for constructive dialogue to share concerns and ideas. We have heard about and advocated on College issues and how they affect specialists. We engage in discussions about changes in regulations for ICBC and IMEs. We stress the importance of a transparent and responsive system for the development and maintenance of the BC privileging system.  We support efforts to ensure that after-hours work is appropriately recognized and compensated.

In BC there is currently a massive effort to reform primary care. Millions of dollars are being invested in developing and deploying Primary Care Networks (PCNs) and supporting the much-needed work of family doctors, including consideration and development of new alternative payment models.

What about the future of specialist care in BC? What is needed to ensure that we have continued sustainability of our specialist practices? What can we do to ensure that we have supports in improving access, reducing wait-times, and interacting effectively with these new PCNs? What are the potential benefits or risks in considering alternative payment models for specialists?

This year, as you renew your membership dues, you will have the option to opt out of CMA membership and we hope you consider that decision seriously. At the same time, we ask that you reflect on the opportunity to opt in to membership with the Specialists of BC. We also welcome feedback, ideas, and suggestions on how to continue to strengthen the specialist physician experience in BC.  

Posted 2021/06/24 & filed under Updates.

The Work of Specialists of BC Continues…

Thank you for the opportunity to serve as President of Specialists of BC. I am a pediatric rheumatologist practicing primarily in North Vancouver in a community-based clinic. I have a special interest in pediatric sport and exercise medicine.

Over the past four years, I have served as a director at the Doctors of BC and been involved with several of their committees. Dr John Falconer has also welcomed me into the leadership of Specialists of BC and it has been a pleasure to meet such a diverse and passionate group of specialists representing more than 30 specialty sections.

I am fortunate to wear a number of hats, working with pediatricians, rheumatologists, and sports medicine doctors, and I have seen that there are so many issues that we have in common as specialists. The Specialists of BC plays a vital role in creating a forum to share these common issues and to listen to unique vantage points from across the health care system.

Together, we form a network of sections that reaches beyond simply our membership numbers. We have been instrumental in getting the conversation going about specialists’ involvement in the Patient Care Networks (PCNs) and raising concerns about College standards and guidelines that sometimes overreach.

As we enter into this new Physician Master Agreement (PMA), and with the government’s focus on primary care reform, it remains critical that specialists are not forgotten. I have seen how specialists support our colleagues; however, it is incumbent on us to define our own priorities and advocate on behalf of our patients and each other.

We can further engage with and support the Specialist Services Committee (SSC) to ensure that its work reflects issues that are important to specialists. We can participate in the Representative Assembly (RA) so that a strong voice of specialists is present.

We can continue to mentor and support new specialist leaders to get involved with critical organizations such as the Specialists of BC, Doctors of BC, and the sections. We can encourage our specialist colleagues to participate in Facility Engagement activities and Physician Quality Improvement projects.

If you, or one of your colleagues, is interested in getting involved or sharing your priorities with us, please get in touch with me

Community Specialists

Over the past year there have been efforts to reach out and engage with specialists who are working primarily in the community. This group of physicians tends not to be directly involved with Facility Engagement and other facility-based projects. However, they are an integral part of our health care system.

The SSC is recognizing the valuable contributions of community-based specialists. Earlier this year, the SSC-funded Specialist Symposium was an opportunity to listen to specialists from facilities and communities across BC. We are pleased that a second Specialist Symposium in 2020 will build on this success.

As the PCNs roll out, it will be important that specialists are engaged at the local level. The new PMA has particular provisions to support specialist practices outside of facilities by introducing, in 2020, the “Business Premium” (3-5% top-up of daily fees to a maximum of $60/day), depending on practice location.

The recognition of the “business cost” of community and private practice is a step in the right direction, albeit a modest one. We hope that SSC-supported initiatives such as PQI and Physician Leadership development will increasingly become accessible to community-based specialists.

Does your Section have a group of specialists primarily practicing in the community (outside facilities)? If so, let us know as we try to understand better how we can support this growing practice environment.

“A rose by any other name would smell as sweet….”

Or so the College of Physicians and Surgeons of BC seems to believe when it released its proposals for standards relating to “Procedural Pain Management.”

The College felt that there was a strong need to further regulate physicians providing “interventional pain” services. However, they have labelled certain procedures as being “pain management” procedures rather than simply procedures that may have multiple indications.

For example, the proposed draft standards indicate that glenohumeral joint injections are a “pain management” procedure requiring regulation and image-guided injection in an accredited facility.

Several sections have raised concerns with these proposals including the BC Society of Rheumatologists which pointed out that a shoulder injection has indications beyond pain management, such as anti-inflammation.

 This procedure has been done safely for decades in community-based clinics and in some of the most immune-suppressed patients out there. This case illustrates the pitfalls of relying on “expert” committees that may not include the appropriate stakeholders and often come up with recommendations that don’t seem to be supported by peer-reviewed evidence.

Hopefully the College will revise these proposals based on the feedback that has been submitted. It is an important reminder that specialists are content experts for the populations they serve and we hope the College will be careful to regulate for appropriate risk rather than restrict the scope of legitimate practice.

The College continues to be most interested in hearing from individual physicians so I encourage you to keep an eye out for opportunities to provide feedback on College proposals. This feedback can be based on issues that affect you or your section directly or in support of your physician colleagues.

Did you know?

The Specialists of BC is separate from the SSC and the Doctors of BC, though we work closely with both.  We’re a registered non-profit society working for the specialist doctors of the province since 1990, and we rely on your dues to do this work. If you want to support specialists, please join the Specialists of BC now https://www.doctorsofbc.ca/account/dues

Posted 2021/06/24 & filed under Updates.

Physician Master Agreement drafted

As you know, Paul Straszak, the Doctors of BC chief negotiator, has drafted a tentative Physician Master Agreement with the government. He has presented this agreement in detail to the Specialists of BC Executive, and at a recent section heads forum. 

It does seem this is the best contract that any of the other provinces have been able to craft with their governments. 

No agreement will ever be perfect, but I think that within today’s economic and political climate, it is as good as we are likely to get. It does address as many concerns as possible that were raised by the various sections.

We at the SBC support the tentative PMA agreement, and encourage your support as well in ratifying it.

Posted 2021/06/24 & filed under Updates.

Specialist’s Symposium a Success

The first ever Specialists’ Symposium was held on January 18 and 19, 2019, presented jointly by Specialists of BC and the Specialist Services Committee (SSC).  There were around 200 participants from most sections, the Ministry of Health (MOH) and Doctors of BC. We had small-group discussions on patient access to specialist care, improving patient flow, Patient Medical Home/Primary Care Networks, physician wellness, SSC initiatives, virtual and team-based care, MOH surgical strategy, chronic and complex patients and digital health strategy. In the afternoon a full-group discussion identified and discussed key issues for BC Specialists.

On the second day, Dr Evert Tuyp presented on income disparity. There has been widespread interest from BC Specialists in reducing the income disparity between us. However, it is really difficult to even measure disparity. One idea is to add “error bars” to incomes to mitigate unknowns such as hours worked. We’ll share more about this approach in the future.

Dr Falconer highlighted the “Model Office” being developed by the Doctors of BC. This model may be a way to track overheads between us more easily. More to come on this topic too.

We have had great feedback from the symposium, and hope to see this event become annual.

Practice Tip: MOCAP Review

The final report of the Provincial MOCAP Review Committee (PMRC) on implementing the redesign recommendations revealed about 85% of on-call groups will stay the same, while the remaining groups are equally split between going up or down.

The PMRC surveyed on-call statistics, and judged intensity as well as frequency. Not everyone will agree with the results but hats off to the committee for approaching this thorny issue objectively via consultation. Once any appeals are resolved, the health authorities (HAs) will be asked to implement the report. The HAs have the final say about whether a group is “needed” for call, but there is a dispute resolution process.

Patient Care Networks (PCNs) and Specialists

The Specialists of BC has a working group composed of section and Representative Assembly reps exploring the interaction of specialists with the PCNs that are being rolled out. These discussions have helped inform SSC and GPSC of issues about PCNs that are important for specialists. Dr Shelley Ross, co-chair of GPSC, recognizes that specialists feel that it is very important that they have a voice in decisions being made around PCNs.

Specialists are also in favour of being able to refer their unattached patients to a PCN as many specialists find themselves with patients who do not have an appropriate primary care provider.

Have you heard about PCNs starting in your community? Do you think a process to support specialists referring patients for attachment to primary care would be beneficial?

Including support for sections and societies with Doctors of BC membership

The Representative Assembly meeting on February 1, 2019 included a debate on incorporating section and Societies support into Doctors of BC membership dues, with Dr Falconer (pro) and Dr Trina Larsen-Soles (con).

The sections and Societies do a good deal of work for all members, but not all members contribute to funding them. If Doctors of BC dues included support automatically, costs would decrease from $500 to $750 per year per doctor to about $250. Membership in the sections and Societies could still be voluntary but at no cost.

Doctors of BC relies on all doctors contributing to the costs of the broad range of support we receive, either through annual membership dues or non-member administrative fees. Section and Societies support through Doctors of BC would ensure this fairness for them as well.

Did you know?

The Specialists of BC is separate from the SSC and the Doctors of BC, though we work closely with both.  We’re a registered non-profit society working for the specialist doctors of the province since 1990, and we rely on your dues to do this work. If you want to support specialists, please join the Specialists of BC now https://www.doctorsofbc.ca/account/dues

The Specialists of BC/SSPS Annual General Meeting is being held the evening of Thursday, April 11, 2019 in Vancouver for members. Mark your calendar and stay tuned!

Posted 2021/06/24 & filed under Updates.

What is extra billing?

The government of BC has decided to enforce legislation that bans extra billing. What does that edict mean? The federal and provincial government mandates that as medical practitioners, we cannot charge patients more for a medically necessary service than would be paid by MSP. Billing MSP at the current rate and then charging patients an extra amount is double billing and has always been illegal. However, private clinics and imaging centers have been operating for years in BC. In this case, a patient is charged whatever fee the private center charges, but no billing to MSP takes place. This approach has allowed some patients to expedite their assessment or treatment. The government buys medical services from some private clinics for WorkSafe BC, for example, albeit outside the MSP budget.

Clearly any emergency medical need in BC is dealt with immediately. Here we are talking about people with non-emergent problems who don’t want to wait for public resources.
Some argue that allowing patients who wish to pay privately for services may free up public resources for those who do not. Others argue that this loophole allows government to under-fund resources, or that it means some patients who can afford it may get faster care than others. If the ban on extra billing stops any private care, what happens to wait lists? I think the government had better be ready to handle the outcry as public waitlists climb when private clinics cannot assess or treat anyone. What do you think? Please let me know.

When do you want your $10,000 this year?

The Specialist Services Committee (SSC) offers funding of up to $10,000 per physician in leadership training scholarships to cover tuition and travel costs. Certificants or fellows of the Royal College of Physicians and Surgeons of Canada practicing in BC can be funded for programs offered by recognized academic institutions, professional bodies and/or quality improvement organizations, with preference given to programs reflecting Canadian context.

Specialists symposium 2019: Get together with your peers

The Specialists of BC and the Specialist Services Committee are in discussions with the Ministry of Health to co-sponsor a “Specialists in BC Symposium” early in the new year. This gathering could be an opportunity to:

• clarify what and how specialists practice in BC
• share telehealth experiences by BC specialists
• define a role for physician extenders
• identify which specialists could work with our GP colleagues in the Patient Medical Home model
• investigate whether there are areas where we could work more efficiently, without asking for more money
• look at recruitment and retention issues and fixes for BC specialists
• what is working in other jurisdictions

There may be many more ideas worthy of inclusion in our symposium. Feel free to share things you would like to discuss!

Priorities for Specialists Services Committee?

The SSC created the telephone consult codes (10001 etc) which have been really great for encouraging communication between us and our GP colleagues. Do you think the telephone codes and other SSC fees need more work? Are you okay with the restrictions that were placed to contain costs, or do we need to prioritize removing or changing them? What are other ways we could utilize funding to improve care? I’d like to hear from you!

Join the Specialists of BC today and receive $100 off your dues

Be part of the Specialists of BC for 2018! Go to https://www.doctorsofbc.ca/
account/dues to get your $100 discount on dues. The reduction will be applied automatically when you select your membership category. Thank you for supporting the Specialists of BC.

Posted 2021/06/24 & filed under Updates.

Who will be leading the Doctors of BC next year?

There is an election being held NOW for this year’s President-Elect of the Doctors of BC. You should have received a link to a ballot to vote on Friday, April 13 from Everyone Counts Canada. You can vote until May 14, 2018. There are two candidates running. The first is Dr Kathleen Ross, a family practitioner in Coquitlam. Dr Ross is a solid choice but I can’t help noting that it has been four years since our provincial medical organization has had a specialist president, and that the Doctors of BC has only had seven specialist presidents in the past 20 years, with another GP incoming in June.

The other candidate Dr Lloyd Oppel is an Emergency Medicine physician who is our Council of Specialists chair, and is on the new Doctors of BC Board, as well as having served there previously and in many other capacities for the profession in the past twenty-plus years. Lloyd’s unique perspective, in addition to the many contacts he has within the specialist community that he is an integral member of, and within the GP community, and the wealth of knowledge and experience he brings to the table will be particularly welcome in this, a negotiating year.

Whoever you decide to support, please be sure to vote, and urge your colleagues to exercise their right to choose a president-elect.

Practice Tip

One complaint we hear from patients is about the “black hole” that referrals to specialists go into. Their GP may advise a specialist’s consult to help in their care, and then send a referral letter to a specialist. But then what? Unfortunately, many of us have a significant waiting list. As we try to work through it, how many of us let the referring doctor and patient know when they might expect an appointment? If you are not doing this, perhaps it is time for you to consider a system change in your practice. Don’t let specialists be the booking black hole.

Specialists of BC and the Specialist Services Committee (SSC)

The Specialist Services Committee (SSC) is about to start developing their next three-year strategic plan. The SSC is a tripartite committee consisting of the Ministry of Health, the Health Authorities, and the Doctors of BC. The Specialists of BC believes the new plan is an opportunity for all specialists to engage with the SSC through the Specialists of BC. The Specialists of BC is looking to form an energetic new partnership with the SSC. We are going to be at the committee table, to help take a leadership role in providing specialty care for our patients and ensuring the right kind and right number of specialists are where they need to be. We want to work with the Ministry and Health Authorities to co-develop new ideas. We need to be sure that specialists are provided with the resources and incentives they require to provide the very best care for BC citizens. Perhaps at the SSC what has been missing is the specialists of, and in, BC? Let’s pull together with the SSC and make it better.

Patient Medical Home

This project is one of the Ministry of Health’s objectives, working with our General Practice colleagues and their patients to create family practices supported to operate at their full potential, integrated into the health care system. As this initiative is being explored, we feel the Ministry should also be asking what it means to specialists. What is our role? How can we help GPs and patients interact more easily in the system? We need to be working with general practice at the start, not coming in at the end. Getting involved with the GP Home is but one of many ways we can support our members. You will be hearing more about this topic from us…

Posted 2021/06/24 & filed under Updates.

What will the new Representative Assembly talk about?

The Doctors of BC new governance structure has come into effect. On September 15, 2017, the Doctors of BC board of directors met, reduced from more than 40 members to 9. The 103-member Representative Assembly (RA) – made up of 35 specialty section representatives, 34 GP representatives, and more than 20 district representatives and others met for the first time the day before. In this all-day meeting of the RA, 10 minutes were allowed for the RA to bring up any issues. So, what did they say? They passed a resolution requesting another RA meeting before the next scheduled one in the February to talk about such important issues as:

  • creating an agenda committee
  • having observers from the RA on the Board
  • automatic section and society membership
  • impact and strategies around the mid-term review of the Physician Master Agreement
  • review the Committee structure of the Doctors of BC
  • work of Divisions integration into Doctors of BC
  • UBC having observer seat
  • review regional problems, e.g. Nanaimo computer order entry issues
  • review lack of GPs, mix of specialists
  • deciding on moving forward with committee reports
  • follow up of committee reports
  • how much of board agenda and reports go to RA
  • react to college issues

Since the newly elected Doctors of BC Board had their first meeting the day after, members may not have had opportunity to consider the RA resolution for another meeting fully. Let’s hope future RA meetings have more time for discussion.

Phone Consults

There is a fee code (10001) for specialists responding within 45 minutes to a request from another doctor for telephone advice. SSC fee codes such as 10001 require some documentation. Our Neurology group has found that dictating even a brief note helps to document the call and support billing, while providing tremendous communication for medical care of each patient. Wouldn’t you love to see in writing what your colleague had to say about a patient that they did a short telephone consult on? Next time you are giving some phone advice, take a minute and dictate a note.

Why should specialists care about the dramatic shortage of GPs in BC?

Recently, I have been supporting a BC Interior community and catchment area neurology service via Telehealth in their time of need. Much to my surprise, up to 50% of these patients have no GP. I have neither the experience nor skill to manage their general care, and yet here I am. These patients have to scramble for a walk-in GP appointment, plead for refills of their other medicines, and have no one to supervise their total care. As a consultant, I rely on family doctors to be involved in longitudinal care, even more so when I am doing a video conference from a distant community.

What is the long-term plan for family doctors? Specialists in general, and the Specialists of BC in particular, would be happy to try to support the Doctors of BC and Ministry of Health in any way we can.

The Overhead and Income Study

Since spring we have been offered an opportunity to participate in a randomized study of our overheads and income. A few sections have had a good participation, but unfortunately quite a few sections have not. The overhead study committee is still hoping that post-survey analysis may correct for a non-participation by some sections and some doctors. We certainly have concerns that non-random lack of participation may make decisions based on this study very difficult. We’ll have to wait and see…