Posted 2022/08/19 & filed under Uncategorized.

Dear Specialist Colleague:

Winter is over, the flowers are up, COVID restrictions are easing, and our minds are starting to drift to summer plans! The Consultant Specialists of BC (cSBC) continues to work on your behalf to advocate for BC Specialists, our working conditions and our patients. Please read on for updates on key issues affecting your practice.

Economics Policy Advisory Committee (EPAC) – in conjunction with Doctors of BC Economics, this committee is taking an in-depth look at financial matters affecting Specialists. Disparity assessment remains an important issue for many Specialties. EPAC has been meeting monthly to craft recommendations for consideration by our Council (Board of Directors) to assist in the disparity award process in the upcoming Physician Master Agreement.

Referral systems We continue to advocate for creating a referral system that works for all stakeholders – patients, referring practitioners, Consulting Specialists, and MSP. The existing system is antiquated, administratively burdensome, and out of touch with the realities of present-day practice, especially the multidisciplinary collaborative care required by BC’s most complex patients. We hope to have more to update you on in the early fall.

cSBC renewal We are implementing changes recommended by the 2020/2021 Renewal Working Group (RWG) to modernize cSBC and ensure a sustainable organization that provides balanced representation for all Specialties. Accordingly, two bylaw amendments will be brought to the AGM for consideration. The first permits virtual meetings and updates terminology. The second reflects the voting changes recommended by the RWG for Council meetings, which would allow each section one vote and restrict Executive members to tie breakers.

Specialist terminology You will have noted the latest CPSBC call-out for Specialist feedback regarding the use of the Specialist terminology (https://www.cpsbc.ca/about/laws-and-legislation/bylaw-amendments/section-7-4). The College has been clear that they want to hear from individual Specialists and patients on this issue. cSBC had not been in favor of these changes. Deadline for your feedback is May 10, 2022.

Website The initial refreshing of the website is done. The Executive is considering future expansion of the website to serve as a resource hub for medico-political and other useful links for practicing Specialists. If you want your picture on the homepage, we welcome high resolution photos of you at work.

Physician Master Agreement Doctors of BC and government are now actively engaged in negotiation of the next PMA. Negotiations remain confidential until a tentative agreement is reached. We hope to have an update from Paul Straszak, the chief negotiator, in the next few months.

Committee positions Click the links and/or email [email protected] for more info:
Doctors of BC Council on Health Economics and Policy (CHEP) cSBC representative: we need three nominees by May 10, 2022 https://www.doctorsofbc.ca/news/opportunity-join-us-help-shape-future-policy
Tariff Committee applications due May 10, 2022 https://www.doctorsofbc.ca/committee/tariff-committee

Kind regards,

Dr Chris Hoag

Posted 2022/08/19 & filed under Uncategorized.

Dear Specialist Colleagues:

Hard to believe that the fall is nearing an end and a new year is almost upon us! I wanted to update you on the work that Consultant Specialists of BC has been doing on your behalf since the last snapshot.

What we’ve been working on:
• Specialist nomenclature – As you know, BC Family Doctors (BCFD) has been lobbying to utilize the term Specialist when referring to themselves and their credentialing. We have concerns about this blurring of terminology and feel that it is neither in the interests of the profession nor patients. The College has proposed bylaw changes that would permit Family Physicians to refer to themselves as “Specialists in Family Medicine” but would not allow them to utilize the terminology of Specialist in isolation. BCFD has requested that physicians should specify what type of Specialist they are, effectively rendering the term ‘Specialist’ meaningless as a differentiating term which quickly and clearly delineates differences in training and scope of practice between Specialists and Family Physicians. It is now critical that the College and Ministry of Health hear your individual voices.

Please write to the College at [email protected] and to the Ministry at [email protected] by January 15, 2022 about the proposed bylaw changes as they value individual over institutional feedback from doctors. The College website has more information about the proposed bylaw change.

• Consultant Specialists of BC renewal
o Rebranding – In September, we officially rebranded from Specialists of BC (SBC) to the updated Consultant Specialists of BC (cSBC).
o Website upgrade – We have begun the project of updating our website. Many of the navigation links have already been updated. The next step is an updated homepage that is more reflective of the diverse work that we do as Specialists. We want to create a collage of BC Specialists at work for our homepage. We need photos of you! Please send photos of yourselves in your work gear to [email protected]
o Communication with members – via these regular snapshots we continue to endeavour to keep you informed!
• Uninsured patients – We are actively lobbying to ensure physicians are paid for the care that they provide to uninsured BC patients. The cost of this care should be borne by government and should not be placed on the backs of physicians providing care.
• New fee item application delays – We are seeing unprecedented delays with MSP processing new fee item applications. Most concerning are the delays in processing the applications requesting funding from the New Fee Item Fund for which $1 million per year of targeted funding was negotiated in the 2019 PMA. The delays in processing these applications have effectively resulted in monies negotiated for Specialists in the last PMA being withheld. We are lobbying to address the backlog of applications and ensure that monies negotiated in a PMA for Specialists are paid to Specialists in a timely manner.
• Re-referrals – The re-referral system and related billing parameters have been problematic for Specialists and Family Physicians alike for many years. A report released by the Consultation Working Group has brought this on-going issue to the fore. In recent weeks, we have heard from many of you with concerns. We know that Specialist physicians work earnestly and tirelessly to provide high quality care, including intermittent longitudinal care, to BC’s most complex patients. We are working on an approach to address this issue that will be more workable for all physicians while maintaining income neutrality and reflecting the important collaborative care that Specialists and Family Physicians have always provided to BC patients. In the meantime, it must be clearly understood that re-referrals are still required for patients who have previously been referred to a Specialist, consultation has been provided, and the patient has been discharged back to the Family Physician, even if the repeat referral is for the same issue.

Other news:
• Specialist symposium postponed – The second co-sponsored SSC-cSBC Specialist Symposium that was planned for January 29, 2022 has been postponed. In light of the ever-changing pandemic it was felt that an in-person meeting of this magnitude was not prudent at this time.
• Doctors of BC Leadership – We learned recently that the Doctors of BC Board of Directors has voted for a change in Chief Executive Officer. We will continue to monitor this situation and wish to thank Mr Allan Seckel for his many years of service. We also wish to extend our thanks to Dr Matthew Chow, retiring President of Doctors of BC, who has led our profession with incredible dignity and poise. We welcome our incoming Doctors of BC President, Dr Ramneek Dosanjh, and President-Elect, Dr Joshua Greggain.
It has been another difficult year for the world. We have seen hardship and heartbreak in our province, but at the same time resilience and acts of kindness and humanity. Wishing you all good health and good fortune for the year to come. We will continue to work on your behalf and will keep you informed.

Kind regards,

Dr Chris Hoag

Posted 2022/08/19 & filed under Updates.

Specialists of BC is the unifying organization representing and advocating for all specialists in the province. Despite summer vacation season, your SBC has been working hard on your behalf.  Here’s a quick snapshot of what the SBC has been doing for you over the summer:

  • Council of Specialists Meeting Planning – We have a great lineup of speakers and topics for discussion at the September 30 COS Meeting, including attendance by Deputy Provincial Health Officer, Reka Gustafson, and a visioning discussion on the future roles of the EPAC (formerly DDOWG).  Don’t miss it!
  • Maintaining current Telehealth Billing provisions – Many will have read the joint CPSBC/MOH/Public Health letter and Matthew Chow’s follow-up Doctors of BC President’s Report.  SBC will also be responding and continuing to advocate to maintain current telehealth billing provisions post-COVID, including maintaining pay parity with in-person visits.
  • Protection of Specialist Nomenclature – lobby to protect Specialist nomenclature for the benefit of patients and physicians is ongoing.  The CPSBC is convening a committee to review this and we will continue to engage in this discussion.
  • Specialist Symposium Planning (Save the date: January 21, 2022) – thanks to Danny Mendelsohn (Neurosurgery) for representing the SBC on the planning committee
  • Ongoing engagement with Pathways to ensure a strong Specialist voice in the development of this proposed referral system including integration with specialist EMRs and lobbying for better specialist representation on the Pathways BOD – thanks to Dana Wong (Otolaryngology) and Frank Ervin (Respirology) for putting their names forward.
  • Revitalization of the DDOWG – new name for the committee is the Economics Policy Advisory Committee (EPAC) – new Terms or Reference to be discussed at Sept 30 COS meeting
  • Nominees submitted for the Worksafe BC PMA Committees – Thanks to Elliott Weiss (Physiatry) and Alastair Younger (Orthopedics) for stepping up.
  • Updating of Website – ongoing; stay tuned for a more navigable informative website including a summary of what the SBC is and why specialists should join.
  • SBC Renewal Project –we need to ensure a sustainable SBC financial model.  The Renewal Working Group has recommended that the dues be spread across all specialists for whom the SBC advocates.   This has been termed the “Doctors of BC Collection Model”, whereby nominal annual dues ($80) would be collected at the time of Doctors of BC membership renewal.  We are currently collecting letters of support from sections to assist with this initiative. If your section has not yet submitted a letter of support, please contact Andrea Elvidge [email protected] to request the template letter for your section.

As always, be sure to reach out if you have any questions for us and we are always looking for people who want to be more involved. Let us know. Contact: [email protected]

Stay well,

Chris Hoag, President

Posted 2022/08/19 & filed under Updates.

Dear Colleagues,

 

I would like to begin by thanking Dr. John Falconer for his five years of service as President of the Specialists of BC.  I am honoured and humbled to take over from him as your new SBC President. During my time in this role, it is my goal to foster an organization grounded in the principles of inclusion, collaboration, transparency and balance of representation across the diversity of specialties in the SBC tent.

 

As we emerge from the pandemic there are many issues facing Specialist care: the future of virtual medicine, post-pandemic PPE requirements, surgical catch-up, to name a few.  Collective advocacy will continue to be essential for Specialists and the SBC will continue to provide this.

 

There has been a recent push by BC Family Doctors to have family physicians recognized as specialists themselves.  With their unique training and expertise in primary care and a knowledge base which covers the daunting breadth of medicine, our colleagues in family medicine deserve to be celebrated and respected.  The proposed extension of the ‘specialist’ nomenclature to family physicians is an avenue they see to fostering this recognition.  There is concern, however, that this change risks introducing confusion to the general public, licencing authorities, and the government. This situation and the related significant implications is an illustration of the necessity for Specialists (as we have been traditionally known) to have a strong counter-balancing organization of our own.  Our influence is lost if we fracture into our individual specialties without the cohesive voice of the SBC.   The SBC needs to remain a strong society to promote the interests of both Specialist physicians and those of our patients.

 

That being said, we are currently at a cross-roads in our organization, with leadership change and a tenuous membership/financial model which is in need of change if we are to remain viable.  We have a lot of work to do over the next couple of years to revitalize our organization. I am confident, however, that with a collective and collaborative effort we can renew the SBC to ensure it remains a prominent and sustainable voice for Specialist care in all of its many forms.

 

Although I take on the job as your President with some trepidation, it is also with optimism and a hope that we can all recognize each other’s value and respect each other’s training, sacrifice, and dedication to a calling which is truly honourable and humbling – caring for each other.  I look forward to working with all of you to guide the SBC through this period of renewal. 

 

Please reach out any time and if you wish to be more involved in the SBC, let us know!  The SBC runs on your engagement!

 

Wishing you all a well-deserved restful summer. 

 

Respectfully,

Dr. Chris Hoag

MD FRCSC

President, Specialists of BC

 

Below is a summary of some of the highlights of issues that your Executive is currently working on:

  1. SBC Renewal: The report from the SBC Renewal Working Group (RWG) was endorsed unanimously by specialty groups at the April 29 Council of Specialists meeting. The Executive is now beginning the work to implement its multiple recommendations.  Regular updates will be provided to Council as a standing item at Council meetings during this process.  A highlight of the RWG recommendations include:
    • New membership collection model designed to decrease individual dues while diffusing the costs across the breadth of specialists for whom the SBC advocates
    • Lower barriers to meeting attendance by maintaining virtual meetings once COVID subsides; as of February 2022, we will alternate in-person and virtual Council of Specialists meetings
    • Increased meeting relevance – in addition to the traditional format of presentations from other organizations, we will have task-oriented discussions on topics of concern to specialty groups as a regular part of Council meetings. As an example, the next SBC meeting in September will include a discussion on what the roles of the Disparity Data and Overhead Working Group (DDOWG) should be going forward.

 

  1. DDOWG Revitalization: The DDOWG will become a standing committee with balanced representation from medical/surgical/diagnostic specialties. A new name, updated terms of reference and regular reporting requirements to Council will be introduced, while the power to endorse recommendations of the new committee will remain with Council. In addition to addressing inter-sectional disparity, this committee should also inform the allocation process between family doctors and Specialists and other economic issues, such as the gender pay gap and full-time equivalent (FTE) definition.

 

  1. “Specialists” in Family Medicine: Many of you will be aware of the recent collaboration by BC Family Doctors and the College of Family Practice of BC to rebrand family doctors as “specialists in family medicine.” The expressed motivation behind this effort is to raise the profile of and increase respect for family doctors. Your Executive has concerns about this development including:
  • Lack of consultation with Specialists
  • Contravention of College of Physicians and Surgeons of BC (CPSBC) bylaws which prohibit family doctors from referring to themselves as ‘specialists’
  • Potential confusion by the public
  • Possible misrepresentation of qualifications (consider the family physician with an ‘area of interest’)
  • Future funding implications of this nomenclature change

Over the last three months, we have engaged with the CPSBC to ask for their position on this development and to express our concerns, underlining the importance of maintaining the distinction between Primary Care/Family Practice and Consultant Specialist care.

 

  1. Other ongoing advocacy: We continue to advocate for clear personal protective equipment (PPE) guidelines as we begin to emerge from the pandemic and as provincial health orders pertaining to PPE begin to relax. We also need to keep pace with the communication codes that our family doctor colleagues enjoy. We will continue to engage with our partner organizations on these issues.

 

Posted 2022/08/19 & 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 2022/08/19 & 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 2022/08/19 & 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]stsofbc.org)

  • 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 2022/08/19 & 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 2022/08/19 & 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