March 2024

cSBC President’s Letter – March 2024

Dear cSBC members:

I hope you have enjoyed the winter holidays with your family and friends. Despite the fun winter festivities, I am looking forward to longer days and warmer months. It is hard for me to believe that it has been ten months since I have accepted the position as President for cSBC. It is an honour to represent Specialists from all parts of British Columbia. I have had many wonderful one-to-one discussions with Specialist Physicians across the province. I have met many physician leaders at the Representative Assembly, Doctors of BC Board Meetings, “Better Together” quarterly meetings, Digital Health and EMR meetings, Specialist Symposium and Team-Based Care meetings. I am in awe of the many great things that Specialist Physicians do on a day-to-day basis to provide adequate care to patients despite the ongoing healthcare crisis.  I look forward in 2024 to engage with more Specialist Physicians and to find ways to help advocate for improved Specialist Physician health and wellbeing.

The last few months have been busy at cSBC. We have been advocating for Specialist Physicians in the following ways:

• We are currently involved in Specialist deliberations with the Ministry of Health (Mark Armitage and Steven Brown) and Doctors of BC (Dr Sam Bugis, Dr Ahmer Karimuddin, Anthony Knight, Paul Straszak and Jim Aikman). We have made progress with agreement on Specialist waitlist management principles and associated fee codes. Due to provincial government budgetary estimates, meetings with MOH have been postponed until April 2024.
  • Doctors of BC (Dr Sam Bugis) and cSBC are planning a “Virtual Specialist Forum” on April 4, 2024 to inform and elicit feedback from Specialist section heads and Specialist leaders in regards to our discussions with Ministry of Health (MOH) to date.

• We are undergoing changes within cSBC by way of strategic and succession planning to make cSBC more relevant to Specialist Physicians in our current healthcare climate.
  • We are in the process of hiring a new cSBC executive assistant and project coordinator to expand our staffing team.
  • The cSBC Executive Committee has passed a motion to amend our bylaws to increase the number of Executive Committee positions to allow for improved leadership succession planning.

• As per the last PMA, cSBC was adjudicated a $15M New Fee Item Fund (NFIF) for Specialist Physicians. The cSBC Economics Policy Advisory Committee (EPAC), chaired by Dr Chris Hoag, has submitted applications to MSP for the following new fees 1. Text Messaging Advice, 2. Specialist Call Initiation for Patient Care Coordination, 3. Removal of Surgical Surcharge Caps, and 4. Utilization of Translation Services.
  • We sent these fee code applications to MSP in June 2023. Correspondence back has been slow. In October 2023, we met with MSP to answer many of their questions regarding these new fees. We recently received several follow-up letters with more questions pertaining to cost and implementation and responded to each of these letters. It is our hope that we will be able to work through the remaining process in the next few months and we will update you as soon as we have reached a conclusion.

• We are currently collaborating with Specialist Services Committee (SSC) members (Dr Jason Kur, Dr Tommy Gerschman and Adrian Leung) on Specialist Team-Based Care. The goal is to expand the option of Team-Based Care to all Specialist Physicians in BC.
  • I was invited to the Specialist Team Care (STC) Outcome Congress on March 4, 2024 in Vancouver. Many of the Specialist teams presented their outcomes at this event. The underlying themes from these presentations were that Specialist team-based care reduces physician burdens and increases patient access to Specialty Care. Many of the teams also expressed the importance of mentorship, physician autonomy and funding of allied health workers to allow the sustainability of team-based care in Specialist community practices.

• Doctors of BC Board Meetings: The Board chair and vice chair, Dr Elizabeth Swiggum and Dr Adam Thompson, have extended invitations to cSBC, BC Family Doctors and the Joint Collaborative Committees leaders to attend the board meetings and “Better Together” quarterly meetings for 2024.
  • I have attended all the invited board meetings and quarterly meetings in the last few months. I have found that these meetings have been very informative and collaborative. The Board Members have been very welcoming, respectful and receptive to my feedback on various important topics pertaining to Specialty Care.

This year is important as there will be a provincial election in October 2024 and Doctors of BC will begin the process of negotiating a new Physician Master Agreement (PMA) for 2025.

• Having heard from many Specialist Physicians over the last two years, the cSBC EPAC established the Specialist priorities for our 2025 PMA submission. These priorities were presented to and approved by the cSBC Executive Committee on March 6, 2024 and forwarded to Doctor of BC’s Chief Negotiator, Paul Straszak, on March 13. The priorities are summarized below.

All four priorities are inter-dependent and equally important.

1. Advocating to rebalance overall PMA funding to address the growing needs and inequalities in Specialty Care
2. Advocating for similar gains achieved by Family Medicine
   1. Payment for indirect care, clinical administration, teaching etc
   2. Payment for Standby Time
   3. Payment for Hospital Rounding and Commuting to see in-hospital patients
   4. Payment for Team-Based Care
3. Advocating on Gender Pay Gap Issues
   1. Improved parental leave indexed to income and overhead expenses
   2. Sick Day Payments
   3. Childcare payments
4. PMA-funding for Specialist Blended Payment Model (SBPM) to address many of the above issues
   1. Tool to address both inter-sectional and intra-sectional disparity (including gender-based payment disparities)
   2. Tool to provide work-hour data to inform future disparity assessment
   3. Tool to compensate Specialist Physicians for all unpaid clinical work
   4. Voluntary alternative payment model for all Specialist Physicians, to provide choice in payment model, similar to Family Physicians

Three Other Priority Areas for Specialists

• Broad Specialist Initiatives:
  • Raise Business Cost Premium (BCP) cap so that Specialist Physicians can fully benefit without ‘capping out’ due to variations in day-to-day income
  • Increase 1200 series fee code rates (after-hours premiums)
  • Increase MOCAP

• APP Specialists:
  • More transparent direction of APP funds
  • Review of salary grid to make it more competitive with fee-for-service and within the grid
  • Advocate for APP funds to be specifically directed to Specialists Physicians and Family Physicians, similar to fee-for-service funding, before further distribution of funds

• Procedural and Diagnostic Specialists
  • The 14-day ‘washout’ period after surgical procedures should be removed for inpatient after-care and additional procedures
  • Multiple Surgical Procedures or Diagnostic Studies are paid at 50% if performed at the same time at present. We advocate that second procedures/studies should be increased and paid at 75%.

I wanted to highlight that on February 29, 2024 Doctors of BC emailed all physicians about “Committee Opportunities.” As I have learned over the last year, the most effective way to advocate for Specialist Physicians is to be at the table of important meetings. I encourage all Specialist Physicians to consider applying to the following committee positions.

• Alternative Payment Physicians Issues Committee (One Service Contract Emergency Physician)
• Council of Health Economics and Policy (One Doctors of BC member)
• Regional Physician Health and Safety Working Group (One Vancouver Coastal Health Physician member)
• Specialist Services Committee (One Medical Specialist – which includes Anaesthesiology)
• Tariff Committee (One Successor Chair)

Please refer to the Doctors of BC website for more information about these committee opportunities. https://www.doctorsofbc.ca/news/current-committee-opportunities-apply-now

Our next cSBC Council of Specialists Meeting and Annual General Meeting are scheduled for May 1, 2024, as a virtual meeting. I welcome all members to attend.

Make the Specialist Voice Heard by Joining Consultant Specialists of BC for 2024

Go to https://doctorsofbc.ca/account/sections Scroll down to Consultant Specialists of BC, click on the + sign, choose box for regular $450; first-year practice/disabled/parental leave $225; OR student/resident/retired free. Click JOIN SELECTED SECTIONS AND SOCIETIES to pay. Thank you!