President’s Bulletin, December 2019

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.