Snapshot June 2023

Dear members and prospective members:

It is finally summer after a long winter! In my first 30 days as President of Consultant Specialists of BC (cSBC), I have heard from many consultant Specialists about how the system-wide healthcare crisis is impacting them. At cSBC we are actively listening to Specialist concerns and advocating on important Specialist issues. Here are a few important updates:

1. Changes to the Re-referral System – effective July 1, 2023

I am delighted to report on a resolution to this long-standing issue. For years there has been growing frustration on all sides (patients plus referring and consultant practitioners) over a referral system that did not meet anyone’s needs nor recognize the important and necessary role of Specialists in longitudinal patient management. In response to these concerns, the Physician Master Agreement (PMA) mandated the formation of the Consultation and Referral Working Group (CRWG), with representation from cSBC, BC Family Doctors (BCFD), Tariff and the Ministry. The CRWG concluded its work in late March and has agreed upon the following consensus resolution:

• All referrals will include an implicit re-referral (IRR) for the same diagnosis unless specifically stated otherwise by the referring practitioner (RP)
• This inclusion will permit Consultant Practitioners (CPs), if medically appropriate, to schedule, perform and bill subsequent consultations (SCs) at intervals of greater than six months from the last date of service without the need for repeat referrals unless:
  • The Referring Practitioner (RP) has explicitly stated that the original referral is for a single consultation only
  • The IRR has been cancelled by the RP via written response within 14 days of receiving notice from the CP of the scheduled date for subsequent consult
• Notification by the CP to the RP of scheduling of the subsequent consultation (which remains a CPSBC requirement) must be provided to the referring practitioner at least 30 days before the scheduled date
• If the RP is no longer in practice, the CP may continue to perform subsequent consultations but document unavailability of the original RP and their advice to the patient to obtain a new referral and/or primary care provider.
• There is no change to the limited/repeat consult referral and billing rules 
• The purpose of these changes is to ease the administrative burden of the previous re-referral system for all stakeholders, while supporting current standards of longitudinal Specialty of care for patients.  MSP will be monitoring the effect of these changes for the next five years.

I want to thank and give credit to our Past President Dr Chris Hoag for initiating this concept and driving it to fruition. 

2. Specialist care crisis and negotiations with government 

cSBC has heard from many members about the ongoing healthcare crisis, most recently the lack of emergency room and hospitalist human resource capacity in our hospitals. We have heard the call for consultant Specialists to do more in this difficult environment, despite consultant Specialists also struggling with overwhelming patient load, lack of resources to provide adequate patient care, and physician burnout. cSBC continues to highlight the Specialist care crisis in the media https://specialistsofbc.org/consultant-specialists-of-bc-in-the-news/ and in our current meetings with the government. 

cSBC met regularly with Doctors of BC (DBC) and the Deputy Minister of Health over many months to find solutions to improve patient access to Specialist care and to reduce the burdens on consultant Specialists. In our last meeting, we saw an encouraging commitment from government and DBC to address solutions to reduce Specialist waitlists and improve inefficiencies in Specialist care. We will continue to update you on our progress.

3. Economics Policy Advisory Committee (EPAC) 

In our recent ratified PMA, $15 million was allocated to a New Fee Fund (NFF) to be available to consultant Specialists. Ideas for the NFF were collated from suggestions from cSBC members. Widely applicable fee codes that have the largest potential benefit to Specialist care are being discussed and scrutinized. We are costing out the small number of fee codes affordable within the $15 million allocation. We will keep members updated.

4. Physician health

It was brought to the attention of cSBC of recent cases of physician suicides in British Columbia. It saddens me to hear of these stories. I would like to direct you to the work that the BC Physician Health Program is doing to support physicians: https://www.physicianhealth.com/ 

The program is free and confidential for physicians, medical students, residents, retired physicians, partners and dependent children. We all need help from time to time, so please do not wait until it is acute, risking your life and livelihood. For example, if you are BIPOC, you can access a peer group monthly support session on Zoom (next one June 12): BIPOC Support Meeting Registration but there are many options for all so please call 1-800-663-6729 24/7 if you are in crisis, or (604) 398-4300 if you have questions.

5. Cost of storage and digitalization of paper medical records for Specialists

Several consultant Specialists have brought up the issue of large costs associated with storage and digitalization of paper medical records. We discussed this issue at our last tripartite meeting between DBC, BCFD and cSBC and agreed that the costs to consultant Specialists were unfair. This issue has been forwarded to the DBC Business Pathways team for further investigation.

This is the kind of work that the cSBC does for Specialists, behind the scenes and out of the spotlight most of the time. cSBC played a prominent and collaborative role in reaching the resolution on the broken re-referral process and continues to advocate on your behalf on the above and many other issues. The strength of cSBC’s advocacy is reliant on individual Specialist dues.  If you or your patients will benefit from this work, please support cSBC and join now for the benefit of you, your colleagues, the profession and the care we are able to deliver to our patients (see link below).

Make the Specialist Voice Heard by Joining Consultant Specialists of BC for 2023

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!