First Nation Engagement Sessions

Port Alberni

First Nation engagement sessions were held in collaboration with RCCBC, Nuu-chah-nulth First Nations and Central Island Division. Each session had three elders from Nuu-chah-nulth territories and 3-5 primary care providers.
Thanks to all who attended. The links below are to the shorter versions. The description below each video contains a link to the longer video if you are interested in watching.

Thanks so much to all of you who came to any or all of these sessions.
The final gathering and feast to celebrate the project will be scheduled in May. Once a date is set, an email notice will go out.

Session 7:  https://www.youtube.com/watch?v=EfK3phXc6Uk

Session 8:  https://www.youtube.com/watch?v=i54iP1ZM7I4

Oceanside

Similar cultural safety sessions are being planned for Oceanside First Nations and primary care providers.
Date will be in June at Qualicum First Nation. More details to come.

SAVE THE DATE: August 5th Summer BBQ

Friday, August 5th

The Central Island Division of Family Practice will be holding a Summer BBQ to welcome members new and old back to in-person collaboration.

We are proud to show off our new Central Island offices, located at the historic Qualicum Beach Train Station, which is surrounded by lovely grounds - perfect for hosting a BBQ with Smokin' George's coming to cater the event.

Accommodation will be provided for members that require it, and you are welcome to bring your spouse or partner. We look forward to seeing you all in person! 

Watch out for the invite arriving to your email inbox soon.

Oceanside on-call physicians

Oceanside on-call physicians: Please check your inbox and/or junk folders for the latest on-call schedule, which runs from April 1- Dec 31.

There will also be a special holiday schedule released closer to the end of the year for those holiday dates.

Thanks,
Sharon Todd

Found in Reddit....

Posted on Reddit under r/britishcolumbia:

There is a primary care shortage in BC and it's unlikely to change follow up.  BC has a primary care shortage and it is not going to end. There is a TDLR at the bottom.  There has been a lot of recent talk about the primary care shortage, but I feel that there are aspects missing from the discussion, particularly why the alternative payment model is not going to help unless there is a serious look at why BC cannot recruit and retain family physicians. The system is broken from recruitment to practice support and there seems to be a lack of interest and insight into why it’s broken. It's not as simple as money.

As background:

• I am a family physician
• I am a Canadian citizen who did my training as an IMG and completed a 3 year residency in family medicine in the US
• I returned to Canada because the H1 visa was changed and that had implications for my spouse and we felt this move back would be better for our marriage and my spouse’s career. I took a substantial pay cut to do so.
• I worked in a patient centered medical home in the US which is basically a PCN (primary care network)
• I have been through the recruitment process in the US and in BC
• I am on the PCN/alternative payment contract

Recruitment:

• Simply put there was no recruitment. I applied with Health match BC. I paid to have my documents certified and waited to be able to look at job postings. Then I submitted all the same documents over and over to jobs, the college in BC, CFPC, the division, CMPA….etc. There was no connectivity. No sharing of documents. It was expensive and took about 1 year.
• There was talk of a work life balance with the PCN and a network. I knew this was a new endeavour for BC.
• In contrast, in the US I was recruited and talked to a recruiter multiple times about what I was looking for and connected with jobs. I met with them and when I decided, I was provided with a lawyer, at no fee, to make sure the H1 and spouse visas were in order. All professional memberships were reimbursed as well. It took a couple months.

Onboarding:

• I did IMG UBC classes, including a fee for service billing course online. Nowhere was I provided with information about how to bill for the PCN visits, resources for referrals (Pathways), how to sign up for Uptodate and the rapid consult service (RACE) or derm consult. I did not get the billing codes until after my first 2 weeks.
• My clinic lead and co physicians were there to help, but since they were fee for service the support they could give me was only for the EMR, orienting to the clinic and the area.
• In contrast, in the US I had computer and billing orientation, and a weekly visit from an IT support person. I also had a monthly billing review with a billing specialist.

Support:

• The PCN contact person did not know much about the contract details. I followed the advice given and in cases when it turned out to be incorrect, it was me who dealt with the consequences.
• As for the network, there was initially none. It has started slowly and now I have access to a dietician, counselor, social worker, and virtual OT.
• There is no support for the referrals from the division and the college. Most of my referrals require that I use a unique form, write a letter, and use my MOA staff to book the patients with the specialist. Despite the fact that there is no need for new referrals for follow up and there is a recommendation that specialists use their staff to make appointments, the lack of support and the limited specialists available means I am stuck making appointments that specialists offices should be making. My patients get angry that my phone lines and staff are busy while I pay for staff to book for a specialist (when we queried this it was >60% of my referrals that had this practice). In case you are wondering, a group of family physicians did write a petition to the BC college for back up on the referrals last year with no response. In my office, we tried to ask specialists to make their own appointments with patients who were referred, and we received no response from some, while others said that it was a recommendation and they don’t have time. And yes, I know what you are thinking, stop referring to them. This is easier said than done. A lot of them are the only options.
• There is no unified EMR. All data on new patients is manually entered by typing and scanning. All medication list queries have to go through a program called pharmanet, which I pay for. All hospital records are found in yet another program called careconnect that is generally unorganized. All of this is time consuming and redundant, and it does not help patient care. This is a network, a unified EMR would allow less meaningless data entry and help share information. This system of each clinic paying for the EMR they can afford is inefficient as every clinic is operating on a different system.
• There is minimal mental health help. People don’t want to self refer at access centers, and asking them to do so affects their trust in me. The same is true when I call for a psych consult on the RACE line. Sure, I can help with anxiety/depression, but with severe mental health issues a direct connection between psych and patient is needed.
• In contrast, while in the US I had a real network with a connected EMR. I did not have to pay extra for this. I had access to a dietician, a diabetic nurse educator, PT, a nurse navigator, a lab on site, and many others close by. I also had a referral team that I gave instructions for referrals and then it was submitted, tracked, redirected as needed. Oddly enough, specialists were nice to us and even sent Christmas cards to say thanks for the referrals. I never got told to get my staff to make their appointments for them or to write their prescriptions and imaging requests like I do here.

Work life balance;

• The BC college is difficult to work with, slow, expensive, and out of touch. Asking for physicians to make plans to have 24/7 contact/care is not reasonable. Asking for written patient care plans in the event of my death is not reasonable. In BC we do have 811 RN access, and we could easily coordinate a system using this to call physicians in real emergencies. With a connected EMR we could organize PCN based call groups to answer these 811 screened calls. Asking for 24/7 on call from offices with groups of a small number of providers means a lot of time, money, organization that negatively impacts work life balance. Physicians have suffered with an increase in calls, emails, and abuse during the pandemic. We don’t want to be called at all hours by those that feel a response on normal labs is warranted within an hour of it being completed. We cannot send rxs if pharmacies are closed, We cannot do imaging over the phone. TThe MOH and divisions need to do better to help organize a system that allows for patient safety while protecting providers from abuse.
• What we don’t want is to give up our entire lives for our work. We want support for boundaries in place in the system. I don’t need a wellness lecturer that tells me to exercise and meditate on a Sunday, I am healthy, I practice mindfulness. I do set boundaries that the practice of medicine doesn’t respect. MOH, Divisions, and doctors of BC, I need your collaboration to find work life balance. We are in a time where other professions are talking about policies for protected time away from work, yet in medicine we are talking about a written plan for who will take over my patient care when I die. I have a plan for records and contacting patients. Any responsible physician does. But there is a doctor shortage that we did not create and cannot fix.
• The PCN metrics from the MOH seem to be those from fee for service, so maybe the MOH doesn’t understand the assignment? There’s a shortage of physicians. BC is already having trouble getting physicians to work in the fee for service model because of the amount of unpaid work. Further, seeing 30-60 people a day isn’t likely to provide good patient care. How then is the PCN contract, based on the same FFS metrics, with lower pay and vague goals, a better option to attract new doctors?

Pay:

• This is where I am going to warn you against making stupid “gaming the system” comments re: the pcn. I took a 100K/year pay cut to come to a network that supposedly had a great work life balance. The plan was to have time to enter all those new patients and set up good records for good care and to not burn out seeing a large number of patients a day, but instead a reasonable 20-25 daily. What I got was a disorganized mess with no support. When incorrect information was given to me that directly affected getting the QI bonus, I got shrugs.
• You can also threaten to replace me with NPs and PAs. I have 11 years of postgraduate education. I am board certified in 2 countries. These providers do have a place in the system, but they don’t have the same specialization. Don’t worry about me. I am smart enough to do something else and be just fine with it. And if you think a bulk of these physician alternatives are going to stay in this current system long-term when they too have better options, best of luck.

And finally retention:

• No one has ever asked for feedback on the process, ever.
• It’s time to ask why doctors are not coming to BC and why they aren’t staying.

TDLR:

• BC has a family doctor shortage, and that is unlikely to change from the view of someone on the alternative payment model, rather than fee for service
• The recruitment to employment is long, unnecessarily redundant, and expensive.
• There is no onboarding.
• There is a minimal network without any EMR connection.
• There is minimal contract and practice support.
• The BC college and division are not supportive for many of the issues affecting primary care.
• The pay is low (and keep in mind that 30% pre tax is overhead for clinic supplies, rent, staff).
• There is not a system to help support a work life balance. I did not spend 11 years in post grad, $250K on student loans, and suffer through residency to be asked to make my career the only thing in my life. No one did.
• MOH, Divisions: do better or stop complaining when people decline to work for you.

21st Annual BC Endocrine Day Invitation

The 21st Annual BC Endocrine Day
Virtual Event
Vancouver – Friday, May 13th, 2022

The Endocrine Research Society is pleased to present the 21st BC Endocrine Day– an annual, CFPC and RCPSC-accredited case-based review of common endocrine problems encountered in clinical office practice.

Join us virtually from home or work over Zoom for a full day presentation series presented by expert physicians. This course will review a variety of endocrine health topics such as adrenal, thyroid, pituitary, and gonadal disorders, as well as pediatric endocrinology, hypertension, diabetes, and some interesting endocrinology cases.

Target Audience: Open to general practitioners, internists, specialists, trainees, and allied health professionals.

Register now as space is limited. Online registration can be found HERE and at the following link: https://www.endocrineresearchsociety.com/events/21st-bc-endocrine-day.

Please contact Calvin Chang at the Endocrine Research Society for more information or registration questions.

Email: endocrine.research.society@gmail.com
Phone: (604) 689-105

Therapeutics Initiative

Please visit our website (click here) 

Therapeutics Letter (click here)

This is a bimonthly publication targeting identified problematic therapeutic issues in a brief, simple and practical manner. The process leading up to publication involves a rigorous, systematic literature review by different working groups of the Therapeutics Initiative, the creation of a draft which is circulated for comment among a sizeable group of over 100 local, national and international specialists with expertise in the particular therapeutic area and the commission of original artwork/illustration. The message is developed collaboratively by different working groups of the Therapeutics Initiative. The current Editor in Chief is Dr. Tom Perry, Chair of the Education Working Group of the Therapeutics Initiative.

Self-Management BC

Please note that workshops are scheduled on an ongoing basis throughout the year. For more information, please click here. 

In addition to our 6-week Self-Management Workshops, we offer the following:

• Self-Management Health Coach Program: this is a 1 to 1 telephone support program for individuals needing the extra support to achieve health goals. Each individual is paired with a coach and receives a weekly, 30-minute phone call for 3 to 6 months. Coaches are volunteers who may be living with chronic health conditions, and are passionate to help others to achieve wellness. For more information, please click here.  

If you have any questions regarding our programs, please email us at: selfmgmt@uvic.ca

Oceanside Hospice Society

The Oceanside Hospice Society serves individuals and families experiencing end-of-life, care-giving and bereavement in the area stretching from Deep Bay to Nanoose, and west to Errington and Whiskey Creek

We strive to provide links in the continuum of care by supporting care giving at home, in hospital or the palliative care unit at Trillium and at community care facilities.

Please contact us at 250.752.6227 or visit www.oceansidehospice.com for further information.

Divisions Dispatch

The latest news from the provincial team and complementary organizations.
https://divisionsbc.ca/provincial/news-events/divisions-dispatch

Divisions in the News

See what is going on in other divisions around BC:
https://www.divisionsbc.ca/provincial/news-and-events/in-the-news