Patients in British Columbia are challenged by access to and availability of timely health care services, while community-based and hospital-based health care providers are experiencing burnout in independent practices. The current health care challenges require novel solutions regarding advocacy for physicians to foster resilience and deliver quality care for British Columbians.
Here we share key learnings from a January 2023 interview with Dr Tommy Gerschman, chair of the CBS working group at the Specialist Services Committee, past president of Specialists of British Columbia, past board member of Doctors of BC, and a community pediatric rheumatologist, who highlights the challenges faced by community-based specialists. Dr Gerschman also shared his perspectives on the experiences and challenges that surfaced during the COVID-19 pandemic.
What are physician advocacy and support organizations?
Various organizations regulate and advocate for physicians across Canada. The national organization, the Royal College of Physicians and Surgeons of Canada (RCPSC), is responsible for setting standards and certification for specialties in Canada. The Specialists of British Columbia, recently renamed Consultant Specialists of BC (CSBC), represents and advocates for all specialist physicians. Doctors of BC is a physician-led advocacy organization in BC that aims for professional satisfaction for physicians and compensation through negotiations. Finally, the Specialists Services Committee (SSC) is a joint collaborative committee with representation from the BC Ministry of Health and Doctors of BC that fulfills the mandate to improve specialist care in BC.
What is community-based specialist care?
Community-based specialists (CBS) are defined by the SSC as specialty-trained physicians without hospital or health authority privileges. CBS work in private practices outside of hospitals or health authorities in a team or in an independent practice. These specialists work almost exclusively in a fee-for-service payment model. Compared to specialists with privileges, community-based specialists are disproportionately challenged with isolation from colleagues and do not have access to technological and clinical supports such as translation services, access to provincial lab and result systems, imaging results, and other benefits that physicians often take for granted (e.g., voice dictation software, electronic medical records).[1] Notably, during the pandemic, community-based specialists did not have readily available PPE and were faced with a lack of availability and rising costs of these materials.
How many physicians are community-based specialists?
This subset of physicians is yet to be quantified. In 2018, the Canadian Medical Association totalled 3742 practising clinical specialists in BC and 28 733 in Canada, but did not tally the number of community-based specialists.[2] Doctors of BC estimates there are approximately 700 community-based specialists in the province. The lack of information about the number and distribution of these physicians in BC makes it challenging to engage and advocate for this demographic.
Lack of involvement in province-wide communication
Dr Gerschman highlighted the shifting standards of care that emerged during COVID-19: “communication was critical” and “the way that we organize ourselves in this province . . . [and] provide information relevant to the local community . . . is crucial when things were changing on a critical basis.” CBS were not included in regional divisions of family practice or any medical staff associations; consequently, they did not have a structured flow of communication, and therefore very limited feedback opportunities.
Absence of multidisciplinary care in community medicine
Although specialists in hospitals readily collaborate with allied health professionals (e.g., nurses, social workers, etc.), Dr Gerschman emphasized that CBS are frequently independent in private practice or have few team members in limited disciplines. This presents significant challenges, such as long wait lists, complex care management, and lengthened visits per patient that would otherwise be better managed with a collaborative team, like in hospitals. Dr Gerschman shared that there is an opportunity for further innovation in practice, which would allow for interdisciplinary medical care in community that may optimize patients’ experiences and physicians’ workflows. For example, nursing staff may be able to counsel patients during an appointment in addition to the physician.
Rising financial burden and logistical management
Dr Gerschman described the increasing business management costs for CBS, such as subscription translation services, electronic medical records, and other hidden business costs. During the pandemic, a need for PPE was challenging, with prioritization of hospitals and a lack of distribution to CBS. Notably, this challenge affected both CBS and specialists with hospital privileges who simultaneously have an independent practice.
The results of advocacy
As of June 2023, after 4 years of advocacy, the Specialist Services Committee has agreed to arrange PPE distribution, spoken-language interpretation services, UpToDate, CareConnect, and Zoom subscription for virtual care.[1] Dr Gerschman’s ongoing work highlights effective physician leadership and change for CBS in British Columbia.
Although these changes reduce financial pressures on CBS, there is still a need for improved communication and multidisciplinary collaborative practices to respond to the needs of isolated specialist physicians.
Why does this matter?
The BC health care landscape relies heavily on CBS, who are frequently in an outpatient setting. The CBS, despite not having hospital privileges, continue to care for hundreds of thousands of patients each year as the health care system faces challenges of high patient volume, long wait lists, provider burnout, and silos of care. Advocacy for CBS in this complex system is critical to foster interconnectedness, support, and professional satisfaction. Qualitative studies have found physician satisfaction is reinforced with physician leadership, effective EMR, social connection, and group practice settings.[5,6] Physician voices are invaluable to driving change that will best support CBS in BC. Together, physician voices can identify gaps and develop novel solutions for the provincial landscape.
What can medical students do?
There is a need for medical students to explore different providers’ experiences as they graduate from medical school, complete residency, and develop their practices.
Competing interests
None declared.
References
1. Canadian Medical Association. Number of physicians by province/territory and specialty, Canada, 2018. Accessed 12 November 2023. www.cma.ca/sites/default/files/2019-03/2018-01-spec-prov.pdf.
2. Specialist Services Committee. Supporting community-based specialists. Accessed 12 November 2023. https://sscbc.ca/CBS.
3. Canadian Institute for Health Information. Overview: COVID-19’s impact on health care systems. 2021. Accessed 12 November 2023. www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/the-big-picture.
4. Canada Health Infoway. Canadians’ health care experiences during COVID-19. 2022. Accessed 12 November 2023. www.infoway-inforoute.ca/en/component/edocman/resources/reports/benefits-evaluation/3828-canadians-health-care-experiences-during-covid-19?Itemid=103.
5. Zazzali JL, Alexander JA, Shortell SM, Burns LR. Organizational culture and physician satisfaction with dimensions of group practice. Health Serv Res 2007;42:1150-1176. https://doi.org/10.1111/j.1475-6773.2006.00648.x.
6. Kase J, Doolittle B. Job and life satisfaction among emergency physicians: A qualitative study. PLoS One 2023;18:e0279425. https://doi.org/10.1371/journal.pone.0279425.
Ms Wang is a third-year student in the Faculty of Medicine at the University of British Columbia. Dr Gerschman is a community pediatric rheumatologist and a clinical instructor with the Division of General Pediatrics in the Department of Pediatrics, Faculty of Medicine, University of British Columbia.
This post has been peer reviewed by the BCMJ Editorial Board.
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