I want to commend Dr Wade on his well-written Premise article detailing the troubled, arguably unnecessary, process that is medical privileging in BC (“Privileging for new medical school graduates in BC,” [BCMJ 2017;59:123-124]).
As I am currently going through my fifth privileging process within the last 24 months, the burden in bureaucracy, burnout, and use of taxpayers’ money is real, especially for locum physicians, and with no studied evidence of benefit in patient care or safety from the process. Dr Wale (of the BC Medical Quality Initiative) attempted a response [BCMJ 2017;59:124] that can be summarized as: “Yes, we acknowledge there are problems, but you should have seen how bad it was previously!” He goes on to say that privileging is meant to be a “conversation.” Not once have I ever discussed my privileging with anyone. He also states that the process “is not [meant] to restrict practice.” If not, then what is the goal? A quick look through the various privileging documents will show that restricting practice is exactly what is intended—if you don’t have the checkbox, you’re not allowed to practise that procedure or skill in that facility.
Privileging stems from the recommendations of the Cochrane Report (2011), but that report is flawed—they considered patient safety in isolation, without regard to costs, administrative burden, or physician burnout, and with an implied assumption of a weak College. In reality, this province has a strong College that we should be proud of, and there are dire consequences for any physicians caught practising out of scope, up to and including losing both their licence and livelihood. We are professionals, and we should be trusted to practise as professionals. The only credential we should need is a medical licence.
—Brady Bouchard, CCFP
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