Re: Changes to medical staff privileging in British Columbia

On behalf of the Physician Quality Assurance Steering Committee, we write in response to Dr Mirwaldtís thoughtful letter published in the June issue [BCMJ 2014;56:219]. We welcome the engagement of the British Columbia College of Family Physicians and have collaborated with its representatives and those of the Society of General Practice to strike a panel that will develop the privileging dictionary for this discipline. We will meet with the panel several times before the dictionary is completed in late October.

Our practice has been to use training objectives to define the privileges for a discipline and expect to do the same for family practice. Dr Mirwaldt's offer to share those objectives is welcome.

Most of Dr Mirwaldt's letter is concerned with the concept of currency. We fully agree that currency for family practice has to be approached from the perspective of the realities of the discipline. Indeed, each discipline we've worked with has found its own unique approach to currency. We also agree that currency is not a measure of competence and it is not intended to be. Assessing competence in established practitioners is a complex task that will take time and iterative study to do well.

Currency is that minimum level of activity below which a conversation needs to be had about comfort and support required to carry out a procedure. It is not an automatic disqualifier. Without clear criteria and a frame of reference most of us are uncomfortable initiating these discussions. Over the next few months our project's steering committee will approve a guideline for physician leaders and support staff to follow. The process is intended to prevent the abandonment of privileges by practitioners across the province. It will be supportive, fluid, and flexible and will seek to engage individuals in a discussion of what further training, mentoring, supported experience is required, if any, to allow the continued practice of the activity in the context of the service provided.

It is intended that dictionaries be reviewed post-implementation in pilot groups and again after reappointment in all health authorities. Following this piloting phase, it is likely dictionaries will be reviewed every 3 to 4 years to keep up with emerging changes in technologies and procedures.

Dr Mirwaldt speaks of the need to consider potential unintended consequences. We agree, and believe that we have done so, and are implementing this process in a way that will support the full engagement of family physicians across the province.

It's important to realize the health authorities of British Columbia have a mandate to deliver services to their populations. We share an interest with the BC College of Family Physicians in supporting physicians and other members of our medical staff and look forward to the work we are about to embark upon.

--Ted Patterson
Assistant Deputy Minister, Health Sector Workforce Division, Ministry of Health,
Chair, Physician Quality Assurance Steering Committee
--Heidi Oetter, MD
Registrar, College of Physicians and Surgeons of British Columbia